Therapeutic Communication Techniques

Our Lady of Fatima University

College of Nursing

NCM101 – Human Behavior

Therapeutic Communication Techniques

Therapeutic communication technique is a tool used by a nurse to help clients with their health problems. It could be physically, socially, mentally and emotionally. Therapeutic communication is focused on patients needs, while in non-therapeutic communication is focused on both the nurse and patient’s needs. For example, the nurse has a personal interest over the patient. The nurse is helping the patient with her needs at the same time the nurse is gaining friend. The approach in therapeutic is professional while in non-therapeutic is more social.

Nurse-patient Relationship

Phases of Nurse-Patient Relationship by Stuart & Sundeen

1. Pre-interaction phase begins before the nurse made first contact with the patient. The tasks of the nurse during this phase includes: a) self exploration of feelings; b) gathering data about the patient if information is available; c) planning for the first interaction with the patient.

2. Orientation or introductory phase is the time you meet your patient. Because first impression last, greet your patient by his name and with a smile. The task of the nurse in this phase are: determine why the patient sought help; establish trust, acceptance and open communication; mutually formulate a contract; explore patient’s thoughts, feelings and actions; identify patient’s problems and define goals with patient. Also this time you get additional or more information from your patient.

3. Working phase is the time you carry out the plan of care. This is the major part where the therapeutic work is carried out. The task of the nurse are: explore relevant stressors; promote patient’s development of insight and use of constructive coping mechanisms and overcome resistance behaviors. Resistance behaviors are usually displayed by patients during this phase because it contains the greater part of the problem-solving process.

4. Termination phase is the last phase of the nurse-patient relationship. The nurse task during this phase are: establishing reality of the situation; reviewing progress of therapy and attainment of goals; mutually explore feelings of rejection, loss, sadness and anger and related behaviors. When termination is near, it may be helpful to decrease the number of visits as well as shorten the time.

General Guidelines in Therapeutic Communication

1. Establish rapport or a mutual trusting relationship. This is the very first thing that a nurse have to do. A patient cannot open up his problem if the patient cannot trust his nurse. Greet your patient by his name to make him comfortable and with a smile.

2. Encourage your patient to verbalize his thoughts and feelings. Even you have not solve any problems yet, by sharing to you the problems of your patient, you are already helping your patient to lessen the burden, feeling of anxiety and you make your patient more relaxed.

3. Avoid asking question starts with Why? Or How? Because you are putting your patient in a defensive side.

4. Avoid the use of close-ended questions. These are questions that are answerable by yes or no.

5. avoid verbalizing value judgment, giving personal opinion or moralizing. This discourages your patient from expressing their own ideas, opinion, feelings and actions.

6. Focus on non-verbal communication. Because actions speak louder than voice, there are some verbal clues that you may find into your patient.

7. Assist your patient in arriving at their own decisions by demonstrating problem-solving or involving them in the process.

The Different Therapeutic Communication Techniques

1. Using silence means the nurse make no verbal response to the client by sitting quietly and waiting attentively for the patient to express their feelings. This allow the patient to talk more. Ex. Sitting quietly with the patient while she’s crying

2. Providing general leads is using statements that encourage client to verbalize, choose a topic for discussion and facilitate continued verbalization. Ex. “perhaps you would like to talk about…”

3. Being specific rather than general. Ex asking the patient about the severity of the pain. (specific) rather if there is a pain or none. (general)

4. Using open-ended questions are questions that are not answerable by yes or no.

5. Using touch are important because tactile contact are used to reinforce a caring feeling for the patient. Ex. Placing a hand over the patient hand.

6. Restating or paraphrasing is altering the statement construction without altering the meaning of the message. This convey that the nurse has listened and understood the basic message and offers the client a clearer idea of what they have said. Ex. Patient: “I barely touch my food last night” Nurse: “Do you have loss of appetite last night?”

7. Seeking clarification is making the message of the client more understandable. The nurse can also clarify their own message with statements. Ex. “I meant this rather than that.”; “I’m puzzled.”

8. Offering self suggest one’s presence, interest or wish to understand the client without making any demand or attaching conditions. The nurse offer time, effort, and services. Ex. “I’ll stay with you for a while.”; “Let me assist you.”

9. Acknowledging is giving recognition to the client without making any good or bad judgment. This will motivate the client to do more. Ex. “I’ve noticed that you comb you hair.”

10. Presenting reality is to help the client to differentiate what is real from unreal.

11. Focusing is helping the client to expand on and develop a topic of importance. Ex. A client enumerated to you a lot of problems. As a nurse try to focus on single and important problem identified by the client.

12. Reflecting is directing feelings, ideas or questions back to the client especially if the questions are about giving of opinions and judgments. Ex. Patient: “what can I do?” Nurse: “What do you think is the best thing to do?”

13. Summarizing is stating the main points of discussion to clarify the relevant points discussed. This technique is useful at the end of an interview or review health teaching session. Ex. “during the past hour we have talked about…”

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