TaBLE 10-2 Therapeutic Communication Techniques

Therapeutic Technique
Using silence Accepting

Description
Gives the person time to collect thoughts or think through a point. Indicates that the person has been understood. An accepting statement does not necessarily indicate agreement but is nonjudgmental. (Nurse should not imply understanding when (s)he does not understand.)

Example
Encouraging a person to talk by waiting for the answers. Yes. Uh-huh. I follow what you say.

Giving recognition

Indicates awareness of change and personal Good morning, Mr. James. efforts. Does not imply good or bad, right or Youve combed your hair today. wrong. I see youve eaten your whole lunch. I would like to spend time with you. Offers presence, interest, and a desire to understand. Is not offered to get the person Ill stay here and sit with you awhile. to talk or behave in a specific way.
Continued

Offering self

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Therapeutic Technique
Offering general leads

Description

Example

Allows the other person to take direction Go on. in the discussion. Indicates that the nurse is And then? interested in what comes next. Tell me about it. Clarifies that the lead is to be taken by the patient. However, the nurse discourages pleasantries and small talk. Puts events and actions in better p erspective. Notes cause-and-effect relationships and identifies patterns of interpersonal difficulties. Where would you like to begin? What are you thinking about? What would you like to discuss? What happened before? When did this happen?

Giving broad openings

Placing the events in time or sequence

Making observations

Calls attention to the persons b ehavior (e.g., You appear tense. trembling, nail biting, restless mannerisms). I notice youre biting your lips. You appear nervous whenever John enters Encourages patient to notice the behavthe room. ior and describe thoughts and feelings for mutual understanding. Helpful with mute and withdrawn people. Increases the nurses understanding of the patients perceptions. Talking about f eelings and difficulties can lessen the need to act them out inappropriately. What do these voices seem to be saying? What is happening now? Tell me when you feel anxious.

Encouraging description of perception

Encouraging comparison

Brings out recurring themes in experiences Has this ever happened before? or interpersonal relationships. Helps the per- Is this how you felt when...? son clarify similarities and differences. Was it something like...? Repeats the main idea expressed. Gives the patient an idea of what has been communicated. If the message has been misunderstood, the patient can clarify it. Patient: I cant sleep. I stay awake all night. Nurse: You have difficulty sleeping? or Patient: I dont know...he always has some excuse for not coming over or keeping our appointments. Nurse: You think he no longer wants to see you? Patient: What should I do about my husbands affair? Nurse: What do you think you should do? or Patient: My brother spends all of my money and then has the nerve to ask for more. Nurse: You feel angry when this happens? This point you are making about leaving school seems worth looking at more closely. Youve mentioned many things. Lets go back to your thinking of ending it all. Tell me more about that. Would you describe it more fully? Could you talk about how it was that you learned your mom was dying of c ancer?

Restating

Reflecting

Directs questions, feelings, and ideas back to the patient. Encourages the patient to accept his or her own ideas and f eelings. Acknowledges the patients right to have opinions and make decisions and encourages the patient to think of self as a capable person. Concentrates attention on a single point. It is especially useful when the patient jumps from topic to topic. If a person is experiencing a severe or panic level of anxiety, the nurse should not persist until the anxiety lessens. Examines certain ideas, experiences, or relationships more fully. If the patient chooses not to elaborate by answering no, the nurse does not probe or pry. In such a case, the nurse respects the patients wishes.

Focusing

Exploring

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Therapeutic Technique
Giving information

Description
Makes facts the person needs available. Supplies knowledge from which d ecisions can be made or conclusions drawn. For example, the patient needs to know the role of the nurse; the purpose of the nurse-patient relationship; and the time, place, and duration of the meetings. Helps patients clarify their own thoughts and maximize mutual understanding between nurse and patient.

Example
My purpose for being here is... This medication is for... The test will determine...

Seeking clarification

I am not sure I follow you. What would you say is the main point of what you just said? Give an example of a time you thought everyone hated you. That was Dr. Todd, not a man from the Mafia. That was the sound of a car backfiring. Your mother is not here; I am a nurse. Isnt that unusual? Really? Thats hard to believe. Tell me whether my understanding agrees with yours.

Presenting reality

Indicates what is real. The nurse does not argue or try to convince the patient, just describes personal perceptions or facts in the situation. Undermines the patients beliefs by not reinforcing the exaggerated or false perceptions. Clarifies that both the nurse and patient share mutual understanding of communications. Helps the patient become clearer about what he or she is thinking. Puts into concrete terms what the patient implies, making the patients communication more explicit.

Voicing doubt

Seeking consensual validation

Verbalizing the implied

Patient: I cant talk to you or anyone else. Its a waste of time. Nurse: Do you feel that no one understands?

Encouraging evaluation

Aids the patient in considering people and How do you feel about...? events from the perspective of the patients What did it mean to you when he said he couldnt stay? own set of values. Patient: I am dead inside. Nurse: Are you saying that you feel lifeless? Does life seem meaningless to you? Perhaps you and I can discover what produces your anxiety. Perhaps by working together, we can come up with some ideas that might improve your communications with your spouse.

Attempting to translate into Responds to the feelings expressed, not just feelings the content. Often termed decoding. Suggesting collaboration Emphasizes working with the patient, not doing things for the patient. Encourages the view that change is possible through collaboration.

Summarizing

Brings together important points of discussion Have I got this straight? to enhance understanding. Also allows the You said that... opportunity to clarify communications so that During the past hour, you and I have both nurse and patient leave the interview discussed... with the same ideas in mind. Allows the patient to identify alternative What could you do to let anger out actions for interpersonal situations the harmlessly? patient finds disturbing (e.g., when anger or The next time this comes up, what might you anxiety is provoked). do to handle it? What are some other ways you can approach your boss?

Encouraging formulation of a plan of action

Adapted from Hays, J. S., & Larson, K. (1963). Interacting with patients. New York: Macmillan. Copyright 1963 Macmillan Publishing Company.