THERAPEUTIC COMMUNICATION TECHNIQUES
• The therapeutic use of self of the nurse
involves making appropriate
communicative responses to the client that
facilitate the client’s recovery.
CHARACTERISTICS OF EFFECTIVE THERAPEUTIC
• Contains words that can be understood by the client
• Is clear in meaning
• Allows for a response from the client
• Deals with the cognitive and emotional aspects of the
• Is consistent: the communication implies the same
• Is repeated by the clinician as required by the client
• Is direct: the communication reflects pertinent problems
and is transmitted to the client with tact
It focuses on the feelings of the client, enabling the
client to express more, to become aware of the
emotional feeling experience, and/or to separate a
cluster of feelings into distinct ones. Although
reflection is usually thought of as rephrasing what
the client has just stated, it should involve different,
Lead in words such as:
- “It seems as if….
- “It appears to me….
- “I’m hearing a lot of ….
These are the good beginnings to reflective
• Client: I don’t even know who I am
anymore. I’m changing and I don’t know
what I’m changing into.
• Nurse: I hear a lot of confusion about who
• Nurse: It sounds confusing and scary not
to know what’s happening to you right
This focuses on the content of what a client is
saying in order to call attention to something that
is unclear or, perhaps, noteworthy.
The above example ( lead-ins) can be
• Nurse: It sounds like your identity is shifting and
you are wondering about it all.
• Nurse: It seems as if you are experiencing a
change from the way that you have been in the
Most often it uses a question to verify what the
client has said or to interpret an ambiguous
statement or expression of feeling.
When using the clarification, it is important to
refrain from beginning the question with “Why.”
Why questions often make the client feels
defensive or judged by the nurse. Beginning
question with” Tell me…, or “ I don’t
understand..”is much more effective.
Using the example above:
• Nurse: Tell me more about what you are feeling
• Nurse: Describe this experience
It is most often used at the end of a session to pull
together the theme/s or topics discussed into a
Summarization entails two or more reflections and
paraphrases combined together.
• As we have explored your feelings and
thoughts, it seems as if you aren’t sure who you
are anymore, or what you are becoming. It
appears that your identity are becoming..
It appears that your identity is shifting, and this
feels scary to you.
• Therapeutic listening can be described as
hearing what the other person is saying without
becoming judgmental or defensive. The client
can express dissatisfaction or anger toward the
nurse. But anger is not usually directed
specifically at the nurse receiving the outburst.
Very often, clients have never had an empathic
or sympathetic listener, but rather have had a
family member or lover who was judgmental and
defensive toward the client. Allowing a client to
express emotion with a supportive look and
statement can ease the client’s distress and
• Client: I’m sick of this place. And I’m sick of you always in my face trying to
help. Just leave me alone.
• Nurse: You sound really angry right now. It’s so hard to allow yourself to
receive help, especially at times when it seems like you are hurting the most.
• Client: Why do you have to be so damn nice? Why aren’t you like all the
rest? Everybody I’ve ever know has treated me like garbage. Never listening,
never asking, never being there (Begins to cry).
• Nurse: We are all here for you, and we do care about you. It hurts to think
about others in your past. Your tears are telling you something. Do you know
what it is?
• Client: (tearful) That I deserve to be cared for? That it’s okay to count on
people in here? Why does it so bad then?
In this example, the nurse responded to the hurt and pain underlying the anger
and the client responded by becoming tearful and in touch with feelings and
• Client: I am sick of this place. And I’m sick of you always in my face trying to
help me. Just leave me alone!!
• Nurse: I am just trying to help you. If you want to be left alone, then go to your
room. This dayroom is for clients who want to be with others peacefully.
• Client: Fine. I’m going now! (Client throws over the dayroom table as he
• Nurse: Destruction of property! Okay , Tom, that’s seclusion room for you.
Come on, staff, we need to escort Tom to the seclusion room. He is obviously
out of control.
The nurse escalated the client’s emotions to the point at which he needed to
release his emotions physically rather than express feelings verbally. The
nurse provoked the client toward violence by repeating the type of verbal
interaction the client was accustomed to: not being heard or supported.
Unfortunately, Tom had to take responsibility for his physically aggressive
response to unempathetic response by the nurse. As treatment continues,
Tom will hopefully gain control over aggressive reactions, and will verbalize
his disappointment or confusion at the nurse’s response.
• Action responses attempt to move a client
toward some change hence the team action
response. Instead of responding to the client from
the client’s point of view, as in listening responses,
action responses move beyond the client’s
viewpoint to state the interviewer’s perspective.
1. Probing- here the nurse asks open-ended
questions to encourage the client to elaborate or
provide examples in order to further clarify
• Example: The nurse may say:
Nurse: Give me an example of when you feel you
don’t know who you are.
2. Information –Giving
• Information –giving provides the client with needed
data. It helps to decrease a client’s anxiety,
especially if the client feels uncomfortable or
bizarre. The nurse can also use information- giving
to share appropriate ideas or alternatives.
Nurse: It is not uncommon for clients in therapy to
feel the way you do right now
Nurse: It is not uncommon for clients to experience a
shift in their identity as they begin to look more
closely at their behaviors and feelings.
Confronting is most often used to point out a
discrepancy in the client’s words and actions,
verbal and non verbal behaviors, or feelings and
thoughts. It can be useful to clarify a mixed or
unusual message that seems inappropriate at the
time. When it is used, statements are made in an
empathic, caring way, rather than in a critical,
• Nurse: I hear you say that you feel a change in your
identity, but you are laughing while you say this.
• Nurse: At the beginning of the session, you stated
that you felt secure in who you were. Now you say
that you are unclear.
It is a sophisticated means of presenting the client
with a connection or reason behind a statement or
feeling. Nurses are able to interpret client’s
statement or feelings when they know the clients
well and have trusting, empathic relationship with
• Nurse: I wonder if you feel a shift in your identity
because you will be visiting your parents this
weekend? You and I have talked about how
controlling and domineering your mother can be
• Nurse: perhaps you feel unsure of your self or
your identity in therapy as you and I talk about
uncomfortable thoughts and feelings.
C.. The Use of Silence:
The appropriateness of client silence depends on
the context of the interview situation.
Client silence is not interrupted when:
• The client uses the quiet time to formulate
thoughts or feelings
• The client attempts to understand what the
clinician or another client ( in a group) has said.
• The client would not learn the skill of initiating or
continuing to probe a topic if the clinician talks.
The silence is interrupted when:
• The client is not accustomed to therapy and
does not know where to begin
• The client indicates, nonverbally, that something
is happening. For example:
• The client seems angry, yet does not mention it.
The nurse could say, “I notice that your fists are
clenched. What are you thinking?.. What are you
• The client experiences anxiety to the extend that
the client’s thoghts are blocked. The nurse
should provide some structures for the client,
such as,” You stopped talking. What are you
D.. Facilitating Emotional Awareness and Experience
• This therapeutic sessions involved an emotional release
by clients prompted by the clinician’s statement.” Talk
about your feelings.”
Some clients can benefit from a focus on what is
emotionally painful in their life. It also focuses on the
cognitive identification of an emotional or painful
Clients can benefit from the therapist’s encouragement to
experience the emotion that are present. As client
releases emotion the energy devoted to the client’s
experiences is released or decreased so that the client
can get beyond the barriers of such painful emotions.
• “What are you feeling?” Or” Tell me more about your
feelings”, or “Allow yourself to experience your feelings
• Here, the client acts out a specific
scenario, designed by the client and the
clinician, that is either similar to a difficult
situation experienced previously by the
client, or a new behavior to be tested by
• Not all clients are suited to role-playing. A
traumatic victim who becomes extremely
anxious when discussing the truma,
should not be asked to role-play a
traumatic experience. The client can gain
new insights as a result of role-playing.
Therapist’s Attitudes Promoting a
These attitudes foster an atmosphere of
trust and caring in a therapeutic
interchange that can lead to therapist
being warm and accepting.
1. Genuineness- means being oneself
without being phony or playing a role.The
therapists are usually comfortable to be
with the client and do not exaggerate their
own role. They are spontaneous and clear
about expectations and roles of
themselves and of clients.
2. Positive Regard
• This includes the ability to “value the client as a
person with worth and dignity.” The therapist tries
to help and to understand the client, thus indicating
that the client is important.
• This is demonstrated through the clinician’s tone of
voice, eye movement, and in other ways. It serves
as a way to reach out to the client to comfort and to
indicate that help is available within the clinician-
client relationship. It can also decrease the client’s
It is the ability to relate one’s perception of what is true in
an experience or situation. Stating the truth is not done
to hurt others.
• Honesty includes the traits of sincerity, fairness, and
straightforwardness and ability to be truthful. Example:
Client: “You aren’t mentally ill. How can you help me?”
Nurse: No, I am not ill and there may be some problems
that I will not fully understand. I can understand some of
your experiences, and you and I can talk about times
when you believe I do not understand you.
• If the nurse is honest and intent to understand, the client
will be equally honest and focused.
When the clinician has an attitude of
immediacy, the clinician seeks to provide
assistance when it is needed, and as soon
as possible. The nurse does not rush the
client, yet the nurse does not withhold
information that could be useful. The
clinician can initiate a discussion of the
concern in a thoughtful manner. Once the
norm of immediacy has been established
an atmosphere of trust can be established.
• It is the ability to be aware of the emotions
of the other in the pursuit of altruistic
purpose, wherein the client experiences
the emphatic attitude of the clinician.
• The client is understood by the clinician,
and the client has the positive benefit of