Therapeutic Communication Techniques
Techniques Description Examples Using Silence
Providing general leads
Being specific and tentative
Using open-ended question
Accepting pauses or silence that may extend for several seconds or minute without
interjecting any verbal response.
Using statement or questions that (a) encourage the client to verbalize (b) choose a topic of conservation; and (c) facilitate
continued verbalization.
Making that are specific rather than general, and tentative rather than absolute.
Asking broad question that lead or invite the client to explore (elaborate, clarify, describe compare, or illustrate) thoughts or
Sitting quietly (or walking the client) and waiting to put thoughts and feelings into words.
“Perhaps you would like to talk about…” “Would it help to discuss your feelings?” “Where would you like to begin?”
“And then what?” “I follow what you are saying.”
“You scratched my arm.”
(specific statement) “You are as clumsy an as ox” (general
statement)”You seem unconcerned about Mary.”(tentative statement)”You don’t give a damn about Mary and you never
will.”(absolute statement)
“I’d like to hear more about that.”
“Tell me about…” “How have you been feeling lately?”
Using touch
Restating or paraphrasing
Seeking clarification
feelings. Open-minded questions specify only the topic to be
discussed and invite answers that are longer than one or two words. Providing appropriate forms if touch to reinforce caring
feelings. Because tactile contracts vary
considerably among individuals, families, and cultures, the nurse must be sensitive to the differences in attitudes and practices of clients and self.
Actively listening for the client’s basic message and then repeating those
thoughts and or feeling in similar word. This conveys that the nurse has listened and
understood the client’s basic message and also offers clients a clearer idea of what they have said.
A method of making the client’s broad overall meaning of the message more
the hospital?”
“What is your opinion?” “You said you were frightened yesterday. How do you feel now?” Putting an arm over the clients shoulder. Placing the hand over the
client’s hand.
Client: “I couldn’t mange to eat any dinner last night not even the desert.
Nurse: “You had difficultly eating yesterday.”
Client: “Yes, I was very upset after family left.” Client: “I have trouble talking the stranger.” Nurse: “You find it difficult talking to people you do not know?”
“I’m puzzled.” “I’m not sure I understand that.”
“Would you please say that again?”
Perception checking or seeking consensual
validation
Offering self
understandable. It is used when the communication is rambling or garbled. To the clarify the message, the nurse can restate the basic message or
confess confusion and ask the client to repeat or restate the message. Nurse can also clarify their own message with statement.
A method similar to clarifying that verifies the meaning of specific words rather than the over all meaning of message.
Suggesting one’s presence, interest, or wish to understand the client without making any demands
“Would you tell me more?”
“I meant this rather than that.”
“I guess I didn’t make that clear – I’ll go over it again.”
Client: “My husband never gives me any presents.”
Nurse: “you mean he has never given you a present for your
birthday or Christmas.” Client: “Well – not ever. He does get me
something for my
birthday and Christmas, but he never thinks of giving me anything at any other time.”
“I’ll stay with you until your daughter arrives.” “We can sit here quietly for a while; we don’t need to talk unless you would like to.”
“I’ll help you to dress to go home.”
Giving information Acknowledging Clarifying time or sequence Presenting reality Providing, in a simple and direct manner, specific factual; information the client may or may not request. When information is not known, the nurse states this and indicates who has it or when the nurse will obtain it.
Giving recognition, in a nonjudgmental way, of a change in behavior, an effort the client has made, or contribution to a communication. Acknowledgement may be with or without understanding, verbal or nonverbal.
Helping the client clarify an event,
situation, or happening in relationship to time.
Helping the client to differentiate the real from the unreal.
“Your surgery is scheduled for 11 AM tomorrow.”
“You will feel a pulling sensation when the tube is removed from your abdomen.”
“I don’t know the
answer to that, but I will find out from Mrs. King, the nurse in charge.”
“You trimmed your beard and mustache and washed your hair.” “I noticed you keep squinting your eyes. Are you having difficulty seeing?”
“You walked twice as far today with your walker.”
Client: “I vomited this morning.”
Nurse: “was that after breakfast?”
Client: “I feel that I have been asleep for weeks.”
Nurse: “You had your operation Monday, and today is Tuesday.” “That telephone ring came from the program on television.”
“That’s not a dead mouse in the corner; it
Focusing
Reflecting
Summarizing and Planning
Helping the client expand on and develop a topic of importance for the nurse to wait until the clients think they have talked about the main concerns before attempting to focus. The focus may be an idea or feeling, however the nurse often emphasizes a feeling to help the client
recognize an emotion disguised behind words. Directing ideas,
feelings, question, or content back to clients to enable them to
explore their own ideas and feelings about a situation.
Stating the main points of a discussion to clarify the relevant points discussed. This technique is useful at the end of an interview
is a discarded washcloth.”
“Your magazine is here in the drawer. It has not been stolen.”
Client: “My wife say she will look after me, but I don’t think she can, what with the children to take care of, and they’re always after her about something clothes, homework, what’s for dinner that night.”
Nurse: “You are
worried about how well she can manage.”
Client: “What can I do?”
Nurse: “What do you think be helpful?” Client: “Do you think I should tell my
husband?”
Nurse: “You seem unsure about telling your husband?” “During the past half hour we have talked about…”
“Tomorrow afternoon we may explore this further.”
or to review a health-teaching session. It often acts as an
introduction to future care planning.
review what you have learned about the actions and effects of your insulin.”
BARRIERS OF THERAPEUTIC COMMUNICATION Technique Description Examples Stereotyping Agreeing and disagreeing Being defensive Offering generalized and oversimplified beliefs about groups of people that are based on experience categories clients and negate their uniqueness as
individuals.
Akin to judgmental responses, agreeing and disagreeing imply that the client is either right or wrong and that the nurse is in a position to judge this. These
responses deter clients from thinking through their position and may cause client to become defensive.
Attempting to protect a person or health care services from negative comments. These responses prevent the client from expressing true concerns. The nurse is saying, “You have no right to complain.” Defensive response protects the nurse from admitting weaknesses in the health care services,
“Two-years olds are brats”
“Women are complainers” “Men don’t cry” “Most people don’t have any pain after this surgery.”
Client: “I don’t think Dr. Broad is a very good doctor. He doesn’t seem interested in his patients.”
Nurse: “Dr. Broad is head of the Department of Surgery and is an excellent surgeon.”
Client: “Those night nurses must just sit around and talk all night. They didn’t answer my light for over an hour.”
Nurse: “I’ll have you know we literally run around on nights. You’re not the only client, you know.”
Challenging Probing Testing Rejecting including personal weaknesses.
Giving a response that makes client prove the statement or point of view. These responses indicate that the nurse is failing to consider the clients feelings, making the client feel it
necessary to defend a position.
Asking for information chiefly out of curiosity rather than with the intent to assist the client. These responses are considered prying and violate the clients privacy. Often asking “why” is probing and places the client in a defensive position. Asking question that make the client admit to something. These
responses permit the client only limited answers and often meet the nurse’s need rather than the client’s.
Refusing to discuss certain topics with the client. These responses often make clients feel
Client: “I felt nauseated after that red pill.” Nurse: “Surely you don’t think I gave the wrong pill?”
Client: “I believe my husband doesn’t love me.”
Nurse: “You can’t say that; why, he visits you every day.”
Client: “I was speeding along the street and didn’t see the stop sign.”
Nurse: “Why were you speeding?”
Client: “I didn’t ask the doctor when he was here.”
Nurse: “Why didn’t you?”
“Who do you think you are?” (enforce people to admit their status is only that of client) “Do you think I am not busy?” (forces the client to admit that the nurse really is busy)
“I don’t want to discuss that.
“Lets discuss other areas of interest to your
Changing topics and subject
Unwarranted reassurance
Passing judgment
that the nurse is
rejecting not only their communication but also the clients themselves.
Directing the
communication into areas of self-interest rather than considering the clients concerns often arises as a self-protecting response imply that what the nurse considers important will be discussed and that clients are not capable of helping themselves. Using clichés or
comforting statements of advices a means to reassure the client. These responses block the fears, feelings, and other thoughts of the client.
Giving opinions and approving of
disapproving responses, moralizing, or implying one’s own values. These responses imply that the client must think as the nurse thinks, fostering the client dependence.
rather than the two problems you keep mentioning.”
“I can’t talk now. I’m on may way for coffee break.’
Client: “I’m separated from my wife. Do you think I should have sexual relation with another woman?” Nurse: “I see that you’re 36 and that you like gardening. This sunshine is good for my roses. I have a beautiful rose garden.
“You’ll feel better soon.”
“I’m sure everything will turn out all right.” Don’t worry.”
“That’s good (bad).” “You shouldn’t do that.” “That’s not good
enough.”
“What you did was wrong (right).”
Giving common advice
Telling the client what do it. These responses deny the clients right to be an equal partner. Note than giving expert rather than common advice is therapeutic.
Client: “Should I move from my home to a nursing home?”
Nurses: “If I were you, I’d go to a nursing home, where you’ll get your meals cooked for you.”
