THERAPEUTIC COMMUNICATION TECHNIQUES Using silence - allows client to take control of the discussion, if he or she so desires Accepting - conveys

Accepting - conveys positive regard Giving recognition - acknowledging, indicating awareness Offering self - making oneself available Giving broad openings - allows client to select the topic Offering general leads - encourages client to continue Placing the event in time or sequence - clarifies the relationship of events in time Making observations - verbalizing what is observed or perceived Encouraging description of perceptions - asking client to verbalize what is being perceived Encouraging comparison - asking client to compare similarities and differences in ideas, experiences, or interpersonal relationships Restating - lets client know whether an expressed statement has or has not been understood Reflecting - directs questions or feelings back to client so that they may be recognized and accepted Focusing - taking notice of a single idea or even a single word Exploring - delving further into a subject, idea, experience, or relationship Seeking clarification and validation - striving to explain what is vague and searching for mutual understanding Presenting reality - clarifying misconceptions that client may be expressing Voicing doubt - expressing uncertainty as to the reality of clients perception Verbalizing the implied - putting into words what client has only implied Attempting to translate words into feelings - putting into words the feelings the client has expressed only indirectly Formulating plan of action - striving to prevent anger or anxiety escalating to unmanageable level when stressor recurs THERAPEUTIC COMMUNICATION AND PROBLEM-SOLVING Goals are often achieved through use of the problem-solving model: Identify the clients problem. Promote discussion of desired changes. Discuss aspects that cannot realistically be changed and ways to cope with them more adaptively. Discuss alternative strategies for creating changes the client desires to make. Weigh benefits and consequences of each alternative. Help client select an alternative.

Encourage client to implement the change. Provide positive feedback for clients attempts to create change. Help client evaluate outcomes of the change and make modifications as required.

Non therapeutic Communication Techniques Giving reassurance - may discourage client from further expression of feelings if client believes the feelings will only be downplayed or ridiculed Rejecting - refusing to consider clients ideas or behavior Approving or disapproving - implies that the nurse has the right to pass judgment on the goodness or badness of clients behavior Agreeing or disagreeing - implies that the nurse has the right to pass judgment on whether clients ideas or opinions are right or wrong Giving advice - implies that the nurse knows what is best for client and that client is incapable of any self-direction Probing - pushing for answers to issues the client does not wish to discuss causes client to feel used and valued only for what is shared with the nurse Defending - to defend what client has criticized implies that client has no right to express ideas, opinions, or feelings Requesting an explanation - asking why implies that client must defend his or her behavior or feelings Indicating the existence of an external source of power - encourages client to project blame for his or her thoughts or behaviors on others Belittling feelings expressed - causes client to feel insignificant or unimportant Making stereotyped comments, clichs, and trite expressions - these are meaningless in a nurse-client relationship Using denial - blocks discussion with client and avoids helping client identify and explore areas of difficulty Interpreting - results in the therapists telling client the meaning of his or her experience Introducing an unrelated topic - causes the nurse to take over the direction of the discussion

Therapeutic Communication Techniques

1. Using silence

Examples
The client says: "We drink and smoke a lot here." The student thinkshow can that bedrinking alcohol in a state hospital? But says nothingusing silencethe client then says: "yes we drink a lot of cokes and smoke a lot." "Yes" or "I follow what you said" "I notice you combed your hair." "I'll sit with you awhile." "What would you like to talk about?" "Tell me what's bothering you."

2. Accepting 3. Giving Recognition 4. Offering self 5. Using Broad Openings

6. Using General Leads (using neutral expressions to encourage continued talking by the client) 7. Placing he event in time or sequence

"Go on.

" Ummm..I am listening"

"Tell me about it" "Was this before or after?" "What seemed to lead up to?"

8. Making Observations

"You appear tense" "I notice you are biting your lips."

9. Encouraging Description of Perceptions

"What do you think is happening to you right now?" Client: "I can't sleep. I stay awake all night." Nurse: "You have difficulty sleeping"

10. Restating

11. Reflecting

Patient: "Do you think I should tell the doctor?" Nurse: "Do you think you should tell the doctor?"

12. Focusing

"This point seems worth looking at more closely."

"You said something earlier that I want you to go back to." 13. Exploring 14. Giving Information 15. Seeking Clarification "Would you describe that more fully." "My name isI am a student nurse.." "What would you say is the main point of what you said?" "Your mother is not hereI am a nurse." Patient: "Did you bring my car today?" Nurse: "No, you do not have a car. I drove my car here today." 17.. Voicing Doubt "That's hard to believe." "Really?" 18. Seeking Consensual Validation 19. Verbalizing the Implied 20. Encouraging Evaluation (asking for the client's view of the meaning or importance of something) 21. Attempting to Translate Into Feelings "How important is it for you to change this behavior?"

16. Presenting Reality

" From what you say, I suspect you are feeling relieved." "Let's see if we can figure this out.." " Let's see, so far you have said..." "What will it take to reach your goal of not hitting anyone?" "So what do you do each time you drink too much and it's time to go home?" What is the major feeling you have about all men?"

22. Suggested Collaboration 23. Summarizing 24. Encouraging Formulation of a Plan of Action 25. Identifying themes ..asking client to identify recurrent patterns in thoughts, feelings, and behaviors