1. Therapeutic Communication
Review outline in notes
communication techniques used with the client, for they are the “tools” of
A. The nurse must be aware of the therapeutic or nontherapeutic value of the
I. Introduction
A. Interpersonal communication is a transaction between the sender and the
II. What Is Communication?
psychosocial intervention.
B. In the transactional model, both participants perceive each other, listen to each
receiver. Both persons participate simultaneously.
III. The Impact of Preexisting Conditions
relationship.
other, and simultaneously engage in the process of creating meaning in a
that influence both the intended message and the way in which it is
A. Both sender and receiver bring certain preexisting conditions to the exchange
expressed through negative stereotyping. A person who values youth may
1. Values, attitudes, and beliefs. Examples: Attitudes of prejudice are
interpreted.
2. Culture or religion. Cultural mores, norms, ideas, and customs provide the
younger.
dress and behave in a manner that is characteristic of one who is much
American culture. Some messages about religion are conveyed by
street give a different message in the Italian culture than they would in the
basis for our way of thinking. Examples: Men who hug each other on the
3. Social status. High-status persons often convey their high-power position
wearing crosses around one’s neck or hanging crucifixes on the wall.
tall, and more distance when communicating with individuals considered
voice pitch, more frequent use of hands on hips, power dressing, standing
with gestures. Examples: less eye contact, more relaxed posture, louder
in communication with others. Examples: differences in posture and
4. Gender. Masculine and feminine gestures influence messages conveyed
to be of lower social status.
communication is especially evident during adolescence, with words such
5. Age or developmental level. The influence of developmental level on
gender roles within various cultures.
system of gestures used by individuals who are deaf or hearing impaired.
as “cool,” “groovy,” “awesome,” and others. Sign language is a unique
a. Territoriality—the innate tendency to own space. All individuals lay
and distance are aspects of environment that communicate messages.
6. Environment in which the transaction takes place. Territoriality, density,
Prolonged exposure to high-density situations elicits certain behaviors,
b. Density—the number of people within a given environmental space.
claim to certain areas as their own, and feel safer in their own area.
communicate.
c. Distance—the means by which various cultures use space to
such as aggression, stress, criminal activity, and hostility.
between themselves and others. In America, it is 0 to 18 inches.
(1) Intimate distance—the closest distance that individuals will allow
(3) Social distance—conversations with strangers or acquaintances
close conversations with friends. In America, it is 18 to 40 inches.
(2) Personal distance—interactions that are personal in nature, such as
(4) Public distance—speaking in public or yelling to someone some
(e.g., at a cocktail party). In America, it is 4 to 12 feet.
A. Physical appearance and dress. Ways in which individuals dress or wear their
IV. Nonverbal Communication
distance away. In America, the distance exceeds 12 feet.
unkempt appearance may give an impression to some people that the individual
hair conveys a message to all who observe their appearance. Example: An
her body communicates messages regarding self-esteem, gender identity, status,
B. Body movement and posture. The way in which an individual positions his or
is sloppy and irresponsible.
low self-esteem.
1. Slumped posture, head and eyes pointed downward conveys a message of
and interpersonal warmth or coldness. Examples:
over the person being addressed.
3. Standing tall with head high and hands on hips indicates a superior status
2. Sitting with legs crossed at the thighs sometimes depicts feminine identity.
still.
4. Warmth is conveyed by a smile, direct eye contact, and keeping the hands
1. Functional–professional—impersonal, businesslike touch. Example: a tailor
interpretation. Types of touch:
C. Touch. Can elicit both negative and positive reactions, depending upon cultural
3. Friendship–warmth—indicates a strong liking for another person. Example:
2. Social–polite—impersonal, but affirming. Example: a handshake.
fitting a suit for a customer.
person. Example: to engage in a strong, mutual embrace.
4. Love–intimacy—conveys an emotional attachment or attraction for another
laying one’s hand upon the shoulder of another.
another in the genital region.
5. Sexual arousal—an expression of physical attraction. Example: touching
happiness, sadness, anger, surprise, doubt, fear, and disgust.
source of communication. The face can give multiple messages, such as
D. Facial Expressions. Next to human speech, facial expression is the primary
can look, and at whom we can look. Eye contact conveys a personal interest in
cultural rules dictate where we can look, when we can look, for how long we
E. Eye Behavior. Eyes have been called the “windows of the soul.” Social and
spoken word. It consists of pitch, tone, and loudness of spoken messages, the
F. Vocal Cues or Paralanguage. Paralanguage is the gestural component of the
the other person. Staring or gazing can make another feel very uncomfortable.
words. How a message is verbalized can be as important as what is verbalized.
rate of speaking, expressively placed pauses, and emphasis assigned to certain
desires.
A. Using silence—allows the client to take control of the discussion, if he or she so
V. Therapeutic Communication Techniques
C. Giving recognition—acknowledging; indicating awareness
B. Accepting—conveys positive regard
F. Offering general leads—encourages the client to continue
E. Giving broad openings—allows the client to select the topic
D. Offering self—making oneself available
time
G. Placing the event in time or sequence—clarifies the relationship of events in
being perceived
I. Encouraging description of perceptions—asking the client to verbalize what is
H. Making observations—verbalizing what is observed or perceived
K. Restating—lets the client know whether an expressed statement has been
differences in ideas, experiences, or interpersonal relationships
J. Encouraging comparison—asking the client to compare similarities and
may be recognized and accepted
L. Reflecting—questions or feelings are referred back to the client so that they
understood or not
N. Exploring—delving further into a subject, idea, experience, or relationship
M. Focusing—taking notice of a single idea or even a single word
P. Presenting reality—clarifying misperceptions that the client may be expressing
and searching for mutual understanding
O. Seeking clarification and validation—striving to explain that which is vague
R. Verbalizing the implied—putting into words what the client has only implied
perceptions
Q. Voicing doubt—expressing uncertainty as to the reality of the client’s
T. Formulating a plan of action—strives to prevent anger or anxiety from
client has expressed only indirectly
S. Attempting to translate words into feelings—putting into words the feelings that
VI. Nontherapeutic Communication Techniques
escalating to an unmanageable level the next time the stressor occurs
B. Rejecting—refusing to consider the client’s ideas or behavior
feelings if he or she believes they will only be belittled.
A. Giving reassurance—may discourage the client from further expression of
D. Agreeing/disagreeing—implies that the nurse has the right to pass judgment on
judgment on the “goodness” or “badness” of the client’s behavior.
C. Giving approval or disapproval—implies that the nurse has the right to pass
the client is incapable of any self-direction.
E. Giving advice—implies that the nurse knows what is best for the client, and that
whether the client’s ideas or opinions are “right” or “wrong.”
causes the client to feel used and valued only for what is shared with the nurse.
F. Probing—pushing for answers to issues the client does not wish to discuss
H. Requesting an explanation—asking “Why?” implies that the client must defend
no right to express ideas, opinions, or feelings.
G. Defending—to defend what the client has criticized implies that he or she has
I. Indicating the existence of an external source of power—encourages the client
his or her behavior or feelings.
unimportant.
J. Belittling feelings expressed—causes the client to feel insignificant or
to project blame for his or her thoughts or behaviors upon others.
meaningless in a nurse–client relationship.
K. Making stereotyped comments, clichés, and trite expressions—these are
M. Interpreting—results in the therapist telling the client the meaning of his or her
identify and explore areas of difficulty.
L. Using denial—blocks discussion with the client and avoids helping the client
the discussion.
N. Introducing an unrelated topic—causes the nurse to take over the direction of
experience
and nonverbally. Several nonverbal behaviors have been designed as
A. To listen actively is to be attentive to what the client is saying, both verbally
VII. Active Listening
SOLER.
facilitative skills for attentive listening. They can be identified by the acronym
3. L—Lean forward toward the client.
2. O—Observe an open posture.
1. S—Sit squarely facing the client.
VIII. Process Recordings
5. R—Relax.
4. E—Establish eye contact.
techniques.
B. They are written by the nurse or student as a tool for improving communication
A. Process recordings are written reports of verbal interactions with clients.
A. Feedback is useful when it is conveyed in the following manner:
IX. Feedback
2. Feedback should be specific rather than general.
rather than on the client.
1. Feedback is descriptive rather than evaluative and focuses on the behavior
4. Feedback should impart information rather than offering advice.
to modify.
3. Feedback should be directed toward behavior that the client has the capacity
5. Feedback should be well timed.

2. The nurse must be aware of the therapeutic or nontherapeutic value of the communication techniques used with the patient—they are the “tools” of psychosocial intervention.

3. Communication 7% of communication is verbal.
38% of communication is vocal cues; cadence, volume and tone.
55% of communication is body language.

4. Nonverbal Communication
Components of Nonverbal Communication
Physical appearance and dress
Body movement and posture
Touch
Facial expressions
Eye behavior
Vocal cues or paralanguage

5. Active Listening
To listen actively is to be attentive to what client is saying, both verbally and nonverbally.
Several nonverbal behaviors have been designed as facilitative skills for attentive listening.
S – Sit squarely facing the patient.
O – Observe an open posture.
L – Lean forward toward the patient.
E – Establish eye contact.
R – Relax.

6. Feedback
Feedback is useful when it
is descriptive rather than evaluative and focused on the behavior rather than on the patient
is specific rather than general
is directed toward behavior that the patient has the capacity to modify
imparts information rather than offers advice
is well timed