1. Therapeutic Communication
Prepared by Sally McDonald
Revised by Tim Corbett

2. Helping vs Social Relationships
Care
Trust
Growth
Purposeful/intentional
Unequal sharing
Focus on Client’s needs
Time limited
SOCIAL
Care
Trust
Growth
Spontaneous
Usually equal or near equal sharing
Focus on needs of
both individuals
Ongoing

3. Locus of Control GIVING HELP Feeling important Feeling useful
Feeling powerful
Feeling gratified
Feeling happy
NEEDING HELP
Feeling unimportant or inadequate
Feeling useless or depressed
Feeling powerless
Feeling frightened or embarrassed
Feeling sad
or angry
It is more pleasant to give help than to need help. Helping professionals must must be constantly aware of the effects of their status on people seeking help. Clients should be empowered by the experience in the helping interview. Empowered clients are likely to participate more fully in their care and return to health faster

4. Phases of Helping Relationships
Orientation Phase
Working Phase
Termination Phase

5. Orientation Phase “getting to know you” phase setting the tone
making introductions
establishing roles
reaching agreement on goals
developing trust
Appearance, professional, clean hair, etc

6. Working Phase “problem solving” phase attending to client’s needs
Nurse in role of teacher/counselor
encouraging active participation by client
gathering further data
assisting client in decision making
facilitating change
Evaluate problems & goals
Once orientation phase completed & trust level fairly comfortable, time for Identification of the problem or problems that are shared by the client.

7. Termination Phase reviewing & summarizing goals met and progress made
acknowledge feelings of loss
reassuring clients with issues such as,
“How will this problem/disease affect
my life ?” or
“What do I need to change ?”
Should meet some resolution at each helping interview

8. Active Listening 3 Phases
restatement involves repeating or paraphrasing the words of the client
reflection is verbalizing both the content and the implied feelings of the client’s message
clarification is summarizing the client’s thoughts & feelings & resolving confusion

9. Active Listening STOP TALKING demonstrate that you want to listen
remove distractions
be patient

10. Techniques
Offering Self-making yourself available on an unconditional basis-
“I’ll stay with you awhile”
Giving Recognition-acknowledging client’s thoughts and feelings
Sharing Observations-”You seem tense and upset”
Encouraging Descriptions-ask client to verbalize experience-
“Tell me what is happening now”

11. Techniques Restating-repeating the main idea
Sequencing-placing events in chronological order
Reflecting-referring questions, thoughts, feelings back to client-
“What do you think you should do?”

12. Assertive Communication
“I” Statements allow people to ‘own’ (take responsibility for) their own thoughts & feelings
assertiveness involves taking a risk

13. NONVERBAL CUES
80-90% of any message is carried nonverbally by our body language (facial expression, paralanguage, and tone, pitch, and volume of voice

14. NONVERBAL CUES professional attire sit arm’s length away
relaxed but attentive posture

15. NONVERBAL CUES facial expressions and tone
should be friendly & interested
use direct eye contact & match your eye contact with the patient’s
pay attention to body language of the patient as well as your own

16. INTERVIEWING TECHNIQUES
the purpose of the interview is to obtain accurate & thorough information
put your client at ease as they may feel uncomfortable about revealing sensitive information to you
explaining your format helps clients accept & understand the purpose of the interview

17. INTERVIEWING TECHNIQUES
in general, use open-ended questions
however, to obtain specific information, closed-ended questions are preferable
validate information
clarify responses
use reflective questions/comments
& paraphrasing

18. Progression of the Interview
Broad Openings- such as
“Tell me about yourself” are designed to allow the client to relate his or her story in a way that is comfortable

19. Progression of the Interview
Open-Ended Questions
encourage the client to elaborate or give explanations (for example,
“What happened yesterday?”)
they provide direction & keep the conversation focused

20. Progression of the Interview
Closed-Ended Questions
can be answered with 1-2 words and can be useful in obtaining specific types of information, such as
“What is today’s date?”

21. EFFECTIVE INTERVIEWING
as a professional nurse, you will spend about half of your time obtaining information from clients & colleagues
excellent communication as well as interviewing skills are fundamental, yet require years of practice

22. WHY, WHAT, HOW why do you need the information?
how will the information I am seeking direct me in helping my client?
how will you phrase your questions?

23. Who to Ask? if the client is able to speak, ask him/her
family perspectives may also be important
written consent may be required to question concurrent/previous healthcare providers
be courteous and respectful
never forget client confidentiality

24. “Why” Questions
offensive misuse of ‘why’ appears threatening and confrontational and puts clients on the defensive
they can interfere with developing a therapeutic relationship & are seldom considered therapeutic

25. Conveying Upsetting Information
The SPIKES Model developed by Radziewicz & Baile (2001)
Setting
Perception
Invitation
Knowledge emotions
Summary

26. Setting
private & comfortable
invite others, such as family members

27. Perception
refers to what client and others already know useful in uncovering misinformation

28. Invitation For example, the statement,
“Would you like me to explain more
about what happened?’

29. Knowledge
gradually dispense information assessing client’s ability to cope with it
The family may insist that the client not be told difficult news

30. Emotions let client vent while you remain calm
keep in mind Stages of Grief & Loss
may need to set limits on inappropriate /harmful behavior

31. Summary review all important information with the client and family
may need to repeat information more than once

32. Self-Disclosure Use self disclosure to help clients open up
to you – not to meet your own needs
Keep disclosures brief
Don’t imply that your experience is exactly the same as the client’s
Only self-disclose about situations that you have mastered

33. Self-Disclosure Monitor your own comfort with self-disclosure
Respect your client’s needs for privacy
Remember that there are cultural variations in the amount of self-disclosure considered appropriate
Identify risks and benefits of self disclosure

34. Therapeutic Versus Nontherapeutic Communication
- Facilitates transformation of working nurse-patient relationship
- Relationship allows for adequate & accurate data collection & assessment
- Performed with & not for patient

35. Therapeutic Versus Nontherapeutic Communication
- Hinders relationship formation
- Prevents patient from becoming mutual partner & relegates him/her to passive recipient of care