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Therapeutic Communication
Prepared by Sally McDonald Revised by Tim Corbett
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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
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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
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Phases of Helping Relationships
Orientation Phase Working Phase Termination Phase
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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
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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.
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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
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Communication Techniques
Validating/Clarifying Reflecting Sequencing Sharing observations Acknowledging feelings
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Avoid Arguing Minimizing Challenging Giving false reassurance
Interpreting or speculating on the dynamics of the client’s problems “Selling” client on accepting treatment Probing sensitive areas Participating in criticism of any staff member Joining any attacks led by the client
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Attentive Listening Scale
-THINGS TO AVOID Lack of eye contact Responding before the other finishes speaking Finishing other people’s sentences Talking so much that others cannot respond Continuing to work while someone is talking to you Repeat a point just made Allow your mind to wander during a conversation
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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
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Active Listening STOP TALKING demonstrate that you want to listen
remove distractions be patient
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Assertive Communication
“I” Statements allow people to ‘own’ (take responsibility for) their own thoughts & feelings assertiveness involves taking a risk
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NONVERBAL CUES professional attire sit arm’s length away
relaxed but attentive posture
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NONVERBAL CUES facial expressions and tone
should be friendly & interested use direct eye contact & match your eye contact with the patient’s eye contact pay attention to body language of patient as well as your own body language
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Interviewing Techniques
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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
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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
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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
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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
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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?”
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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
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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?
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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
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“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
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Conveying Upsetting Information
The SPIKES Model developed by Radziewicz & Baile (2001) Setting Perception Invitation Knowledge emotions Summary
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Setting private & comfortable invite others, such as family members
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Perception refers to what client and others already know useful in uncovering misinformation
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Invitation For example, the statement,
“Would you like me to explain more about what happened?’
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Knowledge gradually dispense information assessing client’s ability to cope with it The family may insist that the client not be told difficult news
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Emotions let client vent while you remain calm
keep in mind Stages of Grief & Loss may need to set limits on inappropriate /harmful behavior
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Summary review all important information with the client and family
may need to repeat information more than once
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AVOID clichés poor listening closed questions
intimidating how/why questions obvious probing questions advice leading questions (that suggest the response that you want) judgmental comments diverting false assurance
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COMMON ERRORS
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Blocks to Communication
Failure to respect client Failure to listen Minimizing feelings Inappropriate comments & questions Excessive questions Clichés Yes/no questions Probing Changing the subject Leading questions Advice Judgments False reassurance Giving approval/disapproval
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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
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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
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Therapeutic Versus Nontherapeutic Communication
- Facilitates transformation of working nurse-patient relationship - Relationship allows for adequate & accurate data collection & assessment - Performed with & not for patient
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Therapeutic Versus Nontherapeutic Communication
- Hinders relationship formation - Prevents patient from becoming mutual partner & relegates him/her to passive recipient of care
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