Therapeutic And Non Therapeutic Communication Techniques

TECHNIQUE 1. EXAMPLE Using Silence 2. Accepting COMMENTS Positive accepting silence often encourages client to speak. Gives client time to organize thoughts. Reduces pace of interview. Gives nurse opportunity to assess non-verbal aspects. Yes. Signifies nurse has heard and follows trend of thought; non-judgment. Uh hum. I follow what you said. Nodding. 3. Giving Good morning, Mr. S. recognition I noticed that you have combed your hair. Show recognition of the client as a person, or an awareness of change. You’ve laced a wallet. 4. Offering self I’ll sit with you awhile. I’ll stay here with you. Unconditional acceptance; nurse makes herself available; her presence, interest, and desire to understand. I’m interested in your comfort. 5. Giving broad Is there something you’d like to talk about? Allows client to take the initiative in introducing topic for discussion. openings What are you thinking about? Where would you like to begin? 6. Offering general leads Go on. And then? Gives client encouragement to continue. Leaves direction of discussion to client. Tell me about it. 7. Placing the event in time or sequence What seemed to lead up to? Was this before or after? When did this happen? 8. Making You appear tense. observations Are you uncomfortable when…? Clarifies relationship of events in time. Helps both nurse and client see events more objectively and in perspective. May identify recurring patterns of difficulties and point out needs. Verbalizing what is perceived, calls client’s attention to something he is unaware of. Offers client something to which he can respond. I notice you’re biting your lips. 9. Encouraging Tell me when you are feeling anxious. description of What is happening? perceptions 10. Encouraging comparison Asking client or verbalize what he perceives. To understand client, nurse must see things as they seem to him. Provides basis for understanding. What does the voice seem to be saying? Was this something like…? Have you had similar experiences? Asking that similarities and differences be noted; may bring out recurring themes; also helps client evaluate feelings about and influence of events. 11. Restating Ct: I can’t sleep; I stay awake all night. Ns: You have difficulty sleeping. 12. Reflecting Ct: Do you think I should tell the doctor? Ns: Do you think you should? Repeating the main idea expressed gives client evidence their idea has been communicated effectively, encourages him to continue. Directing the questions, feelings and ideas back to client. Encourages client to accept as part of himself his own ideas and feelings, and indicates his point of view is of value. Ct: My brother spends all my money, then has nerve to ask for more. Ns: This causes you to feel angry. 13. Focusing This point seems worth looking at more closely. Concentrating on single point helps client center thinking and to understand ideas. 14. Exploring Tell me more about that. Delving further into a subject or idea, to explore more fully certain experiences, but nurse should not pry or probe. Would you like to describe it more fully? What kind of work? 15. Giving information My name is _____ Visiting hours are _____ Makes available the facts the client needs; helps build up trust as well as give knowledge. Defines role of nurse. My purpose in being here is _____ 16. Seeking clarification I’m not sure that I follow. What would you say is the main Seeking to make clear that which is vague or not meaningful. Helps client clarify his own thinking. point of what you said? 17. Presenting reality I see no one else in the room. That sound was a car backfiring. Offers for consideration that which is real; indicates an alternate line of thought for client, but not trying to convince him he is wrong. Your mother is not here; I’m a nurse. 18. Voicing doubt Isn’t that unusual? That’s hard to believe. Really? Expressing uncertainty as to reality of client’s perceptions. May encourage client to reconsider and re-evaluate what has occurred. Nurse neither agrees nor disagrees. 19. Seeking consensual validation Tell me whether my understanding agrees with yours. Are you using that word to convey the idea that ___? Searching for mutual understanding for accord in meaning of words. Should have essentially same meaning. 20. Verbalizing the implied Ct: I can’t talk to anyone. It’s a waste of time. Voicing what client has hinted or suggested. Putting into words what has been implied tends to make discussion less obscure, but nurse should not be blunt. Ns: Is it your feeling that no one understands? Ct: My wife pushes me around just like my mother did. Ns: Is it your impression that all women are domineering? 21. Encouraging What are your feelings in regard to ___? Asking client the quality of his experiences and to consider people and events in the light of his own set evaluation 22. Attempting to translate into feelings Does this contribute to your discomfort? of values, to evaluate ways things affect him. Discourages client from adopting ideas and opinions of others. Ct: I’m dead. Seeking to verbalize the feelings that are being expressed indirectly. It is the latent meaning of the expression the demands attention, enables client to feel understood. Ns: Are you suggesting that you feel lifeless? Ct: I’m way out at sea. Ns: It must be lonely. You feel deserted? 23. Suggesting collaboration 24. Summarizing Perhaps you and I can discuss this and discover what produces your anxiety. Offering to share, to work together with client for his benefit. Offers client a relationship in which he can identify his problems in living with others. Have I got this straight? Organizing and summarizing that which has gone before; seeks to bring together important points and to give each an awareness of progress made towards greater understanding. You’ve said that ___ During this past hour you and I have been discussing ___ 25. Encouraging What could you do to let your anger out harmlessly? formulation of a Next time this comes up, what might you do to handle it? plan of action Asking client to consider kinds of behavior likely to be more appropriate in the future. Helping client plan future actions. Non-Therapeutic Techniques TECHNIQUE EXAMPLE COMMENTS 1. I wouldn’t worry about it. Devaluated client’s own feelings by trying to dispel anxiety; places no value on client’s judgment. Effect of this response is to block person from further expressing feelings; belittling person who has problems or worries. Reassuring Everything will be all right. You’re coming along fine. 2. Giving approval That’s good I’m glad for you - 3. Rejecting Let’s not discuss that I don’t want to hear about it. 4. Disapproving That’s bad I’d rather you wouldn’t - Sanctioning client’s ideas or behavior implies opposite is bad; tends to limit client’s freedom to think, to speak, or act in a way that displeases nurse. Approval and disapproval may alter behavior, but not lasting; no learning. Refusing to consider or showing contempt for client’s ideas or behavior. Closes off topic from exploration. Client himself feels rejected. Client avoids seeking help rather than risk further rejection. Nurse anxious or fearful lacks selfunderstanding. Judgmental - implies client is expected to please the nurse. Should acknowledge client has right to behave as he does - acceptance. 5. Agreeing That’s right - I agree. Gives client idea that he is right because his ideas agree with the nurse’s. Leaves client little opportunity to modify his thinking without admitting error. Should not agree with delusions. 6. That’s wrong - Opposing the client’s ideas, implies client is wrong; he feels called upon to defend himself. Confines client. Disagreeing I definitely disagree with I don’t believe that 7. Advising I think you should Why don’t you - 8. Probing Now tell me about Tell me your life history. 9. Challenging But how can you be the President? If you’re dead, why is your heart beating? 10. Testing What day is this? Telling client what to do implies nurse knows what is best for client and that he is incapable of selfdirection. Keeps client in a state of immature dependence on the judgment and guidance of others. Persistent questioning of client, makes client feel he is being used valued only for what he can give; puts him on the defensive. Demanding proof from the client. The ideas of client conceal feelings and meet needs that are real; tends to expand and strengthen his misinterpretations as he seeks support for his point of view. Delusions not given up to reality. Appraising client’s degree of insight Do you know what kind of hospital this is? tends to try to convince client of his incapacity; demands that he have insight into his lack of insight. Do you still have the idea that 11. Defending The hospital has a fine reputation. No one here would lie to you. But Dr. B. is a very able psychiatrist. 12. Requesting an explanation Why do you think that? Why do you feel that way? Attempting to protect something or someone from verbal attack implies client has no right to criticize or express his ideas, feelings, or opinions. Increases client’s feelings - that he has uncovered a weakness that others are trying to hide from him. Asking the client to provide a reason for his thoughts, feelings, behavior and events. Intimidating effect; may invent a reason. Why did you do that? 13. Indicating the an existence of What makes you say that? Who told you that you were Jesus? external source What made you do that? 14. Belittling the Ct: I have nothing to live for, I wish I were dead. feelings expressed 15. Making Ns: Everybody gets down in the dumps, I’ve felt that way sometimes. Nice weather we’re having. Attributing the source of thoughts, feelings, and behavior to others or to outside influence. Implies client was made to think in a certain way; encourages client to greater utilization of projection as a means of relieving anxiety. Relieves client of responsibility for own thoughts and behavior. Misjudging the degree of client’s discomfort. Implies that the discomfort is temporary, mild and self-limiting; indicates lack of empathy. Offering meaningless cliches, trite expressions; encourages a like stereotyped I’m fine, how are you? comments It’s for your own good. response from client. Keep your chin up. 16. Giving literal responses 17. Using denial Ct: I’m an Easter Egg. Ns: What shade? You don’t look like one. Ct: I’m nothing. Ns: Of course you’re something. Everybody is somebody. Responding to figurative comment as though it were a statement of fact. Client at a loss how to describe his feelings - best way of putting his thoughts into words. Feelings are so strange that unconventional expressions more suitable. Refusing to admit that a problem exists. Tends to avoid discussion of the problem; avoids helping client identify and explore his difficulties. Denies validity of client’s feelings. Ct: I’m dead. Ns: Don’t be silly. 18. Interpreting What you really mean is Unconsciously you’re saying - 19. Introducing an unrelated topic Ct: I’d like to die. Ns: Did you have visitors this weekend? Seeking to make conscious that which is unconscious; telling the client the meaning of his experience. Implies client’s limited capacity to cope with his own problems. (Want to assist toward self-interpretation). Changing the subject takes over the direction of the conversation; takes the initiative from client.