4_principles and techniques of therapeutic communication (2).PPT

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1. Principles, techniques, and elements of
therapeutic communication
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2. Therapeutic Communication
•Therapeutic communication is the use of
communication for the purpose of creating a beneficial
outcome for the client.
•Ruesch (1961), who originated the term therapeutic
communication, stated that the purpose is to improve
the client’s ability to function.
•Furthermore, therapeutic communication facilitates the
establishment of the nurse-client relationship and
fulfills the purposes of nursing.
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3. Therapeutic Communication
•Interactive process between nurse, client
•Helps client overcome temporary stress
oTo get along with other people
oAdjust to the unalterable
oOvercome psychological blocks
•Established with purpose of helping client
•Nurse responds to content
oVerbal, nonverbal

4. Therapeutic Communication Characteristics
• Is purposeful and goal-directed
• Has well-defined boundaries
• Is client-focused
• Is nonjudgmental
• Uses well-planned, selected techniques
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5. The Elements of Therapeutic
Communication
1.Empathy:
•An emotional linkage between two or more people through
which feelings are communicated;
•involves trying to imagine what it must be like to be in
another person’s situation
Behaviors of the Nurse
•Verbal comments: “This must make you feel sad.”
•Nonverbal actions:
•A nod of the head to indicate understanding.
•Mirroring the client’s facial expression in a genuine way.
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6. •Empathizing
oEmpathy is process
•People feel with one another
•Embrace attitude of person who is speaking
•Grasp idea that what client has to say
important
oNOT synonymous with sympathy
oInterprets clients feelings without inserting
own

7. •Empathy
oFour phases of therapeutic empathizing
•Identification
•Incorporation
•Reverberation
•Detachment
oOn guard against over-distancing or burnout

8. Outcomes of empathy
• Promotes understanding of the client’s
feelings and condition.
• Enables the nurse and client to relate
better.
• Provides the client with clues that the nurse is following
and understanding what is being said.
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9. 2. Trust:
The client’s belief that the nurse will behave predictably
and competently while respecting the client’s needs
Behaviors of the Nurse
• Ensure confidentiality.
• Be consistent.
• Do exactly what you say you will do for the client.
• Arrive on time.
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10. • End the session on time.
• Return when you say you will.
• Be consistently friendly, open, and honest.
Outcomes
• Provides the basis for progress during future
encounters.
• Sets up the foundation of the therapeutic relationship.
• Makes the client feel comfortable with the nurse, rather
than guarded or afraid.
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11. Establish TrustEstablish Trust
•Establishing rapport
oInclude adolescent in discussion
oListen more than you talk
oAvoid distractions
oBe truthful with the child
•Establishing trust
oFollow through with promises
oRespect confidentiality
oBe truthful, even if it isn’t what they want

12. 3. Honesty:
The ability to be truthful, frank, and sincere
Behaviors of the Nurse
• Provide realistic reassurance.
• Avoid false reassurance.
• Develop insight into the way your feelings and reactions
affect the client.
• Accept yourself.
Outcomes
• Promotes the development of trust.
• Enables the nurse to gain personal insight. Consequently,
behavior with the client can be modified as needed.
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13. 4. Validation:
Listening to the client and responding congruently in order to
be sure that the nurse and client have the same
understanding of a problem or issue
Behaviors of the Nurse:
Verbal comments:
• “So you are saying that ... ”
• “Let me be sure I understand what you are saying.”
• “Tell me what you understand about what I just
said.”
Outcomes:
• Clarifies communication.
• Helps the client to feel accepted, respected, and understood.
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14. 5. Caring:
The level of emotional involvement between the nurse and the
client.
Behaviors of the Nurse:
Nonverbal actions:
• Seeking the client out each day.
• Spending quality time with the client.
• Paying attention to the client’s needs.
• Using tactile messages, such as a pat on the back, to show support.
Outcomes:
• Makes the client feel accepted.
• Provides the client with the knowledge that the nurse is willing to
help.
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15. 6. Active listening:
Hearing and interpreting language, noticing nonverbal and
paraverbal enhancements, and identifying underlying
feelings.
Behaviors of the Nurse:
• Taking time to listen.
• Giving the client your undivided attention.
• Making eye contact.
• Responding to verbal and nonverbal leads, clues, and signals
from the client.
• Analyzing and validating throughout the conversation.
• Suspending judgment.
• Listening between the lines.
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16. •Attentive listening
oMindful listening
oPaying attention to verbal, nonverbal
oNoting congruence
oAbsorbing content and feeling
oListening for key themes
oBe aware of own biases
oHighly developed skill

17. • Understanding the feelings behind the facts.
• Noticing discrepancies between facts and feelings.
• Noticing things omitted such as topics that the client should
be discussing but avoids.
• Using communication principles and techniques to be a
sounding board.
Outcomes:
• Promotes understanding of the client.
• Allows the client to express self more freely.
• Helps the client gain a better understanding of the
problem(s).
• Promotes problem solving by the client.
• Enhances the client’s self-esteem.
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18. Blocks to Attentive ListeningBlocks to Attentive Listening
1.Rehearsing
2.Being concerned with oneself
3.Assuming
4.Judging
5.Identifying
6.Getting off track
7.Filtering

19. Skills to achieve the maximum of listening:Skills to achieve the maximum of listening:
1. Attending1. Attending
•Physical attending
oFace the person squarely
oAdopt an open posture
oLean toward the person
oMaintain good eye contact
oTry to be relatively relaxed

20. 2. Silence2. Silence
•Using silence
oEncouraging the client to communicate
oAllowing client time to ponder what has been
said
oAllow client time to collect thoughts
oAllow client time to consider alternatives
oLook interested
oUncomfortable silence should be broken
•Analyzed

21. 3. Reflection
•Reflecting
oRepeating the client’s message
•Verbal or nonverbal
oReflecting content repeats client’s statement
•May be misused, overused
•Use judiciously
oReflecting feelings
•Verbalizing implied feelings in client’s comment
oEncourages client to clarify

22. 4. Just the Facts
•Imparting information
oSupplying additional data
oNot constructive to withhold useful information
oLine between information and advice
oAvoid personal, social information
oClient participation in decision making  positive
mental health outcomes
•Take in and understand information
•Educated empowered client

23. 5. Deflection
•Avoiding self-disclosure
oDeflect a request for self-disclosure
•Honesty
•Benign curiosity
•Refocusing
•Interpretation
•Clarification
•Feedback and limit setting
oAssess and evaluate responses

24. 6. Clarification
•Clarifying
oAttempt to understand client’s statement
oAsk client to give an example
•Paraphrasing
oNurse assimilates or restates in own words
oFives nurse opportunity to test understanding
•Checking perceptions
oSharing how one person perceives another

25. 7. Question and Define7. Question and Define
•Questioning
oVery direct way of speaking with clients
oOpen-ended questions focuses the topic
oClose question limits choice of responses
oCareful not to ask questions that steer answer
•Structuring
oAttempt to create order, establish guidelines
oDefine parameters of nurse-client relationship

26. 8. Pinpoint and Link8. Pinpoint and Link
•Pinpointing
oCalls attention to certain kinds of statements
•Relationships
oPoint to inconsistencies
oSimilarities, differences
•Linking
oNurse responds to client
•Ties together two events, experiences, feelings
•Connect past experiences with current behaviors

27. 9. Giving Feedback
•Nurse share reaction to what client said
•Give in a way that does not threaten client
•Risk of client experiencing feedback
oPersonal rejection
•Nurses should be open, receptive to cues

28. 10. Focus Feedback
•On behavior, observations, description
•On more-or-less, rather than either/or
•On here-and-now: what is said, not why
•Sharing of information, ideas
•Exploration of alternatives
•Value to client
•Amount of information client able to use
•Appropriate time and place

29. 11. Confronting
•Deliberate invitation to examine some aspect of
personal behavior that indicates discrepancy
between actions and words
•Informational confrontation
oDescribes visible behavior
•Interpretive confrontation
oDraws inferences about the meaning of behavior

30. Six Skills in ConfrontingSix Skills in Confronting
•Use of personal statements
•Use of relationship statements
•Use of behavior descriptions
•Use of description of personal feelings
•Use of responses aimed at understanding
•Use of constructive feedback skills

31. 12. Summarize and Process
•Summarizing
oHighlighting the main ideas expressed
oConveys understanding
oReviews main themes of conversation
oUse at different times during interaction
oDon’t rush to summarize
•Processing
oDirect attention to interpersonal dynamics

32. Therapeutic Communication MistakesTherapeutic Communication Mistakes
•Common mistakes
oGiving advice
oMinimizing or discounting feelings
oDeflecting
oInterrogating
oSparring لاجسلا باوجتسا تيتشت

33. Barriers and threats to effective Communication
•Failure to listen
•Improperly decoding intended message
•Placing the nurse’s needs above client’s

34. The Therapeutic Relationship
•Growth-facilitating process
oHelp client manage problems in living
•More effectively
•Develop unused, underused opportunities
fully
oHelp client become better at helping self
•May develop over weeks or within minutes
•Influenced by nurse and client
oPersonal and professional characteristics

35. Therapeutic Relationship Characteristics
•Characteristics of therapeutic relationship
oIntellectual and emotional bond
•Focused on client
oRespects client as individual
oRespects client confidentiality
oFocuses on client’s well-being
oBased on mutual trust, respect, acceptance

36. Therapeutic Relationship Phases
•Preinteraction
1.Introductory
2.Working: stage 1 and stage 2
3.Termination

37. 1. Introductory Phase1. Introductory Phase
•Preinteraction phase
•Introductory phase
oOrientation, pretherapeutic phase
oNurse and client observe each other
oOpen relationship
oClarify problem
oStructure and formulate contract
oClient may display resistive behaviors

38. •By end of this phase client begins to
oDevelop trust in nurse
oView nurse as honest, open, concerned
oBelieve nurse will try to understand, respect
oBelieve nurse will respect client confidentiality
oFeel comfortable talking about feelings
oUnderstand purpose of relationship, roles
oFeel an active participant in plan

39. 2. Working Phase Stages
•Stage One
oExploring and understanding thoughts and
feelings
oEmpathetic listening and responding
oRespect, genuineness
oConcreteness
oReflecting, paraphrasing, clarifying, confronting
oIntensity of interaction increases

40. •Stage two
oFacilitate and take action
oCollaborate
oMake decisions
oProvide support
oOffer options

41. 3. Termination Phase
•Difficult, ambivalent
•Summarizing
•Termination discussions
•Allow time for client adjustment to independence

42. Developing the Therapeutic Relationship
•Set mutual goals with client
•Discuss outcomes
•Many ways of helping do not require training

43. Skills for the Therapeutic Relationship
•Listen actively
•Help identify the client’s feelings
•Be empathetic, honest, genuine, and credible
•Use ingenuity
•Be aware of cultural differences
•Maintain confidentiality
•Know your role and your limitations

44. Communication Techniques Working with Children and Communication Techniques Working with Children and
FamiliesFamilies
•Accepting
•Broad openings
•Clarifying
•Focusing
•Observations
•Reflection
•Summarizing
•Active listening
•Collaborating
•Exploring
•Giving recognition
•Offering self
•Restatement or
paraphrasing
•Validating perceptions

45. Developmental Considerations
•Establish rapport with children
oSit or lower self to child’s eye level
oNote what child is playing with or reading
oIf appropriate, agree with child/share feelings
oCompliment a physical features, activity
oUse calm tone of voice, appropriate language
oPace discussion, procedure in nonhurried
manner
oPreschoolers have limited concept of time

46. Conclusion Conclusion
•Nurse’s role requires communication skills
•Effective communication large role
oAbility to deliver highest quality of care
•Nurse needs to be understood
•Nurse needs to understand messages
•Strong verbal, written communication skills
•Monitor own nonverbal communication