Box 1 Therapeutic communication techniques. (From Keltner N, Steele D 2015 Psychiatric Nursing, 7th edn. Mosby, St Louis.)
Technique: Listening
Definition: An active process of receiving information and examining one's reaction to messages received
Example: Consider the cultural practice of your patient, maintain appropriate eye contact, and be receptive to nonverbal communications
Therapeutic Value: Nonverbally communicates nurse’s interest and acceptance to patient
Nontherapeutic Threat: Failure to listen, interrupting patient
Technique: Broad openings
Definition: Encouraging patient to select topics for discussion
Example: ‘What are you thinking about?’
Therapeutic Value: Indicates acceptance by nurse and value of patient’s initiative
Nontherapeutic Threat: Domination of interaction by nurse, rejecting responses
Technique: Restating
Definition: Repeating main thought patient has expressed
Example: ‘You say that your mother left you when you were five years old’
Therapeutic Value: Indicates that nurse is listening and validates, reinforces, or calls attention to something that has been said
Nontherapeutic Threat: Lack of validation of nurse’s interpretation of message, being judgmental, reassuring, offending
Technique: Clarification
Definition: Attempting to improve the nurse’s understanding of words, vague idea, or unclear thoughts of the patient or asking the patient to explain what they mean
Example: ‘I’m not sure what you mean. Could you tell me again?’
Therapeutic Value: Helps to clarify the patient’s feelings, ideas, and perceptions and to provide an explicit connection between them and the patient’s actions
Nontherapeutic Threat: Failure to probe, assumed understanding
Technique: Reflection
Definition: Directing back to the patient ideas, feelings, questions, or content
Example: ‘You’re feeling tense and anxious and it’s related to a conversation you had with your father last night?’
Therapeutic Value: Validates nurse’s understanding of what patient is saying and signifies empathy, interest, and respect for patient
Nontherapeutic Threat: Stereotyping patient’s responses, inappropriate timing of reflections, inappropriate depth of feeling of reflections, inappropriate to the culture and experience and educational level of the patient
Technique: Humour
Definition: Discharging of energy though comic enjoyment of the imperfect
Example: ‘This gives a whole new meaning to “Just relax”’
Therapeutic Value: Can promote insight by making conscious repressed material, resolving paradoxes, tempering aggression, and revealing new options and is a socially acceptable form of sublimation
Nontherapeutic Threat: Indiscriminate use, belittling patient, screen to avoid therapeutic intimacy
Technique: Informing
Definition: Demonstrating skills or giving information
Example: ‘I think it would be helpful for you to know more about how your medication works’
Therapeutic Value: Helpful in patient education about relevant aspects of patient’s well-being and self-care
Nontherapeutic Threat: Giving advice
Technique: Focusing
Definition: Asking questions or making statements that help patients expand on a topic of importance
Example: ‘I think it would be helpful if we talk more about your relationship with your father’
Therapeutic Value: Allows patient to discuss central issues related to problem and keeps communication process goal directed
Nontherapeutic Threat: Allowing abstractions and generalisations, changing topics
Technique: Sharing perceptions
Definition: Asking patient to verify nurse’s understanding of what patient is thinking or feeling
Example: ‘You’re smiling, but I sense that you are really very angry with me’
Therapeutic Value: Conveys nurse’s understanding to patient and has potential for clearing up confusing communication
Nontherapeutic Threat: Challenging patient, accepting literal responses, reassuring, taunting, offending
Technique: Theme identification
Definition: Clarifying underlying issues or problems experienced by patient that emerge repeatedly during nurse–patient relationship
Example: ‘I’ve noticed that in all the relationships that you have described, you’ve been hurt or rejected by the man/woman. Do you think this is an underlying issue?’
Therapeutic Value: Allows nurse to best promote patient’s exploration and understanding of important problems
Nontherapeutic Threat: Giving advice, reassuring, disapproving
Technique: Silence
Definition: Using silence or nonverbal communication for a therapeutic reason
Example: Sitting with patient and nonverbally communicating interest and involvement
Therapeutic Value: Allows patient time to think and gain insights, slows the pace of the interaction, and encourages patient to initiate conversation, while conveying nurse support, understanding, and acceptance
Nontherapeutic Threat: Questioning patient, asking for ‘why’ responses, failure to break a nontherapeutic silence
Technique: Suggesting
Definition: presenting of alternative ideas for patient’s consideration relative to problem solving
Example: ‘Have you thought about responding to your boss in a different way when he raises that issue with you? For example, you could ask him whether a specific problem has occurred’
Therapeutic Value: Increases patient’s perceived options or choices
Nontherapeutic Threat: Giving advice, inappropriate timing, being judgmental
|