chapter 6 therapeutic communication

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 6

Therapeutic Communication

Chapter 6

Therapeutic Communication


CommunicationCommunication

• Exchange of information

• Verbal– Content: literal words spoken– Context: environment, circumstances, situation in

which communication occurs

• Nonverbal– Process: all messages used to give meaning, context

to message– Congruent or incongruent message


Therapeutic CommunicationTherapeutic Communication

• Interpersonal interactions; focus on patient’s needs

• Need for privacy

• Encompasses goals that facilitate the nursing process


Therapeutic Communication (cont.)Therapeutic Communication (cont.)

• Goals of therapeutic communication– Establish therapeutic relationship– Identify patient’s most important concerns; assess

patient’s perceptions– Facilitate patient’s expression of emotions – Teach patient, family necessary self-care skills – Recognize patient’s needs; implement interventions

to address patient’s needs – Guide patient toward acceptable solutions



• Touch

– Five types: functional/professional; social–polite; friendship–warmth; love–intimacy; sexual–arousal

– Comforting and supportive; also possible invasion of intimate and personal space


QuestionQuestion

• Tell whether the following statement is true or false?

• A distance of 2 feet between the nurse and patient is adequate for promoting comfortable therapeutic communication.


AnswerAnswer

• False

• Rationale: For effective therapeutic communication, a distance of 3 to 6 feet between the nurse and patient would be most appropriate.


Verbal Communication SkillsVerbal Communication Skills

• Need for concrete, not abstract, messages

• Techniques (see Table 6.1)– Exploring, focusing, restating, reflecting promotes

discussion of feelings or concerns in more depth

– Other techniques useful in focusing or clarifying what is being said

– Feedback via making an observation or presenting reality


Verbal Communication Skills (cont.)Verbal Communication Skills (cont.)

• Avoidance of nontherapeutic techniques (see Table 6.2)

– Advising, belittling, challenging, probing, reassuring

• Interpretation of signals or cues

– Overt

– Covert (themes, metaphors, proverbs, clichés)


Nonverbal Communication SkillsNonverbal Communication Skills• Facial expression

– Expressive

– Impassive

– Confusing

• Body language– Open body position

– Closed body position


Nonverbal Communication Skills (cont.)Nonverbal Communication Skills (cont.)

• Vocal cues

• Eye contact

• Silence



• Respect for boundaries

– Distance zones• Intimate (0 to 18 inches)• Personal (18 to 36 inches)• Social (4 to 12 feet)• Public (12 to 25 feet)

– Therapeutic communication: most comfortable when nurse and patient are 3 to 6 feet apart



• Active listening (concentrating exclusively on what patient says)

• Active observation (watching nonverbal actions as speaker communicates)


Understanding Meaning, Context, and Spirituality of CommunicationUnderstanding Meaning, Context, and Spirituality of Communication

• Meaning: usually more meaning than just spoken word

• Context

– Validation with client of verbal, nonverbal information

– Who, what, when, how, why


Understanding Meaning, Context, and Spirituality of Communication (cont.)Understanding Meaning, Context, and Spirituality of Communication (cont.)

• Spirituality

– Self-awareness of own spiritual beliefs

– Need for objectivity and nonjudgmental attitude about patient’s beliefs


Cultural ConsiderationsCultural Considerations

• Need for awareness of cultural differences– Speech patterns, habits– Styles of speech, expression– Eye contact– Touch– Concept of time– Health, health care


QuestionQuestion

• Which of the following would be a nontherapeutic communication technique?

– A. Reassuring

– B. Reflecting

– C. Focusing

– D. Exploring


AnswerAnswer

• A. Reassuring

• Rationale: Reassuring is a nontherapeutic technique because it attempts to dispel the patient’s feelings.

– Reflecting, focusing, and exploring are examples of therapeutic communication techniques.


Therapeutic Communication SessionTherapeutic Communication Session

• Goals– Establishing rapport– Identifying issues of concern – Being empathetic, genuine, caring, unconditionally

accepting of the person– Understanding patient’s perception– Exploring patient’s thoughts, feelings– Developing problem-solving skills– Promoting patient’s evaluation of solutions


Therapeutic Communication Session (cont.)Therapeutic Communication Session (cont.)

• Initiation of session– Introduction– Establishment of contract for relationship – Identification of major concern

• Nondirective role (broad-opening, open-ended questions)

• Directive role (direct yes/no questions; usually for patients with suicidal thoughts, in crisis, or who are out of touch with reality)


Therapeutic Communication Session (cont.)Therapeutic Communication Session (cont.)• Proper phrasing of questions

– Clarification

– Identification of patient’s avoidance of anxiety-producing topic

• Guidance in problem-solving, empowerment to change


Assertive CommunicationAssertive Communication

• Expression of positive and negative feelings/ideas in open, honest, direct way– Calm, specific factual statements– Focus on “I” statements

• Possible responses– Aggressive– Passive–aggressive– Passive– Assertive


Community-Based Care Community-Based Care • Nurses increasingly caring for high-risk patients in homes;

families becoming more responsible for primary prevention

• Therapeutic communication techniques and skills are essential for caring for patients in the community.

• Increased self-awareness, knowledge needed about cultural differences; sensitivity to beliefs, behaviors, feelings of others

• Collaboration with patient and family as well as other health-care providers


QuestionQuestion

• Tell whether the following statement is true or false?

• Assertive communication focuses on identifying negative feelings.


AnswerAnswer

• False

• Rationale: Assertive communication focuses on the expression of positive and negative feelings or ideas in an open, honest, direct manner.


Self-Awareness Issues Self-Awareness Issues

• Nonverbal communication: as important as verbal

• Therapeutic communication influential in effectiveness of interventions

• Awareness of own communication is first step in improving communication

– Ask for feedback from colleagues

– Examine own communication skills

chapter 6 therapeutic communication

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