relationship development and therapeutic communication

8/13/2019 Relationship Development and Therapeutic Communication

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Relationship Development and TherapeuticCommunication

Mr. Ibrahim Rawhi AyasrehRN MSN CNS


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Relationship Development and Therapeutic Communication

The nurseclient relationship is the foundation on which

psychiatric nursing is established.

It is a relationship in which both participants must

recognize each other as unique and important human

beings.

It is also a relationship in which mutual learning occurs.


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Relationship Development and Therapeutic Communication

Therapeutic Relationship: is an interaction between two

people (usually a caregiver and a care receiver) in which

input from both participants contributes to a climate of

healing, growth promotion, and/or illness prevention.

Interpersonal communication techniques (both verbal and

nonverbal) are the tools of psychosocial intervention.


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Conditions essentials to Development of a

Therapeutic Relationship

Rapport

Rapportimplies special feelings on the part of both the

client and the nurse based on acceptance, warmth,

friendliness, common interest, a sense of trust, and a

nonjudgmental attitude.


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Trust

To trust another, one must feel confidence in that personspresence, reliability, integrity, veracity, and sincere desire to

provide assistance when requested.

Trust is the initial developmental task described by Erikson.

If the task has not been achieved, this component of

relationship development becomes more difficult. That is not

to say that trust cannot be established, but only that

additional time and patience may be required on the part of

the nurse.


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Examples of nursing interventions that would promote

trust in an individual who is thinking concretely

Providing a blanket when the client is cold

Providing food when the client is hungry

Keeping promises Being honest (e.g., saying I dont know the answer to your question, but Ill try to

find out) and then following through.

Simply and clearly providing reasons for certain policies, procedures, and rules.

Providing a written, structured schedule of activities

Attending activities with the client if he or she is reluctant to go alone

Being consistent in adhering to unit guidelines

Taking the clients preferences, requests, and opinions into consideration when

possible in decisions concerning his or her care

Ensuring confidentiality; providing reassurance that what is discussed will not

be repeated outside the boundaries of the health care team


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Respect

To show respect is to believe in the dignity and worthof an individual regardless of his or her unacceptable

behavior.

Unconditional positive regard : The attitude is

nonjudgmental, and the respect is unconditional inthat it does not depend on the behavior of the client to

meet certain standards.


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Empathy

Empathy is a process wherein an individual is able to see

beyond outward behavior and sense accurately anothers

inner experience at a given point in time .

With empathy, the nurse can accurately perceive and

understand the meaning and relevance of the clients

thoughts and feelings.


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It is not uncommon for the concept of empathy to be

confused with that of sympathy.

The major difference is that with empathy the nurse

accurately perceives or understands what the client is

feeling and encourages the client to explore these feelings.

With sympathy the nurse actually shares what the clientis feeling, and experiences a need to alleviate distress.


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Interpersonal Communication

Interpersonal communication is a transactionbetween the sender and the receiver.

In the transactional model of communication,

both participants are simultaneously perceiving

each other, listening to each other, and mutuallyinvolved in creating meaning in a relationship.


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Pre-existing Conditions Affecting Interpersonal

Communication

Values, Attitudes, and Beliefs

Values, attitudes, and beliefs are learned ways of thinking. Children generally adopt the value systems and internalize

the attitudes and beliefs of their parents.

Children may retain this way of thinking into adulthood or

develop a different set of attitudes and values as theymature.


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Communication

Culture or Religion

Communication has its roots in culture.

Cultural mores, norms, ideas, and customs provide the

basis for our way of thinking.

Cultural values are learned and differ from society to

society. For example, in some European countries (e.g.,

Italy, Spain, and France), men may greet each other with

hugs and kisses. These behaviors are appropriate in those

cultures, but they would communicate a different message

in the United States or England.


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Communication

Social Status

Studies of nonverbal indicators of social status or powerhave suggested that high-status persons are associated

with gestures that communicate their higher-power

position.

For example, they use less eye contact, have a more

relaxed posture, use a louder voice pitch, place hands on

hips more frequently, are power dressers, stand taller,

and maintain more distance when communicating with

individuals considered to be of lower social status.


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Communication

Gender


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Communication

Environment in Which the Transaction Takes Place

Some individuals who feel uncomfortable and refuse to speak during

a group therapy session may be open and willing to discuss problems

on a one-to-one basis with the nurse.

Territoriality, density, and distance are aspects of environment that

communicate messages.

Territorialityis the innate tendency to own space.

Densityrefers to the number of people within a given environmental

space.

Distanceis the means by which various cultures use space to

communicate


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Distances

Intimate distance is the closest distance that individuals will allow

between themselves and others. In the United States, this distance,

which is restricted to interactions of an intimate nature, is 0 to 18inches.

Personal distance is approximately 18 to 40 inches and is reserved for

interactions that are personal in nature, such as close conversations

with friends or colleagues.

Social distance is about 4 to 12 feet away from the body. Interactionsat this distance include conversations with strangers or acquaintances,

such as at a cocktail party or in a public building.

A public distance is one that exceeds 12 feet. Examples include

speaking in public or yelling to someone some distance away.


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Non- Verbal Communication

Physical appearance and dress. Body movement and posture,

Touch.

Facial expressions. eye behavior.

Vocal cues or paralanguage.


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Physical appearance and dress

Dress can be formal or casual, stylish or sloppy. Hair can

be long or short, and even the presence or absence of hair

conveys a message about the person.

Other body adornments that are also considered potential

communicative stimuli include tattoos, masks, cosmetics,

badges, jewelry, and eyeglasses.


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Body Movement and Posture

The way in which an individual positions his or her body

communicates messages regarding self-esteem, gender

identity, status, and interpersonal warmth or coldness.

The individual whose posture is slumped, with head and

eyes pointed downward, conveys a message of low self-

esteem.

To stand straight and tall with head high and hands onhips indicates a superior status over the person being

addressed.


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Touch

Touch is a powerful communication tool. It can elicit both

negative and positive reactions, depending on the people

involved and the circumstances of the interaction.

It is a very basic and primitive form of communication,

and the appropriateness of its use is culturally determined.


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Types of Touch

FunctionalProfessional : This type of touch is impersonal and

businesslike. It is used to accomplish a task.

-Example : A tailor measuring a customer for a suit or a physicianexamining a client.

SocialPolite. This type of touch is still rather impersonal, but it conveys

an affirmation or acceptance of the other person.

- Example: A handshake.

FriendshipWarmth. Touch at this level indicates a strong liking for the

other persona feeling that he or she is a friend.

- Example : Laying ones hand on the shoulder of another.


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Facial Expressions


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Facial Expressions


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Eye Behavior


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Paralanguage, or vocal cues

Paralanguage, or vocal cues, is the gestural component of

the spoken word. It consists of pitch, tone, and loudness of

spoken messages, the rate of speaking, expressively

placed pauses, and emphasis assigned to certain words.

These vocal cues greatly influence the way individuals

interpret verbal messages. A normally soft spokenindividual whose pitch and rate of speaking increases may

be perceived as being anxious or tense.


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Therapeutic Communication Techniques


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Therapeutic Communication Techniques


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Non- Therapeutic Communication Techniques

relationship development and therapeutic communication

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