Therapeutic Communication Techniques in Nursing

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Therapeutic Communication in Nursing
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Learning the techniques of therapeutic communication is an important skill that nurses should possess since communication is an integral part of being a nurse. This is a study guide about the basic principles of therapeutic communication, its purpose, differences of verbal and nonverbal communication, and lastly, the different therapeutic communication techniques.

What is Therapeutic Communication?

Communication is the process that people use to exchange information; messages are simultaneously sent and received on two levels: verbally through the use of words and nonverbally by behaviors that accompany the words.

  • Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client’s specific needs to promote an effective exchange of information.
  • Skilled use of therapeutic communication techniques helps the nurse understand and empathize with the client’s experience.

Goals of Therapeutic Communication

Therapeutic communication can help nurses to accomplish many goals:

  • Establish a therapeutic nurse-client relationship.
  • Identify the most important client concern at that moment (the client-centered goal).
  • Assess the client’s perception of the problem as it unfolds; this includes detailed actions (behaviors and messages) of the people involved and the client’s thoughts and feelings about the situation, others, and self.
  • Facilitate the client’s expression of emotion.
  • Teach the client and the family necessary self-care skills.
  • Recognize the client’s needs.
  • Implement interventions designed to address the client’s needs.
  • Guide the client toward identifying the plan of action to a satisfying and socially acceptable resolution.

Verbal Communication Skills

Verbal communication consists of the words a person uses to speak to one or more listeners.

  • Using concrete messages. The nurse should use words that are as clear as possible when speaking to the client so that the client can understand the message; in a concrete message, the words are explicit and need no interpretation, the speaker uses nouns instead of pronouns; concrete questions are clear, direct, and easy to understand.
  • Using therapeutic communication techniques. The choice of technique depends on the intent of the interaction and the client’s ability to communicate verbally; overall, the nurse selects techniques that facilitate the interaction and enhance communication between client and nurse.
  • Avoiding nontherapeutic communication. In contrast, there are many nontherapeutic techniques that nurses should avoid; these responses cut off communication and make it more difficult for the interaction to continue.
  • Interpreting signals or cues. To understand what a client means, the nurse watches and listens carefully for cues; cues are verbal or nonverbal messages that signal keywords or issues for the client; finding cues is a function of active listening often, cue words introduced by the client can help the nurse to know what to ask next or how to respond to the client.

Nonverbal Communication Skills

Nonverbal communication is behavior that a person exhibits while delivering verbal content.

  • Facial expression. The human face produces the most visible, complex, and sometimes confusing nonverbal messages; facial movements connect with words to illustrate meaning; this connection demonstrates the speaker’s internal dialogue.
  • Body language. Body language (gestures, postures, movements, and body positions) is a nonverbal form of communication; closed body positions, such as crossed legs or arms folded across the chest, indicate that the interaction might threaten the listener who is defensive or not accepting; a better, more accepting body position is to sit facing the client with both feet on the floor, knees parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle.
  • Vocal cues. Vocal cues are nonverbal sound signals transmitted along with the content: voice volume, tone, pitch, intensity, emphasis, speed, and pauses augment the sender’s message; volume, the loudness of the voice, can indicate anger, fear, happiness, or deafness; tone can indicate whether someone is relaxed, agitated, or bored; pitch varies from shrill and high to low and threatening; intensity is the power, severity and strength behind the words; emphasis refers to accents on words or phrases that highlight the subject; and speed is the number of words spoken per minute.
  • Eye contact. The eyes have been called the mirror of the soul because they often reflect our emotions; eye contact, looking into the other person’s eyes during communication, is used to assess the other person and the environment and to indicate whose turn it is to speak; it increases during listening but decreases while speaking.

Therapeutic Communication Techniques

Choosing the appropriate therapeutic communication technique is critical in establishing and maintaining the nurse-patient relationship. These techniques are discussed below:

Therapeutic Communication TechniqueExamplesRationale
Accepting.
Indicating reception
“Yes.”
“I follow what you said.”
Nodding
An accepting response indicates the nurse has heard and followed the train of thought.
Broad openings.
Allowing the client to take the initiative in introducing the topic.
“Is there something you’d like to talk about?”

 “Where would you like to begin?”

Broad openings make explicit that the client has the lead in the interaction.
Consensual validation.
Searching for mutual understanding, for accord in the meaning of the words.
“Tell me whether my understanding of it agrees with yours.”For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both (all) participants.
Encouraging comparison.
Asking that similarities and differences be noted.
“Was it something like…?”

Have you had similar experiences?

Comparing ideas, experiences, or relationships brings out many recurrent themes.
Encouraging description of prescriptions.
Asking the client to verbalize what he or she perceives.
“Tell me when you feel anxious.”
“What is happening?”

“What does the voice seem to be saying?”
To understand the client, the nurse must see things from his or her perspective.
Encouraging expression. Asking the client to appraise the quality of his or her experiences.“What are your feelings in regard to..?”

“Does this contribute to your distress?”

The nurse asks the client to consider people and events in light of his or her own values.
Exploring.
Delving further into a subject or idea.
“Tell me more about that.”

 “Would you describe it more fully?”

When clients deal with topics superficially, exploring can help them examine the issue more fully.
Focusing.
Concentrating on a single point.
“This point seems worth looking at more closely.”The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client.
Formulating a plan of action.
Asking the client to consider kinds of behavior likely to be appropriate in future situations.
“What could you do to let your anger out harmlessly?”It may be helpful for the client to plan in advance what he or she might do in future similar situations.
General leads.
Giving encouragement to continue.
“Go on.”

  “And then?”

General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for interaction.
Giving information. Making available the facts that the client needs.“My name is…”

  “Visiting hours are…”

Informing the client of facts increases his or her knowledge about a topic or lets the client know what to expect.
Giving recognition.
Acknowledging, indicating awareness.
“Good morning Mr…”

  “You’ve finished your list of things to do.”

Greeting the client by name, indicating awareness of change, or noting efforts the client has made all show that the nurse recognizes the client as a person, as an individual.
Making observations.
Verbalizing what the nurse perceives.
“You appear tense.”

“Are you uncomfortable when..?”

Sometimes client cannot verbalize or make themselves understood.
Offering self.
Making oneself available.
“I’ll sit with you awhile.”The nurse can offer his or her presence, interest, and desire to understand.
Placing event in time or sequence.
Clarifying the relationship of events in time.
“What seemed to lead up to…?”Putting events in proper sequence helps both the nurse and client to see them in perspective.
Presenting reality.
Offering for consideration that which is real.
“I see no one else in the room.”When it is obvious that the client is misinterpreting reality, the nurse can indicate what is real.
Reflecting.
Directing client actions, thoughts, and feelings back to client.
Client: “Do you think I should tell the doctor?”

Nurse: “Do you think you should?”

Reflection encourages the client to recognize or accept his or her own feelings.
Restating.
Repeating the main idea expressed.
Client: “I can’t sleep. I stay awake all night.”
Nurse: “You have difficulty sleeping.”
The nurse repeats what the client has said in approximately or nearly the same words the client has used.
Seeking information. Seeking to make clear that which is not meaningful or that which is vague.“I’m not sure that I follow.”The nurse should seek clarification through interactions with clients.
Silence. Absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking.Nurse says nothing but continues to make eye contact and conveys interest.Silence often encourages the client to verbalize, provided that it is interested and expectant.
Suggesting collaboration. Offering to share, to strive, to work with the client for hi or her benefit.“Perhaps you and I can discuss and discover the triggers for your anxiety.”The nurse seeks to offer a relationship in which the client can identify problems in living with others, grow emotionally, and improve the ability to form satisfactory relationships.
Summarizing. Organizing and summing up that which has gone before.“Have I got this straight?”Summarization seeks to bring out the important points of the discussion and to increase the awareness and understanding of both participants.
Translating into feelings. Seeking to verbalize client’s feelings that he or she expresses only indirectly.Client: “I’m dead.”
Nurse: “Are you suggesting that you feel lifeless?”
Often what the client says, when taken literally, seems meaningless or far removed from reality.
Verbalizing the implied. Voicing what the client has hinted or suggested.Client: “I can’t talk to you or anyone. It’s a waste of time.”

Nurse: “Do you feel that no one understands?”

Putting into words what the client has implied or said indirectly tends to make the discussion less obscure.
Voicing doubt. Expressing uncertainty about the reality of the client’s perception.“Isn’t that unusual?”

“Really?”

Another means of responding to distortions of reality is to express doubt.

Practice Quiz: Therapeutic Communication in Nursing

Nursing practice questions for Therapeutic Communication in Nursing. For more practice questions, visit our NCLEX practice questions page.

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1. Which therapeutic communication technique is being used in this nurse-client interaction?

Client: “When I get angry, I get into a fistfight with my wife, or I take it out of the kids.”
Nurse: “I notice that you are smiling as you talk about this physical violence.”

A. Exploring
B. Making observations
C. Encouraging comparison
D. Formulating a plan of action

1. Answer: B. Making observations

  • Option B: The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.

2. Which therapeutic communication technique is being used in this nurse-client interaction?

Client: “My father spanked me often.”
Nurse: “Your father was a harsh disciplinarian.”

A. Accepting
B. Focusing
C. Offering general leads
D. Restatement

2. Answer: D. Restatement

  • Option D: The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client’s statement has been heard and understood.

3. Which therapeutic communication technique is being used in this nurse-client interaction?

Client: “When I am anxious, the only thing that calms me down is alcohol.”
Nurse: “Other than drinking, what alternatives have you explored to decrease anxiety?”

A. Formulating a plan of action
B. Giving recognition
C. Making observations
D. Reflecting

3. Answer: A. Formulating a plan of action

  • Option A: The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client’s poor coping choice, may serve to prevent anger or anxiety from escalating.

4. After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, “I’m so proud of you for being assertive. You are so good!” Which communication technique has the leader employed?

A. The therapeutic technique of presenting reality
B. The nontherapeutic technique of giving approval
C. The therapeutic technique of making observations
D. The nontherapeutic technique of interpreting

4. Answer: B. The nontherapeutic technique of giving approval.

  • Option B: The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client’s ideas or behaviors are “good” or “bad.” This creates a conditional acceptance of the client.

5. Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process?

A. “This new approach worked for you. Keep it up.”
B. “I notice that you seem to be responding to voices that I do not hear.”
C. “We’ve discussed past coping skills. Let’s see if these coping skills can be effective now.”
D. “Please tell me in your own words what brought you to the hospital.”

5. Answer: C. “We’ve discussed past coping skills. Let’s see if these coping skills can be effective now.”

  • Option C: This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level.

References

Sources and references for this study guide for therapeutic communication, including interesting studies for your further reading: 

  • Black, J. M., & Hawks, J. H. (2005). Medical-surgical nursing. Elsevier Saunders,.
  • Daniels, T. G., Denny, A., & Andrews, D. (1988). Using microcounseling to teach RN nursing students skills of therapeutic communication. Journal of Nursing Education27(6), 246-252. [Link]
  • Hammond, D. C., Hepworth, D. H., & Smith, V. G. (2002). Improving therapeutic communication: A guide for developing effective techniques. Jossey-Bass. [Link]
  • Sleeper, J. A., & Thompson, C. (2008). The use of hi fidelity simulation to enhance nursing students’ therapeutic communication skills. International Journal of Nursing Education Scholarship5(1), 1-12. [Link]
  • Videbeck, S. L. (2010). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.

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