Therapeutic Communication Techniques

Techniques Description Examples

Using Silence Accepting pauses or Sitting quietly (or
silence that may extend walking the client) and
for several seconds or waiting to put thoughts
minute without and feelings into words.
interjecting any verbal
response.

Providing general leads Using statement or “Perhaps you would

questions that (a) like to talk about…”
encourage the client to “Would it help to
verbalize (b) choose a discuss your feelings?”
topic of conservation; “Where would you like
and (c) facilitate to begin?”
continued verbalization. “And then what?”
“I follow what you are
saying.”

Being specific and Making that are specific “You scratched my

tentative rather than general, and arm.”
tentative rather than (specific statement)
absolute. “You are as clumsy an
as ox” (general
statement)”You seem
unconcerned about
Mary.”(tentative
statement)”You don’t
give a damn about Mary
and you never
will.”(absolute
statement)

Using open-ended Asking broad question “I’d like to hear more

question that lead or invite the about that.”
client to explore “Tell me about…”
(elaborate, clarify, “How have you been
describe compare, or feeling lately?”
illustrate) thoughts or “What brought you to
 feelings. Open-minded the hospital?”
questions specify only “What is your opinion?”
the topic to be “You said you were
discussed and invite frightened yesterday.
answers that are longer How do you feel now?”
than one or two words.
Putting an arm over the
Using touch Providing appropriate clients shoulder. Placing
forms if touch to the hand over the
reinforce caring client’s hand.
feelings. Because tactile
contracts vary
considerably among
individuals, families,
and cultures, the nurse
must be sensitive to the
differences in attitudes
and practices of clients
and self.
Client: “I couldn’t
Restating or Actively listening for mange to eat any dinner
paraphrasing the client’s basic last night not even the
message and then desert.
repeating those Nurse: “You had
thoughts and or feeling difficultly eating
in similar word. This yesterday.”
conveys that the nurse Client: “Yes, I was very
has listened and upset after family left.”
understood the client’s Client: “I have trouble
basic message and also talking the stranger.”
offers clients a clearer Nurse: “You find it
idea of what they have difficult talking to
said. people you do not
know?”

“I’m puzzled.”
Seeking clarification A method of making “I’m not sure I
the client’s broad understand that.”
overall meaning of the “Would you please say
message more that again?”
 understandable. It is “Would you tell me
used when the more?”
communication is
rambling or garbled. To
the clarify the message,
the nurse can restate the
basic message or
confess confusion and
ask the client to repeat
or restate the message.
“I meant this rather than
Nurse can also clarify that.”
their own message with “I guess I didn’t make
statement. that clear – I’ll go over
it again.”

Client: “My husband

Perception checking or A method similar to never gives me any
seeking consensual clarifying that verifies presents.”
validation the meaning of specific Nurse: “you mean he
words rather than the has never given you a
over all meaning of present for your
message. birthday or Christmas.”
Client: “Well – not
ever. He does get me
something for my
birthday and Christmas,
but he never thinks of
giving me anything at
any other time.”

“I’ll stay with you until

Offering self Suggesting one’s your daughter arrives.”
presence, interest, or “We can sit here quietly
wish to understand the for a while; we don’t
client without making need to talk unless you
any demands would like to.”
“I’ll help you to dress to
go home.”
 “Your surgery is
Giving information Providing, in a simple scheduled for 11 AM
and direct manner, tomorrow.”
specific factual; “You will feel a pulling
information the client sensation when the tube
may or may not request. is removed from your
When information is abdomen.”
not known, the nurse “I don’t know the
states this and indicates answer to that, but I will
who has it or when the find out from Mrs.
nurse will obtain it. King, the nurse in
charge.”

“You trimmed your

Acknowledging Giving recognition, in a beard and mustache and
nonjudgmental way, of washed your hair.”
a change in behavior, an “I noticed you keep
effort the client has squinting your eyes.
made, or contribution to Are you having
a communication. difficulty seeing?”
Acknowledgement may “You walked twice as
be with or without far today with your
understanding, verbal or walker.”
nonverbal.
Client: “I vomited this
Clarifying time or Helping the client morning.”
sequence clarify an event, Nurse: “was that after
situation, or happening breakfast?”
in relationship to time. Client: “I feel that I
have been asleep for
weeks.”
Nurse: “You had your
operation Monday, and
today is Tuesday.”

“That telephone ring

Presenting reality Helping the client to came from the program
differentiate the real on television.”
from the unreal. “That’s not a dead
mouse in the corner; it
 is a discarded
washcloth.”
“Your magazine is here
in the drawer. It has not
been stolen.”

Client: “My wife say

Focusing Helping the client she will look after me,
expand on and develop but I don’t think she
a topic of importance can, what with the
for the nurse to wait children to take care of,
until the clients think and they’re always after
they have talked about her about something
the main concerns clothes, homework,
before attempting to what’s for dinner that
focus. The focus may night.”
be an idea or feeling, Nurse: “You are
however the nurse often worried about how well
emphasizes a feeling to she can manage.”
help the client
recognize an emotion
disguised behind words.
Client: “What can I
Reflecting Directing ideas, do?”
feelings, question, or Nurse: “What do you
content back to clients think be helpful?”
to enable them to Client: “Do you think I
explore their own ideas should tell my
and feelings about a husband?”
situation. Nurse: “You seem
unsure about telling
your husband?”

“During the past half

Summarizing and Stating the main points hour we have talked
Planning of a discussion to about…”
clarify the relevant “Tomorrow afternoon
points discussed. This we may explore this
technique is useful at further.”
the end of an interview “In a few days I’ll
 or to review a health- review what you have
teaching session. It learned about the
often acts as an actions and effects of
introduction to future your insulin.”
care planning.

BARRIERS OF THERAPEUTIC COMMUNICATION

Technique Description Examples

Stereotyping Offering generalized “Two-years olds are
and oversimplified brats”
beliefs about groups of “Women are
people that are based on complainers”
experience categories “Men don’t cry”
clients and negate their “Most people don’t
uniqueness as have any pain after this
individuals. surgery.”

Agreeing and Akin to judgmental Client: “I don’t think

disagreeing responses, agreeing and Dr. Broad is a very
disagreeing imply that good doctor. He doesn’t
the client is either right seem interested in his
or wrong and that the patients.”
nurse is in a position to Nurse: “Dr. Broad is
judge this. These head of the Department
responses deter clients of Surgery and is an
from thinking through excellent surgeon.”
their position and may
cause client to become
defensive.

Being defensive Attempting to protect a Client: “Those night

person or health care nurses must just sit
services from negative around and talk all
comments. These night. They didn’t
responses prevent the answer my light for
client from expressing over an hour.”
true concerns. The Nurse: “I’ll have you
nurse is saying, “You know we literally run
 have no right to around on nights.
complain.” Defensive You’re not the only
response protects the client, you know.”
nurse from admitting
weaknesses in the
health care services,
including personal
weaknesses.

Challenging Giving a response that Client: “I felt nauseated

makes client prove the after that red pill.”
statement or point of Nurse: “Surely you
view. These responses don’t think I gave the
indicate that the nurse is wrong pill?”
failing to consider the Client: “I believe my
clients feelings, making husband doesn’t love
the client feel it me.”
necessary to defend a Nurse: “You can’t say
position. that; why, he visits you
every day.”

Probing Asking for information Client: “I was speeding

chiefly out of curiosity along the street and
rather than with the didn’t see the stop
intent to assist the sign.”
client. These responses Nurse: “Why were you
are considered prying speeding?”
and violate the clients Client: “I didn’t ask the
privacy. Often asking doctor when he was
“why” is probing and here.”
places the client in a Nurse: “Why didn’t
defensive position. you?”

Testing Asking question that “Who do you think you

make the client admit to are?” (enforce people to
something. These admit their status is
responses permit the only that of client)
client only limited “Do you think I am not
answers and often meet busy?” (forces the client
the nurse’s need rather to admit that the nurse
 than the client’s. really is busy)

Rejecting Refusing to discuss “I don’t want to

certain topics with the discuss that.
client. These responses “Lets discuss other
often make clients feel areas of interest to your
that the nurse is rather than the two
rejecting not only their problems you keep
communication but also mentioning.”
the clients themselves. “I can’t talk now. I’m
on may way for coffee
break.’

Changing topics and Directing the Client: “I’m separated

subject communication into from my wife. Do you
areas of self-interest think I should have
rather than considering sexual relation with
the clients concerns another woman?”
often arises as a self- Nurse: “I see that
protecting response you’re 36 and that you
imply that what the like gardening. This
nurse considers sunshine is good for my
important will be roses. I have a beautiful
discussed and that rose garden.
clients are not capable
of helping themselves.

Unwarranted Using clichés or “You’ll feel better

reassurance comforting statements soon.”
of advices a means to “I’m sure everything
reassure the client. will turn out all right.”
These responses block Don’t worry.”
the fears, feelings, and
other thoughts of the
client.

Passing judgment Giving opinions and “That’s good (bad).”

approving of “You shouldn’t do
disapproving responses, that.”
moralizing, or implying “That’s not good
 one’s own values. enough.”
These responses imply “What you did was
that the client must wrong (right).”
think as the nurse
thinks, fostering the
client dependence.

Giving common advice Telling the client what Client: “Should I move
do it. These responses from my home to a
deny the clients right to nursing home?”
be an equal partner. Nurses: “If I were you,
Note than giving expert I’d go to a nursing
rather than common home, where you’ll get
advice is therapeutic. your meals cooked for
you.”