THERAPEUTIC

COMMUNICATION

Janice A. Aloi, DMH, RN, CNE

Communication
The

basic element of human interaction

A complex process
An important element of nursing practice
Requires a conscious application of
principles

LEVELS
Intrapersonal Communication occurs within
an individual.
Interpersonal Communication face-to-face
interaction between two people or a small
group.

FACTORS THAT INFLUENCE

COMMUNICATION

PERCEPTIONS
VALUES
DEVELOPMENT
SPACE AND TERRITORIALITY
EMOTIONS
SOCIOCULTURAL BACKGROUND
KNOWLEDGE
ROLES AND RELATIONSHIPS
ENVIRONMENTAL SETTING

VERBAL COMMUNICATION

Denotative
Connotative
Intonation
Decoding
Feedback

Nonverbal Communication-the
exchange of messages without the use
of words
Facial

expression
Eye contact
Gestures
Posture and gait
Touch
Space and Territoriality

Therapeutic Communication

Fosters
Has

an exchange between parties

a goal or purpose in mind

Non-therapeutic Communication

Hinders

the exchange

THERAPEUTIC COMMUNICATION
OCCURS

IN THE CONTEXT OF THE

NURSE-CLIENT RELATIONSHIP

NURSE-CLIENT RELATIONSHIP
A dynamic

interactive process between a

professionally educated person, the nurse,
who helps another individual, the client, to
seek and use help.

The relationship is productive

Involves verbal and nonverbal communication
An exchange of thoughts and feelings that
facilitate healing

PROBLEM-SOLVING METHOD

Identify the clients problem

Promote discussion of desired changes.
Identify realistic changes.
Discuss alternative strategies for creating changes and ways to
cope with aspects that cannot be realistically changed.
Weigh benefits and consequences of each alternative.
Assist client to select an alternative.
Support clients effort to implement strategy.
Assist the client to evaluate outcomes of the change and make
modifications as required.

ESSENTIAL INGREDIENTS

RAPPORT

TRUST

RESPECT

GENUINENESS

EMPATHY

PHASES OF THE NURSE-PATIENT

RELATIONSHIP
PREORIENTATION
ORIENTATION
WORKING
TERMINATION

CONCERNS OF THE NURSE

FEAR

OF REJECTION
FEAR OF EXPLOITING THE CLIENT
FEAR OF HELPLESSNESS
FEAR OF PHYSICAL AGGRESSION
FEAR OF MENTAL ILLNESS

CONCERNS OF THE CLIENT

THREAT TO

SELF-IMAGE
FEELINGS OF HELPLESSNESS
FEELINGS OF INCOMPETENCE
FEELINGS OF INADEQUACY
AFRAID OF BEING STIGMATIZED
AFRAID OF CHANGE

RELATIONSHIP ISSUES

RESISTANCE

- ANGER

TRANSFERENCE
COUNTERTRANSFERENCE

TRANSFERENCE
AN

INTERPERSONAL EXPERIENCE IN
WHICH FEELINGS, ATTITUDES, AND
WISHES ORIGINALLY LINKED WITH
SIGNIFICANT OTHERS IN ONES LIFE ARE
ATTRIBUTED TO OTHERS WHO
REPRESENT THESE PEOPLE IN THE
CURRENT SITUATION.

COUNTERTRANSFERENCE
A CONSCIOUS

OR UNCONSCIOUS
RESPONSE OCCURRING IN THE NURSE
OR THERAPIST IN RESPONSE TO THE
CLIENT. Wishes and conflicts originating in
the helpers own relationships with significant
others are transferred onto the client. Selfawareness is important for recognizing
countertransference reactions.

EFFECTIVE COMMUNICATION
TECHNIQUES

Broad openers
Paraphrasing
Making an observation
Exploring
Clarifying
Focusing
Reflecting feelings
Giving info
Placing events in time sequence
Encouraging a plan of action
Testing discrepancies
Voicing doubt
Summarizing

NONTHERAPEUTIC RESPONSES

False reassurance
Social responding
Moralizing
Interpreting
Giving advice
Demanding an explanation
Expressing approval or disapproval
Belittling feelings
Making stereotypical comments
Failing to listen
Making personal statements

DECISION-MAKING

INDIVIDUAL

LINEAL
COLLATERAL

SUMMARY
The

nurse-patient relationship is a dynamic

interactive process between the nurse and
the patient.
The relationship is productive.
It involves the use verbal and non-verbal
skills of therapeutic communication by the
nurse..