Therapeutic Communication

1
Therapeutic Communication

• The Helping Interview

2
Helping Relationship Characteristics

• Caring
• Hopeful
• Sensitive
• Genuine
• Empathy
• Positive Regard
• Values Self Others

• Empowering
• Teaching
• Goal- Oriented, Purposeful
• Time Limited
• Assertive

3
Helping vs Social Relationships

• HELPING
• Care
• Trust
• Growth
• Purposeful/Intentional
• Unequal Sharing
• Focus on Clients Needs
• Time Limited

• SOCIAL
• Care
• Trust
• Growth
• Spontaneous
• Similar Sharing
• Focus on Needs of
• Both Individuals
• Ongoing

4
Control

• GIVING HELP
• feeling important
• feeling useful
• feeling powerful
• feeling gratified
• feeling happy

• NEEDING HELP
• feeling unimportant or inadequate
• feeling useless or depressed
• feeling powerless
• feeling frightened or embarrassed
• feeling sad or angry

5
Phases of Helping Relationship

• Orientation (professional and client
• to each other)
• Working (identification of the
• clients problem)
• Termination (resolution of the
• clients problem)

6
Orientation Phase

• getting to know you phase
• sets the tone
• introductions
• roles
• initiated by the nurse
• agreement/contract/goals
• trust develops

7
TRUST

• T try expression
• R reflection
• U use of silence
• S setting limits
• T time with client

8
Working Phase

• problem solving phase
• attend to clients needs
• role of teacher/counselor
• client actively participates
• gather further data
• facilitate change
• evaluate problems goals

9
Termination

• ending phase
• review and summarize progress goals met/not met
• acknowledge feelings
• use clear language
• check the receiver understands
• the message sent

10
Resolution

• clients mostly seeking explanation
• how will problem affect their lives?
• what will need to be changed?
• how will they cope?

11
Avoid

• arguing
• minimizing
• challenging
• giving false reassurance
• interpreting or speculating on the dynamics of
  the
• clients problems

• selling client on accepting treatment
• probing sensitive areas
• participating in criticism of any
• staff member
• joining any attacks led by client

12
Nursing Interventions to EncourageThe Helping
Relationship

• active listening
• therapeutic communication techniques
• other factors

13
attentive listening scale

• hard to maintain eye contact
• respond before other finishes speaking
• finish other peoples sentences
• talk on and on so no one can respond
• go on working while someone is talking to you
• repeat a point just made
• allow your mind to wander during a conversation

14
good listening

• STOP TALKING
• put the speaker at ease
• show that you want to listen
• remove distractions
• empathetic
• be patient
• hold your temper
• go easy on argument and criticism
• STOP TALKING

15
communication techniques

• open ended questions (closed for obtaining
  specific information)
• validating/clarifying
• reflective/restating paraphrasing
• sequencing
• sharing observations
• acknowledging feelings

16
interpersonal skills

• warmth and friendliness
• openness (acceptance)
• consideration of client variables
• non-english speaking
• developmental considerations
• older adults
• sociocultural
• occupational
• patients with special needs

17
other factors promoting therapeutic
communication

• comfortable environment
• Providing some personal space
• privacy
• confidentiality
• client focus
• optimal pacing
• nursing observations

18
blocks to communication

• failure to respect client
• failure to listen
• minimizing feelings
• inappropriate comments questions
• excessive questions
• yes/no questions

• why how
• probing
• changing the subject
• leading questions
• advice
• judgmental
• false reassurance
• giving approval/disapproval

19
therapeutic vs non-therapeutic

• THERAPEUTIC
• facilitates transformation of working
  nurse/patient relationship
• relationship allows for adequate accurate
  assessment
• data collection
• performed with patient, not for patient

• NON-THERAPEUTIC
• hinders relationship formation
• prevents patient from becoming mutual partner
  relegates him/her to passive recipient of care

20
disclosure, yes or no?

• use self disclosure to help clients open up to
  you not to meet your own needs
• keep your disclosures
• very brief
• dont imply that your experience is exactly the
  same as
• the clients
• only self-disclose about situations that
• you have mastered

• monitor your own comfort with
• self-disclosure
• respect your clients needs for privacy
• remember that there are cultural variations in
  the amount of self-disclosure considered
  appropriate
• identify risks and benefits of
• self disclosure
• discuss the goals of the use of therapeutic
  self-disclosure

21
medical care is not enough!

• We need more than medical
• care or surgery--we need
• competent care
• a good communicator