Therapeutic Communication

1
Therapeutic Communication

• the helping interview

2
Helping Relationship Characteristics

• Caring
• Hopeful
• Sensitive
• Genuineness
• Empathy
• Positive regard

• Empowering
• 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
• Usually equal or near equal sharing
• Focus on needs of
• both individuals
• Ongoing

4
LOCUS OF CONTROL

• THOSE GIVING HELP
• Feeling important
• Feeling useful
• Feeling powerful
• Feeling gratified
• Feeling happy

• THOSE 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
• Orientation
• Trust develops

7
Working Phase

• Problem solving phase
• Attend to clients needs
• Nurse in role of teacher/counselor
• Client actively participates
• Gather further data
• Facilitate change
• Evaluate problems goals

8
Termination/Resolution Phase

• Review and summarize progress goals met/not met
• Acknowledge feelings
• Clients mostly seeking explanation
• How will problem affect their lives?
• What will need to be changed?
• How will they cope?

9
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 the client

10
Attentive Listening Scale

• -THINGS TO AVOID
• Lack of eye contact
• Responding before the other finishes speaking
• Finishing other peoples sentences
• Talking so much that others cannot respond
• Continuing to work while someone is talking to
  you
• Repeat a point just made
• Allow your mind to wander during a conversation

11
Active Listening

• STOP TALKING
• Put the speaker at ease
• Show that you want to listen
• Remove distractions
• Be empathetic
• Be patient
• Hold your temper
• Avoid criticism argument
• STOP TALKING

12
Interviewing Techniques

• the purpose of the interview is
• to obtain accurate thorough information
• begin with an explanation
• use open-ended questions
• (exception use closed-ended to obtain
• specific information)
• Validating/Clarifying
• Reflecting
• Sequencing
• Acknowledging feelings

13
Interviewing Techniques

• Validating Clarifying
• Reflecting Paraphrasing
• Sequencing
• Acknowledging feelings
• Sharing Observations

14
Effective Techniques

• as a professional nurse, you will spend about
  half of your time asking questions of clients and
  colleagues
• excellent questioning/interviewing skills are
  fundamental to nurses

15
Why, What, How?

• why do you need the information?
• how will the information I am seeking direct me
  in helping my client?
• explain reasons in advance,
• as this prepares clients for your line
• of questioning
• what will you ask?
• how will you phrase your questions?

16
Who to Ask?

• if client is able to speak for themselves,
• ask them
• family perspectives may also be important
• written consent may be required to question
  concurrent/previous healthcare providers
• be courteous and respectful
• never forget client confidentiality

17
Communication Barriers

• A barrier to communication is something that
  keeps meanings from meeting. Meaning barriers
  exist between all people, making communication
  more difficult than most people seem to realize.
• (Ruel Howe)

18
Communication Barriers

• without realizing it, people typically interject
  communication barriers into conversation 90 of
  the time
• communication barriers trigger
• defensiveness, resistance and resentment,
  withdrawal, and feelings of inadequacy
• they also decrease the likelihood of
• finding a solution

19
Judging

• criticizing making a negative evaluation of
  persons, their actions or attitudes
• putting down stereotyping
• diagnosing analyzing why a person is behaving
  the way he/she is
• praising evaluatively making a positive judgment
  of person, actions or attitudes

20
Avoiding theOthers Concerns

• diverting pushing the other persons problems
  aside through distractions
• logical argument attempting to convince the
  other person with an appeal to facts or logic
  without consideration of the emotional factors
  involved
• False reassurance trying to stop the other
  person from feeling the negative emotions
• they are experiencing

21
Other Barriers

• ordering commanding the other person to do what
  you want
• threatening trying to control the other persons
  actions by warning of negative consequences you
  will impose
• moralizing preaching, telling someone what they
  should do
• excessive/inappropriate questioning

22
Other Barriers

• closed ended questions, like are you sorry you
  did it?
• advising giving the solution

23
Common Errors

• long winded buildup
• (use KISS principle be concise focused)
• the thunder stealer jumping in with your views
  opinions before giving them
• a chance
• bombarding patients with questions
• complicated medical terms-
• dont use terms patients cant understand

24
Common Errors

• offensive misuse of why appears threatening and
  aggressive
• closed questions
• being too abrupt
• use of clichés

25
Blocks to Communication

• Failure to respect client
• Failure to listen
• Minimizing feelings
• Inappropriate comments questions
• Excessive questions
• Clichés
• Yes/no questions

• Probing
• Changing the subject
• Leading questions
• Advice
• Judgments
• False reassurance
• Giving approval/disapproval

26
Blocks to Communication
27
Therapeutic VersusNontherapeutic Communication

• Facilitates transformation of working
  nurse-patient relationship
• Relationship allows for adequate accurate data
  collection assessment
• Performed with not for patient

28
Therapeutic VersusNontherapeutic Communication

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

29
Self-Disclosure

• Use self disclosure to help clients open up
• to you not to meet your own needs
• Keep disclosures brief
• Dont imply that your experience is exactly the
  same as the clients
• Only self-disclose about situations 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