Therapeutic Communication (CC)

C. Calzolari
Therapeutic Communication
• Used by nurses and people in the
helping professions
• Also called “active” or “purposeful”
• Requires “active listening” or “listening
between the lines”
Therapeutic Communication
• Blocks to therapeutic communication
• Impede effective communication
• Often due to using the “social” communication techniques
• Examples
The word “why”
False reassurance/social clichés
Closed-ended questions
Clicker Question
3. True or false: The word “why” is a block to
Correct answer: True
Rationale: The word “why” connotes disapproval or
Techniques of Therapeutic Communication
• Clarifying terms
• Reflecting
• Open-ended questions (the essence
of successful communication)
• Require more than a “yes” or “no”
• Silence
Techniques of Therapeutic Communication
• Asking for what you need
• Identifying thoughts and feelings
• Empathy (not sympathy)
• Using general leads
• Stating implied thoughts and feelings
• Giving information (not advice)
Clicker Question
4. Nurses must be sure that the terms they choose are
correct and mean the same thing to all parties
involved in the interaction. This is considered what
type of therapeutic communication?
A. Reflecting/parroting
B. Empathy
C. Clarifying terms
D. Silence
Correct answer: C
Rationale: English is a very complex language to learn. Some
people use terms very literally. Nursing is a profession that is
filled with inference and nuance; it is highly affective. Because of
that, it is very important to clarify terms with patients and other
workers. Nurses must be sure that the terms they choose are
correct and mean the same thing to all parties involved in the
interaction. The technique is easy to learn: Simply asking. “When
you say ‘I can’t do that,’ what do you mean?” is one way of
clarifying a statement.
Communicating with Persons who are
Experiencing Psychosis
• Nurse’s responsibility is to focus on:
• Reducing the patient’s anxiety
• Decreasing defense mechanisms
• Encouraging participation in therapeutic and social events,
• Raising feelings of self-worth,
• Increasing medication compliance
Communicating with Persons who are
Experiencing Psychosis
• Hallucinations
• Hearing voices
• First, nurse should seek to understand what the voices are saying or
telling the patient to do.
• Suicidal or homicidal messages necessitate immediate safety
• Approach the patient in a nonthreatening & nonjudgmental way.
• Call patient by name, make eye contact, speak simply.
• Second, identify the feelings the patient is experiencing .
• Third, use distraction techniques.
Communicating with Persons who are
Experiencing Psychosis
• Delusions
Are false fixed beliefs
First, assess for safety.
Second, clarify reality of patient’s experience.
Third, identify the patient’s feelings.
• Do not argue with patient.
• Do not touch patient.
• Fourth, engage patient in reality-based activities.
Communicating with Persons who are
Experiencing Psychosis
• Paranoia
• The nurse is to approach the patient in a nonjudgmental, respectful
• Use clear and simple language.
• Be honest and consistent.
• Explain all procedures and policies.
• Do not laugh, whisper or talk quietly when the patient cannot hear
what is being said.
Associative Looseness
• Seen with schizophrenia
• Autistic Thoughts
• Poorly organized thinking
• Patient appears confused and disorganized
• Increased use suggests increased anxiety and inability to control external
and internal stimuli
Tell patient you are having difficulty understanding what he/she is saying.
Look for recurring themes in communication.
Involve patient in reality based activities.
Manipulative Behavior
• Manipulation can be a defense mechanism.
• Recognize splitting.
• Be clear with expectations.
Anxious Behavior
• Gain trust
• Be calm
• Be honest
• Do not discount emotions
Aggressive Behavior
• Aggressive statements most often begin with the word “you.”
• Assertive vs. Aggressive
• Crisis Intervention
Ensure Safety
Diffuse the Situation
Determine Problem
Decrease Anxiety Level
Return Person to Pre-Crisis Level
• Which of the following is an example of a therapeutic, openended question?
• A. “Why did you do that, Mrs. Jones?”
• B. “How can I help you, Mr. Thompson?”
• C. “Can I help you, Ms. Greene?”
• D. “Please, can I ask you a question, Mark?”
• The nurse plans to have a therapeutic communication with the
client. To begin that therapeutic communication the nurse must
first establish _________________ with the client.
• The schizophrenic patient tells you, “I know that the man down
the hall wants to kill me.” How should you respond?
• A. “Don’t worry, I will protect you from him.”
• B. “No one will hurt you here, what makes you say that?”
• C. “It must be frightening to think that. Let’s walk over here to
join in afternoon activities.”
• D. “That is not true, you need to go to your room right away.”
• Your patient has refused all of your attempts to care for him. You
• A. “I’d like to help you; what can I do?”
• B. “Why don’t you like me?”
• C. “What is the matter with you?”
• D. “You must do this; physician’s orders!”
• You are one of the nurses monitoring the dining room during dinner.
A male patient who has schizophrenia asks a table mate to “please
pass the pepper.” When the table mate does so, the first patient
throws the pepper shaker at you. He or she screams, “Now look what
you’ve done! There are spiders all over my food! I can’t eat this! Get
the spiders out of there!” Your best response is:
• A. “Those aren’t spiders; that is the pepper you asked for!”
• B. “I don’t see any spiders. Let’s go to the game room for a little
while before you try eating again.”
• C. “Where are the spiders? I am also afraid of them!”
• D. “It is inappropriate for you to throw things; you need to go to
the locked unit now.”
• Your patient is commenting that the physician has not been in to
visit for two days. You say:
• A. “I hate it when that happens!”
• B. “What do you need to know?”
• C. “Well, he is very busy!”
• D. “You feel ignored by your physician?”
• An example of a therapeutic response conveying support or
encouragement is:
• A. “That must feel very discouraging.”
• B. “Maybe you shouldn’t worry quite so much.”
• C. “Why do you say that?”
• D. “Nobody would deliberately try to hurt you.”
• Linda is pacing the floor and appears extremely anxious. The day
shift nurse approaches Linda in an attempt to lessen her anxiety.
The most therapeutic statement by the nurse would be:
• A. How about watching a football game?
• B. Tell me how you are feeling today.
• C. What do you have to be upset about now?
• D. Ignore the client.
• You observe a patient in the family lounge. She appears to be
talking to herself. You want to find out what is wrong. Your best
approach to her might be:
• A. “Who are you talking to?”
• B. “Please stop talking. You are disturbing the other people.”
• C. “I saw your lips moving. Can you tell me what you are talking
• D. “Why are you talking to yourself?”
• A nurse is assigned to care for a client who is experiencing
disturbed thought processes. The nurse is told that the client
believes that the food is being poisoned. Which communication
technique does the nurse plan to use to encourage the client to
A. Open-ended questions and silence
B. Focusing on self-disclosure regarding food preferences.
C. Stating the reasons that the client may not want to eat.
D. Offering opinions about the necessity of adequate nutrition.
• A nurse is providing care to a client admitted to the hospital with
a diagnosis of anxiety disorder. The nurse is talking with the
client and the client says, “I have a secret that I want to tell you.
You won’t tell anyone about it, will you?” The appropriate
nursing response is which of the following?
A. “No, I won’t tell anyone”.
B. “I cannot promise to keep a secret”.
C. “If you tell me the secret, I will tell it to your doctor”.
D. “If you tell me the secret, I will need to document it in your record”.
• The nurse in the mental health unit reviews the therapeutic and
nontherapeutic communication techniques with a nursing
student. Which of the following are therapeutic communication
A. Restating
B. Listening
C. Asking the patient, “Why?”
D. Maintaining neutral responses
E. Giving advice or approval
F. Providing acknowledgment and feedback