Therapeutic & Non-therapeutic Communication Part One: Therapeutic Communication A. Superficial Methods Examples Silence Eye contact, leaning forward toward patient, facial expression reflect interest Listening Recognition Nod head "yes", say "uh huh" (Use mindfulness to redirect your attention back to the speaker) "Hello Mrs. R”; “I see that you are writing a letter". Offering self "I would like to sit and talk with you for awhile". Broad Openings General Leads “Describe the events that happened that lead up to you coming into the hospital.” "What is on your mind?" "What has you so worried?" “How are you doing with coping with your illness?” "Go on." "Then what happened?" "Describe that." Stating Observations "You seem worried." "I notice that you are wringing your hands." Requesting Descriptions "What thoughts go through your mind?" "What are the voices saying?" Restating Patient: "I can't deal with this, I'm so confused." Nurse: "Confused?" Reflecting Patient: "Do you think I should call my husband?" Nurse: "Do you think you should?" B. Deeper Ventilation Examples Giving Information “My name is… I am going to meet with you for the next 20-30 minutes…” Presenting Reality “I don't see a man behind the door” “That sound is an airplane traveling over the hospital” “I am the nurse working with you today, your sister is not here yet.” Exploring “Tell me more about that.” “Describe that incident in more detail.” “What kind of work do you do?” 2 Seeking Clarification C. Promoting Insight “I'm not sure I follow what you are saying. Are you saying that…” “Of all your concerns, what is the most distressing?” Examples Encouraging Evaluation “Do you think your anxiety interferes with the relationship?” “Do the demands of the job end up contributing to your sense of distress?” Voicing Doubt “That has not been my experience.” “Most people would not describe it that way.” Verbalizing the Implied Patient: It's useless. Nothing I do makes a difference. Nurse: You feel powerless to change your circumstances? Patient: My boss thinks I'm an idiot, just like my wife. Nurse: You have a sense of being undervalued by important people in your life? Attempting to Translate into Feelings Patient: I'm no good Nurse: Are you saying that you feel shame for past decisions? Patient: I'm a woman without a country Nurse: Do you mean that you feel like you don't belong, that you are lonely? Summarizing “Let me review the main points of our discussion …” Encouraging Formulation of a Plan of Action “What are some steps that you could take to try to set up a meeting?” “Once you go home from the hospital, what would you do first to try to address this problem?” 3 Part Two: Non-Therapeutic Communication (assume quotation marks around each example) A. Casual or Unperceptive Methods Examples Rejecting “I don't think that needs to be discussed right now.” False reassurance Don't worry, it will all work out. Everything will be alright. God doesn't give people more strife than they can handle. Stereotypes I'm fine, how are you? It's all for the best. Belittling It’s not that important. You shouldn’t feel that way. Unrelated Topic Patient: I am feeling so frustrated today. Nurse: What did you learn about on the today’s TV news. B. Guiding or Directing Methods Examples Approval I am glad you did that. That's great! Disapproval You should not have done that. It's wrong to… Agree Yes, that is what you should do. Disagree No, that's incorrect. You should not… Advise You should avoid all contact with your sister. She just upsets you. You have to sign up for that pottery class. 4 C. Threatening or Ineffective Methods Examples Probe But how did you really feel? There must have been more to it than that. Denial of Problem No, that's not what you are really worried about. You can't focus on that, we need to move on Test Do you realize what time it is? Do you know your name? Personal You need to do this for me. Can you count to 10 for me. I will be held accountable if you don't comply with your medication Requesting Explanation Why did you do it? Why is she so important to you? Interpreting You really feel jealousy but are too ashamed to admit it. Unconsciously, you want to… Multiple, sequential, closed-ended questions with no additional discussion of the patient’s answers What is your name? (Jill Smith) What do you do? (Retired) Are you married? (Yes) Do you have children? (Yes) Are you a smoker? (Yes) Do you eat red meat? (No) (feels like an interrogation rather than an interaction) Extracted and revised from: Joyce Hays and Kenneth Larson’s Interacting With Patients 1963 Macmillan & Co., New York. (Out of print).
