Handout #2: Therapeutic Communication
I.
Objective #14: Discriminate between hearing & listening
A. More complex: ___________________
B. Hearing: _______________ sound
C. Listening: process that involves ____________________, ____________________,
_____________________ and ________________________ to verbal messages.
D. Listening challenges
1. ____________________________: internal & external
2. ______________________ out the message
3. Rush to _____________________________
4. _________________ hearing
E. Active listening
1. _______________________
a. _____________ contact, _______________ distractions, _____________ & observe
2. ________________________
a. _____________ language
3. ________________________
a. Paraphrase, ___________
b. Most important type of question: ____________________________
4. Defer ___________________
a. Don’t ________________________________
b. _______________________: the process of remaining ____________
5. ________________________
II.
Course objective #15: Relate how therapeutic communication differs from social communication.
Therapeutic
Social
Who
Focus
Structure
Directed by the
Confidentiality
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Client
Professional
Information
III. Course objective #16: Define & describe the important of each of the following: readiness skills,
attending skills, active listening skills, reflecting skills
A. Readiness
1. Establish therapeutic _____________________________
2. Choose a __________________ __________________ setting
B. Attending
1. 90% _______________
2. “You are _________________________ it me”
3. 4 Basic components
a. __________________
1) DO: Make _______ contact ; Be _______________ aware; __________ at the pt.
frequently
2) DO NOT: _________________________________________
b. __________________
1) DO: __________________
2) DO NOT: _____________________, ________________________
3) ___________________ the distance between 2+ people
i.
Intimate: ________________
ii.
Personal: ________________
iii.
Social:___________________
iv.
Public: __________________
c. __________________
d. __________________ (encouraging)
1) Verbal: _______________________________________________
2) Non-verbal: ___________________________________________
C. Active listening
1. Verbal _______________________ (Echoing)
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a. Finding a ____________or two, towards the _________ of the senders
_________________ that you can use to __________________ more clarification or
discussion.
b. “My girlfriend is great with my son. She has really been a life-saver to both of us.”
2. Echoing evaluation
a. How accurately did you repeat your partner's words verbatim?
b. How did you choose which words to repeat?
c. What effect did verbal following have on the intensity and quality of your listening
compared to silent listening or using minimal encouragers?
d. What effect did verbal following have on how your partner disclosed information to you?
e. At what point did you exceed your comfort level with verbal following?
f. When might verbal following be a useful strategy with a client?
g. What did you find easy about this activity?
h. What did you find challenging?
i. What do you need to work on improving with respect to verbal following?
D. Reflecting / _________________________
1. ____________________ before you speak!
2. Reflecting (_______________________) statements
a. _______________________ communication
b. Purpose
1) Convey __________________, Build ______________________
2) Helps pt. ______________________ information & express _____________________
c. Rules
1) Only _______________ client; don’t _______________
2) Listen for the _______________________
3) Reflect the _________________ & __________________
d. Practice
1) Depressed Patient: “I feel like just sleeping or doing nothing but I can’t sleep at night
though. It’s ridiculous. Maybe it’s because I worry too much”
2) Child: “I went to my grandma’s and she wasn’t home”.
3) Patient: “ I hate being in this hospital”
4) Patient: ”I don’t want any students looking in my chart”
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e. Activity
adventurous
afraid
alert
amazed
ambivalent
angry
annoyed
astonished
belligerent
bold
burned out
calm
capable
cautious
challenged
comfortable
concerned
confident
confined
conflicted
confused
delighted
depressed
desperate
disappointed
disgusted
easygoing
ecstatic
edgy
embarrassed
exasperated
excited
exhausted
failure
fantastic
foolish
frenzied
frustrated
funny
gloomy
guilty
happy
hopeful
hopeless
hurt
ignored
impatient
inadequate
indifferent
inspired
intimidated
intrigued
irate
irritated
jealous
joyful
lonely
lost
mad
melancholy
mellow
misunderstood
nervous
nostalgic
numb
optimistic
overwhelmed
patient
peaceful
perplexed
pessimistic
positive
pressured
proud
relieved
resentful
resourceful
restless
sad
scattered
skeptical
startled
stupid
sure
surprised
tense
tired
uncertain
uncomfortable
unsure
vigilant
weary
wistful
wonderful
worried
f. Activity Evaluation
1) How accurately did you identify the feelings communicated by your partner?
2) If a mismatch occurred between the feeling you perceived and the one your partner
conveyed, what might account for the mismatch?
3) Which cues from your partner did you tend to use the most in helping you identify the
feelings?
4) Which cues did you tend to use the least?
5) What did you find easy & what did you find challenging about this activity?
6) What do you need to work on improving with respect to perceiving and reflecting
feelings?
3. ______________________________ (Reflecting of __________)
a. Use your __________ words
b. Help ____________________ inconsistencies
4. ______________________ checking
a. Prevents ____________________________ & ____________________
b. Goal ____________________ understanding
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c. Procedure
1) _____________________: __________________________________
2) Interpretation: Provide _______________________________________
3) Request _________________________________
IV. Course objective #17 Explain the concept of therapeutic self
A. Use of self - _____ therapeutic ____________________
B. 3 Interventions of psychotherapeutic management
1. Therapeutic ______________________________
2. Psycho __________________________________
3. ___________________ management
C. Objectivity: Undistorted by ___________________ or personal _______________
D. Empathy: “Ability to _______________________ & _________________ the patients
______________ and point of view _________________________”
EMPATHY
Accurately
SYMPATHY
Shares
Shared
Taking on other
Emotionally
V.
Emotionally
Describe and give examples of each of the following communication techniques and where they are
commonly used in the nursing process.
A. Giving information: Making available ________________ the patient needs
1. Skill: ______________________________________
2. Example: ______________________________________________________
B. Giving recognition: Acknowledging, indication _____________________
1. Better than a ________________________________
2. Skill: ____________________________________
3. Example: ______________________________________________________
C. Showing acceptance: Giving indication of ______________________________
1. Skill: __________________________________________
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2. Example: ______________________________________________________
D. Offering of self: Making one’s self ______________________________
1. Types
a. __________________
b. __________________
c. __________________
2. Example: __________________________________________________________
E. Making observations: ____________________ what is __________________________
1. Skill: ___________________________________
2. Example: _____________________________________________________________
F. General leads: Encouragement to ________________________
1. Rule: _____________________
2. Example: _____________________________________________________________
G. Broad openings: Allows the patient to take the _________________ in ________________ a
topic
1. __________________________
2. Skill: __________________________________________
3. Example: _________________________________________________________________
4. _________-ended questions: ___________________ be answered with 1-2 words
H. Encouraging descriptions of perceptions: Asking _____________ to ______________ what he
perceives
1. Helpful with ___________________________
2. Example:__________________________________________________________________
I. Clarification: Seeking information to __________________________
1. Examples: _________________________________________________________________
a. ____________________________
b. Avoid _________________________________
c. Helps pt. become more _______________ of their ____________________
J. Reflecting: Directing back to the pt______________________, feelings & ideas
1. Helpful: ______________________________________
K. Restating: _______________________________
1. Repeating the _________________________________
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2. Example:
L. Exploring: ___________________ further into a _______________ or idea
1. Helpful: Patients who remain on a ____________________ level of communication
2. If a patient chooses not to delve  ________________________________________
3. Expanding __________________________________________________________
4. Examples: ____________________________________________________________
M. Verbalizing the implied: ______________ what the patient has _____________ at or suggested
1. Rules
a. Make less ________________________
b. Be ______________________________
c. Express only what is ________________________
2. Helpful: __________________ or ____________________ verbal communication
N. Encouraging comparison: Asking that ____________________ & _________________ be noted
1. Example
O. Translating into feelings: ___________________
1. Find _____________________ in the ____________________ meaning
2. Example: ____________________________________________________________________
P. Sequencing
1. Placing _________________in sequence of ________________
2. __________________
3. Gives ___________________________________
4. Example: _____________________________________________
Q. Stating reality: Offering consideration that which is ___________________
1. Patient ______________________________
2. Nurse: Defines _________________________ or perception
3. Example: ________________________________________________________________
R. Voicing doubt: Expressing _____________________ as to the __________________ of the
patients perceptions
1. Careful: _____________________________
2. Benefit: __________________________________
3. Examples: _________________________________________________________________
S. Focusing: Concentration on a ________________ point (________________ / ____________)
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1. Helpful: __________________________________________________________________
2. Example: _________________________________________________________________
T. Silence: ___________________ of verbal communication
1. Encourages: _______________________________________________________________
2. ______________ pace
3. Give __________________
4. Silence is Golden: Multiple __________________________ valuable _______________
5. Activity evaluation
a. Estimate how long you listened silently before you became uncomfortable.
b. Once you found yourself becoming uncomfortable, what did you do? What went through
your mind?
c. What effect did your silence have on how your partner disclosed information to you?
d. How did you know your partner was finished talking before you asked a question or made
a comment?
e. Estimate your tolerance level for keeping silent (high, pretty good, fair, poor, none)
f. What factors do you think affect your tolerance level for listening silently?
g. What can you do to improve your tolerance for silent listening?
VI. Course Objective #19: Recognize and list non-therapeutic interventions
A. Red flag words:
1. _____________
2. _____________
3. _____________
4. _____________
5. _____________
6. _____________
7. _____________
B. Belittling, _________________, mocking, ______________________
1. Patient feels ___________________, _____________________ validity of their feelings
2. Examples: ______________________________________________________________
C. Giving ___________________ responses
1. Examples: ______________________________________________________________
D. Challenging: Demanding __________________________
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1. Examples: ______________________________________________________________
E. ___________________: Opposing the patients ideas
1. Examples: ______________________________________________________________
2. Be non-___________________________
a. Word, ___________________ & _____________ language
F. ____________________: statement that show you believe the person is correct
1. Examples: ______________________________________________________________
2. Results:
a. Shuts ________________
b. Places value _______________________ on behavior
c. ___________________ assume responsibility
G. _____________________/ Justification: Counter replay to a verbal ____________________
1. Nurse = ________________________
2. Patient = intimidated & _________________________________
3. Examples: ______________________________________________________________
H. _______________________ responses: _____________________
1. Superficial
2. Examples: ______________________________________________________________
I. Giving __________________ reassurance: Without ________________________
1. AKA: ________________________
2. Examples: ______________________________________________________________
J. Giving ________________________: Telling the patient ___________________________
1. ____________________________
2. ____________________________
3. Patient ______________________
4. Examples: ______________________________________________________________
K. ___________________ the subject: Introducing a ______________ topic
1. Examples: ______________________________________________________________
L. Asking _________________ - ending questions: Questions with ________ word answers
M. Asking _________________ questions: Requesting an _______________________
1. Put them on the ___________________________
N. ____________________: Seeking info beyond what is necessary
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VII. Course objective #20: Recognize communication deficits in clients and teach appropriate social
skills.
A. Use ________________________ words
B. _________ messages = _______________________
C. _________ messages = _______________________
1. ____________________ - ______________________ - disrespect
D. Guidelines for CONSTRUCTIVE feedback
1. _____________________
2. _____________________
3. Be ____________________
4. Explain ____________________________
5. Avoid ____________________________________
6. Evaluate ________________________ , not the performer
7. Use _________________________ knowledge
8. ________________ on how to _______________it happening again
E. Giving Praise
1. Be _________________________
2. ____________________________
3. ____________________________
4. Area of ______________________________
5. Be _________________________
F. “Touching” in therapeutic relationship
1. What are the advantages of touching
2. What are the disadvantages of touching
3. When and where is it appropriate?
4. When and where is it NOT appropriate?
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