Therapeutic technique

Therapeutic communication is defined as the
face-to-face process of interacting that focuses on
advancing the physical and emotional well-
being of a patient. This kind of communication has
three general purposes: collecting information to
determine illness, assessing and modifying
behavior, and providing health education. By using
therapeutic communication, we attempt to learn as
much as we can about the patient in relation
to his illness. To accomplish this learning,
both the sender and the receiver must be
consciously aware of the con- fidentiality of the
information disclosed and received during the
communication process. You must always have a
therapeutic reason for invading a patient’s
privacy. When used to collect information,
therapeutic communication requires a great deal of
sensitivity as well as expertise in using
interviewing skills. To ensure the identification
and clarification of the patient’s thoughts and
feelings, you, as the interviewer, must observe his
behavior. Listen to the patient and watch how he
listens to you. Observe how he gives and receives
both verbal and nonverbal responses. Finally,
interpret and record the data you have observed.
As mentioned earlier, listening is one of the most
difficult skills to master. It requires you to maintain
an open mind, eliminate both internal and external
noise and distractions, and channel attention to all
verbal and nonverbal messages. Listening involves
the ability to recognize pitch and tone of voice,
evaluate vocabulary and choice of words, and
recognize hesitancy or intensity of speech as part
of the total communication attempt. The patient
crying aloud for help after a fall is communicating a
need for assistance. This cry for help sounds very
different from the call for assistance you might
make when requesting help in transcribing a
physician’s order. The ability to recognize and
interpret nonverbal responses depends upon
consistent development of observation skills. As
you continue to mature in your role and
responsibilities as a member of the healthcare
team, both your clinical knowledge and
understanding of human behavior will also grow.
Your growth in both knowledge and understanding
will contribute to your ability to recognize and
interpret many kinds of nonverbal
communication. Your sensitivity in listening
with your eyes will become as refined as—if not
better than—listening with your ears. The
effectiveness of an interview is influenced by both
the amount of information and the degree of
motivation possessed by the patient
(interviewee). Factors that enhance the quality of
an interview consist of the participant’s
knowledge of the subject under consideration;
his patience, temperament, and listening
skills; and your attention to both verbal and
nonverbal cues. Courtesy, understanding, and
nonjudgmental attitudes must be mutual goals of
both the interviewee and the interviewer. Finally, to
function effectively in the therapeutic
communication process, you must be an informed
and skilled practitioner. Your development of the
required knowledge and skills is dependent
upon your commitment to seeking out and
participating in continuing education learning
experiences across the entire spectrum of
healthcare services.
Therapeutic Technique
1. Offering Self
 making self-available and showing interest
and concern.
 “I will walk with you”
2. Active listening
 paying close attention to what the patient is
saying by observing both verbal and non-
verbal cues.
 Maintaining eye contact and making verbal
remarks to clarify and encourage further
communication.
3. Exploring
 “Tell me more about your son”
4. Giving broad openings
 What do you want to talk about today?
5. Silence
 Planned absence of verbal remarks to allow
patient and nurse to think over what is
being discussed and to say more.
6. Stating the observed
 verbalizing what is observed in the patient
to, for validation and to encourage
discussion
 “You sound angry”
7. Encouraging comparisons
 · asking to describe similarities and
differences among feelings, behaviors, and
events.
 · “Can you tell me what makes you more
comfortable, working by yourself or
working as a member of a team?”
8. Identifying themes
 asking to identify recurring thoughts,
feelings, and behaviors.
 “When do you always feel the need to
check the locks and doors?”
9. Summarizing
 reviewing the main points of discussions
and making appropriate conclusions.
 “During this meeting, we discussed about
what you will do when you feel the urge to
hurt your self again and this include…”

10. Placing the event in time or sequence
 asking for relationship among events.
 “When do you begin to experience this
ticks? Before or after you entered grade
school?”
11. Voicing doubt
 voicing uncertainty about the reality of
patient’s statements, perceptions and
conclusions.
 “I find it hard to believe…”
12. Encouraging descriptions of perceptions
 asking the patients to describe feelings,
perceptions and views of their situations.
 “What are these voices telling you to do?”
13. Presenting reality or confronting
 stating what is real and what is not without
arguing with the patient.
 “I know you hear these voices but I do not
hear them”.
 “I am Lhynnelli, your nurse, and this is a
hospital and not a beach resort.
14. Seeking clarification
 asking patient to restate, elaborate, or give
examples of ideas or feelings to seek
clarification of what is unclear.
 “I am not familiar with your work, can you
describe it further for me”.
 “I don’t think I understand what you are
saying”.
15. Verbalizing the implied
 rephrasing patient’s words to highlight an
underlying message to clarify statements.
 Patient: I wont be bothering you anymore
soon.
 Nurse: Are you thinking of killing yourself?
16. Reflecting
 throwing back the patient’s statement in a
form of question helps the patient identify
feelings.
 Patient: I think I should leave now.
 Nurse: Do you think you should leave now?
17. Restating
 repeating the exact words of patients to
remind them of what they said and to let
them know they are heard.
 Patient: I can’t sleep. I stay awake all
night.
 Nurse: You can’t sleep at night?
18. General leads
 using neutral expressions to encourage
patients to continue talking.
 “Go on…”
 “You were saying…”
19. Asking question
 using open-ended questions to achieve
relevance and depth in discussion.
 “How did you feel when the doctor told you
that you are ready for discharge soon?”
20. Empathy
 recognizing and acknowledging patient’s
feelings.
 “It’s hard to begin to live alone when you
have been married for more than thirty
years”.
21. Focusing
 pursuing a topic until its meaning or
importance is clear.
 “Let us talk more about your best friend in
college”
 “You were saying…”
22. Interpreting
 providing a view of the meaning or
importance of something.
 Patient: I always take this towel wherever I
go.
 Nurse: That towel must always be with
you.
23. Encouraging evaluation
 asking for patients views of the meaning or
importance of something.
 “What do you think led the court to commit
you here?”
 “Can you tell me the reasons you don’t
want to be discharged?
24. Suggesting collaboration
 offering to help patients solve problems.
 “Perhaps you can discuss this with your
children so they will know how you feel and
what you want”.
25. Encouraging goal setting
 asking patient to decide on the type of
change needed.
 “What do you think about the things you
have to change in your self?”
26. Encouraging formulation of a plan of
action
 probing for step by step actions that will be
needed.

 “If you decide to leave home when your
husband beat you again what will you do
next?”
27. Encouraging decisions
 asking patients to make a choice among
options.
 “Given all these choices, what would you
prefer to do.
28. Encouraging consideration of options
 asking patients to consider the pros and
cons of possible options.
 “Have you thought of the possible effects
of your decision to you and your family?”
29. Giving information
 providing information that will help patients
make better choices.
 “Nobody deserves to be beaten and there
are people who can help and places to go
when you do not feel safe at home
anymore”.
30. Limit setting
 discouraging nonproductive feelings and
behaviors, and encouraging productive
ones.
 “Please stop now. If you don’t, I will ask
you to leave the group and go to your
room.
31. Supportive confrontation
 acknowledging the difficulty in changing,
but pushing for action.
 “I understand. You feel rejected when your
children sent you here but if you look at
this way…”
32. Role playing
 practicing behaviors for specific situations,
both the nurse and patient play particular
role.
 “I’ll play your mother, tell me exactly what
would you say when we meet on Sunday”.
33. Rehearsing
 asking the patient for a verbal description
of what will be said or done in a particular
situation.
 “Supposing you meet these people again,
how would you respond to them when they
ask you to join them for a drink?”.
34. Feedback
 pointing out specific behaviors and giving
impressions of reactions.
 “I see you combed your hair today”.
35. Encouraging evaluation
 asking patients to evaluate their actions
and their outcomes.
 “What did you feel after participating in the
group therapy?”.
36. Reinforcement
 giving feedback on positive behaviors.
 “Everyone was able to give their options
when we talked one by one and each of
waited patiently for our turn to speak”.
Avoid pitfalls:
1. Giving advise
2. Talking about your self
3. Telling client is wrong
4. Entering into hallucinations and delusions
of client
5. False reassurance
6. Cliché
7. Giving approval
8. Asking WHY?
9. Changing subject
10. Defending doctors and other health team
members.
Non-therapeutic Technique
1. Overloading
 talking rapidly, changing subjects too often,
and asking for more information than can
be absorbed at one time.
 “What’s your name? I see you like sports.
Where do you live?”
2. Value Judgments
 giving one’s own opinion, evaluating,
moralizing or implying one’s values by using
words such as “nice”, “bad”, “right”,
“wrong”, “should” and “ought”.
 “You shouldn’t do that, its wrong”.
3. Incongruence
 sending verbal and non-verbal messages
that contradict one another.
 The nurse tells the patient “I’d like to spend
time with you” and then walks away.
4. Underloading
 remaining silent and unresponsive, not
picking up cues, and failing to give
feedback.
 The patient ask the nurse, simply walks
away.
5. False reassurance/ agreement

 Using cliché to reassure client.
 “It’s going to be alright”.
6. Invalidation
 Ignoring or denying another’s presence,
thought’s or feelings.
 Client: How are you?
 Nurse responds: I can’t talk now. I’m too
busy.
7. Focusing on self
 responding in a way that focuses attention
to the nurse instead of the client.
 “This sunshine is good for my roses. I have
beautiful rose garden”.
8. Changing the subject
 introducing new topic
 inappropriately, a pattern that may indicate
anxiety.
 The client is crying, when the nurse asks
“How many children do you have?”
9. Giving advice
 telling the client what to do, giving opinions
or making decisions for the client, implies
client cannot handle his or her own life
decisions and that the nurse is accepting
responsibility.
 “If I were you… Or it would be better if you
do it this way…”
10. Internal validation
 making an assumption about the meaning
of someone else’s behavior that is not
validated by the other person (jumping into
conclusion).
 The nurse sees a suicidal clients smiling
and tells another nurse the patient is in
good mood.
Other ineffective behaviors and responses:
1. Defending – Your doctor is very good.
2. Requesting an explanation – Why did you
do that?
3. Reflecting – You are not suppose to talk
like that!
4. Literal responses – If you feel empty then
you should eat more.
5. Looking too busy.
6. Appearing uncomfortable in silence.
7. Being opinionated.
8. Avoiding sensitive topics
9. Arguing and telling the client is wrong
10. Having a closed posture-crossing arms on
chest
11. Making false promises – I’ll make sure to
call you when you get home.
12. Ignoring the patient – I can’t talk to you
right now
13. Making sarcastic remarks
14. Laughing nervously
15. Showing disapproval – You should not do
those things.

Therapeutic technique

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Therapeutic technique