Chapter 6 Therapeutic Communication

Chapter 6 Therapeutic Communication

Communication is the process people use to exchange information:

• Verbal (what is said, or content)

• Nonverbal (behavior such as facial expression, tone of voice, hesitancy, distance from speaker, or process)

• Context (environment or situation, including culture)

• Congruency (when content and process agree)

• Incongruency (when content and process do not agree; nonverbal is more accurate)

Essential Components of Therapeutic CommunicationEssential Components of Therapeutic Communication

•Privacy and respect for boundaries: therapeutic communication is most comfortable at 3 to 6 feet; should not be less than 18 inches

•Touching a client may be comforting and supportive if it is permitted and welcome; nurse must evaluate whether the client perceives touch as positive or threatening and unwanted and should never assume that touching a client is acceptable

Four Types of TouchFour Types of Touch

Essential Components of Therapeutic Communication (cont’d)Essential Components of Therapeutic Communication (cont’d)• Active listening (concentrating exclusively on

what client is saying) can be promoted by:

– Facing the client

– Using moderate eye contact

– Removing physical barriers

– Maintaining open body posture

– Leaning forward

Essential Components of Therapeutic Communication (cont’d)Essential Components of Therapeutic Communication (cont’d)

•Active listening means refraining from other internal mental activities and concentrating exclusively on what the client says

•Active observation means watching the speaker’s nonverbal actions as he or she communicates

Verbal Communication SkillsVerbal Communication Skills

Use concrete messages

•Concrete messages are specific and clear; abstract messages are unclear and vague and require interpretation

•Concrete messages elicit more accurate responses and avoid the need to go back and rephrase unclear questions, which interrupts the flow of a therapeutic interaction

Verbal Communication Skills (cont’d)Verbal Communication Skills (cont’d)

• Therapeutic communication techniques facilitate interaction and enhance communication between client and nurse. Techniques include:

– Exploring

– Focusing

– Restating

– Reflecting

Nonverbal Communication SkillsNonverbal Communication Skills

•Facial expression

•Body language

•Vocal cues

•Eye contact

•Silence

Understanding the Meaning of CommunicationUnderstanding the Meaning of Communication

•Messages often contain more meaning than just the spoken words

•The nurse must try to discover all the meaning in the client’s communication, not only the literal meaning of the words

Cultural ConsiderationsCultural Considerations

The nurse must be aware of cultural differences in:

• Speech patterns and habits

• Styles of speech and expression

• Eye contact

• Touch

• Concept of time

• Health and health care

Goals of a Therapeutic Communication SessionGoals of a Therapeutic Communication Session• Establishing rapport

• Identifying issues of concern

• Being empathetic, genuine, caring, and unconditionally accepting of the person

• Understanding the client’s perception

• Exploring the client’s thoughts and feelings

• Developing problem-solving skills

• Promoting the client’s evaluation of solutions

Self-Awareness Issues Self-Awareness Issues

•Know that nonverbal communication is as important as verbal

•Ask colleagues for feedback

•Examine your communication skills