Therapeutic Therapeutic CommunicationCommunication

Prepared by Sally McDonaldPrepared by Sally McDonald

Revised by Tim CorbettRevised by Tim Corbett

Helping vs Social Helping vs Social RelationshipsRelationships HELPINGHELPING CareCare TrustTrust GrowthGrowth Purposeful/Purposeful/

intentionalintentional Unequal sharingUnequal sharing Focus on Client’s Focus on Client’s

needsneeds Time limitedTime limited

SOCIALSOCIAL CareCare TrustTrust GrowthGrowth SpontaneousSpontaneous Usually equal or Usually equal or

near equal sharingnear equal sharing Focus on needs ofFocus on needs of both individualsboth individuals OngoingOngoing

Locus of ControlLocus of Control

GIVING HELPGIVING HELP Feeling importantFeeling important Feeling usefulFeeling useful Feeling powerfulFeeling powerful Feeling gratifiedFeeling gratified Feeling happyFeeling happy

NEEDING HELPNEEDING HELP Feeling unimportant Feeling unimportant

or inadequateor inadequate Feeling useless or Feeling useless or

depresseddepressed Feeling powerlessFeeling powerless Feeling frightened Feeling frightened

or embarrassedor embarrassed Feeling sad Feeling sad or angry or angry

Phases of Helping Phases of Helping RelationshipsRelationships Orientation PhaseOrientation Phase

Working PhaseWorking Phase

Termination PhaseTermination Phase

Orientation PhaseOrientation Phase

““getting to know you” phasegetting to know you” phase setting the tonesetting the tone making introductionsmaking introductions establishing rolesestablishing roles reaching agreement on goalsreaching agreement on goals developing trustdeveloping trust

Working PhaseWorking Phase

““problem solving” phaseproblem solving” phase attending to client’s needsattending to client’s needs Nurse in role of teacher/counselorNurse in role of teacher/counselor encouraging active participation by clientencouraging active participation by client gathering further datagathering further data assisting client in decision makingassisting client in decision making facilitating changefacilitating change Evaluate problems & goalsEvaluate problems & goals

Termination PhaseTermination Phase

reviewing & summarizing goals met reviewing & summarizing goals met and progress madeand progress made

acknowledge feelings of lossacknowledge feelings of loss reassuring clients with issues such as,reassuring clients with issues such as,

“ “How will this problem/disease affectHow will this problem/disease affect

my life ?” or my life ?” or

“ “What do I need to change ?”What do I need to change ?”

Communication Communication TechniquesTechniques Validating/ClarifyingValidating/Clarifying ReflectingReflecting SequencingSequencing Sharing observationsSharing observations Acknowledging feelingsAcknowledging feelings

AvoidAvoid

ArguingArguing MinimizingMinimizing ChallengingChallenging Giving false Giving false

reassurancereassurance Interpreting or Interpreting or

speculating on speculating on the dynamics of the dynamics of the client’s the client’s problemsproblems

““Selling” client on Selling” client on accepting accepting treatmenttreatment

Probing sensitive Probing sensitive areasareas

Participating in Participating in criticism of any criticism of any staff memberstaff member

Joining any attacks Joining any attacks led by the clientled by the client

Attentive Listening Attentive Listening ScaleScale-THINGS TO AVOID-THINGS TO AVOID Lack of eye contact Lack of eye contact Responding before the other finishes speakingResponding before the other finishes speaking Finishing other people’s sentencesFinishing other people’s sentences Talking so much that others cannot respondTalking so much that others cannot respond Continuing to work while someone is talking to Continuing to work while someone is talking to

youyou Repeat a point just madeRepeat a point just made Allow your mindAllow your mind to wander during a to wander during a

conversationconversation

Active ListeningActive Listening

3 Phases3 Phases restatementrestatement involves repeating or involves repeating or

paraphrasingparaphrasing the words of the client the words of the client reflection reflection is verbalizing both the is verbalizing both the

content and the implied feelings of the content and the implied feelings of the client’s messageclient’s message

clarificationclarification is summarizing the is summarizing the client’s thoughts & feelings & resolving client’s thoughts & feelings & resolving confusionconfusion

Active ListeningActive Listening

STOP TALKINGSTOP TALKING demonstrate that you want to demonstrate that you want to

listenlisten remove distractionsremove distractions be patientbe patient STOP TALKINGSTOP TALKING

Assertive Assertive CommunicationCommunication ““I” Statements allow people to I” Statements allow people to

‘own’ (take responsibility for) ‘own’ (take responsibility for) their own thoughts & feelingstheir own thoughts & feelings

assertiveness involves taking a assertiveness involves taking a riskrisk

NONVERBAL CUESNONVERBAL CUES

professional attireprofessional attire sit arm’s length awaysit arm’s length away relaxed but attentive posturerelaxed but attentive posture

NONVERBAL CUESNONVERBAL CUES

facial expressions and tonefacial expressions and tone should be friendly & interestedshould be friendly & interested use direct eye contact & use direct eye contact & match match

your eye contact with the your eye contact with the patient’s eye contactpatient’s eye contact

pay attention to body language of pay attention to body language of patient as well as your own body patient as well as your own body languagelanguage

Interviewing Interviewing TechniquesTechniques

INTERVIEWING INTERVIEWING TECHNIQUESTECHNIQUES the purpose of the interview is to the purpose of the interview is to

obtain accurate & thorough obtain accurate & thorough informationinformation

put your client at ease as they may put your client at ease as they may feel uncomfortable about revealing feel uncomfortable about revealing sensitive information to yousensitive information to you

explaining your format helps clients explaining your format helps clients accept & understand the purpose of accept & understand the purpose of the interviewthe interview

INTERVIEWING INTERVIEWING TECHNIQUESTECHNIQUES in general, use open-ended questionsin general, use open-ended questions however, to obtain specific however, to obtain specific

information, closed-ended questions information, closed-ended questions are preferable are preferable

validate informationvalidate information clarify responsesclarify responses use reflective questions/commentsuse reflective questions/comments

& paraphrasing& paraphrasing

Progression ofProgression ofthe Interviewthe Interview Broad Openings- such asBroad Openings- such as

“ “Tell me about yourself” are Tell me about yourself” are designed to allow the client to designed to allow the client to relate his or her story in a way relate his or her story in a way that is comfortablethat is comfortable

Progression ofProgression ofthe Interviewthe Interview Open-Ended QuestionsOpen-Ended Questions

encourage the client to elaborate encourage the client to elaborate or give explanations (for example,or give explanations (for example,

“ “What happened yesterday?”)What happened yesterday?”) they provide direction & keep the they provide direction & keep the

conversation focusedconversation focused

Progression ofProgression ofthe Interviewthe Interview Closed-Ended QuestionsClosed-Ended Questions

can be answered with 1-2 words can be answered with 1-2 words and can be useful in obtaining and can be useful in obtaining specific types of information, such specific types of information, such asas

“ “What is today’s date?”What is today’s date?”

EFFECTIVE EFFECTIVE INTERVIEWINGINTERVIEWING as a professional nurse, you will as a professional nurse, you will

spend about half of your time spend about half of your time obtaining information from clients obtaining information from clients & colleagues& colleagues

excellent communication as well excellent communication as well as interviewing skills are as interviewing skills are fundamental, yet require years of fundamental, yet require years of practice practice

WHY, WHAT, HOWWHY, WHAT, HOW

why do you need the information?why do you need the information? how will the information I am how will the information I am

seeking direct me in helping my seeking direct me in helping my client?client?

how will you phrase your how will you phrase your questions?questions?

Who to Ask?Who to Ask?

if the client is able to speak, ask if the client is able to speak, ask him/her him/her

family perspectives may also be family perspectives may also be importantimportant

written consent may be required to written consent may be required to question concurrent/previous question concurrent/previous healthcare providershealthcare providers

be courteous and respectfulbe courteous and respectful never never forget client confidentialityforget client confidentiality

““Why” QuestionsWhy” Questions

offensive misuse of ‘why’ appears offensive misuse of ‘why’ appears threatening and confrontational threatening and confrontational and puts clients on the defensiveand puts clients on the defensive

they can interfere with they can interfere with developing a therapeutic developing a therapeutic relationship & are seldom relationship & are seldom considered therapeuticconsidered therapeutic

ConveyingConveyingUpsetting InformationUpsetting Information The SPIKES Model developed by The SPIKES Model developed by

Radziewicz & Baile (2001)Radziewicz & Baile (2001) SettingSetting PerceptionPerception InvitationInvitation Knowledge emotionsKnowledge emotions SummarySummary

SettingSetting

private & comfortableprivate & comfortable invite others, such as family invite others, such as family

membersmembers

PerceptionPerception

refers to what client and others refers to what client and others already know useful in uncovering already know useful in uncovering misinformationmisinformation

InvitationInvitation

For example, the statement,For example, the statement,

“ “Would you like me to explain Would you like me to explain more more

about what happened?’about what happened?’

KnowledgeKnowledge

gradually dispense information gradually dispense information assessing client’s ability to cope assessing client’s ability to cope with itwith it

The family may insist that the The family may insist that the client client notnot be told difficult news be told difficult news

EmotionsEmotions

let client let client ventvent while you remain while you remain calmcalm

keep in mind keep in mind Stages of Grief & Stages of Grief & LossLoss

may need to set limits on may need to set limits on inappropriate /harmful behaviorinappropriate /harmful behavior

SummarySummary

review all important information review all important information with the client and familywith the client and family

may need to repeat information may need to repeat information more than oncemore than once

AVOIDAVOID

clichésclichés poor listeningpoor listening closed questionsclosed questions intimidating how/why questionsintimidating how/why questions obvious probing questionsobvious probing questions adviceadvice leading questions (that suggest the responseleading questions (that suggest the response that you want)that you want) judgmental commentsjudgmental comments divertingdiverting false assurancefalse assurance

COMMON ERRORSCOMMON ERRORS

Blocks to Blocks to CommunicationCommunication Failure to respect Failure to respect

clientclient Failure to listenFailure to listen Minimizing feelingsMinimizing feelings Inappropriate Inappropriate

comments & comments & questionsquestions

Excessive questionsExcessive questions ClichésClichés Yes/no questionsYes/no questions

ProbingProbing Changing the Changing the

subjectsubject Leading questionsLeading questions AdviceAdvice JudgmentsJudgments False reassuranceFalse reassurance Giving Giving

approval/disapprovaapproval/disapprovall

Self-DisclosureSelf-Disclosure

Use self disclosure to help clients open Use self disclosure to help clients open upup

to you – not to meet your own needsto you – not to meet your own needs Keep disclosures briefKeep disclosures brief Don’t imply that your experience is Don’t imply that your experience is

exactly the same as the client’sexactly the same as the client’s Only self-disclose about situations that Only self-disclose about situations that

you have masteredyou have mastered

Self-DisclosureSelf-Disclosure

Monitor your own comfort withMonitor your own comfort with self-disclosureself-disclosure Respect your client’s needs for Respect your client’s needs for

privacyprivacy Remember that there are cultural Remember that there are cultural

variations in the amount of self-variations in the amount of self-disclosure considered appropriatedisclosure considered appropriate

Identify risks and benefits of self Identify risks and benefits of self disclosuredisclosure

Therapeutic VersusTherapeutic VersusNontherapeutic Nontherapeutic CommunicationCommunication THERAPEUTICTHERAPEUTIC

- Facilitates transformation of - Facilitates transformation of working nurse-patient relationshipworking nurse-patient relationship

- Relationship allows for adequate - Relationship allows for adequate & accurate data collection & & accurate data collection & assessmentassessment

- Performed with & not for patient- Performed with & not for patient

Therapeutic VersusTherapeutic VersusNontherapeutic Nontherapeutic CommunicationCommunication NONTHERAPEUTICNONTHERAPEUTIC

- Hinders relationship formation- Hinders relationship formation

- Prevents patient from becoming - Prevents patient from becoming mutual partner & relegates mutual partner & relegates him/her to passive recipient of him/her to passive recipient of carecare