Therapeutic Therapeutic CommunicationCommunication

The Helping InterviewThe Helping Interview

Helping Relationship Helping Relationship CharacteristicsCharacteristics

CaringCaring HopefulHopeful SensitiveSensitive GenuineGenuine EmpathyEmpathy Positive RegardPositive Regard Values Self & Values Self &

OthersOthers

Empowering Empowering TeachingTeaching Goal- Oriented, Goal- Oriented,

PurposefulPurposeful Time LimitedTime Limited AssertiveAssertive

Helping vs Social RelationshipsHelping vs Social Relationships

HELPINGHELPING CareCare TrustTrust GrowthGrowth Purposeful/IntentionalPurposeful/Intentional Unequal SharingUnequal Sharing Focus on Client’s Focus on Client’s

NeedsNeeds Time LimitedTime Limited

SOCIALSOCIAL CareCare TrustTrust GrowthGrowth SpontaneousSpontaneous Similar SharingSimilar Sharing Focus on Needs of Focus on Needs of

Both IndividualsBoth Individuals OngoingOngoing

ControlControl

GIVING HELPGIVING HELP feeling importantfeeling important feeling usefulfeeling useful feeling powerfulfeeling powerful feeling gratifiedfeeling gratified feeling happyfeeling happy

NEEDING HELPNEEDING HELP feeling unimportant or feeling unimportant or

inadequateinadequate feeling useless or feeling useless or

depresseddepressed feeling powerlessfeeling powerless feeling frightened or feeling frightened or

embarrassedembarrassed feeling sad or angryfeeling sad or angry

Phases of Helping RelationshipPhases of Helping Relationship

Orientation (professional and client Orientation (professional and client to each other)to each other)

Working (identification of the Working (identification of the client’s problem)client’s problem)

Termination (resolution of the Termination (resolution of the client’s problem)client’s problem)

Orientation PhaseOrientation Phase

““getting to know you” phasegetting to know you” phase sets the tonesets the tone introductionsintroductions rolesroles initiated by the nurseinitiated by the nurse agreement/contract/goalsagreement/contract/goals trust developstrust develops

TRUSTTRUST

T T try expression try expression R R reflection reflection U U use of silence use of silence S S setting limits setting limits T T time with client time with client

Working PhaseWorking Phase

““problem solving” phaseproblem solving” phase attend to client’s needsattend to client’s needs role of teacher/counselorrole of teacher/counselor client actively participatesclient actively participates gather further datagather further data facilitate changefacilitate change evaluate problems & goalsevaluate problems & goals

TerminationTermination

““ending” phaseending” phase review and summarize progress & review and summarize progress &

goals met/not metgoals met/not met acknowledge feelingsacknowledge feelings use clear languageuse clear language check the receiver understandscheck the receiver understands

the message sentthe message sent

ResolutionResolution

clients mostly seeking explanationclients mostly seeking explanation how will problem affect their lives?how will problem affect their lives? what will need to be changed?what will need to be changed? how will they cope?how will they cope?

AvoidAvoid

arguingarguing minimizingminimizing challengingchallenging giving false giving false

reassurancereassurance interpreting or interpreting or

speculating on the speculating on the dynamics of the dynamics of the

client’s problemsclient’s problems

““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 clientled by client

Nursing Interventions to EncourageNursing Interventions to EncourageThe Helping RelationshipThe Helping Relationship

active listeningactive listening therapeutic communication techniquestherapeutic communication techniques other factorsother factors

attentive listening scaleattentive listening scale

hard to maintain eye contact hard to maintain eye contact respond before other finishes speakingrespond before other finishes speaking finish other people’s sentencesfinish other people’s sentences talk on and on so no one can respondtalk on and on so no one can respond go on working while someone is talking to go on working while someone is talking to

youyou repeat a point just maderepeat a point just made allow your mind to wander during a allow your mind to wander during a

conversationconversation

good listeninggood listening

STOP TALKINGSTOP TALKING put the speaker at easeput the speaker at ease show that you want to listenshow that you want to listen remove distractionsremove distractions empatheticempathetic be patientbe patient hold your temperhold your temper go easy on argument and criticismgo easy on argument and criticism STOP TALKINGSTOP TALKING

communication techniquescommunication techniques

open ended questions (closed for open ended questions (closed for obtaining specific information)obtaining specific information)

validating/clarifyingvalidating/clarifying reflective/restating & paraphrasingreflective/restating & paraphrasing sequencingsequencing sharing observationssharing observations acknowledging feelingsacknowledging feelings

interpersonal skillsinterpersonal skills

warmth and friendlinesswarmth and friendliness openness (acceptance)openness (acceptance) consideration of client variablesconsideration of client variables

– non-english speakingnon-english speaking– developmental considerationsdevelopmental considerations– older adultsolder adults– socioculturalsociocultural– occupationaloccupational– patients with special needspatients with special needs

other factors promoting other factors promoting therapeutic communicationtherapeutic communication

comfortable environmentcomfortable environment Providing some personal spaceProviding some personal space privacyprivacy confidentialityconfidentiality client focusclient focus optimal pacingoptimal pacing nursing observationsnursing observations

blocks to communicationblocks to communication

failure to respect failure to respect clientclient

failure to listenfailure to listen minimizing feelingsminimizing feelings inappropriate inappropriate

comments & comments & questionsquestions

excessive questionsexcessive questions yes/no questionsyes/no questions

why & howwhy & how probingprobing changing the subjectchanging the subject leading questionsleading questions adviceadvice judgmentaljudgmental false reassurancefalse reassurance giving giving

approval/disapprovalapproval/disapproval

therapeutic vs non-therapeutictherapeutic vs non-therapeutic

THERAPEUTICTHERAPEUTIC facilitates facilitates

transformation of transformation of working nurse/patient working nurse/patient relationshiprelationship

relationship allows for relationship allows for adequate & accurate adequate & accurate assessment & assessment &

data collectiondata collection performed with performed with

patient, not for patientpatient, not for patient

NON-THERAPEUTICNON-THERAPEUTIC hinders relationship hinders relationship

formationformation prevents patient from prevents patient from

becoming mutual partner becoming mutual partner & relegates him/her to & relegates him/her to passive recipient of carepassive recipient of care

disclosure, yes or no?disclosure, yes or no? use self disclosure to use self disclosure to

help clients open up to help clients open up to you – you – not to meet your not to meet your own needsown needs

keep your disclosureskeep your disclosures very briefvery brief don’t imply that your don’t imply that your

experience is exactly experience is exactly the same as the same as

the client’sthe client’s only self-disclose about only self-disclose about

situations thatsituations that you have masteredyou have mastered

monitor your own comfort monitor your own comfort with with

self-disclosureself-disclosure respect your client’s needs respect your client’s needs

for privacyfor privacy remember that there are remember that there are

cultural variations in the cultural variations in the amount of self-disclosure amount of self-disclosure considered appropriateconsidered appropriate

identify risks and benefits identify risks and benefits of of

self disclosureself disclosure discuss the goals of the discuss the goals of the

use of therapeutic self-use of therapeutic self-disclosuredisclosure

medical care is not enough!medical care is not enough!

We need more than medical We need more than medical

care or surgery--we need care or surgery--we need

competent care & competent care &

a good communicatora good communicator