THERAPEUTIC COMMUNICATION – Nurse Info

THERAPEUTIC COMMUNICATION – Principles or Characteristics, Techniques and Non-therapeutic Communication

UPDATED 2024

Therapeutic
communication is an interpersonal interaction between the nurse and the patient
during which the nurse focuses on the patient’s specific needs to promote an
effective exchange of information. All nurses need skills in therapeutic
communication to effectively apply the nursing process and to meet standards of
care for their patients.

Therapeutic
communication can help nurses to accomplish many goals:

Establish a therapeutic nurse-patient
relationship
Identify the most important patient’s
needs
Assess the patient’s perception of
the problem
Facilitate the patient’s expression
of emotions
Implement interventions designed to
address the patient’s needs

To have an effective therapeutic communication, the nurse
must consider privacy and respect of boundaries, use of touch and active
listening and observation.

Principles or Characteristics of Therapeutic Communication

The patient should be the primary
focus of interaction
A professional attitude sets the tone
of the therapeutic relationship
Use self-disclosure cautiously and
only when it has a therapeutic purpose
Avoid social relationship with
patients
Maintain patient confidentiality
Assess the patient’s intellectual
competence to determine the level of understanding
Implement interventions from a
theoretic base
Maintain a nonjudgmental attitude.
Avoid making judgments about patient’s behavior
Avoid giving advice
Guide the patient to reinterpret his
or her experiences rationally.

Therapeutic Communication Techniques

Listening: It is an active process of
receiving information. Responses on the part of the nurse, such as maintaining
eye-to-eye contact, nodding, gesturing and other forms of receptive nonverbal
communication convey to the patient that he is being listened to and understood.

Therapeutic Value: Nonverbally communicates to the patient the nurse’s
interest and acceptance.

Broad Openings: Encouraging the
patient to select topics for discussion. For example, “What are you thinking
about?”

Therapeutic Value: Indicates acceptance by the nurse and the value of
patient’s initiative.

Restating: Repeating the main thought
expressed by the patient. For example, “You say that your mother left you when
you were 5-year-old”

Therapeutic Value: Indicated that the nurse is listening and validates,
reinforces or calls attention to something important that has been said.

Clarification: Attempting to put
vague ideas or unclear thoughts of the patient into words to enhance the
nurse’s understanding or asking the patient to explain what he means. For
example, “I am not sure what you mean. Could you tell me about the again?”

Therapeutic Value: It helps to clarify feelings, ideas and perceptions of
the patient and provides an explicit correlation between them and the patient’s
actions.

Reflection: Directing back the
patient’s ideas, feelings, questions and content. For example, “You are feeling
tense and anxious and it is related to a conversation you had with your husband
last night”.

Therapeutic Value: Validates the nurse’s understanding of what the
patient is saying and signifies empathy, interest and respect for the patient.

Humor: The discharge of energy
through comic enjoyment of the imperfect. For example, “That gives a whole new
meaning to the word ‘nervous’”, said with shared kidding between the nurse and
the patient.

Therapeutic Value: Can promote insight by making repressed material
conscious, resolving paradoxes, tempering aggression and revealing new options,
and is a socially acceptable for of sublimation.

Informing: The skill of information
giving. For example,” I think you need to know more about your medications.”

Therapeutic Value: Helpful in health teaching or patient education about
relevant aspects of patient’s well-being and self-care.

Focusing: Questions or statements that
help the patient expand on a topic of importance. For example, “I think that we
should talk more about your relationship with your father”.

Therapeutic Value: Allows the patient to discuss central issues and keeps
the communication process goal-directed.

Sharing Perceptions: Asking the
patient to verify the nurses understanding of what the patient is thinking or
feeling. For example, ”You are smiling, but I sense that you are really very
angry with me”.

Therapeutic Value: Conveys the nurse understands to the patient and has
the potential for clearing up confusing communication.

Theme
Identification: This involves identification of underlying issues or problems
experienced by the patient that emerge repeatedly during the course of the
nurse-patient relationship. For example, “I noticed that you said, you have
been hurt or rejected by the man. Do you think this is an underlying issue?”

Therapeutic
Value: It allows the nurse to promote the patient’s exploration and
understanding of important problems.

Silence:
Lack of verbal communication for a therapeutic reason. For example, sitting
with a patient and nonverbally communicating interest and involvement.

Therapeutic
Value: Allows the patient time to think and gain insight, slows the pace of the
interaction and encourages the patient to initiate conversation while enjoying
the nurse’s support, understanding and acceptance.

Suggesting:
Presentation of alternative ideas for the patient’s consideration relative to
problem solving. For example, “Have you thought about responding to your boss
in a different way when he raises that issue with you? You could ask him if a
specific problem has occurred.”

Therapeutic
Value: Increases the patient’s perceived notions or choices.

Ineffective/Non-therapeutic Communication

These include failure to listen, conflicting verbal or non-verbal messages, a judgmental attitude, false reassurance, giving of advice, the inability to receive information because of a preoccupation of impaired thought process and changing of the subject if one becomes uncomfortable with the topic being discussed.