Non-therapeutic Communication Techniques Table 6.2 Flashcards
Advising
telling the client what to do
“I think you should …”
“Why don’t you …”
Rationale
Giving advice implies that only the nurse knows what is best for the client.
Agreeing
indicating accord with the client
“That’s right.”
“I agree.”
Rationale
Approval indicates the client is “right” rather than “wrong.” This gives the client the impression that he or she is “right” because of agreement with the nurse. Opinions and conclusions should be exclusively the client’s. When the nurse agrees with the client, there is no opportunity for the client to change his or her mind without being “wrong.”
Belittling feelings
expressed
misjudging the degree
of the client’s discomfort
Client: “I have nothing to live for … I wish I was dead.”
Nurse: “Everybody gets down in the dumps,” or “I’ve felt that way myself.”
Rationale
When the nurse tries to equate the intense and overwhelming feelings the client has expressed to “everybody” or to the nurse’s own feelings, the nurse implies that the discomfort is temporary, mild, self- limiting, or not that important. The client is focused on his or her own worries and feelings; hearing the problems or feelings of others is not helpful.
Challenging
demanding proof from the client
“But how can you be president of the United States?”
“If you’re dead, why is your heart beating?”
Rationale
Often, the nurse believes that if he or she can challenge the client to prove unrealistic ideas, the client will realize there is no “proof” and then will recognize reality. Actually, challenging causes the client to defend the delusions or misperceptions more strongly than before.
Defending
attempting to protect someone or something from verbal attack
“This hospital has a fine reputation.”
“I’m sure your doctor has your best interests in mind.”
Rationale
Defending what the client has criticized implies that he or she has no right to express impressions, opinions, or feelings. Telling the client that his or her criticism is unjust or unfounded does not change the client’s feelings but only serves to block further communication.
Disagreeing
opposing the client’s ideas
“That’s wrong.”
“I definitely disagree with …”
“I don’t believe that.”
Rationale
Disagreeing implies the client is “wrong.” Consequently, the client feels defensive about his or her point of view or ideas.
Disapproving
denouncing the client’s behavior or ideas
“That’s bad.”
“I’d rather you wouldn’t …”
Rationale
Disapproval implies that the nurse has the right to pass judgment on the client’s thoughts or actions. It further implies that the client is expected to please the nurse.
Giving approval
sanctioning the client’s behavior or ideas
“That’s good.”
“I’m glad that …”
Rationale
Saying what the client thinks or feels is “good” implies that the opposite is “bad.” Approval, then, tends to limit the client’s freedom to think, speak, or act in a certain way. This can lead to the client’s acting in a particular way just to please the nurse.
Giving literal responses
responding to a figurative comment as though it were a statement of fact
Client: “They’re looking in my head with a television camera.”
Nurse: “Try not to watch
television” or “What channel?”
Rationale
Often, the client is at a loss to describe his or her feelings, so such comments are the best he or she can do. Usually, it is helpful for the nurse to focus on the client’s feelings in response to such statements.
Indicating the existence of an external source
attributing the source of thoughts, feelings, and behaviors to others or to outside influences
“What makes you say that?”
“What made you do that?”
“Who told you that you were a prophet?”
Rationale
The nurse can ask, “What happened?” or “What events led you to draw such a conclusion?” However, to question, “What made you think that?” implies that the client was made or compelled to think in a certain way. Usually, the nurse does not intend to suggest that the source is external, but that is often what the client thinks.
Interpreting
asking to make conscious that which is unconscious; telling the client the meaning of his or her experience
“What you really mean is …” “Unconsciously
you’re saying …”
Rationale
The client’s thoughts and feelings are his or her own, not to be interpreted by the nurse for hidden meaning. Only the client can identify or confirm the presence of feelings.
Introducing an unrelated topic
changing the subject
Client: “I’d like to die.”
Nurse: “Did you go fishing last week?”
Rationale
The nurse takes the initiative for the interaction away from the client. This usually happens because the nurse is uncomfortable, doesn’t know how to respond, or has a topic he or she would rather discuss.
Making stereotyped comments
offering meaningless clichés or trite comments
“It’s for your own good.”
“Keep your chin up.”
“Just have a positive
attitude and you’ll be better in no time.”
Rationale
Social conversation contains many clichés and much meaningless chit-chat. Such comments are of no value in the nurse–client relationship. Any automatic responses lack the nurse’s consideration or thoughtfulness.
Probing
persistent questioning of the client
“Now tell me about this problem. You know I have to find out.”
“Tell me your psychiatric history.”
Rationale
Probing tends to make the client feel used or invaded. Clients have the right not to talk about issues or concerns if they choose. Pushing and probing by the nurse will not encourage the client to talk.
Reassuring
indicating there is no reason for anxiety or other feelings of discomfort
“I wouldn’t worry about that.”
“Everything will be alright.” “You’re coming along just fine.”
Rationale
Attempts to dispel the client’s anxiety by implying that there is not sufficient reason for concern completely devalue the client’s feelings. Vague reassurances without accompanying facts are meaningless to the client.
