Therapeutic Communication Techniques Table 6.1

Question 1

Accepting

Answer 1

indicating reception

“Yes.”
“I follow what
you said.”
Nodding

Rationale
An accepting response indicates the nurse has heard and followed the train of thought. It does not indicate agreement but is nonjudgmental. Facial expression, tone of voice, and so forth also must convey acceptance or the words lose their meaning.

Question 2

Broad openings

Answer 2

allowing the client to take the initiative in introducing the topic

“Is there something you’d like to talk about?”
“Where would you like to begin?”

Rationale
Broad openings make it explicit that the client has the lead in the interaction. For the client who is hesitant about talking, broad openings may stimulate him or her to take the initiative.

Question 3

Consensual validation

Answer 3

searching for mutual understanding, for accord in the meaning of the words

“Tell me whether my understanding of it agrees with yours.”
“Are you using this word to convey that…?”

Rationale
For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both or all participants. Sometimes, words, phrases, or slang terms have different meanings to different people and can be easily misunderstood.

Question 4

Encouraging comparison

Answer 4

asking that similarities and differences be noted

“Was it something like…?”
“Have you had similar
experiences?”

Rationale
Comparing ideas, experiences, or relationships brings out many recurring themes. The client benefits from making these comparisons because he or she might recall past coping strategies that were effective or remember that he or she has survived a similar situation.

Question 5

Encouraging description of perceptions

Answer 5

asking the client to verbalize what he or she perceives

“Tell me when you feel
anxious.”
“What is happening?”
“What does the voice seem to be saying?”

Rationale
To understand the client, the nurse must see things from his or her perspective. Encouraging the client to fully describe ideas may relieve the tension the client is feeling, and he or she might be less likely to take action on ideas that are harmful or frightening.

Question 6

Encouraging expression

Answer 6

asking the client to appraise the quality of his or her experiences

“What are your feelings in regard to…?”
“Does this contribute to your distress?”

Rationale
The nurse asks the client to consider people and events in light of his or her own values. Doing so encourages the client to make his or her own appraisal rather than to accept the opinion of others.

Question 7

Exploring

Answer 7

delving further into a subject or an idea

“Tell me more about that.”
“Would you describe it more fully?”
“What kind of work?”

Rationale
When clients deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his or her wishes.

Question 8

Focusing

Answer 8

concentrating on a single point

“This point seems worth looking at more closely.”
“Of all the concerns
you’ve mentioned, which is most troublesome?”

Rationale
The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It is also a useful technique when a client jumps from one topic to another.

Question 9

Formulating a plan of action

Answer 9

asking the client to consider kinds of behavior likely to be appropriate in future situations

“What could you do to let your anger out harmlessly?”
“Next time this comes up, what might you do to handle it?”

Rationale
It may be helpful for the client to plan in advance what he or she might do in future similar situations. Making definite plans increases the likelihood that the client will cope more effectively in a similar situation.

Question 10

General leads

Answer 10

giving
encouragement to continue

“Go on.”
“And then?”
“Tell me about it.”

Rationale
General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. They also encourage the client to continue if he or she is hesitant or uncomfortable about the topic.

Question 11

Giving information

Answer 11

making available the facts that the client needs

“My name is …”
“Visiting hours are …”
“My purpose in being here
is …”

Rationale
Informing the client of facts increases his or her knowledge about a topic or lets the client know what to expect. The nurse is functioning as a resource person. Giving information also builds trust with the client.

Question 12

Giving recognition

Answer 12

acknowledging, indicating awareness

“Good morning, Mr. S …”
“You’ve finished your list of things to do.”
“I notice that you’ve
combed your hair.”

Rationale
Greeting the client by name, indicating awareness of change, or noting efforts the client has made all show that the nurse recognizes the client as a person, as an individual. Such recognition does not carry the notion of value, that is, of being “good” or “bad.”

Question 13

Making observations

Answer 13

verbalizing what the nurse perceives

“You appear tense.”
“Are you uncomfortable
when…?”
“I notice that you’re biting your lip.”

Rationale
Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk.

Question 14

Offering self

Answer 14

making oneself available

“I’ll sit with you awhile.”
“I’ll stay here with you.”
“I’m interested in what you think.”

Rationale
The nurse can offer his or her presence, interest, and desire to understand. It is important that this offer is unconditional; that is, the client does not have to respond verbally to get the nurse’s attention.

Question 15

Placing event in time or sequence

Answer 15

clarifying the relationship of events in time

“What seemed to lead up to…?”
“Was this before or after…?”
“When did this happen?”

Rationale
Putting events in proper sequence helps both the nurse and the client to see them in perspective. The client may gain insight into cause-and-effect behavior and consequences or the client may be able to see that perhaps some things are not related. The nurse may gain information about recurrent patterns or themes in the client’s behavior or relationships.

Question 16

Presenting reality

Answer 16

offering for consideration that which is real

“I see no one else in the room.”
“That sound was a car
backfiring.”
“Your mother is not here; I am a nurse.”

Rationale
When it is obvious that the client is misinterpreting reality, the nurse can indicate what is real. The nurse does this by calmly and quietly expressing his or her perceptions or the facts, not by way of arguing with the client or belittling his or her experience. The intent is to indicate an alternative line of thought for the client to consider, not to “convince” the client that he or she is wrong.

Question 17

Reflecting

Answer 17

directing client actions, thoughts, and feelings back to client

Client: “Do you think I should tell the doctor…?”
Nurse: “Do you think you should?”
Client: “My brother
spends all my money and then has nerve to ask for more.”
Nurse: “This causes you to feel angry?”

Rationale
Reflection encourages the client to recognize and accept his or her own feelings. The nurse indicates that the client’s point of view has value and that the client has the right to have opinions, make decisions, and think independently.

Question 18

Restating

Answer 18

repeating the main idea expressed

Client: “I can’t sleep. I stay
awake all night.” 
Nurse: “You have difficulty sleeping.”
Client: “I’m really mad, I’m really upset.”
Nurse: “You’re really mad and upset.”

Rationale
The nurse repeats what the client has said in approximately or nearly the same words the client has used. This restatement lets the client know that he or she communicated the idea effectively. This encourages the client to continue. Or if the client has been misunderstood, he or she can clarify his or her thoughts.

Question 19

Seeking information

Answer 19

seeking to make clear that which is not meaningful or that which is vague

“I’m not sure that I follow.”
“Have I heard you correctly?”

Rationale

The nurse should seek clarification throughout interactions with clients. Doing so can help the nurse to avoid making assumptions that understanding has occurred when it has not. It helps the client articulate thoughts, feelings, and ideas more clearly.

Question 20

Silence

Answer 20

the absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking

Nurse says nothing but continues to maintain eye contact and conveys interest.

Rationale
Silence often encourages the client to verbalize, provided that it is interested and expectant. Silence gives the client time to organize thoughts, direct the topic of interaction, or focus on issues that are most important. Much nonverbal behavior takes place during silence, and the nurse needs to be aware of the client and his or her own nonverbal behavior.

Question 21

Suggesting collaboration

Answer 21

offering to share, to strive, and to work with the client for his or her benefit

“Perhaps you and I can
discuss and discover the triggers for your anxiety.”
“Let’s go to your room, and I’ll help you find what you’re looking for.”

Rationale
The nurse seeks to offer a relationship in which the client can identify problems in living with others, grow emotionally, and improve the ability to form satisfactory relationships. The nurse offers to do things with, rather than for, the client.

Question 22

Summarizing

Answer 22

organizing and summing up that which has gone before

“Have I got this straight?”
“You’ve said that….”
“During the past hour, you and I have discussed….”

Rationale
Summarizationseekstobringouttheimportantpointsofthe discussion and seeks to increase the awareness and understanding of both participants. It omits the irrelevant and organizes the pertinent aspects of the interaction. It allows both client and nurse to depart with the same ideas and provides a sense of closure at the completion of each discussion.

Question 23

Translating into feelings

Answer 23

seeking to verbalize client’s feelings that he or she expresses only indirectly

Client: “I’m dead.”
Nurse: “Are you suggesting that you feel lifeless?”
Client: “I’m way out in the ocean.”
Nurse: “You seem to feel lonely or deserted.”

Rationale
Often what the client says, when taken literally, seems meaningless or far removed from reality. To understand, the nurse must concentrate on what the client might be feeling to express him or herself this way.

Question 24

Verbalizing the implied

Answer 24

voicing what the client has hinted at or suggested

Client: “I can’t talk to you or anyone. It’s a waste of time.”
Nurse: “Do you feel that no one understands?”

Rationale
Putting into words what the client has implied or said indirectly tends to make the discussion less obscure. The nurse should be as direct as possible without being unfeelingly blunt or obtuse. The client may have difficulty communicating directly. The nurse should take care to express only what is fairly obvious; otherwise, the nurse may be jumping to conclusions or interpreting the client’s communication.

Question 25

Voicing doubt

Answer 25

expressing uncertainty about the reality of the client’s perceptions

“Isn’t that unusual?”
“Really?” “That’s hard to
believe.”

Rationale
Another means of responding to distortions of reality is to express doubt. Such expression permits the client to become aware that others do not necessarily perceive events in the same way or draw the same conclusions. This does not mean the client will alter his or her point of view, but at least the nurse will encourage the client to reconsider or reevaluate what has happened. The nurse neither agreed nor disagreed; however, he or she has not let the misperceptions and distortions pass without comment.