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Communication Skills: Therapeutic and Non –Therapeutic
Therapeutic
Technique: Giving Recognition
Explanation/Rationale
: Acknowledging; indicating
awareness; better than complimenting, which reflects
the nurse’s judgment.
Examples
: “Hello, Mr. J. I notice that you made a
ceramic ash tray in OT.” “I see you made your bed.”
“Good morning, Mrs. J. I notice that you are up early.”
“I see you have a new book.” ”Hello Mrs C, you are
walking better today.”
Technique: Offering self
Explanation/Rationale
: Making one self available on
an unconditional basis, increasing client’s feelings of
self-worth.
Examples:
“I’ll stay with you awhile.” “We can eat
together.” “I’m interested in you.” “I’ll sit with you while
you have your snack.” “I’ll walk with you.”
Technique: Giving broad openings
Explanation/Rationale
: Allows the client to take the
initiative in introducing the topic; emphasizes the
importance of the client’s role in the interaction.
Examples
: “What would you like to talk about today?”
“Tell me what you are thinking.” “Is there something you would like to do today?” “What’s on your mind?”
Technique: Offering general leads
Explanation/Rationale:
Offers the client
encouragement to continue.
Examples:
“Yes, I see.” “Go on.” “And after that?” “You
were saying…” “Tell me about that.” “And then…”
Technique: Placing the event in time or sequence
Explanation/Rationale:
Clarifies the relationship of
events in time so that the nurse and client can view
them in perspective.
Examples:
“What seemed to lead up to…?” “Was this
before or after…?” “When did this happen?” “What
happened after that?”
Technique: Making observation
Explanation/Rationale:
Verbalizing what is observed
or perceived. This encourages the client to recognize
specific behaviors and compare perceptions with the
nurse.
Examples:
“You seem tense.” “I notice you are pacing
a lot.” “You seem uncomfortable when you…” “I noticed
you were…” “You appear upset...”
Technique: Encouraging description of
perceptions
Explanation/Rationale:
Asking the client to compare
similarities and differences in ideas, experiences, or
interpersonal relationships. This helps the client
recognize life experiences that tend to recur as well as
those aspects of life that are changeable.
Examples:
“Tell me what is happening now.” “Are you
hearing the voices again?” “ What do the voices seem
to be saying?” “Tell me when you feel anxious.” “Tell
me how the medications make you feel.”
Technique: Encouraging comparison
Explanation/Rationale:
Asking the client to compare
similarities and differences in ideas, experiences, or
interpersonal relationships. This helps the client
recognize life experiences that tend to recur as well as
those aspects of life that are changeable.
Examples:
“Was this something like…” “How does this
compare with the time when…” “What was your
response the last time this situation occurred?” “What
does this resemble?” “Have you had similar
experiences?”
Technique: Focusing
Explanation/Rationale:
Taking notice of a single idea
or even a single word; works especially well with a
client who is moving rapidly from on thought to
another. This technique is not therapeutic, however,with the client who is very anxious. Focusing should
not be pursued until the anxiety level has subsided. Examples:
“This point seems worth looking at more
closely. Perhaps you and I can discuss it together.” “Of
all the concerns you have mentioned, which one is
most troublesome?”
Technique: Exploring
Explanation/Rationale:
Delving further into a subject,
idea, experience, or relationship; especially helpful with
clients who tend to remain on a superficial level of
communication. However, if the client chooses not to
disclose further information, the nurse should refrain
from pushing or probing in an area that obviously
creates discomfort.
Examples:
“Please explain that situation in more
detail.” “Tell me more about that particular situation.”
“What do you mean?” “What kind of work?”
Technique: Seeking clarification and validation
Explanation/Rationale:
Striving to explain that which
is vague or incomprehensible and searching for mutual
understanding; clarifying the meaning of what has
been said facilitates and increases understanding for
both client and nurse.
Examples:
“I’m not sure that I understand. Would you
please explain?” “ Tell me if my understanding agrees with yours.” “Do I understand correctly that you said…”“Tell me if I understood correctly.” “I’m not sure I follow
what you are saying
Technique: Presenting reality
Explanation/Rationale:
When a client has a
misperception of the environment, the nurse defines
reality or indicates his or her perception of the situation
for the client.
Examples:
“I understand that the voices seem real to
you, but I do not hear any voices.” “There is no one
else in the room but you and me.” “Your mother is not
here.” “That was a car backfiring.”
Technique: Formulating a Plan of Action
Explanation/Rationale:
Having a plan in mind for
dealing with what is considered to be a stressful
situation may help the client prevent anger or anxiety
from escalating to an unmanageable level.
Examples:
“What could you do to let your anger out
harmlessly?” “Next time this comes up, what might you
do to handle it more appropriately?” “How could you
handle this differently in the future?”
Technique: Voicing doubt
Explanation/Rationale:
Expressing uncertainty as to
the reality of the client’s perception of the situation for
the client.
Examples:
“I find that hard to believe.” “That seems
rather doubtful to me.” “Really?” “Isn’t that unusual.”
Technique: Translating words into feelings
Explanation/Rationale: “Desymbolizing” what the client
has said and finding clues to the underlying true
feelings that have been expressed indirectly.
Examples: Cl: “I’m way out in the ocean.” Ns: “You
must be feeling very lonely right now.”
Cl: “I’m dead.” Ns: “Are you suggesting you feel
lifeless?”
Technique: Verbalizing the implied
Explanation/Rationale:
Putting into words what the
client has only implied or said indirectly; can also be
used with the client who is mute or is otherwise
experiencing impaired verbal communication. This
clarifies that which is implicit rather than explicit.
Examples:
Cl: “It’s a waste of time to be here. I can’t
talk to you or anyone.”
Ns: “Are you feeling that no one understands?”
Cl: (mute)
Ns: “It must have been very difficult for you when your
husband died in the fire.”
Cl: “This is a waste of time.”
Ns: “You don’t think this is beneficial?”
Nontherapeutic
Technique: Giving reassurance
Explanation/Rationale:
Indicating to the client that
there is no cause for anxiety; thereby devaluing the
client’s feelings; may discourage the client from further
expression of feelings if he or she believes they will
only be downplayed or ridiculed.
Examples:
“I wouldn’t worry about that if I were you.”
“Everything will be all right.”
Better to say: “We will work on that together.”
Technique: Rejecting
Explanation/Rationale:
Refusing to consider or
showing contempt for the client’s ideas or behavior.This may cause the client to discontinue interaction
with the nurse for fear of rejection.
Examples:
“Let’s not discuss…” “I don’t want to hear
about…” “Don’t say that.” Better to say: “Let’s look at
that a little closer.”
Technique: Approving or disapproving
Explanation/Rationale:
Sanctioning or denouncing
the client’s ideas or behavior; implies that the nurse
has the right to pass judgment on whether the client’s
ideas or behaviors are “good” or “bad”, and that the
client is expected to please the nurse. The nurse’s acceptance of the client is then seen as conditional
depending on the client’s behavior.
Examples:
“That’s right. I agree.” “That’s wrong. I
disagree.” “I don’t believe that.” Better to say: “Let’s
talk about how your behavior invoked anger in the
other clients at dinner.”
Technique: Agreeing or disagreeing
Explanation/Rationale:
Indicating accord with or
opposition to the client’s ideas or opinions; implies that
the nurse has the right to pass judgment on whether
the client’s ideas or opinions are “right” or “wrong”.
Agreement prevents the client from later modifying his
or her point of view without admitting error.
Disagreement implies inaccuracy, provoking the need
for defensiveness on the part of the client.
Examples:
“That’s right. I agree.” “That’s wrong. I
disagree.” “I don’t believe that.” Better to say: “Let’s
discuss what you feel is unfair about the new
community rules.”
Technique: Giving Advice
Explanation/Rationale:
Telling the client what to do
or how to behave implies that the nurse knows what is
best and that the client is incapable of any self-
direction. It nurtures the client in the dependent role by
discouraging independent thinking.
Examples:
“I think you should…” “Why don’t you…”
Better to say: “What do you think you should do?”
Technique: Defending
Explanation/Rationale
: Attempting to protect
someone or something from verbal attack. To defendwhat the client has criticized is to imply that he or she
has no right to express ideas, opinions, or feelings. Defending does not change the client’s feelings and
may cause the client to think the nurse is taking sides
with those being criticized and against the client.
Examples:
“This is a fine hospital.” “No one here would
lie to you.” “You have a very capable physician. I’m
sure he only has your best interests in mind.”
Better to say: “I will try to answer you questions and
clarify some issues regarding your treatment.”
Technique: Requesting an explanation
Explanation/Rationale:
Asking the client to provide
the reasons for thoughts, feelings, behavior, and
events. Asking “why” a client did something or feels a certain way can be very intimidating, and implies thatthe client must defend his or her behavior or feelings. Examples:
“Why do you think that?” “Why do you feel
this way?” “Why did you do that?” Better to say: “
Describe what you were feeling just before that
happended.”
Technique: Indicating the existence of an external
source of power
Explanation/Rationale:
Attributing the source of
thoughts, feelings, and behavior to others or to outsideinfluences. This encourages the client to project blame
for his or her thoughts or behaviors on others rather
than accepting the responsibility personally.
Examples:
“What makes you say that?” “What made
you do that?” “What made you so angry last night?” Better to say: “You became angry when your brother
insulted your wife.”
Technique: Introducing and unrelated topic
Explanation/Rationale:
Changing the subject causes
the nurse to take over the direction of the discussion.
This may occur to get to something that the nurse
wants to discuss with the client or to get away from a
topic that he or she would prefer not to discuss.
Examples:
Cl: “I don’t have anything to live for.” Ns:
“Did you have visitors this weekend?” Better
technique: The nurse must remain open and free to
hear the client and to take in all that is being
conveyed, both verbally and nonverbally.
