Download CLED41024_TherapeuticCommunicationpt1

The Nurse
as
Communicator and Counselor
Part One:
Therapeutic Communication
Objectives:
Following completion of this program the Behavioral Health
Nurse will be able to:
• Describe the process of human communication.
• Define and Describe communication, non-verbal
communication, therapeutic communication, therapeutic
relationships, listening skills and core dimensions of
counseling techniques.
Therapeutic Communication is…
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A process that involves at least two people.
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The exchange of thoughts, messages, or information
as by speech, signals, writing, or behavior.
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The art and technique of using words effectively to
impart information or ideas.
Therapeutic Communication
Basic Principles
• Sender has responsibility for clarity
• Reputation plays a role
• Success may depend on the therapeutic relationship
• Awareness of personal values and biases is essential
• Feedback plays an important role
Therapeutic Communication
• Verbal - through words.
• Non-verbal - does not use spoken language.
Sometimes may be the behaviors that accompany words.
• Para-verbal- information communicated by the way
words are spoken, the rate, tone, volume, emphasis,
inflection.
Non-Verbal Communication
• May be obvious to you but hidden to the patient.
• May be obvious to the patient and hidden to you.
• Patients respond to your non-verbal behavior with or
without their awareness.
• Is important and may not be intentional.
• Differ across cultures – eye contact, physical distance, touch
• Be aware of your own and the patient’s.
Non-Verbal Communication
• Is interrelated with verbal behavior.
Examples of how verbal and non-verbal messages are related:
Congruence –
when the verbal message and the non-verbal message agree ex.
“Come in” and a person smiles and gestures to a chair. Congruence
demonstrates how the body shows intensity ex. A person talks
about being scared and talks faster.
Non-Congruence –
when the non-verbal message and the verbal message disagree ex.
Person states, “I like you” with a frown face and an angry voice.
The non-verbal message often carries more “weight”.
Non-Verbal Communication
• Facial expressions communicate emotions. Primary
emotions are hard-wired, automatic and universal. The
whole body conveys the intensity of the emotion.
• Personal space is patient specific, adjust and be aware,
some patients may need 3 to 4 feet between them and
the professional.
• Sends information to the listener ex. When one nods
their head, a person keeps talking and if one shifts their
body position, a person pauses when talking.
Non-Verbal Communication
• It is often helpful to match or pace your behaviors with
the patients.
• Unless the patient is very agitated, use the same
intensity of voice, body posture and breathing pattern as
the patient.
Silence….
• A period of reflection, confusion, guarded behavior or a
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cultural difference.
Do not fill-in short periods with talk automatically.
Pause and ask yourself about the meaning. Check your
assumptions – ask – “You’re sitting very quietly, What is
going on with you? Or “We were talking about… and
there was a period of silence, what does that mean to
you?”
Listening is hard work
• We must concentrate
• We must focus on the other
• When truly listening – our pulse and B/P rise, we
start sweating!
SPEED
Speech – 150 words per minute
Thought – 400-500 words per minute
What happens in the gap?
• Jump to conclusions
• Daydream
• Plan a reply
• Mentally argue with the speaker
Levels of Listening
Superficial listener
• Hears sounds and words – not meaning and content
• May be in the “speed gap”
Non – Listener
• Doesn’t hear; may pretend listening while mentally
elsewhere; interrupts; last word
Levels of Listening
Evaluative listener
• Actively trying to hear, but not making an effort to
understand intent
Logical listener
• Content over feelings/meaning
• Catch the verbal, but miss the visual and vocal
• Believes that they understand
Definitions of Listening Responses
(Core Counseling Skills)
• Clarification – a question such as – “Do you mean
that” or “Are you saying that “ plus a rephrasing of the
client’s message
• Para-phrase – a response to content , a rephrasing of
the content of the client’s message
• Reflection – a response to feelings, a rephrasing of the
affective part of the client’s message
• Summarization – two or more paraphrases or
reflections that condense the client’s messages or the
session
More Examples…
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It seems like….
It appears as…
From my perspective..
As I see it…
I see what you mean..
It looks like…
Sounds like…
Communication
• Speaker doesn’t always feel understood.
Due to gap between listening and thinking
most of us are either superficial or
evaluative listeners.
Essentials of Communication
Things that get in the way:
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Distractions - noise, activity, people, heat, cold, weather
Interruptions
Can it wait? Do you need to do it now?
Will the message create stress?
How will the listener perceive and value the message?
Are their cultural or language barriers?
Are we stereotyping? race, socio- economic, regional,
geographic, faith or sexual preference
Keys to Communication
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Use Clear concise words
Use language that the listener understands
Evaluate your and the other persons stress level
Focus on the present
Choose the right environment
Choose the right time
Perceptions
Culture
Need to convey an atmosphere - that
regardless of time constraints you are
able to spend time
Barriers to Good Communication
 You are bad or you did something bad
 Expressing dissatisfaction thru a third party
 Assuming rather than checking out
 Communication cutoff
 Put-down question
 Should, could, would
 Sarcasm
 Commanding
 Premature advice
The 3 V’s of communication
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% Verbal – the words we use
% Vocal – our tone and intensity
“The music we play with our voice
% Visual – Everything the listener can see
___ 100% Total = the actual meaning received
Messages - Facilitative or Open
• Create positive outcomes
– People communicating with each other feel good
about their interaction
– Usually begin with what or how
– Draw out feeling and ideas
– Encourage specific information on needs, wants,
problems
– Stimulate thinking
Obstructive or Negative
These messages are fraught with difficulty and
make effective communication nearly impossible
– Personalized criticism
• Negative comments about abilities
• Causes loss of confidence/self-esteem
– Judgmental Comments
• Negative or critical remarks about the work
• Offers no information on what needs improving