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Chapter 6
Therapeutic Communication
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication
• Exchange of information
• Verbal
– Content: literal words spoken
– Context: environment, circumstances, situation in
which communication occurs
• Nonverbal
– Process: all messages used to give meaning, context
to message
– Congruent or incongruent message
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Therapeutic Communication
• Interpersonal interactions; focus on patient’s needs
• Need for privacy
• Encompasses goals that facilitate the nursing process
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Therapeutic Communication (cont.)
• Goals of therapeutic communication
– Establish therapeutic relationship
– Identify patient’s most important concerns; assess
patient’s perceptions
– Facilitate patient’s expression of emotions
– Teach patient, family necessary self-care skills
– Recognize patient’s needs; implement interventions
to address patient’s needs
– Guide patient toward acceptable solutions
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Therapeutic Communication (cont.)
• Touch
– Five types: functional/professional; social–polite;
friendship–warmth; love–intimacy; sexual–arousal
– Comforting and supportive; also possible invasion of
intimate and personal space
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Question
• Tell whether the following statement is true or false?
• A distance of 2 feet between the nurse and patient is
adequate for promoting comfortable therapeutic
communication.
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Answer
• False
• Rationale: For effective therapeutic communication, a
distance of 3 to 6 feet between the nurse and patient
would be most appropriate.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Verbal Communication Skills
• Need for concrete, not abstract, messages
• Techniques (see Table 6.1)
– Exploring, focusing, restating, reflecting promotes
discussion of feelings or concerns in more depth
– Other techniques useful in focusing or clarifying what
is being said
– Feedback via making an observation or presenting
reality
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Verbal Communication Skills (cont.)
• Avoidance of nontherapeutic techniques (see Table 6.2)
– Advising, belittling, challenging, probing, reassuring
• Interpretation of signals or cues
– Overt
– Covert (themes, metaphors, proverbs, clichés)
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Nonverbal Communication Skills
• Facial expression
– Expressive
– Impassive
– Confusing
• Body language
– Open body position
– Closed body position
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Nonverbal Communication Skills (cont.)
• Vocal cues
• Eye contact
• Silence
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Therapeutic Communication (cont.)
• Respect for boundaries
– Distance zones
• Intimate (0 to 18 inches)
• Personal (18 to 36 inches)
• Social (4 to 12 feet)
• Public (12 to 25 feet)
– Therapeutic communication: most comfortable when
nurse and patient are 3 to 6 feet apart
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Therapeutic Communication (cont.)
• Active listening (concentrating exclusively on what
patient says)
• Active observation (watching nonverbal actions as
speaker communicates)
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Understanding Meaning, Context, and
Spirituality of Communication
• Meaning: usually more meaning than just spoken word
• Context
– Validation with client of verbal, nonverbal information
– Who, what, when, how, why
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Understanding Meaning, Context, and
Spirituality of Communication (cont.)
• Spirituality
– Self-awareness of own spiritual beliefs
– Need for objectivity and nonjudgmental attitude
about patient’s beliefs
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Cultural Considerations
• Need for awareness of cultural differences
– Speech patterns, habits
– Styles of speech, expression
– Eye contact
– Touch
– Concept of time
– Health, health care
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Which of the following would be a nontherapeutic
communication technique?
– A. Reassuring
–
B. Reflecting
–
C. Focusing
–
D. Exploring
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Answer
•
•
A. Reassuring
Rationale: Reassuring is a nontherapeutic technique
because it attempts to dispel the patient’s feelings.
– Reflecting, focusing, and exploring are examples of
therapeutic communication techniques.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapeutic Communication Session
• Goals
– Establishing rapport
– Identifying issues of concern
– Being empathetic, genuine, caring, unconditionally
accepting of the person
– Understanding patient’s perception
– Exploring patient’s thoughts, feelings
– Developing problem-solving skills
– Promoting patient’s evaluation of solutions
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Therapeutic Communication Session
(cont.)
• Initiation of session
– Introduction
– Establishment of contract for relationship
– Identification of major concern
• Nondirective role (broad-opening, open-ended
questions)
• Directive role (direct yes/no questions; usually for
patients with suicidal thoughts, in crisis, or who
are out of touch with reality)
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Therapeutic Communication Session
(cont.)
• Proper phrasing of questions
– Clarification
– Identification of patient’s avoidance of anxietyproducing topic
• Guidance in problem-solving, empowerment to change
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Assertive Communication
• Expression of positive and negative feelings/ideas in
open, honest, direct way
– Calm, specific factual statements
– Focus on “I” statements
• Possible responses
– Aggressive
– Passive–aggressive
– Passive
– Assertive
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Community-Based Care
• Nurses increasingly caring for high-risk patients in homes;
families becoming more responsible for primary
prevention
• Therapeutic communication techniques and skills are
essential for caring for patients in the community.
• Increased self-awareness, knowledge needed about
cultural differences; sensitivity to beliefs, behaviors,
feelings of others
• Collaboration with patient and family as well as other
health-care providers
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Question
• Tell whether the following statement is true or false?
• Assertive communication focuses on identifying negative
feelings.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• False
• Rationale: Assertive communication focuses on the
expression of positive and negative feelings or ideas in
an open, honest, direct manner.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Self-Awareness Issues
• Nonverbal communication: as important as verbal
• Therapeutic communication influential in effectiveness of
interventions
• Awareness of own communication is first step in
improving communication
– Ask for feedback from colleagues
– Examine own communication skills
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