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Chapter 10
Therapeutic Communication
Copyright © 2013 by Elsevier Inc. All rights reserved.
Learning Objectives
1)
2)
3)
4)
Examine two theories of communication.
Identify two types of communication.
List the five components or parts of any
communication.
Compare the characteristics of verbal and
nonverbal communications.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 2
Learning Objectives
5)
6)
7)
8)
Identify three interventions for communicating
with people who do not speak your language.
Explain eight principles of therapeutic
communication.
Describe eight therapeutic communication
skills.
Name three techniques for communicating
with clients who have mental-emotional
problems.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 3
Communication (p. 103)


“The reciprocal exchange of information,
ideas, beliefs, feelings, and attitudes between
two persons or among a group of persons”
Those who work with mentally or emotionally
troubled individuals become highly skilled
listeners.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 4
Theories of Communication
(p. 103)

Florence Nightingale


Emphasized the need to effectively understand
and communicate with patients
J. Ruesch


Saw communication as a circular process in which
messages traveled from within one person to
another person and back again
Therapeutic communication is distinguished from
ordinary communications by the intent of one of
the participants to bring about a positive change.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 5
Theories of Communication
cont’d. (p. 104)

Dr. Eric Berne


Used transactional analysis to refer to the process
of investigating what people say and do to each
other
Berne also believed that three ego states exist
within all of us:
• The parent who focuses on rules and values
• The child who focuses on emotions and desires
• The adult who bases his or her approach to the world on
previous observations
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 6
Theories of Communication
cont’d. (p. 104)


By learning an individual’s communication
patterns, one is able to achieve more
effective and fulfilling interactions.
Other theories of communication focus on the
following:

The use of body language (kinesics)
 How people use their space (proxemics)
 Channels of communication
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 7
Characteristics of
Communication (p. 105)


Human behaviors have a strong influence on
communications.
People engage in two types of
communications:

Intrapersonal
• Take place within oneself and commonly are referred to
as our “self-talk” or “self-dialogue”

Interpersonal
• Interactions that occur between two or more persons
• The verbal and nonverbal messages that are sent and
received during every interaction
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 8
Characteristics of
Communication cont’d. (p. 105)

Process of communication

Five elements must be present for successful
communication:
• A sender
• A receiver
• Perception
• Evaluation
• Transmission
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 9
Characteristics of
Communication cont’d. (p. 106)

Factors that influence communication:

Culture
 Social class
 Relationships
 Perceptions
 Values
 Parts of the message
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 10
Levels of Communication
(p. 106)

Verbal communication



Relates to anything associated with the spoken
word
Understanding verbal messages involves the
ability to form abstract ideas and concepts
Represents only a small part of an entire
communication
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 11
Levels of Communication
cont’d. (p. 107)

Nonverbal communication


Messages sent and received without the use of
words
Messages sent at the nonverbal level are
expressed in at least one of four ways:
• Appearance
• Body motions
• Use of space
• Non-language sounds
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 12
Intercultural Communication
(p. 107)

Intercultural differences


To fulfill basic needs, people must interact and
communicate with each other.
Cultural communications may differ in terms of the
following:
• Communication styles
• Nonverbal behaviors
• Values
• Language
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 13
Therapeutic Communication
Skills (p. 108)


The goals of therapeutic communications are to focus on
the client and foster the therapeutic relationship.
Therapeutic communication techniques are divided into
two areas:


Listening skills
• Concentrate on the speaker.
• Listen objectively.
• Make sure nonverbal messages match verbal messages.
• Follow up.
• Clarify.
Interacting skills
• Verbal and nonverbal responses should encourage
clients to communicate in a way that encourages growth.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 14
Nontherapeutic
Communication (p. 110)

Messages that hinder effective
communication


Slow or halt the development of a helping
relationship
Barriers to communication

Behaviors used when one feels threatened
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 15
Nontherapeutic
Communication cont’d. (p. 110)

The following are methods for coping with
barriers to communication:

Recognize that a problem exists.
 Identify what purpose or need the problem is
filling.
 Explore appropriate alternative behaviors.
 Implement alternative behaviors when interacting.
 Evaluate whether communications have improved.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 16
Problems with Communication
(p. 112)

Communicating with mentally troubled clients

Problems with communication are a common feature in
many forms of mental illness.
 To communicate effectively with mentally and
emotionally troubled clients:
• Realize that every interaction is a part of the total
therapeutic process.
• A climate of trust and respect must be established.
• Clients need a routine.

One of the most important tools for
communicating with mentally ill clients is
therapeutic listening.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 17
Question 1
In the 1960s, who coined the term transactional
analysis to describe the process of investigating
what people do and say to each other?
1)
J. Ruesch
2)
Dr. Eric Berne
3)
Dr. Milton Erickson
4)
None of the above
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 18
Question 2
Principles of therapeutic communication include
all of the following except:
1)
Concreteness
2)
Reassurance
3)
Respect
4)
Interest
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Slide 19
Question 3
The nurse enters her client’s room and asks the
client, “How are you?” Her client responds by
saying, “My left hand aches a bit, my nose has
been leaking, my hair won’t stay in place…”
This is an example of:
1)
Flight of ideas
2)
Loose association
3)
Perseveration
4)
Circumstantiality
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 20
Question 4
The nurse is almost at the end of her shift, and her
client tells her that her head hurts. The nurse is
yawning while her client is telling her this and is
looking at her watch. The nurse responds by stating,
“You’re just getting used to your medication.” This is
what type of nontherapeutic technique?
1)
Failure to explore the client’s point of view
2)
Failure to probe
3)
Giving inadequate answers
4)
Failure to listen
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 21
Question 5
Messages sent and received without the use of
words are defined as nonverbal communication.
Messages sent at the nonverbal level are
expressed in at least one of four ways. Which of
the following is not one of them?
1)
2)
3)
4)
Appearance
Smell
Space
Motion
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 22