Download Chapter 11

Chapter 11Therapeutic
Communication and
Relationships
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Listen
When I ask you to listen to me and you start
giving advice, you have not done what I
asked.
When I ask you to listen to me and you begin
to tell me why I shouldn’t feel that way, you
are trampling on my feelings.
When I ask you to listen to me and you feel
you have to do something to solve my
problem, you have failed me, strange as that
may seem.
Listen! All I asked was that you listen, not
talk or do—just hear me.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
And I can do for myself; I’m not helpless.
Maybe discouraged and faltering, but not helpless.
When you do something for me that I can and need
to do for myself, you contribute to my fear and
weakness.
But, when you accept as a simple fact that I do feel
what I feel,
no matter how irrational, then I can quit trying to
convince you and can get about the business of
understanding what’s behind this irrational feeling.
And when that’s clear, the answers are obvious and
I don’t need advice.
So, please listen and just hear me. And, if you want
to talk, wait a minute for your turn; and I’ll listen for
you.
Anonymous
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives
After studying this chapter, you should be able to
•
Explain the process of communication
•
Distinguish the factors that influence communication
•
Describe the importance of assessing nonverbal
communication
•
Articulate the relationship between comfort zones and
effective communication skills
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives (cont.)
•
Recognize factors that contribute to ineffective
communication
•
Compare and contrast social and therapeutic
communication
•
Formulate a list of therapeutic communication
techniques
•
Demonstrate an understanding of the importance
of confidentiality in the clinical setting
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives (cont.)
•
Develop a sample interaction recording in the
clinical setting
•
Construct a list of the essential conditions for a
therapeutic relationship as described by Carl
Rogers
•
Describe the six subroles of the psychiatric–mental
health nurse identified by Hildegard Peplau
•
Discriminate the phases of a therapeutic one-toone relationship
•
Articulate a list of potential boundary violations
that may occur during a therapeutic relationship
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication
•
Factors influencing
communication:
– Attitude
– Sociocultural or ethnic
background
– Past experiences
– Knowledge of subject
matter
– Ability to relate to others
– Interpersonal perceptions
– Environmental factors
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Communication
• Verbal communication
• Nonverbal communication
– Vocal cues
– Gestures
– Physical appearance
– Distance or spatial territory
– Position or posture
– Touch
– Facial expression
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Zones of Distance Awareness
Therapeutic
communication
occurs in the
personal zone.
Intimate
Personal
Social
Public
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Communication
• Effective therapeutic communication
• Ineffective therapeutic communication
– Failure to listen
– Conflicting verbal and nonverbal messages
– A judgmental attitude
– Misunderstanding because of multiple meanings of English words
– False reassurance
– Giving of advice
– Disagreement with or criticism of a person who is seeking support
– The inability to receive information because of a preoccupied or
impaired thought process
– Changing of the subject if one becomes uncomfortable with the
topic being discussed
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Social Versus Therapeutic Communication
Purtilo & Haddad (2002)
Social Communication
Therapeutic Communication
• It is doing a favor for another
person or giving advice.
• It promotes the functional use of
one’s inner resources, encouraging
verbalization of feelings or exploring
ways to cope.
• A personal or intimate relationship
occurs.
• The identification of needs may not
occur.
• Personal goals may or may not be
discussed.
• Constructive or destructive
dependency may occur.
• A variety of resources may be used
during socialization.
• A personal, but not intimate,
relationship occurs.
• Needs are identified by the client
with the help of the nurse.
• Personal goals are set by the client.
• Constructive dependency,
interdependency, and independence
are promoted.
• Specialized professional skills are
used.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Approaches for Therapeutic Interactions
(Purtilo, 1978)
• Translate any technical information into layperson’s
terms.
• Clarify and restate any instructions or information given.
Clients usually do not ask doctors or nurses to repeat
themselves.
• Display a caring attitude.
• Exercise effective listening.
• Do not overload the listener with information.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Conditions Essential for a Therapeutic
Relationship
• Empathy
• Concreteness and
specificity
• Respect
• Confrontation
• Genuineness
• Self-disclosure
• Immediacy of relationship
• Client self-exploration
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Roles of the Psychiatric Nurse
• Nurse–teacher
• Mother surrogate
• Technical nurse
• Nurse–manager
• Socializing agent
• Counselor or nurse–therapist
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Phases of a Therapeutic Relationship
• Initiating or orienting phase
– Building trust and rapport by demonstrating acceptance
– Establishing a therapeutic environment, ensuring safety and
privacy
– Establishing a mode of communication acceptable to both
the client and the nurse
– Initiating a therapeutic contract by establishing a time,
place, and duration for each meeting, as well as the length
of time the relationship will be in effect
– Assessing the client’s needs, coping strategies, defense
mechanisms, strengths and weaknesses
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Phases of a Therapeutic Relationship
(cont.)
• Working phase
– Exploring the client’s perception of reality and providing
constructive feedback
– Helping the client develop positive coping behaviors
– Identifying available support systems
– Promoting a positive self-concept by focusing on what the client
can do and not what the client cannot do
– Encouraging verbalization of feelings
– Promoting client independence by teaching new skills
– Developing a plan of action with realistic goals
– Implementing the plan of action
– Evaluating the results of the plan of action
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Phases of a Therapeutic Relationship
(cont.)
• Terminating phase
– Provides self-care and maintains his or her
environment
– Demonstrates independence and works
interdependently with others
– Copes positively when experiencing feelings such as
anxiety, anger, or hostility
– Demonstrates emotional stability
– Identifies the progress he or she has made
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Interacting with Difficult Clients
• Do not take the client’s words personally.
• Validate the client’s emotions.
• Speak slowly in a soft, low voice.
• Maintain a safe physical distance.
• Ask simple questions such as “How can I help you?”
• Appear confident and speak in a firm, yet amicable,
tone to maintain control of the situation.
• Be familiar with the facility’s emergency plan, and do
not hesitate to employ it if the situation warrants
serious action.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Key Terms
• Comfort zones
• Social communication
• Communication
• Therapeutic
communication
• Countertransference
• Nonverbal communication
• Parataxic distortion
• Process recording
• Professional boundaries
• Therapeutic relationship
• Transference
• Verbal communication
• Zones of distance
awareness
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reflection
Reflect on the quote at the beginning of the chapter.
• Do any of the statements
apply to you?
• If so, which ones?
• What actions can you take
to improve your listening
skills?
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
?