Therapeutic Communication

You use therapeutic communication techniques to promote understanding and establish a constructive relationship with the client. Therapeutic communication is planned, and is client- and goal-directed. It means listening to and understanding the client while promoting clarification and insight. It enables the nurse to form a working relationship with the client and peers, using both verbal and nonverbal communication. Remember that nonverbal communication is the most accurate reflection of attitude.

You should be familiar with the foundations for a therapeutic relationship, which include:

• An understanding of the factors influencing communication
• Realization of the importance of nonverbal communication
• Development of effective communication skills
• Recognition of the causes of ineffective communication
• Ability to participate in a therapeutic communication process

You should also be familiar with the conditions essential for a therapeutic relationship, which include:

• Empathy
• Respect
• Genuineness
• Self-disclosure
• Concreteness and specificity
• Confrontation (limited to a well-established nurse/client relationship with an accepting, gentle manner)

It is important to understand the client’s views and feelings before responding. You also need to recognize barriers to effective communication, such as:

• Failure to listen
• Improperly decoding the client’s intended message
• Placing the nurse’s needs above the client’s needs
• Stereotyping, challenging, probing, and/or rejecting
• Being defensive
• Changing topics and subjects
• Passing judgment

Effective therapeutic responses include:

• Using silence: Allows the client time to think and reflect; conveys acceptance; allows the client to take the lead in the conversation
• Using general leads or a broad opening: Encourages the client to talk; indicates your interest in the client; allows the client to choose the subject
• Clarification: Encourages recall and details of a particular experience; encourages description of feelings; seeks explanation; pinpoints specifics
• Reflecting: Paraphrases what client says