Handout Therapeutic Communication

Therapeutic Communication
Conditions Essential to Development of a Therapeutic Relationship
 Rapport
Getting acquainted and establishing rapport is the primary task in relationship development.
 implies special feelings on the part of both the client and the nurse based on
acceptance, warmth, friendliness, common interest, a sense of trust, and a non-
judgmental attitude.
 Respect
To show respect is to believe in the dignity and worth of an individual regardless of his
or her unacceptable behavior. The psychologist Carl Rogers called this unconditional positive
regard (Raskin, Rogers, & Witty, 2014, Townsend, 2018).
The attitude is nonjudgmental, and the respect is unconditional in that it does not
depend on the behavior of the client to meet certain standards.
The nurse can convey an attitude of respect by:
■ Calling the client by name (and title, if he or she prefers).

■ Spending time with the client.
■ Allowing sufficient time to answer the client’s questions and concerns.
■ Promoting an atmosphere of privacy during therapeutic interactions with the client and
during physical examination or therapy.
■ Always being open and honest with the client, even when the truth may be difficult to
discuss.
■ Listening to the client’s ideas, preferences, and opinions and making collaborative decisions
concerning his or her care whenever possible.
■ Striving to understand the motivation behind the client’s behavior regardless of how
unacceptable it may seem.
 Empathy
Is the ability to see beyond outward behavior and understand the situation from the client’s
point of view. With empathy, the nurse can accurately perceive and comprehend the meaning
and relevance of the client’s thoughts and feelings. The nurse must also be able to
communicate this perception to the client by attempting to translate words and behaviors into
feelings.
 Trust
To trust another, one must feel confidence in that person’s presence, reliability, integrity,
veracity, and sincere desire to provide assistance when requested.
 Genuineness
The concept of genuineness refers to the nurse’s ability to be open, honest, and “real” in
interactions with the client. To be real is to be aware of what one is experiencing internally and
to allow the quality of this inner experience to be apparent in the therapeutic relationship.
When one is genuine, there is congruence between what is felt and what is expressed.
Four phases of therapeutic relationship

1. the pre-interaction phase
2. the orientation (introductory) phase
3. the working phase, and
4. the termination phase
Although each phase is presented as specific and distinct from the others, there may be
some overlap of tasks, particularly when the interaction is limited.
The pre-interaction phase involves preparation for the first encounter with the client.
Tasks include:
■ Obtaining available information about the client from his or her chart, significant others, or
other health-care team members. From this information, the initial assessment begins. The
nurse may also become aware of personal responses to knowledge about the client.
■ Examining one’s feelings, fears, and anxieties about working with a particular client. For
example, the nurse may have been reared in an alcoholic family and have ambivalent feelings
about caring for a client who is dependent on alcohol.
All individuals bring attitudes and feelings from prior experiences to the clinical setting.
The nurse needs to be aware of how these preconceptions may affect his or her ability to care
for individual clients.
The Orientation (Introductory) Phase

During the orientation phase, the nurse and client become acquainted.
Tasks include:
■ Creating an environment for the establishment of trust and rapport.
■ Establishing a contract for intervention that details the expectations and responsibilities of
both nurse and client.
■ Gathering assessment information to build a strong client database.
■ Identifying the client’s strengths and limitations.
■ Formulating nursing diagnoses.
■ Setting goals that are mutually agreeable to the nurse and client.
■ Developing a plan of action that is realistic for meeting the established goals.
■ Exploring feelings of both the client and nurse in terms of the introductory phase.
The Working Phase

The therapeutic work of the relationship is accomplished during this phase.
Tasks include:
■ Maintaining the trust and rapport established during the orientation phase.
■ Promoting the client’s insight and perception of reality.
■ Problem-solving
■ Overcoming resistance behaviors on the part of the client as the level of anxiety rises in
response to discussion of painful issues.
■ Continuously evaluating progress toward goal attainment
The Termination Phase

Termination of the relationship may occur for a variety of reasons:
 the mutually agreed-on goals may have been reached,
 the client may be discharged from the hospital,
 or, in the case of a student nurse, the clinical rotation ends.
Termination can be difficult for both the client and nurse. The main task involves bringing a
therapeutic conclusion to the relationship. This occurs when:
■ Progress has been made toward attainment of mutually set goals.
■ A plan for continuing care or for assistance during stressful life experiences is mutually
established by the nurse and client.
■ Feelings about termination of the relationship are recognized and explored. Both the nurse
and client may experience feelings of sadness and loss. The nurse should share his or her
feelings with the client. Through these interactions, the client learns that it is acceptable to
have these kinds of feelings at a time of separation.
Interpersonal Communication Techniques
What Is Communication?
An interactive process of transmitting information between two or more entities.
The Communication Process
The Impact of Preexisting Conditions

In all interpersonal transactions, the sender and receiver each bring certain preexisting
conditions to the exchange that influence both the intended message and the way in which it is
interpreted.
Examples of these conditions include:
 one’s value system
 internalized attitudes and beliefs
 culture and religion
 social status
 gender
 background knowledge
 experience
 and age or developmental level.
The type of environment in which the communication takes place may also influence the
outcome of the transaction.
Transactional Model of Communication
Nonverbal Communication
About 70 to 80 percent of all effective communication is nonverbal (Khan, 2014, Townsend,
2018).
Other components of nonverbal communication include:
 physical appearance and dress
 body movement and posture
 touch, facial expressions
 eye behavior, and vocal cues or paralanguage.
These nonverbal messages vary from culture to culture.
Therapeutic Communication
Caregiver verbal and nonverbal techniques that focus on the care receiver’s needs and
advance the promotion of healing and change. Therapeutic communication encourages
exploration of feelings and fosters understanding of behavioral motivation. It is nonjudgmental,
discourages defensiveness, and promotes trust.
Effective communication skills, including verbal and nonverbal techniques, are the
building blocks for all successful relationships.
The nurse–patient relationship is built on therapeutic communication, the on- going
process of interaction through which meaning emerges.
Verbal communication, which is principally achieved by spoken words, includes the
underlying emotion, context, and connotation of what is actually said.
Nonverbal communication includes gestures, expressions, and body language.
Both the patient and the nurse use verbal and nonverbal communication. To respond
therapeutically in a nurse–patient relationship, the nurse is responsible for assessing and
interpreting all forms of patient communication.
Principles of Therapeutic Communication

 The patient should be the primary focus of the interaction.
 A professional attitude sets the tone of the therapeutic relationship.
 Use self-disclosure cautiously and only when the disclosure has a therapeutic purpose.
 Avoid social relationships with patients.
 Maintain patient confidentiality.
 Assess the patient’s intellectual competence to determine the level of understanding.
 Implement interventions from a theoretic base.
 Maintain a nonjudgmental attitude. Avoid making judgments about the patient’s
behavior.
 Avoid giving advice.
 Guide the patient to reinterpret his or her experiences rationally.
 Track the patient’s verbal interaction through the use of clarifying statements.
 Avoid changing the subject unless the content change is in the patient’s best interest.
The process of verbal communication involves a sender, a message, and a receiver.
The patient is often the sender, and the nurse is often the receiver, but communication is
always two-way. The patient formulates an idea, encodes that message (puts ideas into
words), and then transmits the message with emotion. The patient’s words and their
underlying emotional tone and connotation communicate the individual’s needs and
emotional problems. The nurse receives the message, decodes it (interprets the message,
including its feelings, connotation, and context), and then responds to the patient.
Hays and Larson (1963, Townsend, 2018), identified number of techniques to
assist the nurse in interacting more therapeutically with clients. These are
important “technical procedures” carried out by the nurse working in psychiatry,
and they should serve to enhance development of a therapeutic nurse-client
relationship.
References:
Boyd, Mary Ann (2018). Psychiatric Nursing Contemporary Practice

Wolters Kluwer
Townsend, Mary C. (2018). Psychiatric Mental Health Nursing: Concepts of Care in Evidence
Based Practice 9th ed. F. A. Davis Company
Prepared by:
Prof. Lucynell C. Balao, RN, MAN, MAPsych

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Therapeutic Communication

Conditions Essential to Development of a Therapeutic Relationship

The nurse can convey an attitude of respect by:

■ Calling the client by name (and title, if he or she prefers).

Four phases of therapeutic relationship

The Orientation (Introductory) Phase

The Working Phase

The Termination Phase

The Impact of Preexisting Conditions

Transactional Model of Communication

Principles of Therapeutic Communication

Hays and Larson (1963, Townsend, 2018), identified number of techniques to

Boyd, Mary Ann (2018). Psychiatric Nursing Contemporary Practice

Prof. Lucynell C. Balao, RN, MAN, MAPsych

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