Therapeutic Communication the helping interview

Helping Relationship Characteristics Caring Caring Hopeful Hopeful Sensitive Sensitive Genuineness Genuineness Empathy Empathy Positive regard Positive regard Empowering Empowering Assertive Assertive

Helping vs Social Relationships HELPING HELPING Care Care Trust Trust Growth Growth Purposeful/intentional Purposeful/intentional Unequal sharing Unequal sharing Focus on Clients needs Focus on Clients needs Time limited Time limited SOCIAL SOCIAL Care Care Trust Trust Growth Growth Spontaneous Spontaneous Usually equal or near equal sharing Usually equal or near equal sharing Focus on needs of Focus on needs of both individuals both individuals Ongoing Ongoing

LOCUS OF CONTROL THOSE GIVING HELP THOSE GIVING HELP Feeling important Feeling important Feeling useful Feeling useful Feeling powerful Feeling powerful Feeling gratified Feeling gratified Feeling happy Feeling happy THOSE NEEDING HELP THOSE NEEDING HELP Feeling unimportant or inadequate Feeling unimportant or inadequate Feeling useless or depressed Feeling useless or depressed Feeling powerless Feeling powerless Feeling frightened or embarrassed Feeling frightened or embarrassed Feeling sad or angry Feeling sad or angry

Phases of Helping Relationship Orientation (professional and client to each other) Orientation (professional and client to each other) Working (identification of the clients problem) Working (identification of the clients problem) Termination (resolution of the clients problem) Termination (resolution of the clients problem)

Orientation Phase Getting to know you phase Getting to know you phase Sets the tone Sets the tone Introductions Introductions Roles Roles Initiated by the nurse Initiated by the nurse Agreement/contract/goals Agreement/contract/goals Orientation Orientation Trust develops Trust develops

Working Phase Problem solving phase Problem solving phase Attend to clients needs Attend to clients needs Nurse in role of teacher/counselor Nurse in role of teacher/counselor Client actively participates Client actively participates Gather further data Gather further data Facilitate change Facilitate change Evaluate problems & goals Evaluate problems & goals

Termination/Resolution Phase Review and summarize progress & goals met/not met Review and summarize progress & goals met/not met Acknowledge feelings Acknowledge feelings Clients mostly seeking explanation Clients mostly seeking explanation How will problem affect their lives? How will problem affect their lives? What will need to be changed? What will need to be changed? How will they cope? How will they cope?

Avoid Arguing Arguing Minimizing Minimizing Challenging Challenging Giving false reassurance Giving false reassurance Interpreting or speculating on the dynamics of the clients problems Interpreting or speculating on the dynamics of the clients problems Selling client on accepting treatment Selling client on accepting treatment Probing sensitive areas Probing sensitive areas Participating in criticism of any staff member Participating in criticism of any staff member Joining any attacks led by the client Joining any attacks led by the client

Attentive Listening Scale -THINGS TO AVOID Lack of eye contact Lack of eye contact Responding before the other finishes speaking Responding before the other finishes speaking Finishing other peoples sentences Finishing other peoples sentences Talking so much that others cannot respond Talking so much that others cannot respond Continuing to work while someone is talking to you Continuing to work while someone is talking to you Repeat a point just made Repeat a point just made Allow your mind to wander during a conversation Allow your mind to wander during a conversation

Active Listening STOP TALKING STOP TALKING Put the speaker at ease Put the speaker at ease Show that you want to listen Show that you want to listen Remove distractions Remove distractions Be empathetic Be empathetic Be patient Be patient Hold your temper Hold your temper Avoid criticism & argument Avoid criticism & argument STOP TALKING STOP TALKING

Interviewing Techniques the purpose of the interview is the purpose of the interview is to obtain accurate & thorough information to obtain accurate & thorough information begin with an explanation begin with an explanation use open-ended questions use open-ended questions (exception: use closed-ended to obtain (exception: use closed-ended to obtain specific information) specific information) Validating/Clarifying Validating/Clarifying Reflecting Reflecting Sequencing Sequencing Acknowledging feelings Acknowledging feelings

Interviewing Techniques Validating & Clarifying Validating & Clarifying Reflecting & Paraphrasing Reflecting & Paraphrasing Sequencing Sequencing Acknowledging feelings Acknowledging feelings Sharing Observations Sharing Observations

Effective Techniques as a professional nurse, you will spend about half of your time asking questions of clients and colleagues as a professional nurse, you will spend about half of your time asking questions of clients and colleagues excellent questioning/interviewing skills are fundamental to nurses excellent questioning/interviewing skills are fundamental to nurses

Why, What, How? why do you need the information? why do you need the information? how will the information I am seeking direct me in helping my client? how will the information I am seeking direct me in helping my client? explain reasons in advance, explain reasons in advance, as this prepares clients for your line as this prepares clients for your line of questioning of questioning what will you ask? what will you ask? how will you phrase your questions? how will you phrase your questions?

Who to Ask? if client is able to speak for themselves, if client is able to speak for themselves, ask them ask them family perspectives may also be important family perspectives may also be important written consent may be required to question concurrent/previous healthcare providers written consent may be required to question concurrent/previous healthcare providers be courteous and respectful be courteous and respectful never forget client confidentiality never forget client confidentiality

Communication Barriers A barrier to communication is something that keeps meanings from meeting. Meaning barriers exist between all people, making communication more difficult than most people seem to realize. A barrier to communication is something that keeps meanings from meeting. Meaning barriers exist between all people, making communication more difficult than most people seem to realize. (Ruel Howe) (Ruel Howe)

Communication Barriers without realizing it, people typically interject communication barriers into conversation 90% of the time without realizing it, people typically interject communication barriers into conversation 90% of the time communication barriers trigger communication barriers trigger defensiveness, resistance and resentment, withdrawal, and feelings of inadequacy defensiveness, resistance and resentment, withdrawal, and feelings of inadequacy they also decrease the likelihood of they also decrease the likelihood of finding a solution finding a solution

Judging criticizing: making a negative evaluation of persons, their actions or attitudes criticizing: making a negative evaluation of persons, their actions or attitudes putting down: stereotyping putting down: stereotyping diagnosing: analyzing why a person is behaving the way he/she is diagnosing: analyzing why a person is behaving the way he/she is praising evaluatively: making a positive judgment of person, actions or attitudes praising evaluatively: making a positive judgment of person, actions or attitudes

Avoiding the Others Concerns diverting: pushing the other persons problems aside through distractions diverting: pushing the other persons problems aside through distractions logical argument: attempting to convince the other person with an appeal to facts or logic without consideration of the emotional factors involved logical argument: attempting to convince the other person with an appeal to facts or logic without consideration of the emotional factors involved False reassurance: trying to stop the other person from feeling the negative emotions False reassurance: trying to stop the other person from feeling the negative emotions they are experiencing they are experiencing

Other Barriers ordering: commanding the other person to do what you want ordering: commanding the other person to do what you want threatening: trying to control the other persons actions by warning of negative consequences you will impose threatening: trying to control the other persons actions by warning of negative consequences you will impose moralizing: preaching, telling someone what they should do moralizing: preaching, telling someone what they should do excessive/inappropriate questioning excessive/inappropriate questioning

Other Barriers closed ended questions, like are you sorry you did it? closed ended questions, like are you sorry you did it? advising: giving the solution advising: giving the solution

Common Errors long winded buildup long winded buildup (use KISS principle & be concise & focused) (use KISS principle & be concise & focused) the thunder stealer: jumping in with your views & opinions before giving them the thunder stealer: jumping in with your views & opinions before giving them a chance a chance bombarding patients with questions bombarding patients with questions complicated medical terms- complicated medical terms- dont use terms patients cant understand dont use terms patients cant understand

Common Errors offensive misuse of why appears threatening and aggressive offensive misuse of why appears threatening and aggressive closed questions closed questions being too abrupt being too abrupt use of clichés use of clichés

Blocks to Communication Failure to respect client Failure to respect client Failure to listen Failure to listen Minimizing feelings Minimizing feelings Inappropriate comments & questions Inappropriate comments & questions Excessive questions Excessive questions Clichés Clichés Yes/no questions Yes/no questions Probing Probing Changing the subject Changing the subject Leading questions Leading questions Advice Advice Judgments Judgments False reassurance False reassurance Giving approval/disapproval Giving approval/disapproval

Blocks to Communication

Therapeutic Versus Nontherapeutic Communication Facilitates transformation of working nurse-patient relationship Facilitates transformation of working nurse-patient relationship Relationship allows for adequate & accurate data collection & assessment Relationship allows for adequate & accurate data collection & assessment Performed with & not for patient Performed with & not for patient

Therapeutic Versus Nontherapeutic Communication NON-THERAPEUTIC NON-THERAPEUTIC Hinders relationship formation Hinders relationship formation Prevents patient from becoming mutual partner & relegates him/her to passive recipient of care Prevents patient from becoming mutual partner & relegates him/her to passive recipient of care

Self-Disclosure Use self disclosure to help clients open up Use self disclosure to help clients open up to you – not to meet your own needs to you – not to meet your own needs Keep disclosures brief Keep disclosures brief Dont imply that your experience is exactly the same as the clients Dont imply that your experience is exactly the same as the clients Only self-disclose about situations you have mastered Only self-disclose about situations you have mastered Monitor your own comfort with Monitor your own comfort with self-disclosure self-disclosure Respect your clients needs for privacy Respect your clients needs for privacy Remember that there are cultural variations in the amount of self- disclosure considered appropriate Remember that there are cultural variations in the amount of self- disclosure considered appropriate Identify risks and benefits of self disclosure Identify risks and benefits of self disclosure