Communication and the Therapeutic Relationship Chapter 10

Self-awareness Process of understanding one’s own beliefs, thoughts, motivations, biases and physical and emotional limitations, and recognizing how they affect others with whom we interact

Self-awareness Biologic Psychological Social Gender, age, body weight, height and other observed physical characteristics Genetic makeup, chronic illness or physical disability Psychological Psychological makeup Traumatic experiences Social Sociocultural values Acknowledge cultural heritage

Understanding Personal Feelings Avoid projecting personal bias on patient. Ask for feedback from people you know and trust. Behavior change can follow serious introspection if there is a willingness to change.

Communication Therapeutic communication Verbal communication Ongoing process of interaction in which meaning emerges Verbal communication Spoken word, underlying emotion, context, connotation Nonverbal communication Gestures, expressions, body language

Communication and the Therapeutic Process Therapeutic communication: Ongoing process of interaction Focuses on the patient and patient-related issues Signs of slipping into a social relationship Telling patient about personal social life Telling patient about frustrating experiences that relieve stress Letting patient believe that relationship is a friendship

Principles of Therapeutic Communication Patient focus of interaction Attitude sets the tone. Use self-disclosure cautiously and for a purpose. Avoid social relationships. Maintain patient confidentiality. Assess level of understanding. Implement intervention from a theoretical basis.

Principles of Therapeutic Communication Maintain a nonjudgmental interaction. Guide patient to reinterpret experiences rationally. Track verbal interaction with clarifying statements. Avoid changing the subject (unless in the best interest of client).

Techniques of Verbal Communication Acceptance Confrontation Doubt Interpretation Observation Open-ended statements Reflection Restatement Silence Validation

Listening Active Focuses on what patient says Uses open-ended statements, questions Avoid changing subject Positive body language Passive Sitting quietly Letting patient talk Boring body language

Selecting a Technique Listen to verbal and non-verbal. Decide goal of communication. Clarify Problem solve Support

Therapeutic Communication Concepts Rapport: Interpersonal harmony characterized by understanding and respect Empathy: Ability to experience, in the present, the situation as another did at some time in the past Boundaries: Defining limits of persons, objects or relationships

Boundaries Physical: Body space zones Social: Psychological Parent-child relationships Romantic relationship Psychological Nurse-patient relationship Problems when: Professional relationship turns into social one. Needs of the nurse are met at expense of patient.

Defense Mechanisms Projection Projective identification Rationalization Reaction formation Repression Self-assertion Self-observation Splitting Acting out Affiliation Altruism Anticipation

Defense Mechanism (cont.) Autistic fantasy Devaluation Displacement Dissociation Help-rejecting Humor Idealization Autistic fantasy Denial Sublimation Suppression Undoing

Analyzing Interactions Process Recordings Analysis Symbolism Themes Communication blocks

Nurse-Patient Relationship (Table 10.6) Orientation Phase First meeting Confidentiality Commits to a therapeutic relationship Testing the relationship Working Phase Identification of problems Problem solving Resolution Phase Problems resolve. Relationship ends.