1. Therapeutic Communication
Chapter 10
Therapeutic Communication
Copyright © 2013 by Elsevier Inc. All rights reserved.

2. Communication (p. 103)
“The reciprocal exchange of information, ideas, beliefs, feelings, and attitudes between two persons or among a group of persons”
Those who work with mentally or emotionally troubled individuals become highly skilled listeners.
What are three ways in which individuals communicate?
Communication is not precise. There are many opportunities for messages to be lost or misunderstood.
Copyright © 2013 by Elsevier Inc. All rights reserved.

3. Theories of Communication (p. 103)
Florence Nightingale
Emphasized the need to effectively understand and communicate with patients
Notes on Nursing
Therapeutic communication did not come into play until 1950’s
List and compare the theories of communication.
What four reasons did Ruesch list to describe interactions that weren’t successful? (interference of sending or receiving messages; inadequate mastery of the language; insufficient information; or no opportunity for feedback)
Copyright © 2013 by Elsevier Inc. All rights reserved.

4. Theories of Communication (p. 103)
J. Ruesch
Saw communication as a circular process in which messages traveled from within one person to another person and back again
Therapeutic communication is distinguished from ordinary communications by the intent of one of the participants to bring about a positive change.
Successful communication
Disturbed communication-unsuccessful
List and compare the theories of communication.
What four reasons did Ruesch list to describe interactions that weren’t successful? (interference of sending or receiving messages; inadequate mastery of the language; insufficient information; or no opportunity for feedback)
Copyright © 2013 by Elsevier Inc. All rights reserved.

5. Theories of Communication cont’d. (p. 104)
Dr. Eric Berne
Used transactional analysis to refer to the process of investigating what people say and do to each other
Berne also believed that three ego states exist within all of us:
The parent who focuses on rules and values
The child who focuses on emotions and desires
The adult who bases his or her approach to the world on previous observations
Berne said that individuals communicate using three “personalities,” child, parent, and adult. What parts of the nurse-client relationship fit this pattern?
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6. Theories of Communication cont’d. (p. 104)
Dr. Eric Berne
He believed these components make up a personality
Structural analysis-study of personality
Ulterior or hidden motives
Need positive feedback
Fostering on one’s abilities can make more satisfying communication
Berne said that individuals communicate using three “personalities,” child, parent, and adult. What parts of the nurse-client relationship fit this pattern?
Copyright © 2013 by Elsevier Inc. All rights reserved.

7. Theories of Communication cont’d. (p. 104)
By learning an individual’s communication patterns, one is able to achieve more effective and fulfilling interactions.
Eye accessing, language pattern, pace, and rhthym
Other theories of communication focus on the following:
The use of body language (kinesics)
How people use their space (proxemics)
Channels of communication
Copyright © 2013 by Elsevier Inc. All rights reserved.

8. Characteristics of Communication (p. 105)
Human behaviors have a strong influence on communications.
Need to have acceptance and respect for all clients
People engage in two types of communications:
Intrapersonal
Take place within oneself and commonly are referred to as our “self-talk” or “self-dialogue”
Interpersonal
Interactions that occur between two or more persons
The verbal and nonverbal messages that are sent and received during every interaction
Two people talking is a simple example of interpersonal communication. If another person wanted to understand what they were saying, would it be enough just to read a transcription of the conversation?
Communication is complicated. It involves the content and context of the message and the perceptions and values of the sender and receiver.

9. Characteristics of Communication cont’d. (p. 105)
Process of communication
Five elements must be present for successful communication:
A sender-forms a message
A receiver-accepts a message
Context or setting-how or where communication takes place
Perception-clarification helps to understand the communication
Evaluation-assessment of the message
Transmission-conscious and unconscious responses
What is unique about these components in the nurse-client relationship? (The nurse-client relationship is different than everyday conversation. It is more analytical, and the nurse wants to help the client make changes.)
What are the potential barriers to each of the components?
What simple techniques are readily available to enhance these components?

10. Characteristics of Communication cont’d. (p. 106)
Factors that influence communication:
Culture
Social class
Relationships
Perceptions
Values
Parts of the message
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11. Levels of Communication (p. 106)
Verbal and nonverbal communication send and receive messages in every interaction
Verbal communication
Relates to anything associated with the spoken word
Understanding verbal messages involves the ability to form abstract ideas and concepts-if not able to do abstract reasoning then need to use simple and concrete reasoning
Represents only a small part of an entire communication
Why is verbal communication important in the nurse-client relationship in the mental health care setting?
Copyright © 2013 by Elsevier Inc. All rights reserved.

12. Levels of Communication cont’d. (p. 107)
Nonverbal communication-Observation
Messages sent and received without the use of words
Messages sent at the nonverbal level are expressed in at least one of four ways:
Appearance
Body motions
Use of space
Non-language sounds
A health care provider is meeting a client for the first time. Can the health care provider use the client’s nonverbal communication to understand him or her? How?
Some clients may be less articulate than others. Understanding their nonverbal communication is critical.
What are some examples of nonverbal communication that might tell a nurse a client is depressed, anxious, angry, and mistrustful?
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13. Intercultural Communication (p. 107)
Intercultural differences
To fulfill basic needs, people must interact and communicate with each other.
Cultural communications may differ in terms of the following:
Communication styles
Nonverbal behaviors
Values
Language
What are some personal and observed examples of cultural communication styles?
How would a client’s grasp and use of language affect intercultural communication?
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14. Therapeutic Communication Skills (p. 108)
The goals of therapeutic communications are to focus on the client and foster the therapeutic relationship.
Therapeutic communication techniques are divided into two areas:
Principles Therapeutic Communication ***Box 10-1***
Listening skills
Concentrate on the speaker.
Listen objectively.
Make sure nonverbal messages match verbal messages.
Follow up.
Clarify.
What are the eight principles of therapeutic communication?
List and describe eight therapeutic communication skills.

15. Therapeutic Communication Skills (p. 109-110)
Interacting skills-Responding strategies
Verbal and nonverbal responses should encourage clients to communicate in a way that encourages growth.
Communicate directly and relate to situation
Do Not Use “WHY”
Important Therapeutic Techniques ***Box 10-5***
What are the eight principles of therapeutic communication?
List and describe eight therapeutic communication skills.
Copyright © 2013 by Elsevier Inc. All rights reserved.

16. Nontherapeutic Communication (p. 110)
Messages that hinder effective communication
Slow or halt the development of a helping relationship
Nontherapeutic Communications ***Box10-2***
Barriers to communication
Behaviors used when one feels threatened
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17. Nontherapeutic Communication cont’d. (p. 110)
The following are methods for coping with barriers to communication:
Recognize that a problem exists.
Identify what purpose or need the problem is filling.
Explore appropriate alternative behaviors.
Implement alternative behaviors when interacting.
Evaluate whether communications have improved.
Copyright © 2013 by Elsevier Inc. All rights reserved.

18. Problems with Communication (p. 111- 112)
Communicating with mentally troubled clients
Problems with communication are a common feature in many forms of mental illness.
Keep from making client become defensive or being challenged or giving false reassurance
Provide an environment that is safe and minimal distractions
Aphasia; Dyslexia; Speech cluttering
Introduce yourself
Maintain good eye contact and attentive behavior
Allow extra time to respond
Importance of appropriate touch
Why is a climate of trust and respect so important when communicating with a client with emotional or mental problems?
How does a health care provider initiate and maintain an environment of trust and respect?

19. Problems with Communication (p. 112)
To communicate effectively with mentally and emotionally troubled clients:
Realize that every interaction is a part of the total therapeutic process.
A climate of trust and respect must be established.
Clients need a routine.
One of the most important tools for communicating with mentally ill clients is therapeutic listening.
Nontherapeutic Communication***Box10-2***
Why is a climate of trust and respect so important when communicating with a client with emotional or mental problems?
How does a health care provider initiate and maintain an environment of trust and respect?

20. Problems with Communication (p. 113)
An assessment of communication important
Assess ability to hear and speak
Note content, quality, and pace of speech
Ability to therapeutically communicate
Practice, patience, continuing evaluation keys to effective communication
Speech Patterns Associated with Psychiatric Problems
***Box10-3***
Why is a climate of trust and respect so important when communicating with a client with emotional or mental problems?
How does a health care provider initiate and maintain an environment of trust and respect?

21. Question 1
In the 1960s, who coined the term transactional analysis to describe the process of investigating what people do and say to each other?
J. Ruesch
Dr. Eric Berne
Dr. Milton Erickson
None of the above
Correct Answer: 2
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22. Question 2
Principles of therapeutic communication include all of the following except:
Concreteness
Reassurance
Respect
Interest
Correct Answer: 2
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23. Question 3
The nurse enters her client’s room and asks the client, “How are you?” Her client responds by saying, “My left hand aches a bit, my nose has been leaking, my hair won’t stay in place…” This is an example of:
Flight of ideas
Loose association
Perseveration
Circumstantiality
Correct Answer: 4
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24. Question 4
The nurse is almost at the end of her shift, and her client tells her that her head hurts. The nurse is yawning while her client is telling her this and is looking at her watch. The nurse responds by stating, “You’re just getting used to your medication.” This is what type of nontherapeutic technique?
Failure to explore the client’s point of view
Failure to probe
Giving inadequate answers
Failure to listen
Correct Answer: 4
Copyright © 2013 by Elsevier Inc. All rights reserved.

25. Question 5
Messages sent and received without the use of words are defined as nonverbal communication. Messages sent at the nonverbal level are expressed in at least one of four ways. Which of the following is not one of them?
Appearance
Smell
Space
Motion
Correct Answer: 2
Copyright © 2013 by Elsevier Inc. All rights reserved.