1. Therapeutic Techniques

2. Therapeutic Techniques
Introducing self
Enables client to meet nurse
Offering self
The nurse offers his or her presence, interest, and desire to understand without making any demands on the patient.
“We can sit here quietly; there’s no need to talk unless you want to.”

3. Therapeutic Techniques
Active Listening
Utilizing both verbal and nonverbal skills that show the client that the nurse is attentive to what is being said
Facing client; maintaining eye contact; “Go on, I hear what you are saying.”

4. Therapeutic Techniques
Open questions
Assist the client to discuss and clarify what is on their minds, what concerns them, and their attitudes and feelings
Allow clients the freedom of expression and doesn’t impose excessive limits
“Where would you like to begin?”
“What brought you into the hospital?”

5. Therapeutic Techniques
Closed questions
Provide structure
Replies are usually “yes” or “no”
Little freedom in latitude of response
“Where is your pain?’
“Are you feeling suicidal?”

6. Therapeutic Techniques
Waiting in Silence
Used so that the client has time to verbalize feelings
Empathizing
Demonstrates warmth and acknowledges client’s feelings
“That must have been very difficult for you.”

7. Therapeutic Techniques
Providing Information
Nurse gives patient facts or specific information that is needed
Questions are answered simply and directed
“You are on the locked unit now.”
“Here is a copy of the unit rules; let’s go over a few important items.”

8. Therapeutic Techniques
Restating
Using different words to repeat the main idea the patient has expressed
Lets the client know that the nurse has heard and understands them
You say that you are saddened by your friend’s death.”

9. Therapeutic Techniques
Clarifying
The nurse makes an effort to have the patient clarify comments that are vague
“You spoke so softly I did not hear what you said.”
“I’m not able to follow that thought; could you tell me a little more about it?”

10. Therapeutic Techniques
Offering Reality
The nurse notices that the patient is misinterpreting reality
An effort is made to indicate what is real from unreal
“That’s a stain on the blanket, it is not a bug.”
“The scream came from the program on TV.”

11. Therapeutic Techniques
Stating Observations
Nurse offers a view of what is seen or heard to increase verbalization
“I see you are quite anxious.”
“You keep rubbing you forehead; are you in discomfort?”

12. Therapeutic Techniques
Summarizing
A concise review of the main ideas that have been discussed
Allows clients to sense whether the nurse understood their message
“From what you describe, your family seems….”

13. Therapeutic Techniques
Focusing
Focuses on a subject until the important points come into clear view for both the client and the nurse
“You touched on his drinking. Tell me more about that.”
Encouraging plan formation
Helps the client develop steps to make changes and solve problems
“Can you think of another way you might be able to handle a situation like this?”
“In what way can you make these visits less upsetting?”

14. Therapeutic Techniques
Role Playing
The nurse plays the part of a person the client needs to say something to
“Let’s go over what you want to say to her.”
Confronting
The nurse supports the client but directly challenges inaction on the part of the client
“You keep telling me that you want to quit drinking, but what actions have you taken thus far to aid with your sobriety?”

15. Encouraging evaluation –
Reflecting - directing back to the client’s questions, feelings, ideas; encouraging client to bring forth his/her own ideas, which the nurse thereby acknowledges
Client: “Do you think I should tell the doctor?”
Nurse: “You are wondering if it is important?”
Encouraging evaluation –
“What are your feelings in regard to…? Does this contribute to your discomfort?”

16. Verbalizing the implied
Client: “My wife pushes me around just like my mother & sister do.”
Nurse: “Is it your impression that women are domineering?”
Attempting to translate in to feelings
Client: “I’ve been in the hospital for 6 weeks. I might as well be dead.”
Nurse: “You think that you’re not getting better?”

17. Non-Therapeutic Responses

18. Probing Serves to control the nature of the client’s responses
Questioning resembles interrogation rather than an interaction—client may feel overwhelmed and withdraw
Tends to put patient on the defensive
“Why do you do this?”
“Why do you feel this way?”

19. Challenging Forces a patient to “prove” his or her point of view
The feelings of the patient go unrecognized
Challenging a patient’s unrealistic ideas or perceptions will not weaken them
“How can you say your wife doesn’t care when she is here for every visiting session?”
“If your leg is missing, then how can you walk up and down the hall?”

20. Advising Undermines clients’ ability to solve their own problems
Renders clients dependent and helpless
Giving advice is different from giving information
“If I were you, I would have the ECT.”
“I think you should do what the doctor says.”

21. False Reassurance
An attempt to dispel a person’s anxiety by implying that there is no cause for worry or alarm or fear
This belittles, devalues, or rejects the patient’s feelings
Communicates lack of understanding and empathy
“Everything will be all right.”
“Don’t worry about it, you’ll soon be ok.”

22. Giving Approval
Can lead a patient to strive for praise rather than progress
Client must ultimately approve of his or her actions
“That’s good.”
“I’m glad that you feel that way.”

23. Disagreeing The nurse criticizes the client who is seeking support
“I definitely don’t agree with your view.”
“I really don’t believe that.”

24. Defending
The nurse attempts to protect the person, place, or thing that the pt is criticizing
The nurse implies that the pt has no right to express his or her negative feelings
“Dr. Lee is a very busy man.”
“This is the finest hospital in the city.”
“I’m sure your therapist had your best interest at heart.”

25. Belittling Feelings Expressed
No comfort to tell a pt that other people have the same or bigger problems
This shows lack of understanding and empathy
“How can you say that? You have a good family.”
“I don’t know why you’re complaining, you should hear the problems your roommate has.”

26. Making Stereotyped Responses
Meaningless cliches and trite expressions have little place in the interaction
Communicate a nurse’s disinterest
“Keep your chin up.”
“Just do what the doctors tell you and you’ll be home in no time.”

27. Changing the Subject
Takes the direction of the conversation away from the pt
Demonstrates the nurse’s anxiety
Patient:
“My mother always puts me down.”
Nurse:
“That’s interesting, but let’s talk about…”

28. Not Listening Nurse is preoccupied with other thoughts
“I’m sorry; what did you say?”
“Could you start again? I was listening to the other nurse.”

29. Judging
The nurse’s responses are filled with his or her own values and judgments
Demonstrates lack of acceptance
“You are not married. Do you think having this baby will solve your problems?”
“That is certainly not the Christian thing to do.”

30. Self-Focusing
The nurse focuses attention away from the client by thinking about or sharing his or her own problems
“That may have happened to you last year, but it happened to me twice this month which hurt me a great deal.”

31. Attending Skills Face the other person Adopt an open stature
Lean towards the other person
Maintain eye contact
Remain relaxed
Create a safe & nonthreatening environment

32. Dysfunctional Communication
Acting on assumptions without validation
Assuming that…..
others share your perception
your perceptions won’t change
your perceptions are complete
others know how you think or feel
Decision-making by power
Stereotyped phrases
Sending mixed messages

33. Obstacles to Therapeutic Communication

34. Obstacles Include: Resistance Transference Counter-transference
Boundary violations

35. Barriers to nurse-client relationship
Violation to confidentiality
Patient anxiety
Lack of personal space
Stereotyping
Institutional –related barriers such as: temporary nurse, lack of consistent assignment of nurses to clients, lack of time, shortage of nurses, early discharges.