1. Communication and the Therapeutic Relationship
Chapter 10

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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.

8. 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).

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

10. 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

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

12. 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

13. 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.

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

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

16. Analyzing Interactions
Process Recordings
Analysis
Symbolism
Themes
Communication blocks

17. 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.