Running head: DIALOGUE

Therapeutic Communication:
The Dialogue of Disarmament
Jack L. Kaczmarczyk
Baker College

Definition of Therapeutic Communication

Coronary artery disease. Palliative care. Cerebrovascular accident. Renal failure.
Intravenous piggyback (IVPB). Concepts like these which healthcare professionals discuss
without batting an eye are, to the patient, personally threatening realities that pose a danger to
their physical and mental well-being. Knowing this, and knowing how patients can inflict more
self-harm than self-healing by dwelling on the more stressful realities of the clinical situation, the
registered nurse (RN) practices therapeutic communication (TC) to effectively disarm the
patient. Therapeutic communication is a patient-focused range of techniques aimed at
establishing a trusting nurse-patient relationship in which both parties work toward the
betterment of clinical outcomes (Kleier, 2013). Other factors also improved are patient
satisfaction, anxiety, and medication adherence (Baer & Weinstein, 2013).
This definition can benefit from a brief study of non-therapeutic communication, just as
noisiness fosters an appreciation of silence. Non-therapeutic communication is not patient-

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centered. It involves the use of no therapeutic techniquesor, it involves the unwitting

implementation of their contradictions. Nothing communicated improves the patients well-being
(Taylor, Lillis, LeMone, & Lynn, 2011). An example: the RN readies medications in a patients
room. The patient has concerns regarding the effectiveness of a medication. Brushing off what
the RN sees as needless, time-wasting chit-chat, the RN administers the medications. The
patients concerns are left unaddressed; the patient is still armed, to continue the metaphor.
Focusing thusly on the task instead of the patient is a trap, one all too easily entered for RNs,
who are trained to be goal-oriented.
One goal in which nurses are trained is to utilize every free moment of time; therefore
silence would appear to be wasteful. Surely this moment can be filled with education, or
assessment, or discharge planning. Yet silence, one of the most powerful techniques of TC,
allows time for reflection. Silence can express empathy, or regard. Even the discomfort generated
by silence, that uncomfortable vacuum that the patient, like nature itself, abhors and is compelled
to fill. In this moment, what the patient says can be a revelation otherwise unutterable before the
silence allowed it (Ladany, Hill, Thompson, OBrien, 2004). Other techniques of TC are the
prudent use of touch, asking open-ended questions, focusing, giving information,
acknowledging, and clarifying (Kleier, 2013).
Techniques like these are never more evidently useful and helpful than at the disposal of
oncology nurses. In the setting of an oncology clinic, the nurse faces many difficult questions,
and, in advanced practice, might even be the member of the healthcare team designated to give
bad news to patients and families (Baer & Weinstein, 2013). This continues the current trend in
healthcare in which nurses are increasingly relied upon to perform what is, traditionally, a
physicians role. Given that recent healthcare reforms have led to a reduction in payment rates,
physicians have taken on a greater caseload (Fodeman, n.d.). What little time a physician had

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with patients has been further reduced. This creates a yet another vacancy for nurses to fill and
another need to further sophisticate an ever-expanding scope of practice.
To view TC as a set of techniques, aimed at the patient, with the intent to form a trusting
and effective relationship and improve clinical outcomes, is exhaustivein more than one sense
of the word. Ultimately, however, this definition is lacking. Another element is missing, though it
would not appear possible, and that is empathy. Empathy is identifying with the way another
person feels, (Taylor, et al., 2011, p. 450). Failing to identify those feelings renders TC into yet
another task. At the same time, an indulgent empathy becomes more like sympathy; this can
jeopardize the objectivity of the nurse. Therefore this author will practice an empathetic,
professional TC, withholding any personal emotional projections, and to the extent that negative
feelings are identified and disarmed, positive ones are encouraged, and outcomes are improved.
References
Baer, L., & Weinstein, E. (2013). Improving Oncology Nurses' Communication Skills for
Difficult Conversations. Clinical Journal Of Oncology Nursing, 17E45-51.
doi:10.1188/13.CJON.E45-E51
Fodeman, J. (n.d.). The New Health Law: Bad for Doctors, Awful for Patients. Theihcc.com.
Retrieved 5 August 2014, from
http://www.theihcc.com/en/communities/policy_legislation/the-new-health-law-bad-fordoctors-awful-for-patie_gn17y01k.html
Kleier, J. (2013). Disarming the Patient through Therapeutic Communication. Urologic Nursing,
33(3), 110-133. doi:10.7257/1053-816X.2013.33.3.110
Ladany, N., Hill, C., Thompson, B., & O'Brien, K. (2004). Therapist perspectives on using
silence in therapy: a qualitative study. CPR, 4(1), 80-89.
Taylor, C., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing (7th ed.).
Philadelphia: Lippincott Williams & Wilkins.