Running head: THERAPEUTIC COMMUNICATION IN MENTAL HEALTH

Clinical Implications of Therapeutic Communication in Mental Health Nursing

Halea Dardin
Auburn University NURS 4230

THERAPEUTIC COMMUNICATION IN MENTAL HEALTH

Abstract
Therapeutic communication and therapeutic relationships are building blocks upon which good
nursing care is built. This concept especially holds true in mental health nursing. The purpose
of this paper is to describe the clinical benefits and effectiveness as well as the clinical
limitations therapeutic communication can provide in patient centered care. Clinical benefits
will include encouraging communication between the patient and nurse as well as creating a
deeper understanding surrounding the patients perspectives and plans of care, all while creating
elements of trust and respect within the nurse-patient relationship. Other aspects of therapeutic
communication in mental health nursing are questioned when it comes to the effectiveness.
Things such as the use of interdisciplinary teams, decreased understanding due to difficulty in
social functioning and disorganized thinking on the patients part, as well as the maintenance
and control mentality of many nursing units can create limitations to the effectiveness of
therapeutic communication in these nurse-patient settings.
Keywords: therapeutic communication, mental health nursing, therapeutic relationships,
therapeutic alliance

THERAPEUTIC COMMUNICATION IN MENTAL HEALTH

The goal for nurses, in general, is to provide quality, patient-centered care and to create
an environment in which the patient can heal and move past their present illness. To make this a
reality, therapeutic relationships are critical to the patients process of care. As this is the case in
any nurse-patient setting, this is especially important in mental health nursing. In nursing
practice, much of the time is spent administering medications and interventions, and relationship
building can fall by the wayside. According to Cahill, Paley, and Hardy (2013), mental health
nursing itself is divided between therapeutic relationships, which focus primarily on
therapeutic factors, and biology, which focus primarily on biological factors and mental health
problems. The purpose of this paper is to explore the implications and benefits, as well as the
limitations and ineffective outcomes from therapeutic communication and relationships in mental
health nursing.
Clinical Implications and Benefits
Communicating through conversation is one of the core skills of mental health nursing
(Burnard, 2003) and patient satisfaction is largely based on the extent to which relationships are
developed with nurses and other health care providers. In mental health nursing, therapeutic
communication is a way to promote a patients well being and understanding, as well as the
nurses understanding of patients expectations and feelings regarding their state of mind, desires
of care, willingness and compliancy. In a 2006 review of mental health nursing, a
recommendation stated: Developing and sustaining therapeutic relationships with service users,
their families, and/or carers should form the basis of all care (Cahill et al., 2013). Research
continues to impress that nurses include evidence-based therapies, along with therapeutic
relationships that support the delivery of those therapies while implementing interventions. The
shift in nursing care has become that of simple administration and focus on specific factors to

THERAPEUTIC COMMUNICATION IN MENTAL HEALTH

one of therapeutic communication and more holistic approaches. According to Cahill et al.
(2013), it has been argued that common factors such as the instillation of hope, warmth, and
attention have a greater impact on patient outcomes than do focuses on specific factors of
psychotherapy. The process of building a therapeutic relationship with a patient creates a sense
of trust and respect between the nurse and patient, as well as allows the nurse to understand
aspects of care from the patients perspective. In an article by Farrelly and Lester (2014),
therapeutic communication involves trust, respect, and shared decision-making. Trust is linked
to mutually agreed goals. Respectful interactions are person-centered and include effective
listening, empathy, genuineness, availability, and continuity, as well as increased partnership and
trust between the nurse and patient. Although these qualities are strongly supported in clinical
practice, there was a consensus that shared decision-making, although beneficial, was not as
evident in most evidenced based practice.
It is important in health care settings that patients feel that they can talk to the nurse about
how they are feeling as well as about doubts and concerns regarding their treatments. By doing
so, the patients gain the sense that the nurse truly cares about their care, lines of communication
will open, and the patients view of the alliance becomes a predictive outcome in itself. Through
therapeutic communication, nurses are able to better build on their already existing
understandings of the patients needs and address needs that may not have been met otherwise,
whether that be emotional, physical, psychological, or spiritual. Quality care requires getting to
know the patients specific needs, and sitting down and taking time to talk to the patient allows
the nurse to involve the patient when creating a specific, patient-centered plan of care. By
involving the patient, the patients compliance and willingness will increase, thus leading to
better patient outcomes. The study by Farrelly and Lester (2014) aligned with this idea, as they

THERAPEUTIC COMMUNICATION IN MENTAL HEALTH

pointed out, the desire to change is nurtured through the relationship, not by one persons plan
for another. The outcome is that people dont continue to feel separate, different, and alone.
Some of the greatest fears, which simply come from human nature, are fears of the unknown and
of being alone, and it is the nurses responsibility to ensure patients that the nurse is there for
them every step of the way throughout their care. The nurse should be continuously teaching the
patient about the process in which they are going through, and especially in mental health
settings, communicate about plans for the patient once they move on from the current program or
health care facility. By having a prepared state of mind for what is to come and by working with
the nurse to establish this plan, the patient is more likely to be compliant and strive towards the
established goals once they are no longer at the facility. By establishing a therapeutic
relationship, the nurse is essentially showing the patient that they are not alone, that they are
understood, and that they have some say in their care during their stay as well as in the future.
Clinical Limitations
While having therapeutic communication as a basis and a consistent element in mental
health nursing is a strong foundation of care, the nurse must also do work within this relationship
to allow it to be as therapeutic as possible. According to Browne, Hurley, and Lakeman (2014),
this work includes talking therapies, family therapy, behavioral therapy, and other forms of
psychotherapy. The nurse must make a point to stay up to date in trainings and education to
maximize options of care and use the best evidence based practice regarding these methods, as
mental health nursing can revolve around sensitive patient cases. As mental health is an area that
is becoming more understood and as newer research is becoming available, it is the nurses
responsibility to stay up to date on the most current, nursing knowledge of care. Therapeutic
relationships in mental health nursing can also encounter specific obstacles as many of the

THERAPEUTIC COMMUNICATION IN MENTAL HEALTH

patients may have a varying capacity and communication ability (Farrelly & Lester, 2014), and
part of the therapeutic relationship is built so firmly on strong communication. Some research
questions if mental health patients are capable of developing therapeutic relationships and
opening this line of communication with their health care providers, while others question if it is
possible for all mental health patients, including those who have severely disorganized thoughts
and understanding, to truly connect with a nurse on the therapeutic level when they have such
difficulty with social functioning and interaction. Therapeutic communication may prove more
effective with mental illnesses such as depression and anxiety disorders, as opposed to more
cognitively debilitating illnesses such as schizophrenia and bipolar disorder.
Therapeutic communication initially seems to be something that all nurses should and
would implement in everyday care, but in the fast paced environment of administering
medications and implementing interventions, the time to sit down and create these relationships
is not always realistic. Farrelly and Lester (2014) note that in the past, there has been a focus on
maintenance and control aspects of treatment, which lessens the focus on factors that
encourage and facilitate therapeutic relationships. Another barrier, often found in community
settings, is the use of interdisciplinary teams. As the patient interacts and works with multiple
health care workers, the frequency of interaction with any worker in particular is very limited,
which can impact and lessen the ability to build therapeutic relationships. Patients sometimes
have a hard time differentiating between the RN, the LPN, the tech, the physician, the therapist,
etc. The sense of continuity and availability from which therapeutic communication stems can
become masked by the overwhelming amount of people working with the patient at different
times during the day, which is commonly found in hospital settings.

THERAPEUTIC COMMUNICATION IN MENTAL HEALTH

Conclusion
Therapeutic relationships are becoming essential to nursing care. As facilities and health
care providers are evolving into more innovative models of care, such as patient-centered care,
therapeutic communication forms the basis of this process. Therapeutic relationships and
communication are extremely beneficial and should be put into nursing practice, as they open up
communication between the nurse and patient, allow the nurse to gather more of an
understanding from the patients perspective, encourage shared decision making, enable the
nurse to create a plan of care unique and specific to the patients needs, and create a sense of
trust and respect between the nurse and patient. Although these benefits are supported in
research and are being implemented in recent clinical practice, limitations and questions also
arise when referring to therapeutic communication in the mental health setting. Some of these
limitations include the use of interdisciplinary teams, the maintenance and control mentality of
many nursing units and health care facilities, as well as the decreased ability of patients to
understand the relationships when they have underlying difficulties with social interaction,
disorganized thinking, and decreased capacities to learn and communicate. Although there may
be barriers to the effectiveness of therapeutic communication in mental health nursing, the
process of building these relationships, even if not beneficial to the patient, will always enable
the nurse to have a better understanding of the patients needs and in many patients, will make a
huge impact on the view of their care and outcomes in regard to managing and coping with their
illness.

THERAPEUTIC COMMUNICATION IN MENTAL HEALTH

References
Browne, G., Hurley, J., & Lakeman, R. (2014). Mental health nursing: What difference does it
make?. Journal Of Psychiatric And Mental Health Nursing, 21(6), 558-563.
Burnard, P. (2003). Ordinary chat and therapeutic conversation: phatic communication and
mental health nursing. Journal Of Psychiatric And Mental Health Nursing, 10(6), 678682.
Cahill, J., Paley, G., & Hardy, G. (2013). What do patients find helpful in psychotherapy?
Implications for the therapeutic relationship in mental health nursing. Journal Of
Psychiatric And Mental Health Nursing, 20(9), 782-791.
Farrelly, S. & Lester, H. (2014). Therapeutic relationships between mental health service users
with psychotic disorders and their clinicians: A critical interpretive synthesis. Health &
Social Care In The Community, 22(5), 449-460. doi:10.1111/hsc.12090