TRI-COUNTY TECHNICAL COLLEGE ASSOCIATE DEGREE NURSING PROGRAM Nur 214 Mental Health Nursing Interpersonal Techniques

Therapeutic Communication Techniques 1. 2. Using Silence Accepting Examples (Wait for the client to talk.) Yes. Uh hmm. I follow what you said. Nodding Good morning Mr. S. Youve drawn a picture. I notice that you combed your hair. Ill sit with you awhile. Ill stay here with you. Im interested in your comfort. Is there something youd like to talk about? What are you thinking about? Where would you like to begin? Go on. And then? Tell me about it. What seemed to lead up to? Was this before or after ..? When did this happen? You appear tense. Are you uncomfortable when you..? I notice youre biting your lip. You start wringing your hands when your husband is here. Tell me when you feel anxious. What is happening? What does the voice seem to be saying? Was this something like.? Have you had similar experiences before? This point seems worth looking as more closely. Tell me more about. Isnt that unusual? Really? Thats hard to believe.

3.

Giving Recognition

4.

Offering Self

5.

Giving Broad Openings

6.

Offering General Leads

7.

Placing the Event in Time or Sequence Making Observations

8.

9.

Encouraging Description of perceptions Encouraging Comparison Focusing Voicing Doubt

10. 11. 12.

Therapeutic Communication Techniques 13. Restating

Examples Client: I cant sleep. I stay awake all night. Nurse: You have difficulty sleeping. Client: Susie makes me so angry. She thinks better than everyone else. Nurse: Youre angry with Susie?

14.

Reflecting

Client: Do you think I should tell the doctor? Nurse: Do you think you should? Client: My brother spent all my money and then he had the nerve to ask for more. Nurse: He spent all your money?

15.

Exploring

Tell me more about that. How did you happen to be admitted to the hospital? My name is . Visiting hours are My purpose in being here is to Im not sure that I follow what youre saying. What would you say is the main point of what you said? I see no one else in the room. That sound was a car backfiring. Your mother is not here; Im a student nurse. Tell me if my understanding agrees with yours. Are you using this word to convey the idea? Client: I cant talk to you or to anyone. Its a waste of time. Nurse: You dont believe that anyone cares? Client: My wife pushes me around just like my mother and sister did. Nurse: Is it your impression that women are domineering?

16.

Giving Information

17.

Seeking Clarification

18.

Presenting Reality

19. 20.

Seeking consensual Validation Verbalizing the Implied

21. 22.

Encouraging Evaluation Attempting to Translate into feeling

What are your feelings in regard to.? Does this contribute to your discomfort? Client: Im dead. Nurse: Are you saying that you feel lifeless? Or: Is it that life seems without meaning? Client: Im way out in the ocean. Nurse: It must be lonely. Or: You seem to feel deserted.

Therapeutic Communication Techniques 23. 24. Suggesting Collaboration Summarizing

Examples Perhaps you and I can discuss and discover what produces your anxiety. Have I got this straight? Youve said that. During the past hour you and I have discussed . What could you do to let your anger out harmlessly? The next time this comes up, what can you do differently?

25.

Encouraging Formulation of a Plan

Important Differences Between Social & Therapeutic Communication

Social Communication 1. Can occur at any time and is not time limited. aremet. 2. Responsibility for the structure and conduct of the conversation is the responsibility of both parties. 3. Communication is spontaneous and not necessarily goal directed. 4. The needs and concerns of both partners can receive equal consideration 5. The purpose is for both parties to achieve greater intimacy in the relationship. 6. Self-disclosure of the details of private life is acceptable to both parties. 7. Social decorum and adherence to the rules etiquette are expected. 8. Can continue spontaneously at any time, depending on the desires of the participants. Therapeutic Communication 1. Occurs within designated time frames & terminates when therapeutic goals

2. Responsibility for the structure and conduct of conversation is ultimately the nurses. 3. Communication is purposeful and directed towards mutually established goals. 4. The focus of the conversation is always on the needs and concerns of the patient. 5. The purpose is for the patient to achieve greater self-understanding from the relationship. 6. Self-disclosure of nurses private life is limited & acceptable only under certain circumstances. 7. Conversation does not always reflect adherence to the rules of social etiquette. 8. Formally terminates with the end of the session or the relationship.

Nontherapeutic Communication Techniques 1. Reassuring

Examples I wouldnt worry about Everything will be all right. Youre coming along fine. Thats good. Im glad that you.. Lets not discuss this. I dont want to hear about Thats bad. Id rather you wouldnt . Thats right. I agree. Thats wrong. I definitely disagree with I dont believe that. I think you should. Why dont you.. Why is it you run around with other women? Tell me how you spent your pay check this week? But how can you be President of the United States? What day is this? Do you know what kind of hospital this is? This hospital has a fine reputation. No one here would lie to you. But Dr. B, is a very capable psychiatrist. Im sure that he has your welfare in mind when he.. Why do you think that? Why do you feel that way? Why did you do that? What makes you say that? Who told you that you were Jesus? What made you do that?

2. Giving Approval 3. Rejecting 4. Disapproving 5. Agreeing 6. Disagreeing

7. Advising 8. Probing 9. Challenging 10. Testing (Not testing for reality orientation) 11. Defending

12. Requesting an Explanation

13. Indicating the Existence of an External Source