TOPIC 1 - Components of Therapeutic Communication

• Components of a Therapeutic Relationship

  • Trust
  • Genuine Interest
  • Empathy
• Incongruent behavior


  When the nurse’s voice or body language is inconsistent with the words he or she speaks
• Therapeutic communication techniques for empathy

  • Reflection
  • Restatement
  • Clarification
• Components of Trust

  • Caring
  • Openness
  • Objectivity
  • Respect
  • Interest
  • Understanding
  • Consistency
  • Treating the client as a human being
  • Suggesting without telling
  • Approachability
  • Listening
  • Keeping promises
  • Honesty
• Therapeutic relationships with clients is one of the most important skills a nurse can develop and especially crucial to the success of interventions with clients requiring psychiatric care because of the therapeutic relationship and the communication
• Example of using reflection


  • A client says, “I’m so confused! My son just visited and wants to know where the safety deposit box key is.” Using reflection, the nurse responds, “You’re confused because your son asked for the safety deposit key?”
• Components of a therapeutic relationship

  • An appropriate response to a client putting his arm around the nurse’s waist
  • An inappropriate response to a client putting his arm around the nurse’s waist
• Communication techniques that help the nurse send empathetic messages to the client

  1. Reflection

  2. Restatement

  3. Clarification
• Empathy versus sympathy


  • The nurse must understand the difference between empathy and sympathy
  • Empathy is understanding the feeling of others
  • Sympathy is feeling pity for others
• Values

  • Abstract standards that give a person a sense of right and wrong and establish a code of conduct for living
  • Values include hard work, honesty, sincerity, cleanliness, and orderliness
• Values clarification process is helpful for gaining insight into oneself and personal values
• Empathetic moments


  A bond can be established to serve as the foundation for the nurse–client relationship
• Acceptance


  1. A nurse who does not become upset or responds negatively to a client’s outbursts, anger, or acting out conveys acceptance to the client

  2. Avoiding judgments of the person, setting boundaries for behavior in the nurse–client relationship, being clear and firm without anger or judgment, allowing the client to feel intact while conveying that certain behavior is unacceptable
• Self-Awareness and Therapeutic Use of Self


  1. Before understanding clients, the nurse must first know him or herself

  2. Developing an understanding of one’s own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths, and limitations and how these qualities affect others
• Positive Regard


  • The nurse who appreciates the client as a unique worthwhile human being can respect the client regardless of his or her behavior, background, or lifestyle
  • Positive regard implies respect, calling the client by name, spending time with the client, listening and responding openly, considering the client’s ideas and preferences when planning care
• Example of using clarification


  • The nurse, using clarification, responds “Are you confused about the purpose of your son’s visit?”
• Values

  Silent forces behind many actions and decisions
• Attitudes


  General feelings or frame of reference organizing knowledge about the world
• Johari window areas

  • Quadrant 1: Open/public—self-qualities known to oneself and others
  • Quadrant 2: Blind/unaware—self-qualities known only to others
  • Quadrant 3: Hidden/private—self-qualities known only to oneself
  • Quadrant 4: Unknown—an empty quadrant symbolizing qualities yet undiscovered by oneself or others
• Beliefs examples

  • “All old people are hard of hearing,”
  • “If the sun is shining, it will be a good day”
• Values Clarification


  Ideas about what is most important in life, what one wants to live by and live for
• Johari window is a tool useful in learning more about oneself
• Beliefs

  Ideas held to be true, some with evidence, others irrational
• Values Clarification process


  1. Choosing

  2. Prizing

  3. Acting
• Attitudes examples

  • Hopeful
  • Optimistic
  • Pessimistic
  • Positive
  • Negative
• Therapeutic Use of Self in the nurse–client relationship


  Nurses must clearly understand themselves to promote clients’ growth and avoid limiting choices to those valued by nurses
• Therapeutic Use of Self


  Developing self-awareness to use aspects of personality, experiences, values, feelings, intelligence, needs, coping skills, and perceptions to establish relationships with clients
• Values Clarification process example


  • A clean and orderly student living with a messy roommate, examining personal space differences, discussing conflict, and negotiating for a compromise