Nontherapeutic Communication Techniques

• Telling the client what to do

  Advising
• "I think you should..."

  "Why don't you..."

  Are examples of:

  Advising
• Giving advice implies that only the nurse knows what is best for the client

  Advising
• Indicating accord with the client

  Agreeing
• "That's right."

  " I agree."

  Are examples of:

  Agreeing
• Approval indicates the client is "right" rather than "wrong." This gives the client the impression that he or she is "right" because of agreement with the nurse. Opinions and conclusions should be exclusively from the client. When the nurse agrees with the client, there is no opportunity for the client to change his or her mind without being "wrong." 

  Agreeing
• Misjudging the degree of the client's discomfort

  Belittling feelings expressed
• Client: "I have nothing to live for... I wish I was dead."

  Nurse: "Everybody gets down in the dumps." OR "I've felt that way myself."

  Are examples of:

  Belittling feelings expressed
• When the nurse tries to equate the intense and overwhelming feelings the client has expressed to "everybody" or to the nurse's own feelings, the nurse implies that the discomfort is temporary, mild, self-limiting, not very important. The client is focused on his or her own worries and feelings; hearing the problems or feelings or others is not helpful.

  Belittling feelings expressed
• Demanding proof from the client

  Challenging
• "But how can you be President of the United States?"

  "If you're dead, why is your heart beating?"

  Are examples of:

  Challenging
• Often the nurse believes that if he or she can challenge the client to prove unrealistic ideas, the client will realize there is no "proof" and then will recognize reality. Actually, challenging causes the client to defend the delusions or misperceptions more strongly than before.

  Challenging
• Attempting to protect someone or something from verbal attack

  Defending
• "This hospital has a fine reputation."

  "I'm sure your doctor has your best interests in mind."

  Are examples of:

  Defending
• Defending what the client has criticized implies that he or she has no right to express impressions, opinions, or feelings. Telling the client that his or her criticism is unjust or unfounded does not change the client's feelings but only serves to block further communication.

  Defending
• Opposing the client's ideas

  Disagreeing
• "That's wrong."

  " I definitely disagree with .."

  "I don't believe that."

  Are examples of:

  Disagreeing
• It implies the client is "wrong."

  Consequently, the client feels defensive about his or her point of view or ideas.

  Disagreeing
• Denouncing the client's behavior or ideas

  Disapproving
• "That's bad."

  "I'd rather you wouldn't...."

  Are examples of:

  Disapproving
• It implies that the nurse has the right to pass judgement on the client's thoughts or actions. It further implies that the client is expected to please the nurse

  Disapproving
• Sanctioning the client's behavior or ideas

  Giving approval
• "That's good." "I'm glad that....". Are examples of:

  Giving approval
• Saying what the client thinks or feels if "good" implies that the opposite is "bad." Approval, then, tends to limit the client's freedom to think, speak, or act in a certain way. This can lead to the client's acting in a particular way just to please the nurse.

  Giving approval
• Responding to a figurative comment as though it were a statement of fact

  Giving literal responses
• Client: "They're looking in my head with a television camera."

  Nurse: "Try not to watch television." OR "What channel?"

  Are examples of:

  Giving literal responses
• Often the client is at a loss to describe his or her feelings, so such comments are the best he or she can do. Usually it is helpful for the nurse to focus on the client's feelings in response to such statements.

  Giving literal responses
• Attributing the source of thoughts, feelings, and behavior to others or to outside influences

  Indicating the existence of an external source
• "What makes you say that?"

  "What made you do that?"

  "Who told you that you were a prophet?"

  Are examples of:

  Indicating the existence of an external source
• The nurse can ask, "What happened?" or "What events led you to draw such a conclusion?"

  But to question, "What made you think that?" implies that the client was made or compelled to think in a certain way. Usually the nurse does not intend to suggest that the source is external but that is often what the client thinks

  Indicating the existence of an external source
• Asking to make conscious that which is unconscious; telling the client the meaning of his or her experience

  Interpreting
• "What you really means is...."

  "Unconsciously you're saying..."

  Are examples of:

  Interpreting
• The client thoughts and feelings are his or her own, not to be interpreted by the nurse or for hidden meaning. Only the client can identify or confirm the presence of feelings

  Interpreting
• Changing the subject

  Introducing an unrelated topic
• Client: "I'd like to die "

  Nurse: "Did you have visitors last evening."

  Are examples of:

  Introducing an unrelated topic
• The nurse takes the initiative for the interaction away from the client. This is usually happen because the nurse is uncomfortable, doesn't know how to respond, or has a topic he or she would rather discuss

  Introducing an unrelated topic
• Offering meaningless cliches or trite comments

  Making stereotyped comments
• "It's for your own good."

  "Keep your chin up."

  "Just have a positive attitude and you'll be better in no time."

  Are examples of:

  Making stereotyped comments
• Social conversation contains many cliches and much meaningless chit-chat. Such comments are of no value in the nurse-client relationship  .

  Any automatic responses will lack the nurse's consideration or thoughtfulness

  Making stereotyped comments
• Persistent questioning of the client

  Probing