Therapeutic Communication

1. Therapeutic Communication Prepared by Sally McDonald Revised by Tim Corbett

2. HELPING Care Trust Growth Purposeful/intentional Unequal sharing Focus on Client’s needs Time limited SOCIAL Care Trust Growth Spontaneous Usually equal or near equal sharing Focus on needs of both individuals Ongoing Helping vs Social Relationships

3. GIVING HELP Feeling important Feeling useful Feeling powerful Feeling gratified Feeling happy NEEDING HELP Feeling unimportant or inadequate Feeling useless or depressed Feeling powerless Feeling frightened or embarrassed Feeling sad or angry Locus of Control

4. Phases of Helping Relationships • Orientation Phase • Working Phase • Termination Phase

5. Orientation Phase • “getting to know you” phase • setting the tone • making introductions • establishing roles • reaching agreement on goals • developing trust

6. Working Phase • “problem solving” phase • attending to client’s needs • Nurse in role of teacher/counselor • encouraging active participation by client • gathering further data • assisting client in decision making • facilitating change • Evaluate problems & goals

7. Termination Phase • reviewing & summarizing goals met and progress made • acknowledge feelings of loss • reassuring clients with issues such as, “How will this problem/disease affect my life ?” or “What do I need to change ?”

8. Communication Techniques • Validating/Clarifying • Reflecting • Sequencing • Sharing observations • Acknowledging feelings

9. Arguing Minimizing Challenging Giving false reassurance Interpreting or speculating on the dynamics of the client’s problems “Selling” client on accepting treatment Probing sensitive areas Participating in criticism of any staff member Joining any attacks led by the client Avoid

10. Attentive Listening Scale -THINGS TO AVOID • Lack of eye contact • Responding before the other finishes speaking • Finishing other people’s sentences • Talking so much that others cannot respond • Continuing to work while someone is talking to you • Repeat a point just made • Allow your mindto wander during a conversation

11. Active Listening • 3 Phases • restatement involves repeating or paraphrasing the words of the client • reflection is verbalizing both the content and the implied feelings of the client’s message • clarification is summarizing the client’s thoughts & feelings & resolving confusion

12. Active Listening • STOP TALKING • demonstrate that you want to listen • remove distractions • be patient • STOP TALKING

13. Assertive Communication • “I” Statements allow people to ‘own’ (take responsibility for) their own thoughts & feelings • assertiveness involves taking a risk

14. NONVERBAL CUES • professional attire • sit arm’s length away • relaxed but attentive posture

15. NONVERBAL CUES • facial expressions and tone should be friendly & interested • use direct eye contact & match your eye contact with the patient’s eye contact • pay attention to body language of patient as well as your own body language

16. Interviewing Techniques

17. INTERVIEWING TECHNIQUES • the purpose of the interview is to obtain accurate & thorough information • put your client at ease as they may feel uncomfortable about revealing sensitive information to you • explaining your format helps clients accept & understand the purpose of the interview

18. INTERVIEWING TECHNIQUES • in general, use open-ended questions • however, to obtain specific information, closed-ended questions are preferable • validate information • clarify responses • use reflective questions/comments & paraphrasing

19. Progression ofthe Interview • Broad Openings- such as “Tell me about yourself” are designed to allow the client to relate his or her story in a way that is comfortable

20. Progression ofthe Interview • Open-Ended Questions encourage the client to elaborate or give explanations (for example, “What happened yesterday?”) • they provide direction & keep the conversation focused

21. Progression ofthe Interview • Closed-Ended Questions can be answered with 1-2 words and can be useful in obtaining specific types of information, such as “What is today’s date?”

22. EFFECTIVE INTERVIEWING • as a professional nurse, you will spend about half of your time obtaining information from clients & colleagues • excellent communication as well as interviewing skills are fundamental, yet require years of practice

23. WHY, WHAT, HOW • why do you need the information? • how will the information I am seeking direct me in helping my client? • how will you phrase your questions?

24. Who to Ask? • if the client is able to speak, ask him/her • family perspectives may also be important • written consent may be required to question concurrent/previous healthcare providers • be courteous and respectful • never forget client confidentiality

25. “Why” Questions • offensive misuse of ‘why’ appears threatening and confrontational and puts clients on the defensive • they can interfere with developing a therapeutic relationship & are seldom considered therapeutic

26. ConveyingUpsetting Information • The SPIKES Model developed by Radziewicz & Baile (2001) • Setting • Perception • Invitation • Knowledge emotions • Summary

27. Setting • private & comfortable • invite others, such as family members

28. Perception • refers to what client and others already know useful in uncovering misinformation

29. Invitation • For example, the statement, “Would you like me to explain more about what happened?’

30. Knowledge • gradually dispense information assessing client’s ability to cope with it • The family may insist that the client not be told difficult news

31. Emotions • let client vent while you remain calm • keep in mind Stages of Grief & Loss • may need to set limits on inappropriate /harmful behavior

32. Summary • review all important information with the client and family • may need to repeat information more than once

33. AVOID • clichés • poor listening • closed questions • intimidating how/why questions • obvious probing questions • advice • leading questions (that suggest the response that you want) • judgmental comments • diverting • false assurance

34. COMMON ERRORS

35. Failure to respect client Failure to listen Minimizing feelings Inappropriate comments & questions Excessive questions Clichés Yes/no questions Probing Changing the subject Leading questions Advice Judgments False reassurance Giving approval/disapproval Blocks to Communication

36. Self-Disclosure • Use self disclosure to help clients open up to you – not to meet your own needs • Keep disclosures brief • Don’t imply that your experience is exactly the same as the client’s • Only self-disclose about situations that you have mastered

37. Self-Disclosure • Monitor your own comfort with self-disclosure • Respect your client’s needs for privacy • Remember that there are cultural variations in the amount of self-disclosure considered appropriate • Identify risks and benefits of self disclosure

38. Therapeutic VersusNontherapeutic Communication • THERAPEUTIC - Facilitates transformation of working nurse-patient relationship - Relationship allows for adequate & accurate data collection & assessment - Performed with & not for patient

39. Therapeutic VersusNontherapeutic Communication • NONTHERAPEUTIC - Hinders relationship formation - Prevents patient from becoming mutual partner & relegates him/her to passive recipient of care