Therapeutic Communication

1. Therapeutic Communication Day 2

2. Objective #14 • Discriminate between hearing and listening

3. Becoming a better listener • Hearing • Sensing sound • Listening • “A process that involves sensing, interpreting, evaluating and reacting to spoken messages.”

4. Stages of Listening • Sensation • Interpretation • Evaluation • Reaction

5. Active Listening • Attention • Eye contact • Control distractions • Focus • Observe

6. Active Listening • Attention • Demonstrate • Body language

7. Active Listening • Attention • Demonstrate • Feedback • Paraphrase • Reflect • ?

8. Ask questions • “The most important types of question you will ask are… • CLARIFYING QUESTIONS”

9. Active Listening • Attention • Demonstrate • Feedback • Defer judgment • Don’t interrupt

10. Objectivity • “The process of remaining open…”

11. Active Listening • Attention • Demonstrate • Feedback • Defer judgment • Respond

12. Objective #15 • Relate how therapeutic communication differs from social communication

13. Style of Communication Social Therapeutic Client • Family • Friends

14. Focus Therapeutic Social Equal • Client

15. Therapeutic Social Spontaneity • Planned • Directed by nurse

16. Therapeutic Social Mutual confidentiality • Confidentiality • Tx team • Advocates • Do NOT keep secrets!

17. Therapeutic Communication Client Professional Emotional distance Objective • Discloses information

18. Objective #16 • Define and describe the importance of each of the following: • Readiness skills, Attending skills, Active listening skills, Reflecting skills: content and emotion

19. Readiness • Establishing a therapeutic relationship • Choosing a quiet, safe setting

20. Attending Skills • 90% Non-verbal • “You are important to me!”

21. #1 Attending Skills • Four Basic Components: • Eyes • Posture • Expressions • Prompts

22. Attending RulesEye contact Do DONT Stare Flutter Darting • Make eye contact • Be culturally aware • Look at patient frequently

23. Attending SkillsPosture DO DONT Fidget ?Notes? • Relaxed

24. Prompts • Encouraging prompts • Non-verbal • Verbal

25. Encouraging Leads NON-VERBAL Verbal “good” “yes” “ok” “wonderful” “I see” “go on” • Head nods • Um-hum’s • Hand movements • Smile • Smile/head nod • A half-head nod • Puzzled expression

26. Verbal following • Silent listening  • Repeat few words

27. Verbal following - Echoing • Finding a word or few words • toward the end of the senders sentence/sentences • that you can use to encourage more clarification or discussion.

28. Verbal following - Echoing • Patient: “about a week ago my wife left me.” • P.T. “Left you”? (slight questioning tone)

29. Verbal following - Echoing • Patient: “My girl friend is great with my son. She has really been a life-saver to both of us.” • P.T. “Life-saver”?

30. Think before you speak • Take your time. • “You are important to me. I will be patient and consider my response”. • Silence is OK!

31. Reflective (mirroring) Statements • “Empathic communication” • Convey interest • Build rapport • Help person clarify information • Help person express feelings

32. Reflective (mirroring) Statements • Only mirror client • Don’t add!!!!

33. Responding Skills(action-oriented skills) • “listen” for the feeling • reflect the feeling • feeling vocabulary

34. Reflective (mirroring) Statements Feeling Content “… about ______” • “you’re feeling….”

35. Reflective (mirroring) Statements Patient: (angrily) “why does everyone try to bully me? I can’t make head or tails of anything anymore”! • P.T. “You’re angry about being confused”? • P.T. “You are confused about being bullied and angry about that”?

36. Reflective (mirroring) Statements Depressed Patient: “I feel like just sleeping or doing nothing but I can’t sleep at night though. It’s ridiculous. Maybe it’s because I worry too much” • Feeling? • Content?

37. A response using reflection of feeling and content could be: • Nurse: “You’re feeling really lethargic, but you can’t sleep?” • (condensed version)

38. Responding SkillsExample • Child: “I went to my grandma’s and she wasn’t home”. • Nurse: “No one was home at grandma’s. You were disappointed.(?)”

39. Responding Skills example • Patient: “ I hate being in this hospital” • Nurse: “I know that you just arrived, I’m wondering if you’re scared and missing your family (?)”

40. Responding Skills example • Patient: ”I don’t want any students looking in my chart” • Nurse: “Could you be feeling embarrassed about someone you don’t know looking in your chart because you don’t know me? Let’s have a conversation to remedy that (?)”

41. Paraphrasing (Reflection of Content) • Use our own words • Helps clarify inconsistencies

42. Intervention Skills: • Intervention skills are as individualized as there are patients and various mental illnesses. Many interventions will be taught, discussed, and practiced in 3rd semester!

43. Perception Checking

44. Responding Skills Checking out perceptions • Perception checking • prevent misunderstanding • Prevent conflict • Goal • Mutual understanding

45. 3 partsPerception checking • Description • Behavior • Interpretation • Provide two possible • Clarification • Request

46. ExamplePerception Checking • “When you stomped out of the room and slammed the door…..” • (Describe behavior) • “I wasn’t sure whether you were mad at me….” • (interpretation #1) • “or just in a hurry” • (interpretation #2) • “What were you feeling”? Or “what was going on”? • (request clarification)

47. Sample:Perception Checking • Describe behavior • Interpretation #1 • Interpretation #2 • Request clarification

48. Description • When you walked out of the room without saying “goodbye...” • 2 possible interpretations • “I didn’t know if you were mad at me” • “or if you were in a hurry and forgot.” • Request clarification • “What was up?”

49. Objective #17 • Explain the concept of the therapeutic self.

50. Use of Self • 1o therapeutic agent