THERAPEUTIC AND

NON-THERAPEUTIC
COMMUNICATION
TECHNIQUES
THERAPEUTIC
RELATIONSHIP
A relationship that is established between a health care professional
and a client for the purpose of assisting the client to solve his
problems.
COMPONENTS OF A
THERAPEUTIC RELATIONSHIP
TRUST
Without trust a nurse-client relationship would not be established and interventions won’t be successful.

GENUINE INTEREST
Another essential factor to build a therapeutic nurse-client relationship is showing a genuine interest to
the client. For the nurse to do this, he or she should be open, honest and display a congruent behavior.
Congruence only occurs when the nurse’s words matches with her actions.

EMPATHY
For a nurse to be successful in dealing with clients it is very essential that she empathize with the client.
Empathy is the nurse’s ability to perceive the meanings and feelings of the client and communicate that
understanding to the client. It is simply being able to put oneself in the client’s shoes.
COMPONENTS OF A
THERAPEUTIC RELATIONSHIP
ACCEPTANCE
A nurse, who does not judge the client or person no matter what his or her behavior, is showing
acceptance. Acceptance does not mean accepting all the inappropriate behavior but rather acceptance
of the person as worthy.

POSITIVE REGARD
Positive regard is an unconditional and nonjudgmental attitude where the nurse appreciates the client as
a unique worthwhile human being that shows respect for the client regardless of his or her behavior
background and lifestyle.

SELF-AWARENESS
Self-awareness is the process of understanding one’s own values, beliefs, thoughts, feelings, attitudes,
motivations, prejudices, strengths and limitations. The first step in preparing oneself to build a therapeutic
nurse-patient relationship is to understand oneself.
THERAPEUTIC USE OF SELF
A nurse can only use his or her personality, experiences, values,
feelings, intelligence, needs, coping skills and perceptions to build
a relationship with clients (therapeutic use of self) when he or she
has developed self-awareness and self-understanding.
 THERAPEUTIC TECHNIQUES

Offering Self

making self-available and showing interest and

concern.

“I will walk with you”

 THERAPEUTIC TECHNIQUES

Active Listening

paying close attention to what the patient is saying

by observing both verbal and non-verbal cues

Maintaining eye contact and making verbal

remarks to clarify and encourage further
communication.
 THERAPEUTIC TECHNIQUES

Exploring

to learn about or familiarize oneself with it

“Tell me more about your son”

 THERAPEUTIC TECHNIQUES

Giving Broad Openings

encourages the client to take the lead in the

conversation

“What do you want to talk about today?”

 THERAPEUTIC TECHNIQUES

Silence

Planned absence of verbal remarks to allow

patient and nurse to think over what is being
discussed and to say more.
 THERAPEUTIC TECHNIQUES

Stating the Observed

verbalizing what is observed in the patient to, for

validation and to encourage discussion

“You sound angry”

 THERAPEUTIC TECHNIQUES

Encouraging Comparisons

asking to describe similarities and differences

among feelings, behaviors, and events.

“Can you tell me what makes you more

comfortable, working by yourself or working as a
member of a team?”
 THERAPEUTIC TECHNIQUES

Identifying Themes

asking to identify recurring thoughts, feelings, and

behaviors

“When do you always feel the need to check the

locks and doors?”
 THERAPEUTIC TECHNIQUES

Summarizing

reviewing the main points of discussions and

making appropriate conclusions.

“During this meeting, we discussed about what

you will do when you feel the urge to hurt your self
again and this include...”
 THERAPEUTIC TECHNIQUES

Placing the Event in Time or Sequence

asking for relationship among events

“When do you begin to experience this ticks?

Before or after you entered grade school?”
 THERAPEUTIC TECHNIQUES

Voicing Doubt

voicing uncertainty about the reality of patient’s

statements, perceptions and conclusions

“I find it hard to believe...”

 THERAPEUTIC TECHNIQUES

Encouraging Descriptions of Perceptions

asking the patients to describe feelings,

perceptions and views of their situations.

“What are these voices telling you to do?”

 THERAPEUTIC TECHNIQUES

Presenting Reality or Confronting

stating what is real and what is not without

arguing with the patient.

“I know you hear these voices but I do not hear

them” “I am Lhynnelli, your nurse, and this is a hospital
and not a beach resort.”
 THERAPEUTIC TECHNIQUES

Seeking Clarification
asking patient to restate, elaborate, or give
examples of ideas or feelings to seek clarification
of what is unclear.
“I am not familiar with your work, can you describe
it further for me”.
“I don’t think I understand what you are saying”.
 THERAPEUTIC TECHNIQUES

Verbalizing the Implied

rephrasing patient’s words to highlight an
underlying message to clarify statements

Patient: I wont be bothering you anymore soon.

Nurse: Are you thinking of killing yourself?
 THERAPEUTIC TECHNIQUES

Reflecting
throwing back the patient’s statement in a form of
question helps the patient identify feelings

Patient: I think I should leave now.

Nurse: Do you think you should leave now?
 THERAPEUTIC TECHNIQUES

Restating
repeating the exact words of patients to remind
them of what they said and to let them know they
are heard.
Patient: I can’t sleep. I stay awake all night.
Nurse: You can’t sleep at night?
 THERAPEUTIC TECHNIQUES

General Leads

using neutral expressions to encourage patients to

continue talking.

“Go on...”
“You were saying...”
 THERAPEUTIC TECHNIQUES

Asking Question

using open-ended questions to achieve relevance

and depth in discussion

“How did you feel when the doctor told you that
you are ready for discharge soon?”
 THERAPEUTIC TECHNIQUES

Empathy

recognizing and acknowledging patient’s feelings.

“It’s hard to begin to live alone when you have

been married for more than thirty years”
 THERAPEUTIC TECHNIQUES

Focusing

pursuing a topic until its meaning or importance is

clear

“Let us talk more about your best friend in

college”
“You were saying...”
 THERAPEUTIC TECHNIQUES

Interpreting

providing a view of the meaning or importance of

something.

Patient: I always take this towel wherever I go.

Nurse: That towel must always be with you.
 THERAPEUTIC TECHNIQUES

Encouraging Evaluation

asking for patients views of the meaning or

importance of something

“What do you think led the court to commit you

here?”
“Can you tell me the reasons you don’t want to be
discharged?
 THERAPEUTIC TECHNIQUES

Suggesting Collaboration

offering to help patients solve problems

“Perhaps you can discuss this with your children so

they will know how you feel and what you want”.
 THERAPEUTIC TECHNIQUES

Encouraging Goal Setting

offering to help patients solve problems

“Perhaps you can discuss this with your children so

they will know how you feel and what you want”.
 THERAPEUTIC TECHNIQUES

Encouraging Formulation of a
Plan of Action
probing for step by step actions that will be
needed

“If you decide to leave home when your husband

beat you again what will you do next?”
 THERAPEUTIC TECHNIQUES

Encouraging Decisions

asking patients to make a choice among options.

“Given all these choices, what would you prefer to

do.
 THERAPEUTIC TECHNIQUES

Encouraging Consideration of
Options
asking patients to consider the pros and cons of
possible options

“Have you thought of the possible effects of your

decision to you and your family?”
 THERAPEUTIC TECHNIQUES

Giving Information

providing information that will help patients make

better choices

“Nobody deserves to be beaten and there are

people who can help and places to go when you do
not feel safe at home anymore”.
NON-THERAPEUTIC
TECHNIQUES
NON-THERAPEUTIC TECHNIQUES
AVOID PITFALLS:
Giving advise
Talking about your self
Telling client is wrong
Entering into hallucinations and delusions of client
False reassurance
Cliché
Giving approval
Asking WHY?
Changing Subject
Defending doctors and other health team members
 NON-THERAPEUTIC TECHNIQUES

Overloading
talking rapidly, changing subjects too often, and
asking for more information than can be absorbed
at one time.

“What’s your name? I see you like sports. Where do

you live?”
 NON-THERAPEUTIC TECHNIQUES

Value Judgments
giving one’s own opinion, evaluating, moralizing or
implying one’s values by using words such as “nice”,
“bad”, “right”, “wrong”, “should” and “ought”

“You shouldn’t do that, its wrong”.

 NON-THERAPEUTIC TECHNIQUES

Incongruence
sending verbal and non-verbal messages that
contradict one another

The nurse tells the patient “I’d like to spend time with you” and then walks away.
 NON-THERAPEUTIC TECHNIQUES

Underloading
remaining silent and unresponsive, not picking up cues,
and failing to give feedback

The patient ask the nurse, simply walks away

 NON-THERAPEUTIC TECHNIQUES

False reassurance/ Agreement

Using cliché to reassure client

“It’s going to be alright”

 NON-THERAPEUTIC TECHNIQUES

Invalidation
Ignoring or denying another’s presence, thought’s or
feelings

Client: How are you?

Nurse responds: I can’t talk now. I’m too busy.
 NON-THERAPEUTIC TECHNIQUES

Focusing on Self
responding in a way that focuses attention to the nurse
instead of the client

"That happened to me once too."

 NON-THERAPEUTIC TECHNIQUES

Changing the Subject

introducing new topic
inappropriately, a pattern that may indicate anxiety.

The client is crying, when the nurse asks “How many children do you have?”
 NON-THERAPEUTIC TECHNIQUES

Giving Advice
telling the client what to do, giving opinions or making
decisions for the client, implies client cannot handle his
or her own life decisions and that the nurse is accepting
responsibility.
“If I were you… Or it would be better if you do it this way…”
 NON-THERAPEUTIC TECHNIQUES

Internal Validation
making an assumption about the meaning of someone
else’s behavior that is not validated by the other person
(jumping into conclusion)

The nurse sees a suicidal clients smiling and tells another nurse the patient is in
good mood.
 NON-THERAPEUTIC TECHNIQUES

Other ineffective Behaviors and Responses:

Defending – Your doctor is very good.
Requesting an explanation – Why did you do that?
Reflecting – You are not suppose to talk like that!
Literal responses – If you feel empty then you should
eat more.
Looking too busy.
 NON-THERAPEUTIC TECHNIQUES

Other ineffective Behaviors and Responses:

Appearing uncomfortable in silence.
Being opinionated.
Avoiding sensitive topics
Arguing and telling the client is wrong
Having a closed posture-crossing arms on chest
 NON-THERAPEUTIC TECHNIQUES

Other ineffective Behaviors and Responses:

Making false promises – I’ll make sure to call you
when you get home.
Ignoring the patient – I can’t talk to you right now
Making sarcastic remarks
Laughing nervously
Showing disapproval – You should not do those
things.
THANK YOU FOR
ATTENTIVE
LISTENING