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Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing: Mental Health and Community Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022.
Therapeutic Communication Techniques [7]
| Therapeutic Techniques | Definition | Examples |
|---|---|---|
| Acceptance | Acceptance acknowledges a client’s emotions or message and affirms they have been heard. Acceptance isn’t necessarily the same thing as agreement; it can be enough to simply make eye contact and say, “I hear what you are saying.” Clients who feel their nurses are listening to them and taking them seriously are more likely to be receptive to care. | Client: “I hate taking all this medicine. It makes me feel numb.” Nurse (making eye contact): “Yes, I understand.” |
| Clarification | Clarification asks the client to further define what they are communicating. Similar to active listening, asking for clarification when a client says something confusing or ambiguous is important. It helps nurses ensure they understand what is actually being said and can help clients process their ideas more thoroughly. | Client: “I feel useless to everyone and everything.” Nurse: “I’m not sure I understand what you mean by useless. Can you give an example of a time you felt useless?” |
| Focusing | Focusing on a specific statement made by a client that seems particularly important prompts them to discuss it further. Clients don’t always have an objective perspective on their situation or past experiences, but as impartial observers, nurses can more easily pick out important topics on which to focus. | Client: “I grew up with five brothers and sisters. We didn’t have much money, so my mom was always working and never home. We had to fend for ourselves, and there was never any food in the house.” Nurse: “It sounds as if you experienced some stressful conditions growing up.” |
| Exploring | Exploring gathers more information about what the client is communicating. | Client: “I had to lie when I found out a dark secret about my sister.” Nurse: “If you feel comfortable doing so, tell me more about the situation and your sister’s dark secret.” |
| Giving Recognition | Giving recognition acknowledges and validates the client’s positive health behaviors. Recognition acknowledges a patient’s behavior and highlights it without giving an overt compliment. A compliment can sometimes be taken as condescending, especially when it concerns a routine task like making the bed. | Nurse: “I noticed you took all of your medications.” |
| Open-Ended Questions/ Offering General Leads | Using open questions or offering general leads provides keywords to “open” the discussion while also seeking more information. Therapeutic communication is most effective when clients direct the flow of conversation and decide what to talk about. Giving patients a broad opening such as “What’s on your mind today?” or “What would you like to talk about?” is a good way to encourage clients to discuss what’s on their mind. | Client: “I’m unsure of what to do next.” Nurse: “Tell me more about your concerns.” |
| Paraphrasing | Paraphrasing rephrases the client’s words and key ideas to clarify their message and encourage additional communication. | Client: “I’ve been way too busy today.” Nurse: “Participating in the support groups today has kept you busy.” |
| Presenting Reality | Presenting reality restructures the client’s distorted thoughts with valid information. | Client: “I can’t go in that room; there are spiders on the walls.” Nurse: “I see no evidence of spiders on the walls.” |
| Restating | Restating uses different word choices for the same content stated by the client to encourage elaboration. | Client: “The nurses hate me here.” Nurse: “You feel as though the nurses dislike you?” |
| Reflecting | Reflecting asks clients what they think they should do, encourages them to be accountable for their own actions, and helps them come up with solutions. | Client: “Do you think I should do this new treatment or not?” Nurse: “What do you think the pros and cons are for the new treatment plan?” |
| Providing Silence | Providing silence allows quiet time for self-reflection by the client. | The nurse does not verbally respond after a client makes a statement, although they may nod or use other nonverbal communication to demonstrate active listening and validation of the client’s message. |
| Making Observations | Observations about the appearance, demeanor, or behavior of patients can help draw attention to areas that might pose a problem for them. | Nurse: “You look tired today.” Client: “I haven’t been getting much sleep lately because of so many racing thoughts in my head at night.” |
| Offering Self/Providing Presence | Offering self provides support by being present. Inpatient care can be lonely and stressful at times. When nurses provide presence and spend time with their clients, it shows clients they value them and are willing to give them time and attention. | Offering to simply sit with clients for a few minutes is a powerful way to create a caring connection. |
| Encouraging Descriptions of Perceptions | Asking about perceptions in an encouraging, nonjudgmental way is important for clients experiencing sensory issues or hallucinations. It gives clients a prompt to explain what they’re perceiving without casting their perceptions in a negative light. It is also important to establish safety by ensuring the hallucinations are not encouraging the client to harm themselves or others. | The client looks distracted and frightened as if they see or hear something. Nurse: “It looks as though you might be hearing something. What do you hear now?” or “It looks as if you might be seeing something. What does it look like to you?” |
| Encouraging Comparisons | Encouraging comparisons helps clients reflect on previous situations in which they have coped effectively. In this manner, nurses can help clients discover solutions to their problems. | Nurse: “It must have been difficult when you went through a divorce. How did you cope with that?” Client: “I walked my dog outside a lot.” Nurse: “It sounds as though walking your dog outside helps you cope with stress and feel better?” |
| Offering Hope | Offering hope encourages a client to persevere and be resilient. | Nurse: “I remember you shared with me how well you coped with difficult situations in the past.” |
| Offering Humor | Humor can lighten the mood and contribute to feelings of togetherness, closeness, and friendliness. However, it is vital for the nurse to tailor humor to the client’s sense of humor. | Nurse: “Knock, knock.” Client: “Who’s there?” Nurse: “Orange.” Client: “Orange who?” Nurse: “Orange you glad to see me?” (Laughs with the client) |
| Confronting | Confronting presents reality or challenges a client’s assumptions. Nurses should only apply this technique during the working phase after they have established trust. Confrontation, when used correctly, can help clients break destructive routines or understand the state of their current situation. | Client: “I haven’t drunk much this year.” Nurse: “Yesterday you told me that every weekend you go out and drink so much you don’t know where you are when you wake up.” |
| Summarizing | Summarizing demonstrates active listening to clients and allows the nurse to verify information. Ending a discussion with a phrase such as “Does that sound correct?” gives clients explicit permission to make corrections if they’re necessary. | Client: “I don’t like to take my medications because they make me tired, and I gain a lot of weight.” Nurse: “You haven’t been taking your medications this month because of the side effects of fatigue and weight gain. Is that correct?” |
