Therapeutic Communication

Therapeutic Communication the helping interview

Caring Hopeful Sensitive Genuineness Empathy Positive regard Empowering Assertive Helping Relationship Characteristics

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

THOSE GIVING HELP Feeling important Feeling useful Feeling powerful Feeling gratified Feeling happy THOSE NEEDING HELP Feeling unimportant or inadequate Feeling useless or depressed Feeling powerless Feeling frightened or embarrassed Feeling sad or angry LOCUS OF CONTROL

Phases of Helping Relationship • Orientation (professional and client to each other) • Working (identification of the client’s problem) • Termination (resolution of the client’s problem)

Orientation Phase • “Getting to know you” phase • Sets the tone • Introductions • Roles • Initiated by the nurse • Agreement/contract/goals • Orientation • Trust develops

Working Phase • “Problem solving” phase • Attend to client’s needs • Nurse in role of teacher/counselor • Client actively participates • Gather further data • Facilitate change • Evaluate problems & goals

Termination/Resolution Phase • Review and summarize progress & goals met/not met • Acknowledge feelings • Clients mostly seeking explanation • How will problem affect their lives? • What will need to be changed? • How will they cope?

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

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

Active Listening • STOP TALKING • Put the speaker at ease • Show that you want to listen • Remove distractions • Be empathetic • Be patient • Hold your temper • Avoid criticism & argument • STOP TALKING

Interviewing Techniques • the purpose of the interview is to obtain accurate & thorough information • begin with an explanation • use open-ended questions (exception: use closed-ended to obtain specific information) • Validating/Clarifying • Reflecting • Sequencing • Acknowledging feelings

Interviewing Techniques • Validating & Clarifying • Reflecting & Paraphrasing • Sequencing • Acknowledging feelings • Sharing Observations

Effective Techniques • as a professional nurse, you will spend about half of your time asking questions of clients and colleagues • excellent questioning/interviewing skills are fundamental to nurses

Why, What, How? • why do you need the information? • how will the information I am seeking direct me in helping my client? • explain reasons in advance, as this prepares clients for your line of questioning • what will you ask? • how will you phrase your questions?

Who to Ask? • if client is able to speak for themselves, ask them • 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

Communication Barriers • “A barrier to communication is something that keeps meanings from meeting. Meaning barriers exist between all people, making communication more difficult than most people seem to realize.” (Ruel Howe)

Communication Barriers • without realizing it, people typically interject communication barriers into conversation 90% of the time • communication barriers trigger defensiveness, resistance and resentment, withdrawal, and feelings of inadequacy • they also decrease the likelihood of finding a solution

Judging • criticizing: making a negative evaluation of persons, their actions or attitudes • putting down: stereotyping • diagnosing: analyzing why a person is behaving the way he/she is • praising evaluatively: making a positive judgment of person, actions or attitudes

Avoiding theOther’s Concerns • diverting: pushing the other person’s problems aside through distractions • logical argument: attempting to convince the other person with an appeal to facts or logic without consideration of the emotional factors involved • False reassurance: trying to stop the other person from feeling the negative emotions they are experiencing

Other Barriers • ordering: commanding the other person to do what you want • threatening: trying to control the other person’s actions by warning of negative consequences you will impose • moralizing: preaching, telling someone what they should do • excessive/inappropriate questioning

Other Barriers • closed ended questions, like “are you sorry you did it?” • advising: giving the solution

Common Errors • long winded buildup (use KISS principle & be concise & focused) • the thunder stealer: jumping in with your views & opinions before giving them a chance • bombarding patients with questions • complicated medical terms- don’t use terms patients can’t understand

Common Errors • offensive misuse of ‘why’ appears threatening and aggressive • closed questions • being too abrupt • use of clichés

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

Blocks to Communication

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

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

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 you have mastered 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 Self-Disclosure

Therapeutic Communication