Therapeutic Communication in Psychiatric Nursing
This page was last updated on September 19, 2013
INTRODUCTION
The nurse-client relationship is the foundation on which psychiatric nursing is established.
The therapeutic interpersonal relationship is the process by which nurses provide care for clients
in need of psychosocial intervention.
Mental health providers need to know how to gain trust and gather information from the patient,
the patient's family, friends and relevant social relations, and to involve them in an effective
treatment plan.
Therapeutic use of self is the instrument for delivery of care to clients in need of psychosocial
intervention.
Interpersonal communication techniques are the tools of psychosocial intervention.
THERAPEUTIC NURSE-CLIENT RELATIONSHIP
Therapeutic relationships are goal- oriented and directed at learning and growth promotion.
Therapeutic Use of Self
Definition - ability to use ones personality consciously and in full awareness in an attempt to
establish relatedness and to structure nursing interventions.
Nurses must possess self-awareness, self-understanding, and a philosophical belief about life,
death, and the overall human condition for effective therapeutic use of self.
Requirements for Therapeutic Relationship
Rapport
Trust
Respect
Genuineness
Empathy
Phases of a Therapeutic Nurse-Client Relationship
Pre-interaction phase
Orientation/Introductory Period
Working
Termination
INTERPERSONAL COMMUNICATION
Interpersonal communication is a transaction between the sender and the receiver. Both persons
participate simultaneously.
In the transactional model, both participants perceive each other, listen to each other, and
simultaneously engage in the process of creating meaning in a relationship, focusing on the
patients issues and assisting them learn new coping skills.
Both sender and receiver bring certain preexisting conditions to the exchange that influence the
intended message and the way in which message is interpreted.
CONTEXT OF THERAPEUTIC COMMUNICATION
Values, attitudes, and beliefs.
Example: attitudes of prejudice are expressed through negative stereotyping.
Culture or religion
Cultural mores, norms, ideas, and customs provide the basis for ways of thinking.
Social status
High-status persons often convey their high-power position with gestures of hands on hips, power
dressing, greater height, and more distance when communicating with individuals considered to
be of lower social status.
Gender
Masculine and feminine gestures influence messages conveyed in communication with others.
Age or developmental level
Example: The influence of developmental level on communication is especially evident during
adolescence, with words such as cool, awesome, and others.
The environment
Territoriality, density, and distance are aspects of environment that communicate messages.
o
Territoriality - the innate tendency to own space
Density - the number of people within a given environmental space
Distance - the means by which various cultures use space to communicate
Proxemics: Use of Space
Intimate distance - the closest distance that individuals allow between themselves and other
Personal distance -the distance for interactions that are personal in
nature, such as close conversation with friends
Social distanc - the distance for conversation with strangers or acquaintances
Public distance - the distance for speaking in public or yelling to someone some distance away
Nonverbal Communication: Body Language
Components of nonverbal communication
Physical appearance and dress
Body movement and posture
Touch
Facial expressions
Eye behavior
Vocal cues or paralanguage
THERAPEUTIC COMMUNICATION TECHNIQUES
Using silence - allows client to take control of the discussion, if he or she so desires
Accepting - conveys positive regard
Giving recognition - acknowledging, indicating awareness
Offering self - making oneself available
Giving broad openings - allows client to select the topic
Offering general leads - encourages client to continue
Placing the event in time or sequence - clarifies the relationship of events in time
Making observations - verbalizing what is observed or perceived
Encouraging description of perceptions - asking client to verbalize what is being perceived
Encouraging comparison - asking client to compare similarities and differences in ideas,
experiences, or interpersonal relationships
Restating - lets client know whether an expressed statement has or has not been understood
Reflecting - directs questions or feelings back to client so that they may be recognized and
accepted
Focusing - taking notice of a single idea or even a single word
Exploring - delving further into a subject, idea, experience, or relationship
Seeking clarification and validation - striving to explain what is vague and searching for mutual
understanding
Presenting reality - clarifying misconceptions that client may be expressing
Voicing doubt - expressing uncertainty as to the reality of clients perception
Verbalizing the implied - putting into words what client has only implied
Attempting to translate words into feelings - putting into words the feelings the client has
expressed only indirectly
Formulating plan of action - striving to prevent anger or anxiety escalating to unmanageable
level when stressor recurs
THERAPEUTIC COMMUNICATION AND PROBLEM-SOLVING
Goals are often achieved through use of the problem-solving model:
Identify the clients problem.
Promote discussion of desired changes.
Discuss aspects that cannot realistically be changed and ways to cope with them more
adaptively.
Discuss alternative strategies for creating changes the client desires to make.
Weigh benefits and consequences of each alternative.
Help client select an alternative.
Encourage client to implement the change.
Provide positive feedback for clients attempts to create change.
Help client evaluate outcomes of the change and make modifications as required.
LISTENING TO THE PATIENT
To listen actively is to be attentive to what client is saying, both verbally and nonverbally.
Several nonverbal behaviors have been designed to facilitate attentive listening.
S Sit squarely facing the client.
O Observe an open posture.
L Lean forward toward the client.
E Establish eye contact.
R Relax.
Process Recordings
Written reports of verbal interactions with clients
A means for the nurse to analyze the content and pattern of interaction
A learning tool for professional development
How do I give a Patient Feedback
Feedback is useful when it
is descriptive rather than evaluative and focused on the behavior rather than on the client
is specific rather than general
is directed toward behavior that the client has the capacity to modify
imparts information rather than offers advice.
Nontherapeutic Communication Techniques
Giving reassurance - may discourage client from further expression of feelings if client believes
the feelings will only be downplayed or ridiculed
Rejecting - refusing to consider clients ideas or behavior
Approving or disapproving - implies that the nurse has the right to pass judgment on the
goodness or badness of clients behavior
Agreeing or disagreeing - implies that the nurse has the right to pass judgment on whether
clients ideas or opinions are right or wrong
Giving advice - implies that the nurse knows what is best for client and that client is incapable of
any self-direction
Probing - pushing for answers to issues the client does not wish to discuss causes client to feel
used and valued only for what is shared with the nurse
Defending - to defend what client has criticized implies that client has no right to express ideas,
opinions, or feelings
Requesting an explanation - asking why implies that client must defend his or her behavior or
feelings
Indicating the existence of an external source of power - encourages client to project blame
for his or her thoughts or behaviors on others
Belittling feelings expressed - causes client to feel insignificant or unimportant
Making stereotyped comments, clichs, and trite expressions - these are meaningless in a
nurse-client relationship
Using denial - blocks discussion with client and avoids helping client identify and explore areas
of difficulty
Interpreting - results in the therapists telling client the meaning of his or her experience
Introducing an unrelated topic - causes the nurse to take over the direction of the discussion
CONCLUSION
Effective communication is the core skill in mental health care in primary care settings.
Self-awareness and ability to collaborate with other health care providers are also skills that will
facilitate accurate inquiry into the patient's true concerns and the context in which they occur.
REFERENCES
1. Epstein RM, Borrell F, Caterina M . Communication and mental health in primary care. In New
Oxford Textbook of Psychiatry (Edrs. Gelder MG, Lpez-Ibor JJ, Andreasen NC), Oxford
University Press, 2000.
