UNIVERSITY OF NEGROS OCCIDENTAL – RECOLETOS

Bacolod City

COLLEGE OF ALLIED MEDICAL HEALTH SCIENCES

BS NURSING
LEVEL III

NCAMAN640
Mental Health Nursing

THERAPEUTIC COMMUNICATION TECHNIQUES

TECHNIQUES RATIONALE EXAMPLES

Accepting  Indicates the nurse heard and followed the Nodding.
- indicating reception train of thoughts of the client. Smiling appropriately.
 Does not indicate agreement. “Yes.”
 Nonjudgmental. “Okay.”
 Same with facial expression, tone of voice, “I follow what you are
body language/gestures. saying.”

Broad opening  Makes explicit the client has the lead in the “Is there something you’d like
- allowing the client to take interaction. to talk about?”
the initiative in introducing  May stimulate clients who are hesitant to talk. “Where would you like to
the topic begin?”
Clarifying (seeking information) The nurse should seek clarification throughout “Have I heard you correctly
- seeking information to make interaction with clients. that…?”
clear which is not  Helps the nurse to avoid making assumptions “I’m not sure that I follow…”
meaningful or which is that understanding has occurred even when it
vague has not.
 Helps the client articulate thoughts, feelings,
and ideas more clearly.
Consensual validation  Makes explicit the client has the lead in the “Are you using these words
- searching for mutual interaction. to convey that….?”
understanding in accordance  May stimulate clients who are hesitant to talk. “Tell me whether my
to the meaning of words understanding of it agrees
with you.”
“Do you mean to say…?”
Encouraging comparison  Comparing ideas, experiences, or relationships “Have you had similar
- asking that similarities and brings out recurring themes. experience?”
differences be noted  Benefits = client might recall past coping “Was it something like…?”
strategies that were effective or remember
that he/she survived a similar situation.
Encouraging description of  To understand the client, the nurse must see “Tell me when you feel
perceptions things from client’s perspective. anxious.”
- asking to verbalize what  May relieve tension and lessen harmful or “What is happening?”
he/she perceives frightening ideas. “What does the voice seem
to be saying?”
“Can you describe what you
see…?”
Encouraging expression  Encourages client to make own appraisal “What are your feelings with
- asking to appraise the rather than accept the opinion of others. regards to…?”

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 quality of his/her  Consider people and events in light of his/her “Does this contribute to your
experiences own values and beliefs. distress?”
Exploring  Help examine the issues more fully. “Tell me more about it.”
- delving further into a  Problem or concern can be better understood. “Would you describe it more
subject or an idea  However, if client expresses unwillingness to clearly?”
explore a subject, respect his/her wishes. “What kind of work?”

TECHNIQUES RATIONALE EXAMPLES

Focusing  Useful when client jumps from one topic to “Of all the concerns you’ve
- concentrating on a single another. mentioned, which is most
point or topic  Concentrate client’s energy on a single point. troublesome?”
 May prevent problems or multi-concerns from “This topic seems worth
overwhelming the client. looking at more closely.”
Formulating a plan of action  Helpful for client to plan in advance what to do “Next time this will happen,
- asking the client to consider in future similar situations. what might you do to handle
kinds of behavior likely to be  Increases the likelihood that the client will it?”
appropriate in future cope more effectively in a similar situation. “What could you do to let out
situations your anger harmlessly?”
General leads  Indicates the nurse is listening and following “Go on.”
- giving encouragement to what the client is saying without taking away “And then?”
continue the initiative for interaction. “Tell me about it.”
 Encourages client to continue when hesitant “What happened next?”
or uncomfortable with the topic.
Giving information  Increases client’s knowledge about the topic. “My name is…”
- making available the facts  Allows the client know what to expect. “My purpose in being here is…”
that the client needs  Builds trust with the client. “The schedule of activities is…”
 The nurse functions as a resource person. “Visiting hours are…”
Giving recognition  Indicates awareness of change and noting Greeting the client by name.
- acknowledging, indicating efforts made by the client. “Good morning…”
awareness, and giving  Shows respect and recognition of the client as “I noticed that you have
positive reinforcements a person, as an individual. combed your hair.”
 Such recognition does not carry the notion of “You have completed the task
being “good” or “bad”. on time.”
Making observations  Helpful when clients may not be ready to talk. “You look tense.”
- verbalizing what the nurse  Useful when clients cannot verbalize or make “Are you upset when?”
perceives themselves understood. “I notice that you’re biting
your lips.”
“Don’t you like the taste of
the sandwich?”
Offering self  The nurse can offer his/her presence, interest, “I’ll stay here with you.”
- making one’s self available and desire to understand. “I’ll sit with you for a while.”
 Should be unconditional. “I’ll walk with you.”
 The client does not have to respond verbally to “I’m interested in what you
get the nurse’s attention. think.”
Presenting reality  Useful when client is misinterpreting reality, “I see no one else in the
- orienting or offering having delusions or hallucinations. room.”
consideration of what is real  Calmly and quietly express own perceptions or “That sound was a car honk.”
facts. “Your mother is not here; I
 Do not argue or belittle the client. am a student nurse.”
 The intent is to indicate alternative line of “She is not the Blessed Virgin
thought for the client to consider, not to Mary; she is Dr. ---, the
“convince” that he/she is wrong. resident psychiatrist here.”
Reflecting  Encourages the client to recognize and accept Client: “My mother left and
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 - directing client actions, own feelings. abandoned me.”
thoughts, and feelings back  Indicates that the client’s point of view has Nurse: “This causes you to
to the client value and that the client has the right to have feel angry?”
opinions, make decisions, and think Client: “Do you think I should
independently. tell the doctor…?”
Nurse: “Do you think you
should?”
Restating  Allows the client know that he/she has Client: “I’m really mad, I
- repeating the main idea communicated the idea effectively. really hate it and I’m upset!”
expressed, using nearly or  Encourages client to continue. Nurse: “You don’t like it and
approximately the same  Helpful for client to clarify his/her thoughts you are angry and upset.”
words the client has used when he/she has been misunderstood. Client: “I can’t sleep, I stay
awake all night.”
Nurse: “You have difficulty
sleeping.”
TECHNIQUES RATIONALE EXAMPLES
Sequencing (placing event in  Putting events in proper sequence helps both “When did this happen?”
time or sequence) the nurse and the client see them in “Was this before or after…?”
- clarifying the relationships of perspective. “How old are you when…?”
events in time  The nurse may gain information about “What seemed to lead up
recurrent patterns or themes in the client’s to…?”
behavior or relationships.
 The client may gain insight into cause-and-
effect behavior and consequences, and may be
able to see some things are not related.
Silence  Often encourages client to verbalize, provided Nurse says nothing but
- absence of verbal that it is interested and expectant. continues or maintains eye
communication, which  Gives the client time to organize thoughts, contact with the client and
provides time for the client direct the topic of interaction, or focus on conveys interest by smiling.
to put thoughts or feelings issues that most important.
into words, to regain  Much nonverbal behavior occurs during
composure, or to continue silence, and the nurse should be aware of the
talking client and his/her nonverbal behavior.
Suggesting collaboration  Nurse seeks to offer a relationship in which the “Let’s go to the wash area,
- offering to share, to strive, client can identify problems in living with and I’ll help you find the
and to work with the client others, grow emotionally, and improve the toothbrush you’ve dropped
for his/her benefit ability to form satisfactory relationships. there.”
 The nurse offers to do things with the client, “Perhaps you and I can
and not for the client. discuss and discover what
triggered your anxiety.”
“Let’s plan for the program.”
Summarizing  Seeks to bring out the important points of the “You’ve said that…”
- organizing and summing up discussion and to increase the awareness and “During the past hours, you
what has been done, or that understanding of all participants. and I have discussed…”
which has gone before  Omits the irrelevant and organizes the “Have we reached a decision
pertinent aspects of the interaction. here?”
 Allows both client and nurse to depart with “Have I got this clear and
the same ideas and provides a sense of closure straight?”
at the completion of each discussion.
Translating into feelings  To understand client’s feelings when saying or Client: “I’m in the dessert, all
- seeking to verbalize client’s expressing or behaving in a certain way. alone in the world.”
feelings that he/she  Often what the client says, when taken Nurse: “You seem to feel
expresses only indirectly literally, seems meaningless or far removed lonely and deserted.”
from reality. Client: “I’m dead.”

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  The nurse must concentrate on what the client Nurse: “Are you suggesting
might be feeling to express this way. that you feel lifeless?”
Verbalizing the implied  To make the discussion less obscure. Client: “I cannot talk to you or
- voicing out what the client  The client may have difficulty communicating anyone, it’s a waste of time.”
has hinted at or suggested directly and the nurse should be as direct as Nurse: “Do you feel that no
possible without being unfeelingly blunt. one understands?”
 The nurse should take care to express only Client: “I won’t show my
what is fairly obvious; otherwise, may lead to drawings, they’re not as good
jumping into conclusions or interpreting as the others.”
client’s communication. Nurse: “Do you think others
may laugh at your drawings?”
Voicing doubt  Another means of responding to distortions of “Really?”
- expressing uncertainty about reality. “That’s hard to believe.”
the reality of client’s  Permits the client to become aware that “Isn’t that unusual?”
perceptions others do not necessarily perceive events in
the same way or draw the same conclusions.
 Does not mean client will alter own point of
view, but at least the nurse will encourage
client to reconsider or reevaluate.
 The nurse neither agrees nor disagrees; but do
not let misperceptions and distortions pass
without comment.

NONTHERAPEUTIC COMMUNICATION TECHNIQUES

TECHNIQUES RATIONALE EXAMPLES

Advising  Giving advice implies that only the nurse “I think you should…”
- telling the client what to do knows what is best for the client. “Why don’t you…”
“It’s better that you…”
“The best thing for you is…”
Agreeing  Indicates that the client is right, or this gives “That’s right.”
- indicating accord with the the client the impression that he/she is right. “I agree.”
client  No opportunity for the client to change mind
without being “wrong”.
Asking “why” questions  Usually intimidating. “Why are you here in this
(requesting an explanation)  The client is unlikely to know “why” and may mental institution?”
- asking the client to provide become defensive trying to explain. “Why do you feel that way?”
reasons for thoughts, “Why are you crying?”
feelings, behaviors, or “Why do you think that?”
events “Why did you do it?”
Belittling feelings expressed  When the nurse tries to equate the intense Client: “My life is useless, I wish
- misjudging the degree of the and overwhelming feelings the client has I was dead.”
client’s discomfort expressed, the nurse implies that the Nurse: “Everybody gets down
discomfort is temporary, mild, self-limiting, in the dumps at times.”
or not very important. “I’ve felt that way before.”
 The client is focused on own worries and
feelings, and hearing the problems or
feelings of others is not helpful.
Challenging  Causes the client to defend the delusions or “If you’re dead, why is your
- demanding proof from the misperceptions more strongly than before. heart beating?”
client  May often use to let client realize there is no “How can you be the president
“proof” and then will recognize reality, but of America?”

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 still do not prove unrealistic ideas. “If your power is true, then can
you read my mind now?”
Defending  Implies the client has no right to express “I’m sure your doctor is an
- attempting to protect impressions, opinions, or feelings. expert and has only best
someone or something from  Telling the client that his/her criticism is interest in mind.”
verbal attack unjust, wrong, or unfounded does not “Our school has a fine
change the client’s feelings but only serves reputation.”
to block further communication.
Disagreeing  Implies the client is “wrong”. “That’s wrong.”
- opposing the client’s ideas  Consequently, the client feels defensive “I don’t believe that…”
about his/her point of view or ideas. “I disagree.”
Disapproving  Implies that the nurse has the right to judge “That’s bad.”
- denouncing the client’s on client’s thoughts or actions. “I prefer you would not…”
behavior, feelings or ideas  Further implies the client is expected to “I think it’s not a good idea.”
please the nurse.
Giving approval  Saying what the client thinks or feels is “That’s correct.”
- sanctioning the client’s “good” implies that the opposite is “bad”. “I’m glad that…”
behavior or ideas  Tends to limit the client’s freedom to think, “I think that’s a good idea.”
speak, or act in a certain way.
 This can lead to the client’s acting in a
particular way just to please the nurse.
Giving literal response  Often a client is at loss to describe his/her Client: “The doctor programs
- responding to a figurative feelings and uses figurative comments, so it my brain like a television.”
comment as though it were is helpful for the nurse to focus on client’s Nurse: “What are the
a statement or fact feelings in response to such statements. channels?”
Client: “Sometimes I wish I’m a
butterfly that I could fly.”
Nurse: “You must be a
caterpillar first.”

TECHNIQUES RATIONALE EXAMPLES

Indicating the existence of an  Implies that the client was made or “What made you do that?”
external source compelled to think in a certain way. “What makes you say that?”
- attributing the source of  Clients may often think that the nurse “Who told you that you are the
thoughts, feelings, and intends to suggest the source is external. Son of God?”
behavior to others or to
outside influences
Interpreting  Do not interpret the client’s thoughts and “What you really mean is…”
- telling the client the feelings for hidden meaning. “Unconsciously, you’re
meaning of his/her  Only the client can identify or confirm the saying…”
experience presence of feelings.
Introducing an unrelated topic  Takes the initiative for the interaction away Client: “I’d like to die.”
- changing the subject from the client. Nurse: “Did your family visit
 Usually happens when the nurse is you yesterday?”
uncomfortable, doesn’t know how to Client: “I dreamt of you last
respond, or has a topic preferred to discuss. night.”
Nurse: “I want you to answer
this mathematical question.”
Making stereotyped comments  Indicates that the nurse responses lack “It’s for your own good.”
- offering meaningless clichés consideration or thoughtfulness. “Chin up!”
or trite comments  Clichés and meaningless chitchat are of no “Think positive and you’ll be

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 value in the NPR. better in no time.”
“Try and try until you succeed.”
Probing  Tends to make the client feel used or “Now tell me about this
- persistent questioning of the invaded. problem, you know I have to
client  Will not encourage client to talk or express find out.”
feelings further. “Tell me your psychiatric
 Clients have the right not to talk about issues history.”
or concerns if they choose.
Reassuring  Completely devalues the client’s feelings. “Everything will be all right.”
- indicating there is no reason  False or vague reassurances without “You’re coming along just fine.”
for anxiety or other feelings accompanying facts are meaningless to the “If I were you, I wouldn’t worry
of discomfort client. about it.”

Rejecting  The client may feel personally rejected along “Let’s not discuss about it.”
- refusing to consider or with his/her ideas or feelings. “I don’t want to hear about…”
showing contempt for the
client’s ideas or behaviors
Testing  Force the client to try to recognize own “Do you still have the idea…?”
- appraising the client’s problems. “Do you know what kind of
degree of insight  The client’s acknowledgement if knows the medications you are taking?”
problem or not may meet the nurse’s needs, “Do you know why you were
but it’s not helpful for the client. diagnosed to have
schizophrenia?”
Using denial  Denies the client’s feelings or the Client: “I am nothing.”
- refusing to admit that a seriousness of the situation by dismissing Nurse: “Of course not…you are
problem exists his/her comments without attempting to something, everybody is
discover the feelings or meaning behind something.”
them. Client: “I am a zombie, I am
dead.”
Nurse: “Oh, don’t be silly.”

Reference: Videbeck, S. (2019), Psychiatric-Mental Health Nursing 8th Edition

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