Therapeutic Communication

THERAPEUTIC COMMUNICATION
&
THERAPEUTIC RELATIONSHIP
In The Psychiatric Setting
RAYMUND CHRISTOPHER R. DELA PEÑA, MAN, RN, RM
Assistant Professor II, College of Nursing
University of Northern Philippines
2
 Interactive process that occurs between

the patient and the health professional;
 Focuses solely on the patient’s problem;

THERAPEUTIC
COMMUNICATION
 Establishment of trust is the foundation
of a nurse-client relationship;
3
“C SOAP ME FEG and SURE STROL”
C – clarification
S – silence
Therapeutic O – offering self
Communication
Techniques A – accepting
P – presenting reality
M – making observation
E – empathy
4
F – focusing
E – exploring
G – giving recognition
Therapeutic
Communication
Techniques
S – suggesting collaboration
U – using broad openings
R – reflecting
E – encouraging description
5
S – sharing perceptions
T – translating into feelings
Therapeutic
Communication R – restating
Techniques
O – offering general leads
L – listening
6
 Client able to think about self or his

problems;
 Does not feel any pressure to speak;

SILENCE
 Look into the eyes and listen to the
client while he is talking;
7
 Offer to provide comfort to client by mere

presence;
 “I’ll sit with you.”
 “I’ll walk with you.”
 “I’m here for you.”
OFFERING SELF
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 by nodding and following what client says;
ACCEPTING
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 Reports events and situations as they really are;
 Client: “I don’t have a chance talking to my

PRESENTING doctor.”
REALITY  Nurse: “I saw you and your doctor talking this
morning”
 Client: “These voices are bothering. They want

me to jump from the window.”
 Nurse: “There are no other people here.”
PRESENTING
REALITY
11
 Verbalize what you perceive;
 “I notice that you can’t sit still.”
 “I notice that something is bothering you.”

MAKING
OBSERVATION
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 Showing or telling what you feel in relation to

the client’s suffering.
 “I know what you feel………”
 “I know this is hard for you……….”

EMPATHY
EMPATHY
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 Encouraging the client to stay or focus on the

topic;
 “You were talking about your mother.”
 “You were saying that your………..”
FOCUSING
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 Encourage client to express feelings or ideas

deeply;
 “Tell me more about you and your mother.”
 “How did you respond to……..”
EXPLORING
EXPLORING
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 Indicate to client your awareness of him and his

behaviors;
 “Good morning, I noticed that you combed your

GIVING hair today.”
RECOGNITION
 “I observed that you’re behaving
appropriately.”
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 Offer to work with client towards a specific

goal;
 Client: “I fail at everything I try.”
 Nurse: “May be we can figure out something
together so that you can accomplish something
SUGGESTING you want to do.”
COLLABORATION
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 Encourage client to introduce the topic of

conversation; or to start a conversation;
 “Where shall we begin today?”
 “What are you thinking about?”
USING
BROAD
OPENINGS
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 Direct client’s questions or statements back to

encourage expression of ideas and feelings;
 Client: “Do you think I should talk to my
doctor.”
 Nurse: “What do you want to talk about?”
REFLECTING
REFLECT
ING
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 Ask the client to verbalize his

perception;
 “What is happening to you right now?”
ENCOURAGING  “What are you doing in front of the
DESCRIPTION window?”
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 The nurse describes his or her

understanding of the patient’s feelings
and ideas;
 Nurse: “I noticed that you have an
unresolved feelings towards your
SHARING mother.”
PERCEPTIONS
25
 Encourage client to verbalize feelings

expressed in another way;
 Client: “I will never get better.”
TRANSLATING  Nurse: “You sound rather hopeless and
INTO helpless.”
FEELINGS
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 Repeat what client has said;

 Client: “I don’t want to take my
medicines.”
 Nurse: “You don’t want to take your
medicines?”
RESTATING
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 Encourage client to continue discussing

the topic;
 “And then?” or “Go on I’m listening.”
 “Tell me more about what you just
said?”
OFFERING
GENERAL
LEADS
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 These are methods of communication that

obstruct the process of therapeutic
Blocks to conversations (“Non-therapeutic”)
Therapeutic
Communication
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B – belittling feelings
A – agreeing / disagreeing
D – denial
Non- S – stereotypical response

Therapeutic C – changing topic
Communicatio A – approval / disapproval
n R – reassuring
D – defending
R – requesting explanation
O – offering advise
P – probing
Non-
Therapeutic
Communicatio
n
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NON-THERAPEUTIC COMMUNICATION
Belittling feelings “Everybody experiences

failures and downs.”
“I’ve felt the same sometimes.”
Agreeing / “That’s right….. I agree.”

Disagreeing
“It’s wrong… I don’t agree…”
Denial P – “I’m nothing.”

N – “Of course you’re
something.”
32
Stereotypical “Nice weather were having.”

response “I’m fine and how are you?”
Changing P – “I want to die!”

topic N – “Did your parents visited
you?”
Approval / “I’m glad that you…”
Disapproval “I’d rather you wouldn’t…”
Reassuring “Everything will be alright.”

“Don’t worry it’s fine.”
33
Defending “That nurse is competent.”

“His thinking of you all the
time.”
Requesting “Why do you think that…”
explanation “Why do you feel this way…”
“Why did you do that?”
Offering advise “I think you should…”
“Why don’t you…”
Probing “Now tell me about you….”

“Tell me your history.”
36
ORIENTATION
 or Assessment or analysis;
 The nurse establishes trust with the client;
 The nurse assesses the client;

Phasesof
Therapeutc
i
Rea
lto
inshp
i
 Formulation of nursing diagnosis;
 Prioritization of the client’s problems;
 The nurse and the client establish mutually

agreed goals;
 Discussing the indications for termination;

37
 Pertains to planning and intervention;
 the nurse plans outcomes and related

interventions to assist client to meet goals;
WORKING
PHASE  The nurse facilitates the client’s expression of
problems, thoughts, and feelings;
 The nurse uses problem-solving approach;

38
 Pertains to evaluation;
 The nurse evaluates outcomes, reassess

TERMINATION the problems, goals and interventions;
PHASE
 Needs close attention to avoid destroying
the benefits gained from the
relationship;
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 The nurse and client express feelings regarding

the termination of the interactions;
 The nurse observes the client for negative

behaviors:
TERMINATION
 Regression
PHASE  Anger
 Inappropriate expressions (laughter)
 The nurse evaluates the entire nurse-client

relationship;

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THERAPEUTIC COMMUNICATION

 Interactive process that occurs between

 Focuses solely on the patient’s problem;

“C SOAP ME FEG and SURE STROL”

 Client able to think about self or his

 Does not feel any pressure to speak;

 Offer to provide comfort to client by mere

 by nodding and following what client says;

 Reports events and situations as they really are;

 Client: “I don’t have a chance talking to my

 Client: “These voices are bothering. They want

 Verbalize what you perceive;

 “I notice that you can’t sit still.”

 “I notice that something is bothering you.”

 Showing or telling what you feel in relation to

 “I know what you feel………”

 “I know this is hard for you……….”

 Encouraging the client to stay or focus on the

 Encourage client to express feelings or ideas

 Indicate to client your awareness of him and his

 “Good morning, I noticed that you combed your

 Offer to work with client towards a specific

 Encourage client to introduce the topic of

 Direct client’s questions or statements back to

 Ask the client to verbalize his

 The nurse describes his or her

 Encourage client to verbalize feelings

 Repeat what client has said;

 Encourage client to continue discussing

 These are methods of communication that

Non- S – stereotypical response

Belittling feelings “Everybody experiences

Agreeing / “That’s right….. I agree.”

Denial P – “I’m nothing.”

Stereotypical “Nice weather were having.”

Changing P – “I want to die!”

Reassuring “Everything will be alright.”

Defending “That nurse is competent.”

Probing “Now tell me about you….”

 The nurse establishes trust with the client;

 The nurse assesses the client;

 Formulation of nursing diagnosis;

 Prioritization of the client’s problems;

 The nurse and the client establish mutually

 Discussing the indications for termination;

 Pertains to planning and intervention;

 the nurse plans outcomes and related

 The nurse uses problem-solving approach;

 The nurse evaluates outcomes, reassess

 The nurse and client express feelings regarding

 The nurse observes the client for negative

 The nurse evaluates the entire nurse-client

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