Transcript Therapeutic communication

Therapeutic
Communication
The Helping Interview
Helping Relationship
Characteristics
Caring
 Hopeful
 Sensitive
 Genuine
 Empathy
 Positive Regard
 Values Self &
Others
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Empowering
 Teaching
 Goal- Oriented,
Purposeful
 Time Limited
 Assertive
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Helping vs Social Relationships
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HELPING
Care
Trust
Growth
Purposeful/Intentional
Unequal Sharing
Focus on Client’s
Needs
Time Limited
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SOCIAL
Care
Trust
Growth
Spontaneous
Similar Sharing
Focus on Needs of
Both Individuals
Ongoing
Control
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GIVING HELP
feeling important
feeling useful
feeling powerful
feeling gratified
feeling happy
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NEEDING HELP
feeling unimportant or
inadequate
feeling useless or
depressed
feeling powerless
feeling frightened or
embarrassed
feeling sad or angry
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
 trust develops
TRUST
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try expression
reflection
use of silence
setting limits
time with client
Working Phase
 “problem
solving” phase
 attend to client’s needs
 role of teacher/counselor
 client actively participates
 gather further data
 facilitate change
 evaluate problems & goals
Termination
 “ending”
phase
 review and summarize progress &
goals met/not met
 acknowledge feelings
 use clear language
 check the receiver understands
the message sent
Resolution
 clients
mostly seeking explanation
 how will problem affect their lives?
 what will need to be changed?
 how will they cope?
Avoid
arguing
 minimizing
 challenging
 giving false
reassurance
 interpreting or
speculating on the
dynamics of the
client’s problems
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“selling” client on
accepting
treatment
 probing sensitive
areas
 participating in
criticism of any
staff member
 joining any attacks
led by client
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Nursing Interventions to Encourage
The Helping Relationship
active listening
 therapeutic communication techniques
 other factors
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attentive listening scale
hard to maintain eye contact
 respond before other finishes speaking
 finish other people’s sentences
 talk on and on so no one can respond
 go on working while someone is talking to
you
 repeat a point just made
 allow your mind to wander during a
conversation
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good listening
STOP TALKING
 put the speaker at ease
 show that you want to listen
 remove distractions
 empathetic
 be patient
 hold your temper
 go easy on argument and criticism
 STOP TALKING
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communication techniques
 open
ended questions (closed for
obtaining specific information)
 validating/clarifying
 reflective/restating & paraphrasing
 sequencing
 sharing observations
 acknowledging feelings
interpersonal skills
 warmth
and friendliness
 openness (acceptance)
 consideration of client variables
– non-english speaking
– developmental considerations
– older adults
– sociocultural
– occupational
– patients with special needs
other factors promoting
therapeutic communication
 comfortable
environment
 Providing some personal space
 privacy
 confidentiality
 client focus
 optimal pacing
 nursing observations
blocks to communication
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failure to respect
client
failure to listen
minimizing feelings
inappropriate
comments & questions
excessive questions
yes/no questions
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why & how
probing
changing the subject
leading questions
advice
judgmental
false reassurance
giving
approval/disapproval
therapeutic vs non-therapeutic
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THERAPEUTIC
facilitates
transformation of
working nurse/patient
relationship
relationship allows for
adequate & accurate
assessment &
data collection
performed with
patient, not for patient
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NON-THERAPEUTIC
hinders relationship
formation
prevents patient from
becoming mutual partner
& relegates him/her to
passive recipient of care
disclosure, yes or no?
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use self disclosure to
help clients open up to
you – not to meet
your own needs
keep your disclosures
very brief
don’t imply that your
experience is exactly
the same as
the client’s
only self-disclose
about situations that
you have mastered
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monitor your own
comfort with
self-disclosure
respect your client’s
needs for privacy
remember that there
are cultural variations
in the amount of selfdisclosure considered
appropriate
identify risks and
benefits of
self disclosure
discuss the goals of
medical care is not enough!
We need more than medical
care or surgery--we need
competent care &
a good communicator