THE THERAPEUTIC COMMUNICATION
The nurse uses all the therapeutic communication tech-niques and
skills previously described to help achieve the following goals:
Establish rapport with the client by being empathetic, genuine,
caring, and unconditionally accepting of the client regardless of his or her
behavior or beliefs.
Actively listen to the client to identify the issues of concern and
to formulate a client-centered goal for the interaction.
Gain an in-depth understanding of the client’s percep-tion of the
issue, and foster empathy in the nurse–client relationship.
Explore the client’s thoughts and feelings.
Facilitate the client’s expression of thoughts and feelings.
Guide the client to develop new skills in problem-solving.
Promote the client’s evaluation of solutions.
Often the nurse can plan the time and setting for therapeu-tic
communication, such as having an in-depth, one-on-one interaction with an
assigned client. The nurse has time to think about where to meet and what to
say and will have a general idea of the topic, such as finding out what the
client sees as his or her major concern or following up on interaction from a
previous encounter. At times, however, a client may approach the nurse saying,
“Can I talk to you right now?” Or the nurse may see a client sitting alone,
crying, and decide to approach the client for an interac-tion. In these
situations, the nurse may know that he or she will be trying to find out what
is happening with the client at that moment in time.
When meeting the client for the first time, introducing oneself and
establishing a contract for the relationship is an appropriate start for
therapeutic communication. The nurse can ask the client how he or she prefers
to be addressed. A contract for the relationship includes outlining the care
the nurse will give, the times the nurse will be with the client, and
acceptance of these conditions by the client.
Nurse: “Hello, Mr. Kirk. My name is Joan, and I’ll be your nurse today. I’m here from 7 AM to 3:30
PM. Right now I have a few minutes, and I see you are dressed and ready for the
I would like to
spend some time talking with you if this is convenient.” (giving
recognition and introducing self,
setting limits of contract)
After making the introduction and establishing the con-tract, the
nurse can engage in small talk to break the ice and to help get acquainted with
the client if they have not met before. Then the nurse can use a broad opening
ques-tion to guide the client toward identifying the major topic of concern.
Broad opening questions are helpful to begin the therapeutic communication
session because they allow the client to focus on what he or she considers
important. The following is a good example of how to begin the therapeutic
Nurse: “Hello, Mrs. Nagy. My name is Donna, and I am your nurse today and tomorrow from 7 AM to
3:30 PM. What do you like to be called?” (introducing self,
establishing limits of relationship)
Client: “Hi, Donna. You can call me Peggy.”
Nurse: “The rain today has been a welcome relief from the heat of the past few days.”
Client: “Really? It’s hard to tell what it’s doing outside. Still seems hot in here to me.”
Nurse: “It does get stuffy here sometimes. So tell me, how are you doing today?” (broad opening)
When beginning therapeutic interaction with a client, it is often
the client (not the nurse) who identifies the problem he or she wants to
discuss. The nurse uses active listening skills to identify the topic of
concern. The client identifies the goal, and information gathering about this
topic focuses on the client. The nurse acts as a guide in this conversation.
The therapeutic communication centers on achieving the goal within the time
limits of the conversation.
The following are examples of client-centered goals:
Client will discuss her concerns about her 16-year-old daughter,
who is having trouble in school.
Client will describe difficulty she has with side effects of her
Client will share his distress about son’s drug abuse.
Client will identify the greatest concerns he has about being a
The nurse is assuming a nondirective
role in this type of therapeutic communication, using broad openings and
open-ended questions to collect information and help the client to identify and
discuss the topic of concern. The cli-ent does most of the talking. The nurse
guides the client through the interaction, facilitating the client’s expression
of feelings and identification of issues. The following is an example of the
nurse’s nondirective role:
Client: “I’m so upset about my family.”
Nurse: “You’re so upset?” (reflecting)
Client: “Yes, I am. I can’t sleep. My appetite is poor. I just don’t
know what to do.”
Nurse: “Go on.” (using a
Client: “Well, my husband works long hours and is very tired when he gets home. He barely sees the children
before their bedtime.”
Nurse: “I see.” (accepting)
Client: “I’m busy trying to fix dinner, trying to keep an eye on the children, but I also want to talk to my
Nurse: “How do you feel when all this is happening?” (encouraging
Client: “Like I’m torn in several directions at once. Noth-ing seems to
go right, and I can’t straighten everything out.”
sounds like you’re
Client: “Yes, I am. I can’t do everything at once all by myself. I think we have to make some changes.”
Nurse: “Perhaps you and I can discuss some potential changes you’d like to make.” (suggesting
In some therapeutic interactions, the client wants only to talk to an interested listener and feel like he or she has been heard. Often just sharing a distressing event can allow the client to express thoughts and emotions that he or she has been holding back. It serves as a way to lighten the emotional load and release feelings without a need to alter the situation. Other times, the client may need to remi-nisce and share pleasant memories of past events. Older adults often find great solace in reminiscing about events in their lives such as what was happening in the world when they were growing up, how they met and when they married their spouses, and so forth.
When the client is suicidal, experiencing a crisis, or outof touch
with reality, the nurse uses a directive
role, ask ing direct yes/no questions and using problem-solving to help the
client develop new coping mechanisms to deal with present here-and-now issues.
The following is an example of therapeutic communication using a more directive
role: As the nurse–client relationship progresses, the nurse therapeutic
communication interventions and examples of how to use the techniques