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Chapter: Psychiatric Mental Health Nursing : Therapeutic Communication

Therapeutic Communication

COMMUNICATION IS THE PROCESS that people use to exchange information.

Therapeutic Communication

COMMUNICATION IS THE PROCESS that people use to exchange information. Messages are simultaneously sent and received on two levels: verbally through the use of words and nonverbally by behaviors that accompany the words (DeVito, 2008). Verbal communication consists of the words a person uses to speak to one or more listeners. Words represent the objects and concepts being discussed. Placement of words into phrases and sen-tences that are understandable to both speaker and listeners gives an order and a meaning to these symbols. In verbal communication, content is the literal words that a person speaks. Context is the environment in which communication occurs and can include the time and the physical, social, emotional, and cultural environments. Context includes the situation or circumstances that clarify the meaning of the content of the message.


Nonverbal communication is the behavior that accompanies verbal con-tent such as body language, eye contact, facial expression, tone of voice, speed and hesitations in speech, grunts and groans, and distance from the listeners. Nonverbal communication can indicate the speaker’s thoughts, feelings, needs, and values that he or she acts out mostly unconsciously.


Process denotes all nonverbal messages that the speaker uses to give meaning and context to the message. The process component ofcommunication requires the listeners to observe the behav-iors and sounds that accent the words and to interpret the speaker’s nonverbal behaviors to assess whether they agree or disagree with the verbal content. A congruent message is conveyed when content and process agree. For example, a client says, “I know I haven’t been myself. I need help.” She has a sad facial expression and a genuine and sincere voice tone. The process validates the content as being true. But when the content and process disagree—when what the speaker says and what he or she does do not agree— the speaker is giving an incongruent message. For exam-ple, if the client says, “I’m here to get help,” but has a rigid posture, clenched fists, an agitated and frowning facial expression, and snarls the words through clenched teeth, the message is incongruent. The process or observed behavior invalidates what the speaker says (content).


Nonverbal process represents a more accurate message than does verbal content. “I’m sorry I yelled and screamed at you” is readily believable when the speaker has a slumped posture, a resigned voice tone, downcast eyes, and a shameful facial expression because the content and process are congruent. The same sentence said in a loud voice and with raised eyebrows, a piercing gaze, an insulted facial expression, hands on hips, and outraged body lan-guage invalidates the words (incongruent message). The message conveyed is “I’m apologizing because I think I have to. I’m not really sorry.”


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