Communicationm(apprx.m18)
1.mTherapeuticmCommunication
TherapeuticmCommunication:m4mTechniques:mSilence,mActivemListening,mClarifying
mTechniques,mQuestions
1:mSilence:m
● Cuttingmoffmpatientsmwhenmsilencemfeelsmuncomfortablemcanmpreventmthemmfrommsh
aringmimportantminformation
● Notmthemabsencemof mcommunicationmbutmspecificmchannelmformtransmittingmandmrec
eivingminformation
● Positives:
○ Momentsmof mreflection
○ Psychiatricmdisorders,mdepression,mAlzheimer’smDisease,mschizophrenia,ma
ndmsomemmedsmslow mpatientsmandmtheymneedmamlongermwindow mtomrespond
● Negatives:
○ Icymsilencemmaymexpressmangermandmhostility
○ Prolongedmcanmmakempeoplemuncomfortable,mespeciallymwithmyoungmpeople
2:mActivemListening:mNursesmfocus,mrespond,mandmremembermwhatmampatientmismsayingmv
erballymandmnonverbally
● Enhancesmself mesteemmandmencouragesmthempatientmtomdirectmenergymtowardsmfind
ingmwaysmtomdealmwith mproblems
● Strengthensmpatient’smproblemmsolvingm
● Nursemism“soundingmboard”m
● Enablesmpatientmclarifymthinking,mlinkmideas,mandmtentativelymdecidemwhatmshouldmb
emdonemandmhow mbestmtomdomit
● Offeringmgeneralmleads:mAllowsmthemothermpersonmtomtakemdirectionminmthemdiscus
sion m
○ Indicatesmthatmthemnursemisminterested
○ “Gomon”m“Andmthen?”mm“Tell mmemaboutmit”
● Placingmthemeventsminmtime/msequence:mPutsmeventsmandmactionsmin mbettermpers
pective,m
○ NotesmcausemandmeffectmrelationshipsmandmIDsmpatternsmof minterpersonal mdif
ficulties
○ “Whatmhappenedmbefore?”m“When mdidmitmhappen?”
,3.mClarifyingmTechniques:mMethodsmthatmverifymthemnursesminterpretation mofmthempatient’
smmessage
● a.mParaphrasing:mWhen myoumrestatemthembasicmcontentmof mpatient’smmessagemin m
different,musuallymfewer,mwords
○ “You mseemmtombemsaying…”m“I’mmnotmsuremImunderstand…”
● b.mRestating:mInvolvesmrepeatingmsamemkeymwordsmpatientmhasmspoken
○ “Mymlifemfeelsmempty…mitmhasmnommeaning.”m->m“Yourmlifemismempty?
○ Don’tmoveruse,mcan mcomemacrossminattentive/mdisinterested
○ Combinemwith mdirectmquestionsmtomencouragemdescriptions
■ “Whatmdoesmyourmlifemlack?mWhatmkindmof mmeaningmismmissing?”
● c.mReflecting:mStatementmormquestion mconveyingmnursesmobservationsmofmthempati
entmwhen mdiscussingmsensitivemissues
○ “You msoundmasmifmyou mhavemhadmmanymdisappointments.”m“You mlookmsad.”
○ MakingmObservations:mCallsmattention mtomthemperson'smbehavior
■ Encouragesmpatientmtomnoticemthembehaviormandmdescribemthoughtsm
andmfeelingsmformmutual munderstanding
■ “You mappearmtense.”m“Imnoticemyou’rembitingmyourmlips.”m“Youmseemmn
ervousmaroundmX,mY,mZ.”m
● d.mExploring:mTechniquemthatmenablesmnursemtomexaminemimportantmideas,mexperi
ences,mrelationshipsmmoremfully
○ “Tell mmemmore…”m“Describe…”m“Givemmeman mexample…”
■ Greatlymclarifymamvague/mgenericmstatementmmadembymampatient
4.mQuestioning:m
● a.mOpen-
endedmQuestions:mEncouragesmpatientsmtomshareminformation maboutmexperience
s,mperceptions,mormresponsesmtomamsituation
○ “Whatmdomyou mperceivemismyourmbiggestmproblemmrightmnow?”m“Whatmismanme
xamplemof…”mHow mwouldmyou mdescribe…”
○ Notmintrusivemandmdon’tmputmpatientmon mthemdefense
○ Greatmformestablishingmrapportmwith mpatient
● b.mClose-
endedmQuestions:mYes/mno/monemwordmanswerable/mspecificmresponsemquestions
○ Greatmforminitial minterview mtomdeterminemspecificminformation
○ “Aremthemmedicationsmhelping?”m“When mdidmyou mstartmhearingmvoices?”
● c.mProjectivemQuestions:mStartmwith m“whatmif”mtomhelpmpeoplemexploremandmIDmtho
ughtsmandmfeelingsm
, ○ Strongmabilitymtomfacilitatemampatient'smthinkingmaboutmproblemsmdifferentlyma
ndmtomIDmproblems
■ “If myou mhadm3mwishes..”
■ “If myou mcouldmgombackmandmchangemhow myou macted…”
■ “Whatmwouldmyou mdomif myou mweremgiven m$1mmillion…”
● d.mThemmiraclemquestion:mGoal msettingmquestionmthatmhelpsmpatientmtomseemwhatm
themfuturemwouldmlookmlikemif mthemproblemmwasmtomvanish
■ Shouldmbemaskedmdramatically
● GivingmRecognition:mIndicatesmawarenessmofmchangemandmpersonal meffortsmWIT
HOUTmIMPLYINGmGOOD mORmBAD,mrightmormwrong
○ “Goodmmorning…”m“You’vemcombedmyourmhairmtoday.”
● OfferingmSelf:mOffersmpresence,minterest,mandmamdesiremtomunderstand
○ Notmofferedmtomgetmthemperson mtomtalkmormbehavemin mamspecificmway
○ “Imwouldmlikemtomspendmtimemwith myou.”m“I’ll mstaymheremandmsitmwithmyoumawhil
e.”
● EncouragingmComparison:mbringsmoutmrecurringmthemesminmexperiencesmormrelat
ionships.mHelpsmclarifymsimilaritiesmandmdifferences
○ “Hasmthismevermhappenedmbefore?”m“Ismthismhow..”m“Wasmitmlike..?”
● Focusing:mConcentratesmattention mon msinglempoint
○ “Thismpointmyou maremmakingmaboutm…mseemsm…?”
● Seekingmclarification:m“ImammnotmsuremImfollow”
● PresentingmReality:mIndicatesmwhatmismreal.mNursemdoesn’tmarguemormtrymtomconvin
ce,mjustmdescribesmpersonal mperceptionsmormfactsmin mthemsituation
○ “ThatmwasmDrmTodd,mnotmamninja.”m“Yourmmothermismnotmhere,mImammamnurse.”
● VoicingmDoubt:mExpressingmuncertaintymregardingmthemrealitymofmthempatient’smper
ceptionsmormconclusions,mespeciallymhallucinations
○ “Isn’tmthatmunusual?”m“That’smhardmtombelieve”
● Seekingmconsensualmvalidation:mmClarifiesmthatmboth mpartiesmsharemmutualmunde
rstandingmof mcommunication m
○ “Tell mmemwhethermmymunderstandingmagreesmwith myou.”
● Verbalizingmthemimplied:mPutsmintomconcretemtermsmwhatmthempatientmimplies,mma
kingmitmexplicit
○ “Domyou mfeel mthatmnomonemunderstandsmyou?”
● EncouragingmEvaluation:m“How mdomyou mfeel mabout..?”m
● Attemptingmtomtranslatemintomfeelings:mP:m“mImammdeadminside.”’ mN:m“Aremyou msay
ingmyou mfeel mlifeless?mDoesmlifemseemmmeaninglessmtomyou?”
● SuggestingmCollaboration:mEmphasizesmworkingmwithmthempatient,mnotmdoingmthi
ngsmformthempatient.
○ “Maybemtogethermwemcan…”
● Summarizing:mBringsmtogethermimportantmpointsmof mthemdiscussion m
, ○ Opportunitymformpatientmtomclarifym
m
2.mTherapeuticmRelationships
Therapeuticmrelationship:mnursemmaximizesmcommunicationmskills,munderstandingmof mh
uman mbehaviors,mandmpersonal mstrengthsmtomenhancemthempatient’smgrowth
- Ptmmoremeasilymengagemmwhenmclinician’sminteractionsmaddressmtheirm
concerns,mrespectmpatientsmasmpartners,minmdecisionmmaking,mandmus
emstraight-forwardmlanguage
- Contextmof mamTherapeuticmRelationship
■ 1.mIdentifymthemneedsmofmthempatient
■ 2.mEstablishmclearmboundaries
■ 3.mHelpmpatientmdevelopmnew mcopingmskills
■ 4.mSupportmbehavioralmchange
● Analyzemthemmeaningmof mboundariesmandmtheminfluencemofmtransferencemandmcount
ertransferencemon mboundarymblurring.
○ Boundaries:mthemexpectedmandmacceptedmlegal,methical,mandmprofessionalm
standardsmthatmseparatemnursesmfrommpatients
○ Transference:moccursmwhenmpatientmunconsciouslymandminappropriatelymdi
splacesm(transfers)mfeelings/mbehaviorsmrelatedmtomsignificantmfiguresminmthem
patientsmpastmontomthemnurse
■ Common min mshiftedmpowermdynamics
■ Positive:mPatientmmotivatedmtomworkmwithmyou,mcompletemassignment
smbetween msessions,mandmsharesmfeelingsmopenlym
■ Negative:mPatientmdirectsmpainful/mangrymfeelingsmtowardsmthemnurse
○ Countertransference:mnursemunconsciouslymdisplacesmfeelingsmrelatedmtom
significantmfiguresmin mthemnursesmpastmontomthempatient
■ Often mresultsminmoverinvolvementmandmimpairsmtherapeuticmrelations
hip
■ Sign:mover-identification mwith mthempatientm
● Nursemhasmdifficultymrecognizing/mobjectivelymviewingmpatients
mproblemsmthatmaremsimilarmtomthemnursesm
■ Sign:mFeelingmdisinterestedmormdisgustedmwith mpatient
■ Sign:mGettingminvolvedmin mpowermstruggles,mcompetition,mormargume
ntsmwith mthempatient
3.mMilieu mTherapy
1.mTherapeuticmCommunication
TherapeuticmCommunication:m4mTechniques:mSilence,mActivemListening,mClarifying
mTechniques,mQuestions
1:mSilence:m
● Cuttingmoffmpatientsmwhenmsilencemfeelsmuncomfortablemcanmpreventmthemmfrommsh
aringmimportantminformation
● Notmthemabsencemof mcommunicationmbutmspecificmchannelmformtransmittingmandmrec
eivingminformation
● Positives:
○ Momentsmof mreflection
○ Psychiatricmdisorders,mdepression,mAlzheimer’smDisease,mschizophrenia,ma
ndmsomemmedsmslow mpatientsmandmtheymneedmamlongermwindow mtomrespond
● Negatives:
○ Icymsilencemmaymexpressmangermandmhostility
○ Prolongedmcanmmakempeoplemuncomfortable,mespeciallymwithmyoungmpeople
2:mActivemListening:mNursesmfocus,mrespond,mandmremembermwhatmampatientmismsayingmv
erballymandmnonverbally
● Enhancesmself mesteemmandmencouragesmthempatientmtomdirectmenergymtowardsmfind
ingmwaysmtomdealmwith mproblems
● Strengthensmpatient’smproblemmsolvingm
● Nursemism“soundingmboard”m
● Enablesmpatientmclarifymthinking,mlinkmideas,mandmtentativelymdecidemwhatmshouldmb
emdonemandmhow mbestmtomdomit
● Offeringmgeneralmleads:mAllowsmthemothermpersonmtomtakemdirectionminmthemdiscus
sion m
○ Indicatesmthatmthemnursemisminterested
○ “Gomon”m“Andmthen?”mm“Tell mmemaboutmit”
● Placingmthemeventsminmtime/msequence:mPutsmeventsmandmactionsmin mbettermpers
pective,m
○ NotesmcausemandmeffectmrelationshipsmandmIDsmpatternsmof minterpersonal mdif
ficulties
○ “Whatmhappenedmbefore?”m“When mdidmitmhappen?”
,3.mClarifyingmTechniques:mMethodsmthatmverifymthemnursesminterpretation mofmthempatient’
smmessage
● a.mParaphrasing:mWhen myoumrestatemthembasicmcontentmof mpatient’smmessagemin m
different,musuallymfewer,mwords
○ “You mseemmtombemsaying…”m“I’mmnotmsuremImunderstand…”
● b.mRestating:mInvolvesmrepeatingmsamemkeymwordsmpatientmhasmspoken
○ “Mymlifemfeelsmempty…mitmhasmnommeaning.”m->m“Yourmlifemismempty?
○ Don’tmoveruse,mcan mcomemacrossminattentive/mdisinterested
○ Combinemwith mdirectmquestionsmtomencouragemdescriptions
■ “Whatmdoesmyourmlifemlack?mWhatmkindmof mmeaningmismmissing?”
● c.mReflecting:mStatementmormquestion mconveyingmnursesmobservationsmofmthempati
entmwhen mdiscussingmsensitivemissues
○ “You msoundmasmifmyou mhavemhadmmanymdisappointments.”m“You mlookmsad.”
○ MakingmObservations:mCallsmattention mtomthemperson'smbehavior
■ Encouragesmpatientmtomnoticemthembehaviormandmdescribemthoughtsm
andmfeelingsmformmutual munderstanding
■ “You mappearmtense.”m“Imnoticemyou’rembitingmyourmlips.”m“Youmseemmn
ervousmaroundmX,mY,mZ.”m
● d.mExploring:mTechniquemthatmenablesmnursemtomexaminemimportantmideas,mexperi
ences,mrelationshipsmmoremfully
○ “Tell mmemmore…”m“Describe…”m“Givemmeman mexample…”
■ Greatlymclarifymamvague/mgenericmstatementmmadembymampatient
4.mQuestioning:m
● a.mOpen-
endedmQuestions:mEncouragesmpatientsmtomshareminformation maboutmexperience
s,mperceptions,mormresponsesmtomamsituation
○ “Whatmdomyou mperceivemismyourmbiggestmproblemmrightmnow?”m“Whatmismanme
xamplemof…”mHow mwouldmyou mdescribe…”
○ Notmintrusivemandmdon’tmputmpatientmon mthemdefense
○ Greatmformestablishingmrapportmwith mpatient
● b.mClose-
endedmQuestions:mYes/mno/monemwordmanswerable/mspecificmresponsemquestions
○ Greatmforminitial minterview mtomdeterminemspecificminformation
○ “Aremthemmedicationsmhelping?”m“When mdidmyou mstartmhearingmvoices?”
● c.mProjectivemQuestions:mStartmwith m“whatmif”mtomhelpmpeoplemexploremandmIDmtho
ughtsmandmfeelingsm
, ○ Strongmabilitymtomfacilitatemampatient'smthinkingmaboutmproblemsmdifferentlyma
ndmtomIDmproblems
■ “If myou mhadm3mwishes..”
■ “If myou mcouldmgombackmandmchangemhow myou macted…”
■ “Whatmwouldmyou mdomif myou mweremgiven m$1mmillion…”
● d.mThemmiraclemquestion:mGoal msettingmquestionmthatmhelpsmpatientmtomseemwhatm
themfuturemwouldmlookmlikemif mthemproblemmwasmtomvanish
■ Shouldmbemaskedmdramatically
● GivingmRecognition:mIndicatesmawarenessmofmchangemandmpersonal meffortsmWIT
HOUTmIMPLYINGmGOOD mORmBAD,mrightmormwrong
○ “Goodmmorning…”m“You’vemcombedmyourmhairmtoday.”
● OfferingmSelf:mOffersmpresence,minterest,mandmamdesiremtomunderstand
○ Notmofferedmtomgetmthemperson mtomtalkmormbehavemin mamspecificmway
○ “Imwouldmlikemtomspendmtimemwith myou.”m“I’ll mstaymheremandmsitmwithmyoumawhil
e.”
● EncouragingmComparison:mbringsmoutmrecurringmthemesminmexperiencesmormrelat
ionships.mHelpsmclarifymsimilaritiesmandmdifferences
○ “Hasmthismevermhappenedmbefore?”m“Ismthismhow..”m“Wasmitmlike..?”
● Focusing:mConcentratesmattention mon msinglempoint
○ “Thismpointmyou maremmakingmaboutm…mseemsm…?”
● Seekingmclarification:m“ImammnotmsuremImfollow”
● PresentingmReality:mIndicatesmwhatmismreal.mNursemdoesn’tmarguemormtrymtomconvin
ce,mjustmdescribesmpersonal mperceptionsmormfactsmin mthemsituation
○ “ThatmwasmDrmTodd,mnotmamninja.”m“Yourmmothermismnotmhere,mImammamnurse.”
● VoicingmDoubt:mExpressingmuncertaintymregardingmthemrealitymofmthempatient’smper
ceptionsmormconclusions,mespeciallymhallucinations
○ “Isn’tmthatmunusual?”m“That’smhardmtombelieve”
● Seekingmconsensualmvalidation:mmClarifiesmthatmboth mpartiesmsharemmutualmunde
rstandingmof mcommunication m
○ “Tell mmemwhethermmymunderstandingmagreesmwith myou.”
● Verbalizingmthemimplied:mPutsmintomconcretemtermsmwhatmthempatientmimplies,mma
kingmitmexplicit
○ “Domyou mfeel mthatmnomonemunderstandsmyou?”
● EncouragingmEvaluation:m“How mdomyou mfeel mabout..?”m
● Attemptingmtomtranslatemintomfeelings:mP:m“mImammdeadminside.”’ mN:m“Aremyou msay
ingmyou mfeel mlifeless?mDoesmlifemseemmmeaninglessmtomyou?”
● SuggestingmCollaboration:mEmphasizesmworkingmwithmthempatient,mnotmdoingmthi
ngsmformthempatient.
○ “Maybemtogethermwemcan…”
● Summarizing:mBringsmtogethermimportantmpointsmof mthemdiscussion m
, ○ Opportunitymformpatientmtomclarifym
m
2.mTherapeuticmRelationships
Therapeuticmrelationship:mnursemmaximizesmcommunicationmskills,munderstandingmof mh
uman mbehaviors,mandmpersonal mstrengthsmtomenhancemthempatient’smgrowth
- Ptmmoremeasilymengagemmwhenmclinician’sminteractionsmaddressmtheirm
concerns,mrespectmpatientsmasmpartners,minmdecisionmmaking,mandmus
emstraight-forwardmlanguage
- Contextmof mamTherapeuticmRelationship
■ 1.mIdentifymthemneedsmofmthempatient
■ 2.mEstablishmclearmboundaries
■ 3.mHelpmpatientmdevelopmnew mcopingmskills
■ 4.mSupportmbehavioralmchange
● Analyzemthemmeaningmof mboundariesmandmtheminfluencemofmtransferencemandmcount
ertransferencemon mboundarymblurring.
○ Boundaries:mthemexpectedmandmacceptedmlegal,methical,mandmprofessionalm
standardsmthatmseparatemnursesmfrommpatients
○ Transference:moccursmwhenmpatientmunconsciouslymandminappropriatelymdi
splacesm(transfers)mfeelings/mbehaviorsmrelatedmtomsignificantmfiguresminmthem
patientsmpastmontomthemnurse
■ Common min mshiftedmpowermdynamics
■ Positive:mPatientmmotivatedmtomworkmwithmyou,mcompletemassignment
smbetween msessions,mandmsharesmfeelingsmopenlym
■ Negative:mPatientmdirectsmpainful/mangrymfeelingsmtowardsmthemnurse
○ Countertransference:mnursemunconsciouslymdisplacesmfeelingsmrelatedmtom
significantmfiguresmin mthemnursesmpastmontomthempatient
■ Often mresultsminmoverinvolvementmandmimpairsmtherapeuticmrelations
hip
■ Sign:mover-identification mwith mthempatientm
● Nursemhasmdifficultymrecognizing/mobjectivelymviewingmpatients
mproblemsmthatmaremsimilarmtomthemnursesm
■ Sign:mFeelingmdisinterestedmormdisgustedmwith mpatient
■ Sign:mGettingminvolvedmin mpowermstruggles,mcompetition,mormargume
ntsmwith mthempatient
3.mMilieu mTherapy
