3.14: Therapeutic Communication Techniques

Table 1 gives an overview of therapeutic communication techniques and provides examples of each technique [10, 13].

General area of issue	Therapeutic communication techniques	Rationale	Examples
To obtain information	Make broad opening remarks	This gives the patient the freedom to choose what he/she wishes to talk about	“Please tell me more about yourself”
	Use open-ended questions	This type of question allows the patient to talk about his/her views about the subject. In this way, what the patient sees as important, what his/her intellectual capacity is and how well-orientated he/she is, becomes clear. This encourages the patient to say more and does not limit answers to a ‘yes’ or ‘no’	“How did you experience the pain?” “You say you felt dizzy, and then…” “Tell me more about that”
	Share observations and thoughts	This shows that you are aware of what is happening to the patient and encourages him/her to talk about it	“You seem to be upset”
	Confrontation	This entails confronting the patient with an observation you have made and assess his/her reaction to it. This technique is useful when verbal and non-verbal communication do not match	“You say that your ankle is very painful, but you do not react when I bend the ankle. How is it possible?”
	Reflection	This means that you repeat what the patient said in the same or different words. This shows you are involved in what the patient is saying and that he/she should talk more about a specific point, or explain further	Patient: “It is sore”. Nurse: “Very painful?”
	Encourage description	This is used to obtain more information about patient’s views and feelings	“Tell me how it happened”
	Validate what is being said	This is to make sure that you understand the patient correctly	“Do I understand you correctly when you say…”
	Offer your presence	The nurse offers his/her attention and interest without making demands	“I will be with you until they come to fetch you for the operation in theater”
	Summarizing	By organizing and checking what the patient has said, especially after a detailed discussion. This technique is used to indicate that a specific part of the discussion is coming to an end and that if the patient wishes to say any more, she should do so	“You went for a walk and then you felt the sharp chest pains, which radiated down your arm”
	Use of interpretation	Draw a conclusion from the information you have gathered and discuss it with your patient to see whether it is true. The patient can then disagree with it, or confirm that your conclusions are true	“You must have been exhausted after walking a long distance from home to the hospital”
To give support	Supportive remarks	Make supportive remarks to encourage the patient to participate in the conversation. Show that you are listening	“Yes….” “Mmmm…” “Go on, I am listening”
	Appropriately touch the patient	Touch can assure the patient that the nurse cares and is present	Hold his/her hand. Consider the cultural belief and comfort of the patient before touching
	Paraphrasing	This conveys understanding of the patient’s basic message	“It sounds as though the most important problem is the diet”
To assist in analysis and problem solving	Acknowledge the person	This promotes a sense of dignity	“Good morning Mr. Jones”
	Sequencing	This helps the patient to see the connection between the parts of an occurrence. To effectively assess the patient’s needs, the nurse often needs to know the time frame within which symptom sand /or problems developed or occurred	“Did you experience this sharp pain before or after eating?”
	Ask for clarification	This helps the nurse to understand and the patient to communicate more clearly	“What do you mean by everybody?”
	Ask for alternatives	This stimulates creative thought and promotes finding solutions	“What else can you try?”
	Use of transition	This is used to guide the conversation to another subject, without losing the continuity of the conversation	“It seems to me that you have solved the problem of poor appetite, but I would like to hear more about your diabetes. How long have you been aware of this illness?”
	Comparison	Use of examples and comparisons to concrete objects. In this way, a vague or abstract concept can be more easily explained	“Does the pain feel like a sharp or a blunt object that hits you?”
	Use silence	This gives the patient the chance to think, and/or to his/her organize thoughts. Silence also give a nurse an opportunity to observe the patient. However, the nurse should avoid silences that last too long because they can make the patient anxious
To instruct the patient	Give information	This explains information and puts it at the patient’s disposal	“After the operation, you will have a drainage tube”
	Orientate the patient towards reality	When the patient interprets something incorrectly, the nurse draws his/her attention to reality	“I am not your daughter, I am Nurse Jones”
	Query what the patient says	The patient’s observation is called into question without belittling him/her, or arguing about it	Are you sure about that?”
	Withhold social reward	Do not give social approval to wrong behavior so as not to encourage a repeat of the wrong behavior	Do not smile, nod or agree when the patient jeopardizes his/her recovery with wrong behavior
	Give social reward	Reward behavior that promotes health to encourage a repeat of the correct behavior	Nod is approval at a patient with a weight problem who declines to eat a heavy meal

-Therapeutic communication techniques.