THERAPEUTIC TECHNIQUES,RESPONSE DIMENSION, ACTION DIMENSION

1. THERAPEUTIC COMMUNICATION
TECHNIQUES

2. INTRODUCTION
Communication is a critical component of
all successful health care. Doctors and nurses have to
effectively diagnoses and treatments to patients.
All current and aspiring nursing
professionals need to know the value of this type of
communication and the best ways to provide it.

3. DEFINITION
Therapeutic communication is a process in
which the nurse consciously influences the patient or
helps them in better understanding through verbal and
nonverbal communication, while encouraging patients
to express their feelings and ideas which is an
important prerequiste for the realization of relation of
mutual acceptance and respect.

4. COMMUNICATION

5. GOALS
 Self Realization,self Acceptance,self respect
 Facilitate the patient’sexpression of emotions
 Increased ability to satisfy needs and achieve realistic
personal goals.
 A clear sense of personal identity and improved level
of personal integration.
 Assess the patient’s perception of the problem

6. PURPOSES
 Environmental change from home to hospital
 Nurturance
 Control
 Psychiatric symptoms
 Problem solving
 Advice to come to hospital

7. PRINCIPLES
 Patient should be the primary focus of interaction.
 A professional attitude sets the tone of the therapeutic
relationship.
 Use self disclosure cautiously and only when it has a
therapeutic purpose.
 Avoid social relationship with patient.
 Maintain confidentiality and non - judgmental attitude
 Avoid giving advise
 Guide the patient to reinterpret his/her experiences
rationally.

8. CHARACTERISTICS
The nurse must achieve certain skills or qualities to initiate
and continue a therapeutic relationship.
Truax,Carkhoff and Berenson have identified specific core
conditions for facilitative interpersonal relationships. They
broadly divided these conditions into
 Responsive Dimension
 Action Dimension

9. RESPONSIVE DIMENSION
Genuineness
Open,honest,sincere person
Respect
Non possessive warmth or unconditional positive
regard
Empathic understanding
Ability to accurately perceive other person’s feelings
and meanings.
Behaviors that manifest high level of empaMirror
imaging of body position and gesturesthy: Leaning
forward,conveyance of interest,concern,warmth by facial
expression,Tone of voice,

10. Concreteness :
Using specific terminology rather than
abstractions .It avoids vagueness and ambiguity.

11. ACTION DIMENSION
Confrontation
Usually implies venting anger and aggressive
behavior.This has the effect of belittling, blaming and
embarassing the receiver. Carkhoff identifies three
categories:
- discrepancy between the patient’s expression of
what he is and what he wants to be
-discrepancy between the patient’s verbal
expressions about himself and his behavior
-discrepancy between the patient’s expressed
experience of himself and nurse’s experience of him.

12.  Immediacy
Involves focusing on the current interaction of the
nurse and patient in the relationship. May be viewed as
empathy, genuineness,confrontation.
 Nurse self disclosure
Nurse reveals information about herself such as ideas,
values, feelings,attitudes. The three characteristics are
subjectively true, personal statement about self,
intentionally revealed to another person.

13. Emotional catharsis
It occurs when the patient is encouraged to talk
about things that bother him most. Catharsis brings
fear, feelings and experiences out into the open so that
they can be discussed with nurse.
Role playing
It involves acting out particular situation. It
provides a bridge between thought and action in a safe
environment.

14. THERAPEUTIC
COMMUNICATION TECHNIQUES
 LISTENING
Skills needed are :
L= Look at others, keep good eye contact
A= Ask appropriate questions only
D= Do not interrupt
D= Do not change the subject
E= Express emotions with control
R= Responsively listen

15. Several non verbal behaviors have been designed to
facilitate attentive listening posture
S= Sit squarely facing the client
O= Observe an open
L= Lean forward towards the client
E= Establish eye contact
R= Relax

16.  RESTATING
The nurse restates or repeats what the patient has
been saying. It can be in the form of question or
statement.
Example :
Patient : My children are going through a financial
problem because am sick
Nurse : Your children are going through a financial
problem because you are sick.

17.  VALIDATING
It is a technique which the nurse uses to confirm the
accuracy of data or information given by the patient.
Example :
Patient : I get very upset when my husband beats me if I
talk anything against my mother in law.
Nurse : Yes,it makes sense that you get upset when your
husband beats you when complaining against your
mother in law. I wonder if you would like to explain
further.

18.  REFLECTING
In reflection, the nurse highlights the affective content
of the patient’s communication that is the feeling or
attitude which is implicitly expressed.
Example :
Patient : I am very angry with my wife
Nurse : It sound that you are really angry with your wife

19.  PROVIDING INFORMATION
Providing personal, social and therapeutic information
increases the patient resources
Example :
The nurse inform the patient that a social worker will
be here from 10.00 AM TO 01.00 PM today. Group
therapy will be from 02.00 PM to 03.00 PM tomorrow.
The patient may ask for more information and utilize
the opportunity to clarify doubts.

20.  CLARIFYING
The nurse’s information of a patient’s statement or
expression of feelings in clearer terms without
indicating approval or disapproval.
Example :
Patient : I am very sad today.
Nurse : You say you are feeling very sad today. Would
you elaborate what is happening ?
Explanation given by the patient will clarify further what
is making him feel sad.

21.  PARAPHRASING
The nurse restates whatever she has heard from the patient.
Example :
Patient : Sister, all my friends and relatives point out that I
will never be able to look after my family members that
makes me feel depressed.
Nurse : I hear you saying that whenever you meet any one of
your friends or relatives that they point out that you will
always remain sick and will be no good to your family.T
his makes you more sad.
The nurse’s paraphrasing gives a feeling to the patient to test
whether she has understood what he want to communicate

22.  CONFRONTATION
Helping the client become more aware of
inconsistensies in his or her feelings, attitudes, beliefs
and behaviors, only to be used after trust has been
established. It should be done gently and with
sensitivity.
Example : You say you have already
decided what to do, yet you are
still talking a lot about your options.

23.  FOCUSING
Concentrating on one single point.
Example :
Nurse : since when did you start taking alcohol?
Patient : 20 years
Nurse : How did you start taking it?
 EXPLORING
When clients deal with topics superficially, exploring can
help them examine the issues more fully.
Example :
Tell me more about that ? Or Would you describe it
more ?

24.  SHARING PERCEPTIONS
Asking the patient to verify the nurse’s understanding
of what the patient is thinking or feeling.
Example : you are smiling, but I sense that you are really
very angry with me
 ENCOURAGING COMPARISON
Comparing ideas, experiences or relationships brings
out many recurrent themes.
Example : Was it something like?
Asking the similarities and differences be
noted?

25.  ENCOURAGING DESCRIPTION OF
PERCEPTIONS
For patients experiencing sensory issues or
hallucinations. It can be helpful to ask about them in
an encouraging , non judgemental way.
Example : What do you hear now ?
What does that look like to you?
 It gives the patient a prompt to explain what they are
perceiving without casting their perceptions in a
negative light.

26.  THEME IDENTIFICATION
This involving identification of underlying issues or
problems experienced by the patient that emerge
repeatedly during the course of the nurse – patient
relationship.
Example : I noticed that you said you have been hurt or
rejected by man. Do you think this is an un

27.  BROAD OPENING
Encouraging the patient to select topics for discussion.
Example : what are you thinking about ?
 SILENCE
Lack of verbal communication for a therapeutic
reason.
Example : Sitting with a patient and non verbal
communication interest and involvement.

28.  SUGGESTING
Presentation of alternative ideas for the patient’s
consideration relative to problem solving.
Example : Have you thought about responding to your
Boss in a different way when he raises that issue with
you ? You could ask him if a specific problem has
occurred?

29.  HUMOR
The discharge of energy through the comic enjoyment
of the imperfect. That gives a whole new meaning to
the word nerous,with shared kidding between nurse
and the patient.
 PLACING THE EVENT IN TIME OR
SEQUENCE
Asking questions about when certain events occurred
in relation to other events can help patients get a closer
sense of the whole picture. It forces patient to think
about the sequence of events and may prompt them to
remember something they otherwise wouldn’t.

30.  PRESENTING REALITY
When it is obvious that the client is misinterpreting
reality, the nurse can indicate what is real.
Example : Nurse : I see no else in the room
 VOICING DOUBT
It can be gentler way to call attention to the incorrect
or delusional ideas and perception of patients. By
expressing doubts, nurses can force patients to
examine their assumptions.

31.  OFFERING SELF
Hospital stays can be lonely, stressful times.When nurses
offer their time , it shows that someone is willing to give
them time and attention.
Example : Offering to stay for lunch, watch aTV show, simply
sit with patient for a while can help boost their mood.
 SUMMARIZING
The nurses summarize what patient have said after the fact.
This demonstrates that the nurse was listening and allows the
nurse to document conversation.
Ending summary with a phrase like “ oes that sound correct?”

32. TYPES OF RELATIONSHIPS
 SOCIAL RELATIONSHIP
 INTIMATE RELATIONSHIP
 THERAPEUTIC RELATIONSHIP
 HELPING RELATIONSHIP

33.  SOCIAL RELATIONSHIP
A social relationship can be defined as a
relationship that is primarily initiated with the purpose
of friendship, socialization, enjoyment or
accomplishing a task.
mutual needs are met during social
interaction.
There is no predetermined goals or focus in
the relationship and the continuation of the relationship
is not determined at the onset.

34.  INTIMATE RELATIONSHIP
An intimate relationship is a relationship
between two individuals committed to one another,
caring for and respecting each other and who have
emotional commitment to each other.
It usually react naturally with each other.
Often the relationship is a partnership between each
member cares about the other’s need for growth and
satisfaction.

35.  THERAPEUTIC RELATIONSHIP
The therapeutic relationship between nurse
and the client differs from both a social and an intimate
relationship in that the nurse maximizes inner
communication skills, understanding of human
behavior and personal strengths in order to enhance the
client’s growth.
In this interaction is purposefully
established, maintained and carried out with the
anticipated outcome of helping the client to gain new
coping and adaptation skills.

36.  HELPING RELATIONSHIP
It exists among people who provide and receive
assistance in meeting human needs. Therefore need
gratification occurs as a result of successful helping
relationship between the nurse and the clients.

37. Helping relationship contains many
qualities of social relationship, they have common
components of care, concern, trust and growth.
KNOWLEDGE