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1. Therapeutic Communication,
Therapeutic Nurse Patient Relationship

2. OBJECTIVES
•Define therapeutic communication
•Explain elements of commication
•Describe the therapeutic and non therapeutic verbal communication
techniques.
•Identify the factors affecting communication.
•Discuss therapeutic touch.
•Describe active listening

3. Therapeutic Communication
•Is an interpersonal interaction between the nurse and the
patient during which the nurse focuses on the patient’s
specific need to promote an effective exchange of
information.
•Therapeutic use of self is the ability to use one’s
personality consciously and in full awareness in an attempt
to establish relatedness and to structure nursing
interventions.

4. Elements of communication process

5. Elements:
Sender- prepare or creates messages
Receiver-who gets the messages
Message – the content of communication
Feedback- response to the received message

6. Types of communication
Verbal communication – words
Non verbal Communication
o Vocal cues or Paralanguage
o Eye Behavior
o physical appearance and dress
o Body movement and posture
o Touch
o Facial expression

7. Factors Affecting Communication
Values
Attitudes
Beliefs
Perceptions
Culture or Religion
Social Status
Gender
Age or developmental level
Environment

8. Goals Of Therapeutic Communication
Establish a therapeutic nurse patient relationship
Identify the most important patient needs
Assess the patient’s perception of problem
Facilitate the patient’s expression of emotion
Implement interventions designed to address
the patient’s needs.

9. Principles of therapeutic communication
1.The patient should be the primary focus
2. A professional attitude sets the tone of therapeutic
relationship
3.Use self disclosure only when it has therapeutic purpose
4. Avoid social relationship with patients
5. Maintain confidentiality
6. Maintain non judgmental attitude
7. Assess patient intellectual competence
8. Avoid giving advice

10. Therapeutic Communication Techniques:
There are two requirements for therapeutic
communication:
1. All communication must preserve the self-
respect of both individuals.
2. One should understand communication
before giving any suggestions or advice.

11. 1. Listening:
It is an active process of receiving
information.
Responses on the part of the nurse such as
maintaining eye-to-eye contact, nodding,
gesturing and other forms of receptive
nonverbal communication convey to the
patient that she is listened.

12. LISTENING TO THE PATIENT
To listen actively is to be attentive to what
client is saying, both verbally and nonverbally.
Several nonverbal behaviors have been
designed to facilitate attentive listening.
S – Sit squarely facing the client.
O – Observe an open posture.
L – Lean forward toward the client.
E – Establish eye contact.
R – Relax.

13. 2. Broad Openings:
Encouraging patients to select topics for
discussion.
Broad opening questions, such as
"What are you thinking about?“
 "Can you tell me more about that?" and
"What shall we discuss today?" encourage the
patient to select topics to discuss.

14. 3. Restating:
Repeating the main thought expressed by the
patient.
It calls attention to something important that
has been said.
Eg: “You say that your mother left you when you
were 5 years old”

15. 4. Clarification:
 Attempts to put vague ideas or unclear thoughts of
the patient into words to enhance nurse’s
understanding.
 Eg: I'm not sure what you mean. Could you tell me
about that again ?"

16. 5. Reflection:
Directing back the patient’s ideas, feelings, questions and
content.
Validates the nurse’s understanding of what the patient is
saying and signifies empathy, interest and respect for the
patient.
Example: You are felling tense and anxious and it is related
to the conversation you had with your son last night.

17. 6. Focusing:
Statements that help the patient to expand on a single
topic of importance.
Eg: I think that we should talk more about your
relationship with your father
Allow the patient to discuss central issue

18. 7. Sharing Perceptions:
Asking the patient to verify the nurse's understanding
of what the patient is thinking or feeling.
Eg: "You're smiling, but I sense that you're really angry
with me."

19. 8. Theme Identification:
Identification of underlying issues or problems
experienced by the patient that emerge repeatedly
during the course of the nurse-patient relationship.
Eg:I noticed that you said, you have been hurt or
rejected by the man. Do you think this is an underlying
issue?

20. 9. Silence:
Lack of verbal communication for therapeutic reason.
Eg: sitting with the patient and non-verbally
communicating interest and involvement.

21. 10. Humor:
The discharge of energy through comic enjoyment of
the imperfect.

22. 11. Informing:
 Information giving, is an essential nursing technique
in which the nurse shares simple facts or information
with the patient.
Eg: I think you need to know more about your
medication.
12. Suggesting:
Presentation of alternative ideas, for the patient’s
consideration relative to problem solving and is
exploring alternative coping mechanisms.

23. Non therapeutic Communication Techniques
Giving reassurance - may discourage client from further
expression of feelings if client believes the feelings will only
be downplayed or ridiculed
Rejecting - refusing to consider client’s ideas or behavior
Approving or disapproving - implies that the nurse has
the right to pass judgment on the “goodness” or “badness”
of client’s behavior

24. Non therapeutic Communication
Techniques
Agreeing or disagreeing - implies that the nurse has the
right to pass judgment on whether client’s ideas or
opinions are “right” or “wrong”
Giving advice - implies that the nurse knows what is best
for client and that client is incapable of any self-direction
Probing - pushing for answers to issues the client does
not wish to discuss causes client to feel used and valued
only for what is shared with the nurse

25. Non therapeutic Communication
Techniques
Defending - to defend what client has criticized implies that client
has no right to express ideas, opinions, or feelings
Requesting an explanation - asking “why” implies that client must
defend his or her behavior or feelings
Indicating the existence of an external source of power -
encourages client to project blame for his or her thoughts or
behaviors on others
Belittling feelings expressed - causes client to feel insignificant or
unimportant

26. Non therapeutic Communication
Techniques
Making stereotyped comments, clichés, and trite
expressions - these are meaningless in a nurse-client
relationship
Using denial - blocks discussion with client and avoids
helping client identify and explore areas of difficulty
Interpreting - results in the therapist’s telling client the
meaning of his or her experience
Introducing an unrelated topic - causes the nurse to take
over the direction of the discussion

27. Touch
Touch is a powerful communication tool
It is very basic and primitive form of communication
Appropriate use of communication is culturally determined
It can elicit both negative and positive reactions,
depending on the people involved and the circumstances of
the interaction

28. Categories of Touch
1. Functional-Professional
Impersonal and business-like
Used to accomplish a task Eg: physician
examining a client
2. Social-Polite
Impersonal but it conveys an
affirmation or acceptance of the other
person
Eg: Handshake
3. Friendship-Warmth
Indicates a strong liking for the other
person Eg: Laying one’s hand on the
shoulder
4.Love- Intimacy
Conveys an emotional attachment or
attraction for another person. Eg:
Engaging in strong emotional embrace.
5. Sexual-Arousal
Touch at this level is an expression of
physical attraction only.

29. THERAPEUTIC COMMUNICATION AND
PROBLEM-SOLVING
Goals are often achieved through use of the problem-solving
model:
 Identify the client’s problem.
 Promote discussion of desired changes.
Discuss aspects that cannot realistically be changed and
ways to cope with them more adaptively.
 Discuss alternative strategies for creating changes the
client desires to make.

30. THERAPEUTIC COMMUNICATION AND
PROBLEM-SOLVING
Weigh benefits and consequences of each alternative.
 Help client select an alternative.
 Encourage client to implement the change.
 Provide positive feedback
Help client evaluate outcomes of the change and make
modifications as required.

31. THERAPEUTIC NURSE –PATIENT
RELATIONSHIP

32. THERAPEUTIC NURSE –PATIENT
RELATIONSHIP
A relationship is defined as a state of being related
between two individuals.
In a therapeutic relationship the nurse and patient interact
with each other in the health care system with the goal of
assisting the patient to use personal resources to meet his
or her unique needs.
It is the foundation on which psychiatric nursing is
established
Therapeutic use of self is the instrument for delivery of
care to client in need of psychosocial intervention

33. Components of the Nurse-patient
Relationship
Trust
Rapport
Warmth
Genuine interest
Empathy
Acceptance
Positive Regard
Therapeutic Use of Self

34. Characteristics of Nurse Patient
:Relationship
Observation
Understanding of behavior
Communication
Mutual growth
Grow patient to his fullest potential
Gain new coping and adaptation

35. Types of relationship
Therapeutic
Intimate
Social
Focuses on
client’s needs,
experiences,
feelings, ideas.
Goal oriented
Emotional
commitment
May be sexual/
emotional
intimacy
Friendship
Companion
Uses small talk
superficial

36. Phases of the Nurse-patient
Relationship
Pre- interaction phase
Orientation phase
Working phase
Termination phase

37. Phases
PRE-INTERACTION
 Self assessment, examine own feelings, fears,
anxieties.
Gather data about patient
Plan for first meeting
Analyze own professional strengths and
limitations

38. Phases
ORIENTATION – INTRODUCTORY PHASE
establish trust, rapport and acceptance
Establish communication
Gather data about patient feelings
Define patient problem
Set goals

39. Phases
THE WORKING PHASE –
Gather further data
Promote insight
Facilitate behavioral change
Provide opportunity for independent functioning
Evaluate problems and goals redefine if necessary

40. Phases
TERMINATION PHASE – RESOLUTION PHASE
 establish reality of separation
Review progress of therapy
Formulate plan for meeting future therapy needs

41. Obstacles to the Therapeutic Relationship
Inappropriate Boundaries
Encouraging dependence
Non acceptance/Avoidance
Resistance

42. References
1. Mary.C. Townsend (2013). Essentials of Psychiatric Mental Nursing.
Sixth Edition. Philadelphia. F.A. Davis Company.
2.Kaplan and Sadock’s , (2012 ) Comprehensive text book of psychiatry.
9th Edition, Lippincott Williams and willkins,
3.https://www.psychiatry.org/psychiatrists/practice/dsm

43. THANKYOU