therapeutic communication

1. PRESENTED BY:
PANKAJ SINGH SHEKHAWAT
M.SC.NURSING PREV. YEAR

2. INTRODUCTION
 A relationship is defined as a state of being
related or a state of affinity between two
individuals. The nurse and client interact
with each other in the health care system
with the goal of assisting the client to use
personal resources to meet his or her unique
needs.

3. DEFINITION:
 THERAPEUTIC COMMUNICATION- “Therapeutic
communication is defined as communication
strategies that support a patient's feeling of well-
being”.

4. TYPES OF COMMUNICATION:
1. Verbal.
2. Non verbal

5. VERBAL

6. 2. NONVERBAL COMMUNICATION

7. VOCAL

8. ACTION

9. OBJECT

10. SPACE

11. TOUCH

12. GOALS OF NURSE PATIENT
RELATIONSHIP
 THE NURSE HELPS THE PATIENT TO COPE WITH
THE PRESENT PROBLEMS
 THE NURSE HELPS THE PATIENT TO UNDERSTAND
HIS PROBLEM
 THE NURSE HELPS THE PATIENT TO UNDERSTAND
HIS ACTIVE PARTICIPATION IN AN EXPERIENCE
 THE NURSE ASSISTS THE PT. TO IDENTIFY
EMERGING PROBLEMS REALISTICALLY

13.  THE NURSE HELPS THE PATIENT TO FIND NEW
ALTERNATIVE FOR HIS/HER PROBLEM
 THE NURSE HELPS THE PATIENT TO TRY OUT
NEW PATTERNS OF BEHAVIOR
 THE NURSE HELPS THE PATIENT TO
COMMUNICATE
 THE NURSE HELPS THE PATIENT TO SOCIALIZE
 THE NURSE HELPS THE PATIENT TO FIND A
MEANING IN HIS ILLNESS

14. TYPES OF RELATIONSHIP

15. SOCIAL RELATIONSHIP

16. INTIMATE RELATIONSHIP

17. THERAPEUTIC RELATIONSHIP

18. CONDITIONS ESSENTIAL FOR
DEVELOPMENT

19. RAPPORT

20. TRUST

21. MUTUAL RESPECT

22. GENUINESS

23. EMPATHY

24. WARMTH

25. PROFFESIONALISM

26. UNCONDITIONAL POSITIVE
REGARD CARING

27. PARTNERSHIP

28. PHASES OF THERAPEUTIC
RELATIONSHIP

29. PRE-INTERACTION PHASE
NURSE TASK
Explore own feelings, fantasies and fear
Analyze own professional strength and
limitations.
Gather data about patient whenever
possible
Plan for first meeting with patient.

30. PROBLEMS ENCOUNTERED:
 DIFFICULTY IN SELF ANALYSIS AND SELF
ACCEPTANCE: promoting a patient’s self-acceptance
is facilitated by the nurse’s acceptance of herself and
behaving in ways congruent with her own personality.
 ANXIETY: Quite frequently, the nurse may experience
anxiety of varying intensity during the pre-interaction
phase due to role threat feelings of incompetence, fear
of being hurt or causing distress, fear of losing control
and fear of rejection.

31. WAYS TO OVERCOME
 The nurse needs help from her supervisor and peers in
self analysis and facing reality in order to help patient’s
do likewise.
 It is also helpful to conceptualize in advance what she
wishes to accomplish during the relationship. the
nurse may in consultation with her supervisor identify
in writing goal for the initial interaction, and decide
the methods to be used in achieving the goals

32. INTRODUCTORY/ORIENTATION
PHASE
NURSE TASK:
Establish rapport, trust and acceptance.
Establish communication assist in the
verbal expression of thoughts and feelings.
Gather data including the client’s feeling,
strengths and weakness.
Define client’s problem.
Mutually set goals.

33. PROBLEMS ENCOUNTERED
 The main problem is the manner in which nurse and
patient perceive each other. She may reject patient
only in terms of stereotyped view about a psychiatric
patient, not in his individuality.

34. WAYS TO OVERCOME
 The nurse must be willing to relate honestly to her
perception, thought and feelings and to share the data
collection during the nurse-patient interaction with
the supervisor.

35. WORKING PHASE
 NURSE’S TASK:
 Gather further data, explore relevant stressors
 Promote patient’s development of insight and
use of constructive coping mechanism.
 Facilitate behavioral change.
 Provide him with opportunities for
independent functioning.
 Evaluate problems and goals and redefine as
necessary

36. PROBLEMS ENCOUNTERED
 TESTING OF THE NURSE BY THE PATIENT: The
patient may test nurse in number of ways for many
reason. for e.g. he may check her ability to set limits
and abide by them.
 PROGRESS OF THE PATIENT: Another barrier is the
nurse unrealistic assumption as to the progress the
patient should be making.
 THE NURSE FEAR OF CLOSENESS: If nurse fear
closeness too much, she may react by being
indifferent, rejecting or being cold towards the patient.

37. WAYS TO OVERCOME
 Conferences with supervisors and group discussion
with another staff member
 When out of personal stressors nurse exhibit a
reluctance to do something, discussion of meaning of
behavior and ways to overcome is essential
 Handling resistances be done by listening, she should
use clarification and reflection.
 Ignoring the transference can perpetuate the pattern

38. TERMINATON PHASE
NURSE’S TASK
Establish reality of separation.
Review progress of therapy and
attainment of goals.
Formulate plans for meeting future
therapy needs.

39. PROBLEMS ENCOUNTERED
 Patient may perceive termination as dissertation and
demonstrate angry behavior.
 Some punish nurse for this by not talking during last
few interactions.
 Some become depressed or assume attitude of not
caring.
 Fault finding is another behavior.

40. WAYS TO OVERCOME
 Nurse should be aware of the patient’s feelings and be
able to deal with them appropriately. The nurse can
assist the patient by openly eliciting his thought and
feeling about termination.
 The supervisor should assist nurse to persevere and
intensify he efforts to prepare both self and patient for
his eventual release from hospital.

41. DYNAMICS
 THERAPEUTIC USE OF SELF
 GAINING SELF AWARENESS
 BELIEF:
 Rational belief
 Irrational belief
 Faith(blind belief)
 Stereotype

42.  ATTITUDES - An attitude is a frame of reference around
which an individual organizes knowledge his or her world.
An attitude also has an emotional component. It can be a
prejudgment and may be selective and biased.
 VALUES - Values are abstract standards positive or
negative that represents an individuals ideal mode of
conduct and ideal goals. behaving with sincerity, justice,
reason, compassion, humility, respect, honor and loyality.

43. JOHARI WINDOW
1
KNOWN TO SELF AND TO
OTHERS
2
KNOWN ONLY
TO OTHERS
3
KNOWN ONLY
TO SELF
4
KNOWN NEITHER TO SELF NOR
TO OTHERS

44. THERAPEUTIC IMPASSES AND IT’S
MANAGEMENT
 RESISTANCE: An attempt to remain unaware of
anxiety situation. It is a natural learned reluctance of
verbalizing or even experiencing troubled aspects of
self.

45.  TRANSFERANCE: Unconscious response of the client
in which he experience feelings and attitudes towards
the nurse, associated with significant figure.

46. INTERVENTION FOR RESISTANCE
AND TRANSFERANCE
 The nurse must be prepared to be exposed to powerful
negative and positive emotional feelings coming from the
patient.
 Make therapeutic contracts, develop a mutually acceptable
goals and plans of action, coals, purpose and roles of the
nurse and the patient in the relationship.
 Listen to the patient’s analysis of the resistance and
transference .use clarification and reflection of feelings.
 Explore possible reasons for resistance and wok through
the transference reaction with patient

47. COUNTER TRANSFERANCE
 It is created by nurse. The nurse specific emotional
response generated by the qualities of the patient.
Nurse will identify the client’s need which will
interfere therapeutic effectiveness

48. TYPES OF COUNTER
TRANSFERANCE
 Reaction of intense love or caring.
 Reaction of intense hostility or hatred.
 Reaction of intense anxiety often in response to
resistance.

49. FORMS OF COUNTER
TRANSFERANCE DISPLAYED BY
NURSE
 Inability to empathize with the client sometimes.
 Carelessness about implementing the contract b being
late running overtime.
 Drowsiness during session.
 Feeling of anger.
 Encouragement of patient’s dependency, praise or
affection.

50. ADVANTAGE OF COUNTER
TRANSFERANCE
 Power tool in exploring inner self
 It can lead to further information, can bring to light
new materials and help in developing insight.
 Understanding of this will help to maintain a
therapeutic relationship wit the patient

51. INTERVENTION
 Experience of working with psychiatric patient.
 Constantly look out for counter transference.
 Hold it for abeyance or utilize it for therapeutic goal.
 Apply self examination through out the course of
relaxation.
 Pursue to find out the source of problems.

52. GIFT GIVING
TANGIBLE GIFTS
INTANGIBLE

53. BOUNDARY VIOLATION
occurs when nurse goes outside the
boundaries of therapeutic relationship
and establish a personal, social,
economical relationship with patient

54. POSSIBILTY OF OCCURANCE OF
BOUNDARY VIOLATION
 Has difficulty in setting limits with a patient.
 Relate to patient like friend or family members.
 Has sexual feelings towards patient
 Believes that other staffs are jealous of their
relationship.

55. INTERVENTION
 Nurse has to follow some limitation in maintaining
such relations.
 Too much personal involvement in client’s affair
should be limited.

 Ambiguity and misunderstanding with other staff
should be avoided.
 Adverse feeling like sexuality should be avoided
 Ethics and moral principles should be followed

56. TECHNIQUES OF THERAPEUTIC
COMMUNICATION
 Listening:
 Broad openings:
 Restating :
 Clarification :
 Reflection :
 Focusing :
 Sharing perception :
 Theme identification :
 Silence:
 Informing:
 Suggesting:

57. NON THERAPEUTIC
COMMUNICATION TECHNIQUES
 1. Asking personal questions
 2. Giving personal opinions
 3. Changing the subject
 4. Automatic responses
 5. False Reassurance
 6. Sympathy
 7. Asking for Explanations
 8. Approval or Disapproval
 9. Defensive Responses

58.  10. Passive or Aggressive Responses
 11. Arguing

59. ROLES OF NURSE
 Stranger: receives the client in the same way one
meets a stranger in other life situations provides an
accepting climate that builds trust.
 Teacher: who imparts knowledge in reference to a
need or interest
 Resource Person: one who provides a specific needed
information that aids in the understanding of a
problem or new situation

60.  Counselors: helps to understand and integrate the
meaning of current life circumstances ,provides
guidance and encouragement to make changes
 Surrogate: helps to clarify domains of dependence
interdependence and independence and acts on
clients behalf as an advocate.
 Leader: helps client assume maximum responsibility
for meeting treatment goals in a mutually satisfying
way

61. CONCLUSION
In a therapeutic relationship the nurse and client work
together towards the goal of assisting the client to
regain inner resources to meet life challenges and
facilities growth. The interaction is purposefully
established, maintained and carried out with the
anticipated outcome of helping the client gain new
coping and adaptation skill.

62. ASSIGNMENT
 Write down techniques of therapeutic and non
therapeutic communication with an example and
submit it on 18/07/2017 at 01:00 pm.

63. THANK YOU