1. Therapeutic Technique  “I don’t think I understand what you are saying”.
1. Offering Self 15. Verbalizing the implied
 making self-available and showing interest and concern.  rephrasing patient’s words to highlight an underlying message to clarify
 “I will walk with you” statements.
2. Active listening  Patient: I wont be bothering you anymore soon.
 paying close attention to what the patient is saying by observing both verbal  Nurse: Are you thinking of killing yourself?
and non-verbal cues. 16. Reflecting
 Maintaining eye contact and making verbal remarks to clarify and encourage  throwing back the patient’s statement in a form of question helps the patient
further communication. identify feelings.
3. Exploring  Patient: I think I should leave now.
 “Tell me more about your son”  Nurse: Do you think you should leave now?
4. Giving broad openings 17. Restating
 What do you want to talk about today?  repeating the exact words of patients to remind them of what they said and
5. Silence to let them know they are heard.
 Planned absence of verbal remarks to allow patient and nurse to think over  Patient: I can’t sleep. I stay awake all night.
what is being discussed and to say more.  Nurse: You can’t sleep at night?
6. Stating the observed 18. General leads
 verbalizing what is observed in the patient to, for validation and to  using neutral expressions to encourage patients to continue talking.
encourage discussion  “Go on…”
 “You sound angry”  “You were saying…”
7. Encouraging comparisons 19. Asking question
 · asking to describe similarities and differences among feelings, behaviors,  using open-ended questions to achieve relevance and depth in discussion.
and events.  “How did you feel when the doctor told you that you are ready for discharge
 · “Can you tell me what makes you more comfortable, working by yourself or soon?”
working as a member of a team?” 20. Empathy
8. Identifying themes  recognizing and acknowledging patient’s feelings.
 asking to identify recurring thoughts, feelings, and behaviors.  “It’s hard to begin to live alone when you have been married for more than
 “When do you always feel the need to check the locks and doors?” thirty years”.
9. Summarizing 21. Focusing
 reviewing the main points of discussions and making appropriate  pursuing a topic until its meaning or importance is clear.
conclusions.  “Let us talk more about your best friend in college”
 “During this meeting, we discussed about what you will do when you feel the  “You were saying…”
urge to hurt your self again and this include…” 22. Interpreting
10. Placing the event in time or sequence  providing a view of the meaning or importance of something.
 asking for relationship among events.  Patient: I always take this towel wherever I go.
 “When do you begin to experience this ticks? Before or after you  Nurse: That towel must always be with you.
entered grade school?” 23. Encouraging evaluation
11. Voicing doubt  asking for patients views of the meaning or importance of something.
 voicing uncertainty about the reality of patient’s statements, perceptions and  “What do you think led the court to commit you here?”
conclusions.  “Can you tell me the reasons you don’t want to be discharged?
 “I find it hard to believe…” 24. Suggesting collaboration
12. Encouraging descriptions of perceptions  offering to help patients solve problems.
 asking the patients to describe feelings, perceptions and views of their  “Perhaps you can discuss this with your children so they will know how you
situations. feel and what you want”.
 “What are these voices telling you to do?” 25. Encouraging goal setting
13. Presenting reality or confronting  asking patient to decide on the type of change needed.
 stating what is real and what is not without arguing with the patient.  “What do you think about the things you have to change in your self?”
 “I know you hear these voices but I do not hear them”. 26. Encouraging formulation of a plan of action
 “I am Lhynnelli, your nurse, and this is a hospital and not a beach resort.  probing for step by step actions that will be needed.
14. Seeking clarification  “If you decide to leave home when your husband beat you again what will
 asking patient to restate, elaborate, or give examples of ideas or feelings to you do next?”
seek clarification of what is unclear. 27. Encouraging decisions
 “I am not familiar with your work, can you describe it further for me”.  asking patients to make a choice among options.

2.  “Given all these choices, what would you prefer to do.  “What’s your name? I see you like sports. Where do you live?”
28. Encouraging consideration of options 2. Value Judgments
 asking patients to consider the pros and cons of possible options.  giving one’s own opinion, evaluating, moralizing or implying one’s values by
 “Have you thought of the possible effects of your decision to you and your using words such as “nice”, “bad”, “right”, “wrong”, “should” and “ought”.
family?”  “You shouldn’t do that, its wrong”.
29. Giving information 3. Incongruence
 providing information that will help patients make better choices.  sending verbal and non-verbal messages that contradict one another.
 “Nobody deserves to be beaten and there are people who can help and  The nurse tells the patient “I’d like to spend time with you” and then walks
places to go when you do not feel safe at home anymore”. away.
30. Limit setting 4. Underloading
 discouraging nonproductive feelings and behaviors, and encouraging  remaining silent and unresponsive, not picking up cues, and failing to give
productive ones. feedback.
 “Please stop now. If you don’t, I will ask you to leave the group and go to  The patient ask the nurse, simply walks away.
your room. 5. False reassurance/ agreement
31. Supportive confrontation  Using cliché to reassure client.
 acknowledging the difficulty in changing, but pushing for action.  “It’s going to be alright”.
 “I understand. You feel rejected when your children sent you here but if you 6. Invalidation
look at this way…”  Ignoring or denying another’s presence, thought’s or feelings.
32. Role playing  Client: How are you?
 practicing behaviors for specific situations, both the nurse and patient play  Nurse responds: I can’t talk now. I’m too busy.
particular role. 7. Focusing on self
 “I’ll play your mother, tell me exactly what would you say when we meet on  responding in a way that focuses attention to the nurse instead of the client.
Sunday”.  “This sunshine is good for my roses. I have beautiful rose garden”.
33. Rehearsing 8. Changing the subject
 asking the patient for a verbal description of what will be said or done in a  introducing new topic
particular situation.  inappropriately, a pattern that may indicate anxiety.
 “Supposing you meet these people again, how would you respond to them  The client is crying, when the nurse asks “How many children do you have?”
when they ask you to join them for a drink?”. 9. Giving advice
34. Feedback  telling the client what to do, giving opinions or making decisions for the
 pointing out specific behaviors and giving impressions of reactions. client, implies client cannot handle his or her own life decisions and that the
 “I see you combed your hair today”. nurse is accepting responsibility.
35. Encouraging evaluation  “If I were you… Or it would be better if you do it this way…”
 asking patients to evaluate their actions and their outcomes. 10. Internal validation
 “What did you feel after participating in the group therapy?”.  making an assumption about the meaning of someone else’s behavior that
36. Reinforcement is not validated by the other person (jumping into conclusion).
 giving feedback on positive behaviors.  The nurse sees a suicidal clients smiling and tells another nurse the patient
 “Everyone was able to give their options when we talked one by one and is in good mood.
each of waited patiently for our turn to speak”. Other ineffective behaviors and responses:
Avoid pitfalls: 1. Defending – Your doctor is very good.
1. Giving advise 2. Requesting an explanation – Why did you do that?
2. Talking about your self 3. Reflecting – You are not suppose to talk like that!
3. Telling client is wrong 4. Literal responses – If you feel empty then you should eat more.
4. Entering into hallucinations and delusions of client 5. Looking too busy.
5. False reassurance 6. Appearing uncomfortable in silence.
6. Cliché 7. Being opinionated.
7. Giving approval 8. Avoiding sensitive topics
8. Asking WHY? 9. Arguing and telling the client is wrong
9. Changing subject 10. Having a closed posture-crossing arms on chest
10. Defending doctors and other health team members. 11. Making false promises – I’ll make sure to call you when you get home.
Non-therapeutic Technique 12. Ignoring the patient – I can’t talk to you right now
1. Overloading 13. Making sarcastic remarks
 talking rapidly, changing subjects too often, and asking for more information 14. Laughing nervously
15. Showing disapproval – You should not do those things.
than can be absorbed at one time.