The document provides an overview of therapeutic communication, emphasizing its importance in nursing to address patient needs and establish effective relationships. THERAPEUTIC COMMUNICATION included some topics like introduction of COMMUNICATION, definition, types, process of communication, definition therapeutic communication, goal, techniques of therapeutic communication, non-therapeutic communication, few ways to improved therapeutic communication, characteristics of therapeutic communication, barrier of THERAPEUTIC RELATIONSHIP, introduction of interpersonal relationship, types of IPR, elements/ dynamics of IPR, introduction of therapeutic nurse patient relationship, definition, purpose, elements/characteristics , and phases of therapeutic communication, definition of Johari window, uses, what actually model represent and its areas, THERAPEUTIC IMPASSES and its management in 5th semester Bsc. nursing and 2nd GNM students

1. THERAPEUTIC
COMMUNICATION
Ms. JULI PARMAR
ASSISTANT PROFESSOR
MDBCON,MEHSANA

2. INTRODUCTION
Communication refers to the exchange of
information, ideas, beliefs,attitudes between
persons or among group of persons.
It is goal directed process In nursing it used
in nursing process

3. DEFINITION OF COMMUNICATION
Communication is process by which
information is exchange between
individual through common system of
sign, symbol or behavior.”

4. COMMUNICATION PROCESS

5. TYPES COMMUNICATION:-
1. Oral communication
2. Written communication
3. Visual and audio communication
4. Silence

6. DEFINITION OF THERAPEUTIC
COMMUNICATION
“In therapeutic communication the nurse directs
the communications towards the patient to identify
his current health problem, plan, implement &
evaluation the action taken.”
OR
An interaction between a nurse or a health
professional and a patient that aims to enhance the
patient's comfort, safety,trust,health, and well
being.

7. GOAL
Establish a therapeutic nurse-patient
relationship.
Identify the most important patient s needs.
‟
Assess the patient s perception of the problem.
‟
Facilitate the patient s expression of emotions
‟
Implement interventions designed to address
the patient s needs
‟

8. TECHNIQUES OF THERAPEUTIC
COMMUNICATION
Nurses may use a wide variety of approaches to
engage in therapeutic communication. Some of the
techniques are discussed below.
👇
1. Use silence 🤐
2. Accepting
3. Affirm desired behaviour
4. Offering self
5. Ask open - ended questions
6. Active listening
7. Seeking clarification

9. 8. Paraphrasing
9. Restating
10. Placing the event in time or sequence
11. Share thoughts and observations
12. Read body cues
13. Recognize, acknowledge, and accept
14. Offering hope and humor.

10. 1. Use silence 🤐
Deliberate silence is a communication technique
that can be exactly what is necessary for a stressful
situation .
This will provide the team the opportunity to
comprehend a topic before moving on to the next .

11. 2. Accepting
Listening and affirming that the nurse heard her
patient is necessary for inpatient care .
Keeping eye contact and a simple " yes , I
understand " can go a long way .
It makes the patients feel heard and in control of
their care .

12. 3. Affirm desired behaviors
Letting the patients know that the nurse is aware
of their efforts and acknowledgment of positive
behaviors can go a long way .
Rather than giving a compliment , giving
recognition is more suitable .

13. 4. Offering self
Hospital stays can be stressful and lonely at
times for patients .
Nurses offering up their time shows that they
care and value their patients .
Simply offering to stay for lunch or simply sitting
with patients can boost their mood .

14. 5. Ask open - ended questions
By asking open - ended questions ,
nurses are able to capture their patient's
thoughts and perceptions .

15. 6. Active listening
Active listening is vital for effective
communication .
Simply maintaining eye contact or keeping
the conversation moving with an " I hear you
" shows the patients that the nurse do care
and are listening when they speak .

16. 7. Seeking clarification
When communicating with a patient or
patients ' family , nurses can ask for
clarification when a topic is confusing .
This , along with active listening is vital to
an open line of communication between the
nurse and the patient .

17. 8. Paraphrasing
 This therapeutic communication technique
entails taking what the patient has said and trying
to express it in your own words.
 It's an excellent way to clarify the patient's
meaning.
 It might be useful to ask the patient if you
understood correctly and your paraphrasing fits
their initial statement.

18. 9. Restating
 Although this is also a clarification technique,
restating is slightly different from paraphrasing .
 When attention to detail is of almost importance,
the nurse might have to resort to this nursing
therapeutic approach, by which she repeats back
to the patient what they said.
 Asking " Did I summarize what said correctly ?
"is an you efficient way to round off this method.

19. 10. Placing the event in time or sequence
Getting a clearer sense of the whole
picture can help with a care plan .
Putting events in a sequence of when
they happened in relation to others can
be very important .

20. 11. Share thoughts and observations
This proves to the patient that the
nurse is paying attention and
encourages patients to keep sharing.

21. 12. Read body cues
Pay attention to the patient's body
language , a simple smile can show
that the patient understands what the
nurse says .

22. 13. Recognize , acknowledge and
accept
It is vital that patients feel respected and
understood .
Allowing patients to feel empowered can
assist in building a positive nurse - client
relationship .

23. 14. Offering hope and humor
Sharing hope with patients can preserve a
patient's emotional status while they are in
the hospital .
Lightening the mood with humor can help
keep patients in a positive state of mind .
Ways to improve therapeutic
communication

24. NON-THERAPEUTIC TECHNIQUES
• Changing the subjects
• Being defensive
• Giving false reassurance
• Judging the patient

25. Few ways to improve the
therapeutic communication are:
1. Improve body language
2. Become a better listener
3 . Avoid interruptions
4. Exercise patients
5. Maintain positive attitude
6. Keep Emotions in Check

26. CHARACTERISTICS OF
THERAPEUTIC COMMUNICATION
 Therapeutic communication is a specialized form of
communication used in healthcare and counseling
settings to build and maintain a therapeutic relationship
between a healthcare professional or counselor and a
patient or client.
 It aims to promote healing , emotional support , and
effective information exchange .
The following are key characteristics of therapeutic
communication :

27. Empathy
 The ability to understand and share the feelings
of another person .
Healthcare professionals or counselors should
convey genuine empathy to their patients or
clients to create a supportive and caring
environment .

28. Active Listening
It involves giving your full attention to the
patient or client , making eye contact , nodding ,
and using verbal and non - verbal cues to show
that engaged and interested in what they are
saying .

29. Confidentiality
Respect and maintain the confidentiality of the
information shared during therapeutic
communication sessions .
Patients and clients need to feel that their
information is secure .

30. Nonverbal Communication
You are pay attention to nonverbal cues such as
body language , facial expressions , and tone of
voice .
These cues can provide valuable insights into a
patient's emotional state and can help you
respond appropriately .

31. Open - ended Questions
Encourage patients or clients to express
themselves by asking open - ended questions that
require more than a simple " yes " or " no "
response .
This allows them to share their thoughts and
feelings more freely .

32. Respect and Non - judgment
Treat all patients or clients with respect and
without judgement .
This creates a safe and non- threatening
atmosphere where individuals feel comfortable
sharing their concerns and emotions .

33. Clarification
 If there is any ambiguity or confusion in the
communication , it's important to seek
clarification by asking for more details or
context to ensure that you fully understand the
patient or client's perspective .

34. Feedback
Offer constructive feedback when appropriate ,
but do so in a gentle and supportive manner .
Feedback should focus on behavior or actions ,
not on the person's character

35. Boundary Setting
Maintain professional boundaries in therapeutic
communication .
It's essential to establish a balance between
providing support and maintaining a professional
relationship .

36. Problem - solving and Information
Sharing Sometimes , therapeutic communication
involves providing information , education , and
helping patients or clients find solutions to their
problems ,

37. Trust Building
Building and maintaining trust is crucial in
therapeutic communication .
Trust is the foundation of a therapeutic
relationship , and it takes time and
consistency to develop .

38. BARRIERS OF THERAPEUTIC
COMMUNICATION

39. BARRIERS OF THERAPEUTIC COMMUNICATION
" Blocks " to communication of feelings and ideas
• These are the pattern of communication that adversely
affect therapeutic process between nurse and patient
and create blocks to communication of feelings and
ideas .
• Nurses needs to be aware of these barriers and should
not be used while interacting with the patients.

40. Asking
personal
questions
Changing
the subject
Giving
personal
opinion
Approval or
disapproval
Automatic
response
Defensive
response
Passive or
aggressive
response
Arguing
False
reassurance
Sympathy
Asking for
explanation

41. INTERPERSONAL RELATIONSHIP

42. Interpersonal relationships are connections or
associations between two or more individuals .
These relationships can be characterized by various
factors , such as emotional closeness , mutual support ,
shared interests , and the ways in which people interact
with one another .
Interpersonal relationships are a fundamental aspect of
human life .
A relationship is an interpersonal process that involves
two or more people .

43. On the basis of the nature of relationship
it can be classified into three types.
Social
relationship
Intimate
relationship
Therapeutic
relationship

44. Social relationship
It is primarily established for the purpose of
friendship , socialization , enjoyment
accomplishment of any work .
It is directed to meet the mutual social needs of
the individuals such as sharing ideas , feelings
and experiences.

45. Intimate Relationships
 It is the relationships between two or more
individual that have emotional commitment .
 In such relationships , mutual needs are met and
intimate desires , feeling and information are
shared .

46. Therapeutic Relationships
It is deliberately established , goal directed ,
purposeful , time bounded professional
relationships between professionals and clients .
Relationships between nurse and patient ,
teacher and students , lawyer and client , doctor
and patients or doctor and nurses all are the
examples of therapeutic relationship .

47. Commu
nication
Trust
Respect
Empathy
Conflicts
resolution
s
Support
Elements &
dynamics
in
interpersonal
relationships

48. THERAPEUTIC NURSE PATIENT
RELATIONSHIP

49. THERAPEUTIC NURSE - PATIENT
RELATIONSHIP
The therapeutic nurse - client relationship is
the fundamental aspect of mental health
nursing .
It is the first important step to establish an
understanding patient's concerns and make
patient to feel that the relationship is safe ,
confidential , reliable , and consistent with
appropriate and clear boundaries .

50. Definition
The nurse - patient relationship is the result
of series of interaction between the nurse
and the patient over a period of time with the
nurse focusing on needs and problems of
patient and his family while using the
scientific knowledge and scientific skills of
nursing profession .
 -Joyce Travelbee

51. Purpose of Nurse - Patient
Relationship
Identify and explore patient's current needs
Develop adaptive problem - solving approaches
Develop adaptive coping skills among patients
Change maladaptive behavior to adaptive .
Improve patient's functioning
Promote patient's recovery

52. Commu
nication
Role &
responsi
bility
Confiden
tiality
Informed
consent
Signature
Safety
Elements ( Characteristics ) of Nurse
Patient Relationship
Respect
&
dignity
Docum
entation
Mutual
goal
M
e
d
i
c
a
t
i
o
n
m
n
g
t
Treatmen
t plan

53. PHASES OF THE NURSE - PATIENT
RELATIONSHIP
The nurse - client relationship is a kind of therapeutic
or professional helping relationship where nurse
establish a relationship with an intention to help
patient to solve his problems .

54. Hildegard Peplau proposed a nurse - client interaction process
where she stated that the nurse and client relationship is
significantly influenced by the background of the both , i.e. ,
nurse and patient .
These include values , culture , belief , past experience and
expectations of nurse as well as patient .
 Hildegard Peplau described four interlocking , overlapping
phases of the nurse - client relationship
Although each phase of nurse - patient relationship has different
goals but these phases are overlapping .

55. Phases of therapeutic nurse patient relationship
1. Pre-
interaction
2.
Introductor
y /
orientation
phase
4.
Termination
phase
3. Working
phase

56. 1. Pre-interaction phase
Pre-interaction is a phase which a nurse goes through
before actual interaction with the patient .
This phase begins when the nurse is assigned a patient
to develop therapeutic relationship with him till, she
goes to him for interaction

57. 2. INTRODUCTORY / ORIENTATION PHASE
Begins when the nurse goes to the patient , introduces
herself and gets introduction about him .
The nurse and client get acquainted ( know someone
slightly).
The orientation phase ends when the nurse and the
patient begin to accept each other as a unique human
being

58. 3. WORKING PHASE .
Working Phase starts when the nurse and the patient
are able to overcome the barriers of orientation and
introductory phase .
During this phase the nurse and the patient actively
work on meeting the goals which they had establish
during the orientation phase .

59. 4. TERMINATION PHASE .
The final step of the therapeutic relationship is
the termination phase .
The nurse terminates the relationship when they
mutually agreed on goals are reached

60. Johari window

61. INTRODUCTION
 Luft and Ingham called their Johari Window
model 'Johari' after combining their first names,
Joe and Harry.
 In early publications the word appears as
'JoHari'.

62. DEFINITION
 The Johari Window model can also be used to
assess and improve a group's relationship with
other groups.

63. USE OF JOHARI WINDOW
 Understanding And Training
 Self-Awareness
 Personal Development
 Improving Communications
 Team Development

64. WHAT ACTUALLY MODEL REPRESENTS :-
 The Johari Window model is also referred to as a
‘feedback model of self awareness', and by some
people an 'information processing tool'.
 The Johari Window actually represents information
- feelings, experience, views, attitudes, skills,
intentions, motivation, etc. within or about a
person- in relation to their group, from four
perspectives.

65. AREAS OF MODEL
 The four Johari Window perspectives are called
'regions' or 'areas' or 'quadrants'.
 Each of these regions contains and represents the
information - feelings, motivation, etc.

67. This is also known by others - OPEN AREA,
OPEN SELF, FREE AREA, FREE SELF.
This is also known as the 'area of free activity'.
This is the information about the person -
behavior, attitude, feelings, emotion, knowledge,
experience, skills, views, etc. known by the
person ('the self') and known by the group
('others')
1. Open area

68. 2. Blind area
which others know as - BLIND AREA,
BLIND SELF, OR 'BLINDSPOT’.
Johari region 2 is what is known about a
person by others in the group, but is unknown
by the person him/herself.

69. 3. Hidden area
what is known to ourselves but kept hidden from,
and therefor unknown to others

70. 4. Unknown area
It contains information, feelings, talent
abilities, aptitudes, experiences etc, that are
unknown to the person him/herself and
unknown to others in the group.

71. THERAPEUTIC
IMPASSES AND ITS
MANAGEMENT

72. DEFINITION
Therapeutic impasses are blocks in the progress of the
NPR .
Impasses provoke intense feelings in both nurse and
the patient , which may range from anxiety and
apprehension to frustration , love or intense anger .

73. TYPES OF
THERAPEUTIC IMPASSES

74. I. RESISTANCE
Resistance is the patient's attempt to remain
unaware of anxiety producing aspects within the
self .

75. II. TRANSFERENCE
It is an unconscious response in which the patient
experiences feelings and attitudes towards the nurse that
were originally associated significant figures in the patient's
early life .

76. III. COUNTER TRANSFERANCE
It is a therapeutic impasses created by the nurse . it
refers to the nurse's specific response generated by the
qualities of the patient

77. IV. BOUNDARIES VIOLANCE
It occurs when a nurse goes outside the boundaries of
the therapeutic relationship and establishes a social ,
economic or personal relationship with the patient .

78. MANAGEMENTS
Support the nurse assist her in identifying counter transference .
Discuss with the superiors .
Self - examination
Peer consultation
Active listening
Clarification
Reflection
Explore behaviour to find possible reasons .
Maintain open communication