Therapeutic communication is a process that focuses on advancing a patient's physical and emotional well-being. It involves establishing trust and respect between the nurse and patient to effectively exchange information and address the patient's needs. Therapeutic communication utilizes both verbal and non-verbal techniques, including active listening, open-ended questions, reflecting, clarifying and informing. The goal is to develop a therapeutic relationship in order to help patients understand and cope with their health issues. Key aspects of this relationship include empathy, support, and facilitating patient expression while maintaining objectivity.

1. THERAPEUTIC
COMMUNICATION
MRS.RAMYA SURESH,M.SC(N)
ASSOCIATE PROFESSOR,
GIHS.

2. INTRODUCTION
• Communication is simply the act of transferring
information from one place, person or group to
another.
• Every communication involves (at least) one
sender, a message and a recipient.
• The transmission of the message from sender to
recipient can be affected by a huge range of
things. These include our emotions, the cultural
situation, the medium used to communicate, and
even our location.

3. THERAPEUTIC COMMUNICATION
Therapeutic communication is the face-to-face process of
interaction that focuses on advancing the physical and
emotional well-being of a patient.
Nurses use therapeutic communication techniques to provide
education and support to patients, while maintaining objectivity
and professional distance.

4. DEFINITION
“It is an interpersonal interaction between the
nurse and the patient during which the nurse
focuses on the patient’s specific needs to promote
an effective exchange of information.”

5. GOALS OF THERAPEUTICCOMMUNICATION
• 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.

6. PRINCIPLESORCHARACTERISTICSOF
THERAPEUTICCOMMUNICATION
• The patient should be the prime focus of the interaction.
• A professional way sets the nature of the therapeutic
relationship.
• Use self-disclosure carefully & slowly only when it has a
therapeutic purpose.
• Avoid social relationship with patients
• Maintain patient confidentiality.
• Assess the patient’s mental competence to determine the
extent of understanding.
• Maintain a non-judgmental attitude. Avoid making judgments
about a patient’s behaviour.
• Avoid giving advice.
• Guide the patient to describe his or her experiences
rationally.

7. REQUIREMENTS FOR THERAPEUTIC
RELATIONSHIP
RAPPORT

8. TRUST

9. RESPECT

10. GENUINENESS

11. EMPATHY

12. TYPES OF THERAPEUTIC
COMMUNICATION
VERBAL COMMUNICATION
It occurs through the medium of words- spoken,
or written.
It can convey factual information accurately and
efficiently.

13. NON VERBAL COMMUNICATION
NON – VERBAL COMMUNICATION:
• It includes everything that does not involve the spoken or written
word. It involves all five senses.
There are five types of non – verbal Behavior.
• Vocal
• Action
• Object
• Space
• Touch

14. Vocal Cues
• Are also known as Paralinguistic cues .
• They include all the noises and extra
speech sounds .
• EXAMPLE - Tone of voice, pitch, Sounds
such as Laughing, nervous coughing.

15. 2. Action Cues
• Are mainly body movements.
• They include posture, Facial expression, mannerisms,
actions etc.
• Facial movements and postures particularly significant in
interpreting the speaker’s mood
3. Object Cues
• Are dress, furnishings and possessions.
• They communicate something to the observer about the
speaker’s feelings.

16. 4. Space
• Provides another cue to the nature of the relationship
between two people .
• Example- Chairs placed in a circle decrease the space
between the patient’s and between the nurse and the
patients.

17. 5.Touch
• Is the most personal of the non- verbal messages . It
involves both personal space and action .
• Most often in nursing, we use touch with therapeutic
goal . We lay hands on the body of an ill person for the
purpose of comforting him/her .

18. THERAPEUTIC COMMUNICATION
TECHNIQUES
1.LISTENING :
• It is an active process of receiving information.
• Observing and listening skills.
• Therapeutic value :Non-verbally communicates
to the patient the nurse's interest and
acceptance.

19. 2. BROAD OPENINGS:
• Encouraging the client to select topics for
discussion.
• Eg : What are you thinking about ?
• Therapeutic value: Indicates acceptance by the
nurse and the value of patient's initiative.

20. 3. RESTATING:
• Repeating the main thought expressed by the client .
• Eg : You say that your Mother left you when you were 5
years old.
• Therapeutic value: Indicates that the nurse is listening
and validates, reinforces or calls attention to something
important that has been said.

21. 4. CLARIFICATION:
• Attempting to put unclear thoughts of the client into
words to enhance nurse’s understanding or asking the
client to explain what he/she means.
• Eg: “I am not sure about what you mean; could you tell
me again” ?
• Therapeutic value: It helps to clarify feelings, ideas and
perceptions of the patient and provides an explicit
correlation between them and the patient's actions.

22. 5. REFLECTING:
• Patients often ask nurses for advice about what
they should do about particular problems or in
specific situations.
• Nurses can ask patients what they think they
should do, which encourages patients to be
accountable for their own actions and helps
them come up with solutions themselves.

23. 6.HUMOR:
• The discharge of energy through the comic enjoyment of
the imperfect. That gives a whole new meaning to the
word ‘nervous’ , said with shared kidding between nurse
and the patient.
• Therapeutic value: Can promote insight by making
repressed material conscious, resolving paradoxes,
tempering aggression and revealing new options, and is a
socially acceptable form of sublimation.

24. 7. INFORMING :
• The skill of information sharing.
• Eg: “I think you need to know more about your
medications . ”
• Therapeutic value: Helpful in health teaching or patient
education about relevant aspects of patient's well-being
and self-care.

25. 8. FOCUSING
Questions or statements that help the patient expand on
a topic of importance.
Eg : “I think we should talk more about your relationship
with your Father”.
Therapeutic value: Allows the patient to discuss central
issues and keeps the communication process goal-
directed.

26. 9.Encouraging Descriptions of Perception
• For patients experiencing sensory issues or
hallucinations, it can be helpful to ask about
them in an encouraging, non-judgmental way.
Phrases like “What do you hear now?” or “What
does that look like to you?” give patients a
prompt to explain what they’re perceiving
without casting their perceptions in a negative
light.

27. 10.THEME IDENTIFICATION:
• This involves identification of underlying issue or problems
experienced by the client that emerge repeatedly during the
course of the nurse-client relationship .
• Eg : “I noticed that you said, you have been hurt or rejected by
the man. Do you think this is an underlying issue?”
• Therapeutic value: It allows the nurse to promote the patient's
exploration and understanding of important problems.

28. 11.SILENCE:
• Lack of communication for a therapeutic reason.
• Eg : Sitting with a client and non-verbally
communicating interest and involvement .
• Therapeutic value: Allows the patient time to
think and gain insight, slows the pace of the
interaction and encourages the patient to initiate
conversation while enjoying the nurse's support,
understanding and acceptance.

29. • At times, it’s useful to not speak at all. Deliberate
silence can give both nurses and patients an
opportunity to think through and process what
comes next in the conversation.
• It may give patients the time and space they
need to broach a new topic. Nurses should
always let patients break the silence.

30. 12.SUGGESTING :
• Presentation of alternative ideas for the patient's
consideration relative to problem solving.
• For 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.“
• Therapeutic value: Increases the patient's perceived
notions or choices.

31. 13.Making Observations
• Observations about the appearance, demeanour,
or behaviour
• of patients can help draw attention to areas that
might pose a problem for them.
• Observing that they look tired may prompt
patients to explain why they haven’t been
getting much sleep lately; making an observation
that they haven’t been eating much may lead to
the discovery of a new symptom.

32. INTRODUCTION
• A relationship is defined as a state of being
related or a state of affinity between two
individuals.
• Therapeutic nurse patient relationship is a
supportive interaction that moves a patient
toward wellness. It’s based on trust, respect,
interest and empathy.

33. DEFINITION
•Therapeutic nurse patient relationship
is the interaction process in which the
nurse fulfils her role by using her
professional knowledge and skills in
such a way that she is able to help the
patient physically, socially and
emotionally.

34. Goals of Nurse Patient Relationship
• The nurse helps the patient to cope with the present
problems
• The nurse helps the patient to understand the problems
• The nurse helps the patient to understand the active
participation in an experience.
• The nurse assists the patient to identify emerging
problems realistically.
• The nurse helps the patient to find out a new alternative
for his or her problem.

35. CONT..
• The nurse help the patient to communicate.
• The nurse helps the patient to try out new
patterns of behaviour.
• The nurse helps the patient to socialize.
• The nurse helps the patient to find meaning of
his illness.

36. • Therapeutic interpersonal relationship is the means by
which the nursing process is implemented. Task of the
relationship has been categorized into four phases.
PHASES OFTHERAPEUTIC RELATION SHIP

37. Phase and Tasks of Therapeutic
interpersonal relationship
1.Pre interaction Phase:
This phase begins when the nurse is assigned to
initiate a therapeutic relationship and this includes
obtaining information about the patient from
charts, significant others or health team
members.
Involves Preparation for the first encounter with the
client.

38. • Definition: Pre interaction means a phase which
a nurse goes through before the actual
interaction with the patient.
Nurses tasks:
• Explore own feelings, fantasies and fears
• Analyse own professional strengths and limitations
• Gather data about patient whenever possible.
• Plan for first meeting with the patient.

39. • Common concerns of nursing students in this phase are
• Afraid of being rejected by the patient
• Anxiety due to newness of the experience
• Doubtful about the effectiveness of the skills or coping activity.
• Fearful of physical danger or violence
• Suspiciousness of psychiatric patients behaviour
• Worried about hurting the patient psychologically

40. 2.Orientation Phase:
• It is in this phase, the nurse and client meet for the first time.
• Introductory or orientation phase begins when the nurse goes to the
patient ,introduces herself and gets introduction about himself.
• Nurses tasks:
• Determine why the patient sought help
• Create an environment for the establishment of trust and rapport.

41. • Gather assessment information to build a strong
client data base.
• Mutually formulate a contract.
• Explore patients thoughts, feelings and actions.
• Identify patients problems.
• Define goals with the patient.

42. • 3.Working Phase:
• The therapeutic work of relationship is accomplished during
this phase.
• Nurses tasks:.
• The nurse maintains the trust and rapport.
• She uses the problem solving approaches to over come the
resistances.
• She continuously evaluates and explore for stressors.

43. • She promotes Insight and constructive coping mechanism to
overcome the patients problems.
• Exhibition or reduction of anxiety in both patient and the
nurse.
• Client accepts boundaries of relationship.
• Nurse uses interpersonal skills that foster communication.

44. 4.Termination Phase:
• Is to bring a therapeutic end to the relationship, which is the
most difficult, but most important phase.
• Causes of Termination:
• The patient may be discharged
• The patient may go on parole
• The nurse may terminate relationship due to various reason.

45. • Nurses tasks:
• Establish reality of separation.
• Review progress of therapy and attainment of goals.
• Mutually explore feelings of rejection, loss, sadness, anger and
related behaviours.
• Assist client to review what has been learned and to transfer
his learning to his relationship with others.

46. NONTHERAPEUTIC COMMUNICATIONTECHNIUES
Nontherapeutic communication techniques are those which hinder or
damage or prevent the professional relationship.
• Asking personal questions
• Giving personal opinions
• Changing the subject
• Using Reassuring Clichés
• Defensive Responses
• Sympathy
• Arguing