Nicanor I. Marcelo, Jr.

Group 3
SBC-CON

PRE-INTERACTION
◦ Major task of nurse- to develop self-awareness

ORIENTATION
◦ Major task of the nurse: to develop a mutual acceptable contract

WORKING
◦ Major task: identification and resolution of patient’s problem

TERMINATION
◦ Major task: to assist the patient to review what he has learned and transfer
his learning to his relationship with others
◦
THERAPEUTIC COMMUNICATIONS
ORIENTATION
◦ Broad Opening
◦ Recognition
◦ Giving information
◦ Silence
◦ Offering Self – “Do you want me to sit beside you?”

WORKING
◦ Focusing – “Let us discuss this topic more.”
◦ Exploring – “Tell me more about it.”
◦ Encourage Evaluation – “IS this what you want?”
◦ Reflecting – same idea
◦ Restating – same statement
◦ Verbalizing Implied – “Are you going to kill yourself?”
◦ Seeking Clarification – “May you please repeat that statement”
◦ General lead – “Please continue.”; “And then?”
◦ Limit setting – “Stop.”
◦ Interpreting – “Maybe that thing is very significant to you.”

TERMINATION
◦ Summarizing – “Let us now sum up. You have stated earlier…etc.”
◦ “Do you have any questions?”
◦ “Our next therapy…”
◦ Look for changes in behavior
◦ Resistance is a common problem
Therapeutic Communication Techniques
Accepting-indicating reception
 Eg.”Yes”
“I follow what you said”
Nodding..

Broad Openings
 Allowing the client to take the initiative in introducing the topic
 Eg. “is there something you’d like to talk about?”
“Where would you like to begin?”

Consensual Validation
 Searching for mutual understanding, for accord in the meaning of the words
 Eg. “Tell me whether my understanding of it agrees with yours”
“Are you using this word to convey that. . .?”

Encouraging Comparison
 Asking that similarities and differences be noted
 Eg. “was it something like..?”
“Have you had similar experiences?”

Encouraging Description of Perceptions

 Asking the client to verbalize what he or perceives
 Eg.”Tell me when you feel anxious”
“What is happening?”
‘What does the voice seem to be saying?”

Encouraging Expression
 Asking client to appraise the quality of his or her experience
 Eg. “what are your feelings in regard to..?”
“Does this contribute to your distress?”

Exploring
 Delving further into a subject or idea
 Eg. “Tell me more about that.”
“Would you describe it more fully?”
“What kind of work?”

Focusing
 Concentrating on a single point
 Eg. “This point seems worth looking at more closely”
“Of all the concerns you’ve mentioned, which is most troublesome?”

Formulating a Plan of Action

 -Asking the client to consider kinds of behavior likely to be appropriate in future
situations
 Eg. “What could you do to let your anger out harmlessly?”
“Next time this comes up, what might you do to handle it?”

General Leads
 Giving encouragement to continue
 Eg. “Go on”
“And then?”
“Tell me about it”

Giving Information
 Making available the facts that the client needs
 Eg. “My name is…”
“Visiting hours are…”
“My purpose in being here is… “

Giving Recognition
 Acknowledging, indicating awareness
 Eg. “Good morning, Mr. S…”
“You’ve finished your list of things to do.”
“I noticed that you’ve combed your hair”

Making Observations
 Verbalizing what the nurse perceives
 Eg. “You appear tense..”
“I notice that your biting your lips”

Offering Self
 Making oneself available
 Eg. “I’ll sit with you awhile”
“I’ll stay here with you”
“I’m interested in what you think”

Placing Event in Time or Sequence

 Clarifying the relationship of events in time
 Eg. “what seemed to lead up to…?
“Was this before or after?”

Presenting Reality
 Offering for consideration that which is real
 Eg. “I see no one else in the room.”
“Your mother is not here; I am a nurse.”
 ReflectingDirecting client actions, thoughts, and feelings back to client
 Eg. Client: “Do you think I should tell the doctor…? Nurse: “Do you think you
should?”
Restating
 Repeating the main idea expressed
 Eg. Client: I can’t sleep. I stay awake all night.”
Nurse:You have difficulty sleeping.”
Client:”I’m really mad, and upset”
Nurse: You’re really mad and upset.”

Seeking Information
 Seeking to make clear that which is not meaningful or that which is vague
 “I’m not sure that I follow.”
“Have I heard you correctly?”

Silence
 Absence of verbal communication, which provides time for for the client to put
thoughts or feelings into words, regain composure, or continue talking
 Eg. Nurses says nothing but continues to maintain eye contact and conveys
interest.

Suggesting Collaboration
 Offering to share , to strive, to work with the client for his or her benefit
 Eg. Perhaps you and I can discuss and discover the triggers for your anxiety

Summarizing
 Organizing and summing up that which has gone before
 Eg. “Have I got this straight?”

Translating into Feelings

 seeking to verbalize client’s feelings that he or she expresses only indirectly
 Eg. Client: “I’m dead”
Nurse: “Are you suggesting that you feel lifeless?”

Verbalizing the Implied

 Voicing what the client has hinted at or suggested
 Eg. Client: I cant’ talk to you or anyone. It’s a waste of time.” Nurse: “Do you feel
that no one understands”

Voicing Doubt
 Expressing uncertainty about the reality of the client’s perceptions
 “Isn’t that unusual?”
“Really?”
“That’s hard to believe.”
Non-therapeutic Technique
1. Overloading
· talking rapidly, changing subjects too often, and asking for more information than can
be absorbed at one time.
· “What’s your name? I see you like sports. Where do you live?”
2. Value Judgments
· giving one’s own opinion, evaluating, moralizing or implying one’s values by using
words such as “nice”, “bad”, “right”,
“wrong”, “should” and “ought”.
· “You shouldn’t do that, its wrong”.
3. Incongruence
· sending verbal and non-verbal messages that contradict one another.
· The nurse tells the patient “I’d like to spend time with you” and then walks away.
4. Underloading
· remaining silent and unresponsive, not picking up cues, and failing to give feedback.
· The patient ask the nurse, simply walks away.
5. False reassurance/ agreement
· Using cliché to reassure client.
· “It’s going to be alright”.
6. Invalidation
· Ignoring or denying another’s presence, thought’s or feelings.
· Client: How are you?
· Nurse responds: I can’t talk now. I’m too busy.
7. Focusing on self
· responding in a way that focuses attention to the nurse instead of the client.
· “This sunshine is good for my roses. I have beautiful rose garden”.
8. Changing the subject
· introducing new topic
· inappropriately, a pattern that may indicate anxiety.
· The client is crying, when the nurse asks “How many children do you have?”
9. Giving advice
· telling the client what to do, giving opinions or making decisions for the client, implies
client cannot handle his or her own life
decisions and that the nurse is accepting responsibility.
· “If I were you… Or it would be better if you do it this way…”
10. Internal validation
· making an assumption about the meaning of someone else’s behavior that is not
validated by the other person (jumping into
conclusion).
· The nurse sees a suicidal clients smiling and tells another nurse the patient is in good
mood.
 Other ineffective behaviors and responses:
1. Defending – Your doctor is very good.
2. Requesting an explanation – Why did you do that?
3. Reflecting – You are not suppose to talk like that!
4. Literal responses – If you feel empty then you should eat more.
5. Looking too busy.
6. Appearing uncomfortable in silence.
7. Being opinionated.
8. Avoiding sensitive topics
9. Arguing and telling the client is wrong
10. Having a closed posture-crossing arms on chest
11. Making false promises – I’ll make sure to call you when you get home.
12. Ignoring the patient – I can’t talk to you right now
13. Making sarcastic remarks
14. Laughing nervously
15. Showing disapproval – You should not do those things.

Interventions
 Explore client’s perception and meaning of the loss
 Allow adaptive denial
 Assist client to reach out for and accept support
 Encourage client to examine patterns of coping in past and present situation of
loss
 Encourage client to care for himself
 Offer client food without pressure to eat
 Use effective communication