Therapeutic Communication

Nurse Rose works in an outpatient mental health clinic and has noticed that one of the clients, Gabriella, is visibly upset and sitting by herself away from the other clients. Nurse Rose says, “Gabriella, what’s wrong? Is something bothering you?” Gabriella rolls her eyes and shakes her head stating, “I just want to be left alone.” Nurse Rose is formulating a response when Gabriella stands up and yells, “Why don’t you go and talk to one of the other patients? You like them better anyway!” Nurse Rose is surprised by the increase in intensity of Gabriella’s emotions and does not understand what she is referring to. Nurse Rose will use what she has learned about therapeutic communication to determine how best to handle this situation. 

Communication is the process of sending and receiving information between two or more people. One type of communication that is used by many disciplines, including nurses, is therapeutic communication. Therapeutic communication is a type of communication where information between clinicians and clients is exchanged in order to collaborate effectively and promote the physical and psychological well-being of clients. Therapeutic communication is crucial to the formation of client-centered relationships, which can foster trust and respect, especially for clients experiencing emotional distress, like Gabriella.

Another use of therapeutic communication is de-escalation, which is a goal of communication when escalation occurs. Escalation refers to an increase, or rise in intensity, during an interpersonal interaction. This is what is occurring between Nurse Rose and Gabriella. Nurse Rose can recognize Gabriella’s emotions are escalating when she stands up and yells. When faced with an escalating interaction, it is important for the nurse to de-escalate the situation.

De-escalation occurs when a person reduces the intensity of a conflict. One way to do this is through therapeutic communication.

There are two main types of communication: verbal and nonverbal. Verbal communication refers to spoken or written words, so Gabriella could’ve told Nurse Rose, “I want to be left alone.”  Nonverbal communication can include sighs, moans, physical gestures, and even eye contact. So when Gabriella rolls her eyes and shakes her head, she is using nonverbal communication. 

Now, there are several factors which can affect the process of communication. These factors include personal factors, relationship factors, and environmental factors. Personal factors that affect communication include emotions, such as Gabriella’s anger and jealousy as well as social factors, like the primary language that’s spoken by Nurse Rose and Gabriella. Relationship factors can also affect communication such as when the individuals communicating are equals, like two nursing colleagues or when the  people communicating are not equals, such as Nurse Rose and Gabriella. Lastly, environmental factors can also impact communication; such as an uncomfortable temperature or a lack of privacy, like trying to communicate in a busy mental health clinic such as the one Nurse Rose and Gabriella are in.

You can use therapeutic communication skills to enhance information exchange and build rapport with clients. These skills include silence, active listening, reflection, and clarification. 

Silence is an effective tool to encourage clients to open up. It is beneficial for clients who are reluctant to speak because it provides them with extra time to gather their thoughts.

Next, active listening means being attentive to what a client is saying both verbally and nonverbally. SURETY is a model to help you to remember the steps of active listening. During active listening, you should sit at an angle facing the client, uncross legs and arms, relax, make eye contact, use gentle touch and trust your intuition. 

Reflecting involves repeating back what the client says to show them you are listening. 

Lastly, clarification is a technique used to verify the interpretation of the client’s message. This gives the opportunity to clear up any misconceptions and avoid misunderstandings. 

On the other hand, non-therapeutic communication can negatively impact the nurse-client relationship. Non-therapeutic communication includes asking too many “why” questions, giving premature advice, falsely reassuring, making value judgments, or minimizing feelings.