LECTURE 3_Therapeutic Communication.pdf

THERAPEUTIC COMMUNICATION  COMMUNICATION The term communication has various meanings, depending on the context in which it is used. 1.To some, communication is the inter- change of information between two or more people; in other words, the exchange of ideas or thoughts. ...

THERAPEUTIC COMMUNICATION  COMMUNICATION The term communication has various meanings, depending on the context in which it is used. 1.To some, communication is the inter- change of information between two or more people; in other words, the exchange of ideas or thoughts.  COMMUNICATION 2. Thoughts are expressed to others not only by spoken or written words but also by gestures or body actions. 3. It can be a transmission of feelings or a more personal and social interaction between people.  COMMUNICATION Any means of exchanging information or feelings between two or more people. It is a basic component of human relationships, including health professions and other disciplines.  Communication Process Face-to-face communication involves a sender, a message, a receiver, and a response, or feedback  SENDER The sender, a person or group who wishes to communicate a message to another, can be considered the source-encoder.  MESSAGE What is actually said or written, the body language that accompanies the words, and how the message is transmitted. The method used to convey the message can target any of the receiver’s senses.  RECEIVER The third component of the communication process, is the listener, who must listen, observe, and attend. This person is the decoder, who must perceive what the sender intended (interpretation).  FEEDBACK Feedback can be either verbal, nonverbal, or both. Non-verbal examples are a nod of the head or a yawn. Either way, feed- back allows the sender to correct or reword a message.  MODES OF COMMUNICATION Verbal communication uses the spoken or written word; Nonverbal communication uses other forms, such as gestures or facial expressions, and touch. NONVERBAL Nonverbal communication, COMMUNICATION sometimes called body language, includes gestures, body movements, use of touch, and physical appearance, including adornment. To observe nonverbal behavior efficiently requires a systematic assessment of the person’s overall physical appearance, posture, gait, facial expressions, and gestures.  PERSONAL APPEARANCE Clothing and adornments can be sources of information about a person. Although choice of apparel is highly personal, it may convey social and financial status, culture, religion, group association, and self-concept.  POSTURE AND GAIT The ways people walk and carry themselves are often reliable indicators of self-concept, current mood, and health.  FACIAL EXPRESSION No part of the body is as expressive as the face. Feelings of surprise, fear, anger, disgust, happiness, and sadness can be conveyed by facial expressions. Although the face may express the person’s genuine emotions, it is also possible to control these muscles so the emotion expressed does not reflect what the person is feeling.  GESTURES Hand and body gestures may emphasize and clarify the spoken word, or they may occur without words to indicate a particular feeling or to give a sign. Ex: A father awaiting information about his daughter in surgery may wring his hands, tap his foot, pick at his nails, or pace back and forth. Therapeutic Communication It requires the use of verbal and non verbal techniques that are focused on client needs. It requires the avoidance of unhelpful or non therapeutic technique  Therapeutic Communication Therapeutic communication promotes understanding and can help establish a constructive relationship between the HCP and the client. Unlike a social relationship, where there may not be a specific purpose or direction, the therapeutic helping relationship is client and goal directed. Therapeutic Communication Techniques Therapeutic Communication Techniques Technique Description Examples Accepting pauses or silences Sitting quietly (or walking that may extend or several with the client) and Using seconds or minutes without waiting attentively until interjecting any verbal the client is able to put silence response. thoughts and feelings into words. Technique Description Examples Providing Using statements or questions that “Can you tell me how it is for you?” general (a) encourage the client to “Perhaps you would like verbalize, to talk about....” leads (b) choose a topic of “Would it help to discuss conversation, and your feelings?” (c) facilitate continued “Where would you like to verbalization. begin?” “And then what?” Technique Description Examples Using Asking broad questions that lead or “I’d like to hear more about invite the client to explore that.” open- (elaborate, clarify, describe, “Tell me more....” ended compare, or illustrate) thoughts or “How have you been feeling questions feelings. Open-ended questions lately?” specify only the topic to be “What brought you to the discussed and invite answers that hospital?” are longer than one or two words. “What is your opinion?” “You said you were frightened yesterday. How do you feel now?” Technique Description Examples Using Providing appropriate forms of touch to reinforce caring Putting an arm over the client’s shoulder. touch feelings. Because tactile contacts vary considerably Placing your hand over among individuals, families, the client’s hand. and cultures, the HCP must be sensitive to the differences in attitudes and practices of clients and self Technique Description Examples Actively listening for the Client: “I couldn’t client’s basic message and manage to eat any then repeating those dinner last night— Restating or thoughts and/or feelings in not even the dessert.” paraphrasing similar words. HCP: “You had This conveys that the HCP difficulty eating has listened and understood yesterday.” the client’s basic message Client: “Yes, I was very and also offers clients a upset after my family clearer idea of what they left.” have said. Techniqu Description Examples e ✔ A method of making the client’s “I’m puzzled.” broad overall meaning of the “I’m not sure I understand Seeking message more understandable. It that.” clarification is used when paraphrasing is “Would you please say that difficult or when the again?” communication is rambling or “Would you tell me more?” garbled. “I meant this rather than ✔ To clarify the message, the HCP that.” can restate the basic message or “I’m sorry that wasn’t very confess confusion and ask the clear. Let me try to explain client to repeat or restate the another way.” message. ✔ HCP can also clarify their own message with statements. Technique Description Examples Offering Suggesting one’s presence, interest, or wish to understand “I’ll stay with you until your daughter arrives.” self the client without making any “We can sit here quietly demands or attaching for a while; we don’t need conditions that the client must to talk comply with to receive the unless you would like to.” HCP’s attention. “I’ll help you to dress to go home, if you like.” Technique Description Examples Providing, in a simple and direct “Your surgery is manner, specific factual information scheduled for 11 am Giving the client may or may not request. tomorrow.” information When information is not known, the “You will feel a HCP states this and indicates who has pulling sensation it or when the HCP will obtain it. when the tube is removed from your abdomen.” “I do not know the answer to that, but I will find out from Dr. King, the resident in charge.”  Technique Description Examples Giving recognition, in a “You trimmed your Acknowledging nonjudgmental way, of a change inbeard and behavior, an effort the client has mustache and made, or a contribution to a washed communication. your hair.” “I notice you keep Acknowledgment may be with or squinting your eyes. without understanding, verbal or Are you having nonverbal. difficulty seeing?” “You walked twice as far today with your walker.” Technique Description Examples Helping the client to “That telephone Presenting differentiate the real from the ring came from unreal. the program on reality television.” “Your magazine is here in the drawer. It has not been stolen.”  Technique Description Examples Helping the client expand on and develop a Client: “My wife says Focusing topic of importance. It is important for theshe will look after HCP to wait until the client finishes stating me, but I don’t the main concerns before attempting to think she can, what focus. with the children to take care of, The focus may be an idea or a feeling; and they’re always however, the HCP often emphasizes a feeling after her about to help the client recognize an emotion something—clothes, disguised behind words. homework, what’s for dinner that night.” HCP : “Sounds like you are worried about how well she can manage.” Technique Description Examples Directing ideas, feelings, Client: “What can I Reflecting questions, or content back to do?” HCP: “What do you clients to enable them to think would be explore their own ideas and helpful?” feelings about a situation. Client: “Do you think I should tell my husband?” HCP: “You seem unsure about telling your husband.”  Technique Description Examples Stating the main points of a “During the past half Summarizing discussion to clarify the relevant hour we have talked about....” and Planning points discussed. This technique “Tomorrow is useful at the end of an afternoon we may interview or to review a health explore this further.” teaching session. It often acts as “In a few days I’ll review what you an introduction to future care have learned about planning. the actions and effects of your insulin.” “Tomorrow, I will look at your feeling journal.”  BARRIERS TO COMMUNICATION  Technique Description Examples Offering generalized and “Two-year-olds are oversimplified beliefs about groups brats.” Stereotyping of people that are based on “Women are complainers.” experiences too limited to be valid. “Men don’t cry.” These responses categorize clients “Most people don’t and negate their uniqueness as have any pain after individuals. this type of surgery.”  Technique Description Examples Similar to judgmental responses, Client: “I don’t think agreeing and disagreeing imply that the Dr. Broad is a very Agreeing and client is either right or wrong and thatgood doctor. disagreeing the HCP is in a position to judge this. He doesn’t seem interested in his These responses deter clients from clients.” thinking through their position and may HCP: “Dr. Broad is cause a client to become defensive. head of the department of surgery and is an excellent surgeon.” Technique Description Examples Attempting to protect a person or health Client: “Those night care services from negative comments. nurses must just sit Being These responses prevent the client from around and talk all defensive expressing true concerns. night. They didn’t The HCP is saying, “You have no right to answer my light for complain.” over an hour.” Defensive responses protect the HCP from admitting weaknesses in the health HCP: “I’ll have you care services, including personal know we literally run weaknesses. around on nights. You’re not the only client, you know.”  Technique Description Examples Giving a response that makes clients Client: “I felt Challenging prove their statement or point of view. nauseated after that red pill.” These responses indicate that the HCP is HCP: “Surely you failing to consider the client’s feelings, don’t think I gave making the client feel it necessary to you the wrong pill?” defend a position. Client: “I feel as if I am dying.” HCP: “How can you feel that way when your pulse is 60?” Technique Description Examples Asking for information chiefly out of Client: “I was Probing curiosity rather than with the intent to assist the client. speeding along the street and didn’t see the stop sign.” These responses are considered HCP: “Why were you prying and violate the client’s speeding?” privacy. Asking “why” is often probing and Client: “I didn’t ask places the client in a defensive the doctor when he position. was here.” HCP: “Why didn’t you?” Technique Description Examples Asking questions that make the client “Who do you think Testing admit to something. These responses you are?” people to admit (forces permit the client only limited answers their status is only and often meet the HCP’s need rather that of client) than the client’s. “Do you think I am not busy?” (forces the client to admit that the HCP really is busy) Technique Description Examples Refusing to discuss certain topics “I don’t want to Rejecting with the client. discuss that. Let’s talk about....” These responses often make clients “Let’s discuss other feel that the HCP is rejecting not areas of interest to only their communication but also you rather than the the clients themselves. two problems you keep mentioning.” Technique Description Examples Directing the communication into “I can’t talk now. I’m on my Changing areas of self-interest rather than way for coffee break.” topics and considering the client’s concerns Client: “I’m separated from is often a self-protective subjects my wife. Do you think I should response to a topic that causes have sexual relations with anxiety. another woman?” These responses imply that what HCP: “I see that you’re 36 and the HCP considers important will that you like gardening. This be discussed and that clients sunshine is good for my should not discuss certain topics. roses. I have a beautiful rose garden.” Technique Description Examples Using clichés or comforting “You’ll feel better Unwanted statements of advice as a means to soon.” reassure the client. These responses “I’m sure everything reassurance will turn out all block the fears, feelings, and other right.” thoughts of the client. “Don’t worry.” Technique Description Examples Giving opinions and approving or “That’s good (bad).” Passing disapproving responses, moralizing, “You shouldn’t do or implying one’s own values. These that.” judgment “That’s not good responses imply that the client must enough.” think as the HCP thinks, fostering “What you did was client dependence. wrong (right).” Technique Description Examples Telling the client what to do. These Client: “Should I Giving responses deny the client’s right to be move from my home an equal partner. to a nursing home?” common advice Note that giving expert rather than HCP: “If I were you, I’d go to a nursing common advice is therapeutic. home, where you’ll get your meals cooked for you.” Phases of the Helping Relationship Phases of the Helping Relationship HCP can identify the progress of a relationship by understanding these phases: pre interaction phase, introductory phase, working (maintaining) phase, and termination phase.  PRE INTERACTION PHASE The pre interaction phase is similar to the planning stage before an interview. In most situations, the HCP has information about the client before the first face-to-face meeting. Such information may include the client’s name, address, age, medical history, and/or social history. INTRODUCTORY PHASE The introductory phase, also referred to as the orientation phase, is important because it sets the tone for the rest of the relationship. During this initial encounter, the client and the HCP closely observe each other and form judgments about the other’s behavior. WORKING PHASE During the working phase of a helping relationship, the HCP and the client begin to view each other as unique individuals. They begin to appreciate this uniqueness and care about each other. Caring is sharing deep and genuine concern about the welfare of another person. Once caring develops, the potential for empathy increases.  WORKING PHASE The working phase has two major stages: exploring and understanding thoughts and feelings, and facilitating and taking action. The HCP helps the client to explore thoughts, feelings, and actions and helps the client plan a program of action to meet pre-established goals. FACILITATING AND TAKING ACTION Ultimately the client must make decisions and take action to become more effective. The responsibility for action belongs to the client. The HCP , however, collaborates in these decisions, provides support, and may offer options or information. TERMINATION PHASE The termination phase of the relationship is often expected to be difficult and filled with ambivalence. However, if the previous phases have evolved effectively, the client generally has a positive outlook and feels able to handle problems independently. Many methods can be used to terminate relationships. Summarizing or reviewing the process can produce a sense of accomplishment. This may include sharing reminiscences of how things were at the beginning of the relationship and comparing them to how they are now.