Therapeutic Communication Techniques PDF

Therapeutic Communication Techniques The social worker can use many therapeutic communication techniques to interact with clients. The choice of technique depends on the intent of the interaction and the client’s ability to communicate verbally. Overall, the social worker selects techniques that fa...

Therapeutic Communication Techniques The social worker can use many therapeutic communication techniques to interact with clients. The choice of technique depends on the intent of the interaction and the client’s ability to communicate verbally. Overall, the social worker selects techniques that facilitate the interaction and enhance communication between client and social worker. In contrast, there are many nontherapeutic techniques that social workers should avoid. These responses cut off communication and make it more difficult for the interaction to continue. Many of these responses are common in social interaction such as advising, agreeing, or reassuring. Therefore, it takes practice for the social worker to avoid making these typical comments. Therapeutic Examples Rationale Communication Technique Accepting - indicating “Yes” An accepting response indicates the social worker reception “I follow what you has heard and followed the train of thought. It does said.” not indicate agreement but is nonjudgmental. Nodding Facial expression, tone of voice, and so forth also must convey acceptance or the words lose their meaning. Broad openings - allowing “Is there Broad openings make explicit that the client has the the client to take the something you’d lead in the interaction. For the client who is initiative in introducing like to talk hesitant about talking, broad openings may the topic about?” stimulate him or her to take the initiative. “Where would you like to begin?” Consensual validation - “Tell me whether For verbal communication to be meaningful, it is searching for mutual my understanding essential that the words being used have the same understanding, for accord of it agrees with meaning for both (all) participants. Sometimes, in the meaning of the yours.” words, phrases, or slang terms have different words “Are you using meanings and can be easily misunderstood. this word to convey that...?” Encouraging comparison - “Was it something Comparing ideas, experiences, or relationships asking the similarities and like...? bring out many recurring themes. The client differences be noted “Have you had benefits from making these comparisons because similar he or she might recall past coping strategies that experiences?” were effective or remember that he or she has  survived a similar situation. Encouraging description “Tell me when you To understand the client, the social worker must of perceptions - asking feel anxious.” see things from his or her perspective. Encouraging the client to verbalize “What is the client to describe ideas fully may relieve the what he or she perceives. happening?” tension the client is feeling, and he or she might be “What does the less likely to take action on ideas that are harmful voice seem to be or frightening. saying?” Encouraging expression - “What are your The social worker asks the client to consider people asking the client to feelings in regard and events in light of his or her own values. Doing appraise the quality of his to... ?” so encourages the client to make his or her own or her experiences “Does this appraisal rather than to accept the opinion of contribute to your others. distress?” Exploring - delving further “Tell me more When clients deal with topics superficially, into a subject or idea. about that.” exploring can help them examine the issue more “Would you fully. Any problem or concern can be better describe it more understood if explored in depth. If the client fully?” expresses an unwillingness to explore a subject, “What kind of however, the social worker must respect his or her work?” wishes. Focusing - concentrating “This point seems The social worker encourages the client to on a single point worth looking at concentrate his or her energies on a single point, more closely.” which may prevent a multitude of factors or “Of all the problems from overwhelming the client. It is also a concerns you’ve useful technique when a client jumps from one mentioned, which topic to another. is most troublesome?” Formulating a plan of “What could you It may be helpful for the client to plan in advance action - asking the client do to let your what he or she might do in the future similar to consider kinds of anger out situations. Making definite plans increases the behavior likely to be harmlessly?” likelihood that the client will cope more effectively appropriate in future “Next time this in similar situation. situations comes up, what might you do to handle it?” General leads - giving “Go on.” General leads indicate that the social worker is encouragement to “And then?” listening and following what the client is saying continue “Tell me about it.” without taking away the initiative for the interaction. They also encourage the client to continue if he or she is hesitant or uncomfortable about the topic. Giving information - “My name is... “ Informing the client of facts increases his or her making available the facts “Visiting hours are knowledge about a topic or lets the client know that the client needs...“ what to expect. The social worker is functioning as “My purpose of a resource person. Giving information also builds  being here is... “ trust with the client. Giving recognition - “Good morning, Greeting the client by name, indicating awareness acknowledging, indicating Mr. S.... “ of change, or noting efforts the client has made all awareness “You’ve finished show that the social worker recognizes the client as your list of things a person, as an individual. to do.” “I notice that you’ve combed your hair.” Making observations - “You appear Sometimes clients cannot verbalize or make verbalizing what the social tense.” themselves understood. Or the client may not be worker perceives “Are you ready to talk. uncomfortable when... “ “I notice that you’re biting your lip.” Offering self - making “I’ll sit with you The social worker can offer her presence, interest oneself available awhile.” and desire to understand. It is important that this “I’ll stay here with offer is unconditional, that is, the client does not you.” have to respond verbally to get the social worker’s “I’m interested in attention. what you think.” Placing event in time or “What seemed to Putting events in proper sequence helps both the sequence - clarifying the lead up to... ? social worker and client see them in perspective. relationship of events in “Was this before The client may gain insight into cause-and-effect time or after... ? behavior and consequences, or the client may be “When did this able to see that perhaps some things are not happen?” related. The social worker may gain information about recurrent patterns or themes in the client’s behavior or relationships. Presenting reality - “I see no one else When it is obvious that the client is misinterpreting offering for consideration in the room.” reality, the social worker can indicate what is real. that which is real “That sound was a The social worker does this by calmly and quietly car backfiring.” expressing the social worker’s perceptions of the “Your mother is facts, not by way of arguing with the client or not here; I am a belittling his or her experience. The intent is to social worker.” indicate an alternative line of thought for the client to consider, not to “convince” the client that he or she is wrong. Reflecting - directing Client: “Do you Reflection encourages the client to recognize and client actions, thoughts, think I should tell. accept his or her own feelings. The social worker and feelings back to client..? indicates that the client’s point of view has value, Social worker: “Do and that the client has the right to have opinions, you think you make decisions, and think independently. should?” Client: “My brother spends all my money and  then has never to ask for more.” Social worker: “This causes you to feel angry?” Restating - repeating the C: “I can’t sleep. I The social worker repeats what the client has said main idea expressed stay awake all in approximately or nearly the same words the night.” client has used. This restatement lets the client SW: “You have know that he or she communicated the idea difficulty effectively. This encourages the client to continue. sleeping.” Or if the client has been misunderstood, he or she C: “I’m really mad, can clarify his or her thoughts. I’m really upset.” SW: “You’re really mad and upset.” Seeking information - “I’m not sure that The social worker seek clarification throughout seeking to make clear that I follow.” interactions with clients. Doing so can help the which is not meaningful or “Have I heard you social worker to avoid making assumptions that that which is vague correctly?” understanding has occurred when it has not. It helps the client to articulate thoughts, feelings, and ideas more clearly. Silence - absence of verbal Social worker says Silence often encourages the client to verbalize, communication, which nothing but provided that it is interested and expectant. Silence provides time for the continues to gives the client time to organize thoughts, direct client to put thoughts or maintain eye the topic of interaction, or focus on issues that are feelings into words, to contact and most important. Much nonverbal behavior takes regain composure, or to conveys interest. place during silence, and the social worker needs to continue talking be aware of the client and his or her own nonverbal behavior. Suggesting collaboration - “Perhaps you and The social worker seeks to offer a relationship in offering to share, to strive, I can discuss and which the client can identify problems in living with to work with the client for discover the others, grow emotionally, and improve the ability his or her benefit triggers for your to form satisfactory relationships. The social worker anxiety.” offer to do things with, rather than for the client. Summarizing - organizing “Have I got this Summarization seeks to bring out the important and summing up that straight?” points of the discussion and to increase the which has gone before “You’ve said that. awareness and understanding of both participants...” It omits the irrelevant and organizes the pertinent “During the past aspects of the interaction. It allows both client and hour, you and I social worker to depart with the same ideas and have discussed.. provides a sense of closure at the completion of.” each discussion. Translating into feelings - C: “I’m dead.” Often what the client says, when taken literally, seeking to verbalize SW: “Are you seems meaningless or far removed from reality. To client’s feelings that he or suggesting that understand, the social worker must concentrate on she expresses only you feel lifeless?” what the client might be feeling to express himself indirectly C: “I’m way out in or herself this way. the ocean.” SW: “You seem to  feel lonely or deserted.” Verbalizing the implied - C: “I can’t talk to Putting into words what the client has implied or voicing what the client has you or anyone. It’s said indirectly tends to make the discussion less hinted at or suggested a waste of time.” obscure. The social worker should be as direct as SW: “Do you feel possible without being unfeelingly blunt or obtuse. that no one The client may have difficulty communicating understands?” directly. The social worker should take care to express only what is fairly obvious; otherwise, the social worker may be jumping to conclusions or interpreting the client’s communication. Voicing doubt - expressing “Isn’t that Another means of responding to distortions of uncertainty about the unusual?” reality is to express doubt. Such expression permits reality of the client’s “Really?” the client to become aware that others do not perceptions “That’s hard to necessarily perceive events in the same way or believe.” draw the same conclusions. This does not mean the client will alter his or her point of view, but at least the social worker will encourage the client to consider or re-evaluate what has happened. The social worker agreed nor disagreed; however, he or she has no let the misperceptions and distortions pass without comment. Nontherapeutic Communication Techniques Advising - telling the client “I think you Giving advice implies that only the social worker what to do should...” knows what is best for the client. Agreeing - indicating “Why don’t you.. accord with the client.“ Approval indicates the client is “right” rather than “That’s right.” “wrong.” This gives the client the impression that “I agree.” he or she is “right” because of agreement with the social worker. Opinions and conclusions should be exclusively the client’s. When the social worker agrees with the client, there is no opportunity for the client to change his mind without being “wrong.” Belittling feelings C:”I have nothing When the social worker tries to equate the intense expressed - misjudging to live for... I and overwhelming feelings of the client has the degree of the client’s wish I was dead.” expressed to “everybody” or to the social worker’s discomfort SW: “Everybody own feelings, the social worker implies that the  gets down in the discomfort is temporary, mild, self-limiting, or not dumps,” or “I’ve very important. The client is focused on his or her felt that way own worries and feelings; hearing the problems or myself.” feelings of other is not helpful. Challenging - demanding “But how can you Often the social worker believes that if she can proof from the client be president of challenge the client to prove unrealistic ideas, the the Philippines?” client will realize there is no “proof” and then will “If you’re dead, recognize reality. Actually, challenging causes the why is your heart client to defend the delusions or misperceptions beating?” more strongly than before. Defending - attempting to “This agency has a Defending what the client has criticized implies that protect someone or fine reputation.” he has no right to express impressions, opinions, or something from verbal “I’m sure your feelings. Telling the client that his or her criticism is attack father has your unjust or unfounded does not change the client’s best interest in feelings but only serves to block further mind.” communication. Disagreeing - opposing “That’s wrong.” Disagreeing implies the client is “wrong.” the client’s ideas “I definitely Consequently, the client feels defensive about his disagree with... “ or her point of view or ideas. “I don’t believe that.” Disapproving - “That’s bad.” Disapproval implies that the social worker has the denouncing the client’s “I’d rather you right to pass judgment on the client’s thoughts or behavior or ideas wouldn’t... ” actions. It further implies that the client is expected to please the social worker. Giving approval - “That’s good.” Saying what the client thinks or feels is “good” sanctioning the client’s “I’m glad that... implies that the opposite is “bad.” Approval, then, behavior or ideas “ tends to limit the client’s freedom to think, speak, or act in a certain way. This can lead to the client’s acting in a particular way just to please the social worker. Giving literal responses - C: “They’re Often the client is at loss to describe his or her responding to a figurative looking in my feelings, so such comments are the best he can do. comment as though it head with a Usually, it is helpful for the social worker to focus were a statement of fact television on the client’s feelings in response to such camera.” statements. SW: “Try not to watch television,” or “What channel?” Indicating the existence “What makes you The social worker can ask, “What happened?” or of an external source - say that?” “what events led you to draw such a conclusion?” attributing the source of “What makes you But to question, “What made you think that?” thoughts, feelings, and do that?” implies that the client was made or compelled to behavior to others or to “Who told you think in a certain way. Usually, the social worker outside influences that you were a does not intend to suggest that the source is prophet?” external, but that is often what the client thinks. Interpreting - asking to “What you really The client’s thoughts and feelings are his or her make conscious that mean is... “ own, not to be interpreted by the social worker or which is unconscious, “Unconsciously for hidden meaning. Only the client can identify or telling the client the you’re saying... “ confirm the presence of feelings. meaning of his experience Introducing an unrelated C: “I’d like to die.” The social worker takes the initiative for the topic - changing the SW: “Did you have interaction away from the client. This usually subject visitors last happens because the social worker is evening?” uncomfortable, doesn’t know how to respond, or has a topic she would rather discuss. Making stereotyped “It’s for your own Social conversations contains many clichés and comments - offering good.” much meaningless chitchat. Such comments are of meaningless clichés or “Keep your chin no value in the social worker-client relationship. trite comments up.” Any automatic responses lack the social worker’s “Just have a consideration or thoughtfulness. positive attitude and you’ll be better in no time.” Probing - persistent “Now tell me Probing tends to make the client feel used or questioning of the client about this invaded. Clients have the right not to talk about problem. You issues or concerns if they choose. Pushing and know I have to probing by the social worker will not encourage the find out.” client to talk. “Tell me your psychiatric history.” Reassuring - indicating “I wouldn’t worry Attempts to dispel the client’s anxiety by implying there is no reason for about that.” that there is not sufficient reason for concern anxiety or other feelings “Everything will completely devalue the client’s feelings. Vague of discomfort be all right.” reassurances without accompanying facts are “You’re coming meaningless to the client. along just fine.” Rejecting - refusing to “Let’s not discuss. When the social worker rejects any topic, she consider or showing..“ closes it off from exploration, in turn, the client contempt for the client’s “I don’t want to may feel personally rejected along with his ideas. ideas or behaviors hear about... “ Requesting an “Why do you think There is a difference between asking the client to explanation - asking the that?” describe what is occurring or has taken place and client to provide reasons “Why do you feel asking him to explain why. Usually, a “why” for thoughts, feelings, that way?” question is intimidating. In addition, the client is behaviors, events unlikely to know “why” and may become defensive trying to explain himself. Testing - appraising the “Do you know These types of questions force the client to try yo client’s degree of insight what kind of recognize his problems. The client’s agency this is?” acknowledgement that he or she doesn’t know “Do you still have these things may meet the social worker’s needs the idea that... but is not helpful for the client. ?“ Using denial - refusing to C: “I’m nothing.” The social worker denies the client’s feelings or the admit that a problem SW: “Of course seriousness of the situation by dismissing his exists you’re something comments without attempting to discover the - everybody’s feelings or meaning behind them. something.” C: “I’m dead.” SW: “Don’t be silly.” NONVERBAL COMMUNICATION SKILLS Nonverbal communication is behavior that a person exhibits while delivering verbal content. It includes facial expression, eye contact, space, time boundaries, and body movements. Nonverbal communication is as important, if not more so, than verbal communication. It is estimated that one third of meaning is transmitted by words and two thirds is communicated nonverbally. The speaker may verbalize what he or she believes the listener wants to hear, whereas nonverbal communication conveys the speaker’s actual meaning. Nonverbal communication involves the unconscious mind acting out emotions related to the verbal content, the situation, the environment, and the relationship between the speaker and listener. Knapp and Hall (2002) listed ways in which nonverbal messages accompany verbal messages:  Accent: using flashing eyes or hand movements  Complement: giving quizzical looks, nodding  Contradict: rolling eyes to demonstrate that the meaning is the opposite of what one is saying  Regulate: taking a deep breath to demonstrate readiness to speak, using “and uh” to signal the wish to continue speaking  Repeat: using nonverbal behaviors to augment the verbal message such as shrugging after saying “Who knows?”  Substitute: using culturally determined body movements that stand in for words such as pumping the arm up and down with a closed fist to indicate success FACIAL EXPRESSION The human face produces the most visible, complex, and sometimes confusing nonverbal messages. Facial movements connect with words to illustrate meaning; this connection  demonstrates the speaker’s internal dialogue. Facial expressions can be categorized into expressive, impassive, and confusing:  An expressive face portrays the person’s moment-by-moment thoughts, feelings, and needs. These expressions may be evident even when the person does not want to reveal his emotions.  An impassive face is frozen into an emotionless deadpan expression similar to mask.  A confusing facial expression is one that is the opposite of what the person wants to convey. A person who is verbally expressing sad or angry feelings while smiling is exhibiting a confusing facial expression. Facial expressions often can affect the listener’s response. Strong and emotional facial expressions can persuade the listener to believe the message. For example, by appearing perplexed and confused, a client could manipulate the social worker into staying longer than scheduled. Facial expressions such as happy, sad, embarrassed, or angry usually have the same meaning across cultures, but the social worker should identify the facial expression and ask the client to validate the social worker’s interpretation of it - for instance, “You’re smiling, but I sense you are very angry” Frowns, smiles, puzzlement, relief, fear, surprise and anger are common facial communication signals. Looking away, not meeting the speaker’s eyes and yawning indicate that the listener is disinterested, lying, or bored. To ensure the accuracy of information, the social worker identifies the nonverbal communication and checks its congruency with the content. An example is “Mr. Santiago, you said everything is fine today, yet you frowned as you spoke. I sense that everything is not really fine” (verbalizing the implied). BODY LANGUAGE Body language (gestures, postures, movements, and body positions) is a nonverbal form of communication. Closed body positions, such as crossed legs or arms folded across the chest, indicate that the interaction might threaten the listener who is defensive or not accepting. A better, more accepting body position is to sit facing the client with both feet on the floor, knees parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle. This open posture demonstrates unconditional positive regard, trust, care, and acceptance. The social worker indicates interest in and acceptance of the client by facing and slightly leaning toward him while maintaining nonthreatening eye contact. Hand gestures add meaning to the content. A slight lift of the hand from the arm of a chair can punctuate or strengthen the meaning of words. Holding both hands with palms up while shrugging the shoulders often means “I don’t know.” Some people use many hand gestures to demonstrate or act out what they are saying whereas others use very few gestures. The positioning of the social worker and client in relation to each other is also important. Sitting beside or across from the client can put the client at ease, whereas sitting behind a desk (creating a physical barrier) can increase the formality of the setting and may decrease the client’s willingness to open up and communicate freely. The social worker may wish to create a more formal setting with some clients, however, such as those who have difficulty maintaining boundaries. VOCAL CUES  Vocal cues are nonverbal sound signals transmitted along with the content: voice volume, tone, pitch, intensity, emphasis, speed and pauses augment the sender’s message. Volume, the loudness of voice, can indicate whether someone is relaxed, agitated, or bored. Pitch varies from shrill and high to low and threatening. Intensity is the power, severity, and strength behind the words, indicating the importance of the message. Emphasis refers to accents on words or phrases that highlight the subject or give insight on the topic. Speed is the number of words spoken per minute. Pauses also contribute to the message, often adding emphasis or feeling. The high-pitched rapid delivery of a message often indicates anxiety. The use of extraneous words with long tedious descriptions is called circumstantiality. Circumstantiality can indicate the client is confused about what is important or is a poor historian. Slow, hesitant responses can indicate that the person is depressed, confused and searching for the correct words, having difficulty finding the right words to describe an incident or reminiscing. It is important for the social worker to validate these nonverbal indicators rather than to assume that she knows what the client is thinking or feeling (e.g., “Mr. Jose, you sound anxious. Is that how you’re feeling?). EYE CONTACT The eyes have been called the mirror of the soul because they often reflect our emotions. Messages that the eyes give include humor, interest, puzzlement, hatred, happiness, sadness, horror, warning, and pleading. Eye contact, looking into the other person’s eyes during communication, is used to assess the other person and the environment and to indicate whose turn it is to speak; it increases during listening but decreases while speaking. Although maintaining good eye contact is usually desirable, it is important that the social worker doesn’t “stare” at the client. SILENCE Silence or long pauses in communication may indicate many different things. The client may be depressed and struggling to find the energy to talk. Sometimes pauses indicate the client is thoughtfully considering the question before responding. At times, the client may seem to be “lost in his own thoughts” and not paying attention to the social worker. It is important to allow the client sufficient time to respond, even if it seems like a long time. It may confuse the client if the social worker “jumps in” with another question or tries to restate the question differently. Also, in some cultures, verbal communication is slow with many pauses, and the client may believe the social worker is impatient or disrespectful if she does not wait for the client’s response.