Chapter 6
Therapeutic Communication
COMMUNICATION is the process that people
use to exchange information.
Messages are simultaneously sent and received
on
two levels:
 Verbal - through the use of words
 Nonverbal - by behaviors that
accompany the words
Verbal communication
 Content - is the literal words that a
person speaks.
 Context - is the environment in which
communication occurs
Nonverbal communication
is the behavior that accompanies verbal
content such as body language, eye contact,
facial expression, tone of voice, speed and
hesitations in speech, grunts and groans, and
distance from the listeners.
Process
denotes all nonverbal messages that
the speaker uses to give meaning and context
to the message.
Congruent message
Conveyed when content and process
agree
Incongruent message
But when the content and process
disagree when what the speaker says and what
he or she does do not agree
WHAT IS THERAPEUTIC COMMUNICATION?
Therapeutic communication
is an interpersonal interaction between
the nurse and the client during which the nurse
focuses on the client’s specific needs to
promote an effective exchange of information.
Privacy and Respecting Boundaries
Privacy is desirable but not always
possible in therapeutic communication.
Proxemics
is the study of distance zones between
people during communication
People feel more comfortable with smaller
distances when communicating with someone
they know rather than with strangers
Four distance zones:
 Intimate zone (0 to 18 inches between
people): personal contact or people
whispering.
 Personal zone (18 to 36 inches):
between family and friends who are
talking.
 Social zone (4 to 12 feet):
communication in social, work, and
business settings.
 Public zone (12 to 25 feet): between a
speaker and an audience, small groups,
and other informal functions
The therapeutic communication interaction is
most comfortable when the nurse and client are
3 to 6 feet apart.
If a client invades the nurse’s intimate space (0
to 18 inches), the nurse should set limits
gradually, depending on how often the client
has invaded the nurse’s space and the safety of Concrete Messages
the situation.
When speaking to the client the nurse
Touch should use words that are as clear as possible so
that the client can understand the message
As intimacy increases, the need for
distance decreases. Abstract messages

Five types of touch: unclear patterns of words that often

 Functional-professional touch
 Social-polite touch
 Friendship-warmth touch
 Love-intimacy touch
 Sexual-arousal touch
contain figures of speech that are difficult to
interpret.
THERAPEUTIC COMMUNICATION TECHNIQUES
Using Therapeutic Communication

Techniques
Active Listening and Observation
The choice of technique depends on the intent
Active listening of the interaction and the client’s ability to
communicate verbally.
means refraining from other internal
mental activities and concentrating exclusively
on what the client says.

Active observation

means watching the speaker’s

nonverbal actions as he or she communicates.

Active listening and observation help the nurse

to:

 Recognize the issue that is most

important to the client at this time.
 Know what further questions to ask the
client.
 Use additional therapeutic
communication techniques to guide the
client to describe his or her perceptions
fully.
 Understand the client’s perceptions of
the issue instead of jumping to
conclusions.
 Interpret and respond to the message
objectively.

VERBAL COMMUNICATION SKILLS