THERAPEUTIC COMMUNICATION BROAD OPENING *to elicit wide range of response *giving the patient an opportunity to set the

direction of the conversation. - Allowing the client to take the initiative in introducing the topic. (patient selecting topics for discussion.) Directing back ideas, feelings, content, questions. Encouraged further verbalization of feeling. y What would you like to talk about today? y Tell me what you thinking. y What do you feel about not able to control the situation? y what are you thinking about? y What shall we discuss today? y Is there something you d like to talk about?

REFLECTING

GIVING INFORMATION

y What do you think should do? y C: Do you think I should tell the doctor ? N: Do you think you should? y C: My brother spends all my money and then has nerve to ask for more. N: This causes you to feel angry? You re feeling tense and anxious, and it s related to a conversation you had with your husband last night? y C: When I walked into the room, I felt like I was going to faint. I knew I had tried to do too much to quickly, and I just wasn t ready for it. N: you thought you were ready to put yourself to the test, but when you got there, you realized it was too much too soon. y C: it s not so much that I mind changing jobs. It s just that I let down all the people working for me relying on me. N: You feel responsible for your employees, and so you re both sad and guilty about what has happened at work. C: Yes sad, guilty and pretty angry now that we re talking about it. - Providing information that y I can tell you about your medicine. will help patients make better y I think you need to know more about how choice. your medication works. y My name is.. y Visiting hours are y My purpose in being here is

ENCOURAGING - To elicit further information COLLABORATION about the topic - helps patient describe fully the concern or problem under discussion (cont.. with broad opening)?? FOCUSING -* Ask goal directed question to help the client focus on a specific area of concern. -* helps patient to centralized conversation on issues ad not deviated from it for a while. - questions or statement that help the patient expand on a topic of importance SUMMARIZING - *to recount or recapping what has occurred during the interaction

y Tell me more about that . y I am not certain that I follow what you mean

PRESENTING REALITY

-*especially appropriate and useful in times of perception problems like hallucinations or delusion. - *helps keep the pt of what is real from what is not. -*checking to see if you interpreted a message in the way the speaker meant it. -this is done by rephrasing the meaning of the message -*Repeating the exact words of patients to remind them of what they said; to let them know what they heard. -*mean you have to listen for the message the patient is conveying and then rephrase the message. -Restating the maid idea

y Explain more about it. y Let s talk about your difficulty with your father y I think that we should talk more about your relationship with your father. y This point seems worth looking at more closely. y Of all the concerns you ve mentioned, which is most troublesome? y Let s see, so how far have you said . y During this meeting / during the past hour, we discussed about y Have I got his straight? y You have said that y I understand that the voices see real to you, but I do not hear any voices. y I see no one else in the room. y That sound was a car backfiring. y Your mother is not here; I am a nurse. y I thought you conveyed anger when you said y Is your headache severe

OBTAINING FEEDBACK

RESTATING

y C: my son hasn t been here to see me in months. N: Your son hasn t been here for months. / You miss your sons visit. y C: I can t sleep, I stay awake all night N: You have difficulty sleeping. y C: I m really mad, I m really upset. N: you re really mad and upset. You say that your mother left you when you

expressed THERAPEUTIC TOUCH SILENCE

were 5yo.

y Nurse says nothing but continues to maintain eye contact and conveys interest.

CLEAR AND -*internal and external CONGRUENT IN consistency, perceived by EVERY WAY other as sincerity or certainty. -*defined as rapport within oneself ASK QUESTION -*Open Ended Question Open Ended Question Asking broad questions that - I d like to hear more about that. lead or invite the client to - Tell me about explore(elaborate, clarify, - How have you been feeling lately? describe, compare, or - What brought you to the hospital? illustrate) thoughts or - What is your opinion? feelings. Open-ended - You said you were frightened questions specify only the yesterday. How do you feel now? topic to be discussed and invite answers that are longer than one or two words. *Closed Ended Question RECOGNITION - Acknowledging, y Hello, I noticed that you made a ceramic indicating awareness ashtray in occupational therapy y Good morning, Mr. S.. y You ve finished your list of things to do.. y I notice that you ve combed your hair. y I notice you keep squinting your eyes. Are you having difficulty seeing? y You walked twice as far today with your walker. GENERAL LEAD -*useful first thing in the y I noticed that you seem to be anxious morning or meeting the today. patient for the first time when y Go on, I m listening. rapport and trust is not y And then? sufficiently established. y Tell me about it. -*general statement based on y Go on.. I see..Uh Huh.. assessment of the client. y Please continue -*using neutral expressions to encourage patients to

continue talking. OFFERING SELF Making self available & y I ll stay here with you. showing interest and concern y I ll sit with you awhile. y I m interested in what you think. y We can sit here quietly for while; we don t need to talk unless you would like to. GOOD AT -*asking patient to restate, y Are you saying that the coffee kept you CLARIFYING elaborate or give examples of awake? ideas or feelings. y I m not sure what you mean. Could you -*the nurse helps the client tell me about that again? put unclear thoughts or ideas into words. MAKING -*commenting on what is y You seem uncomfortable when OBSERVATION seen or heard to start a y You seem restless. discussion. y You appear tense. -verbalizing what the nurse y Are you uncomfortable when? perceives y I notice that you re biting your lip. ACCEPTING -*conveys attitude of regard y Yes, I understood what you said. y Yes. y I follow what you said. y NODDING LISTENING -*paying close attention to y Maintain eye contact receptive nonverbal SKILLS verbal and nonverbal communication. communications, patterns of thinking, feelings and behaviors. -*face the patient, maintan eye contact: be open, be alert and be patient; respond appropriately. EGO DEFENSE MECHANISM DENIAL -*The simplest defense to y I m not an alcoholic, I just drink a understand, learned and few bottle to steady my nerve. used. y A student refuses to admit he is -*it is unconscious refusal failing a course despite an F on to see reality or to the first exam. acknowledge what has, is y Delusion is an example of denial

or will happen. utilized by mentally ill person. -*a refusal to contained y Diabetic person eating chocolate the anxiety-provoking candy. situations out of conscious y Spending money freely when awareness broke -*it protect from finding y Eating 3 days to seek help for out his true behavior. sever abdominal pain COMPENSATION -*an attempt to abandoned inferiority and weaknesses by achievement in other areas where the individual show potential success. y Low athletics, high academics y Blind person who becomes professor in music y Napoleon complex: diminutive man becoming emperor y Nurse with low self-esteem works double shifts so her supervisor will like her. y A business perceives his small physical stature negatively. He tries to overcome this by being aggressive, forceful, and controlling in business dealings. -*anxiety channeled or y A severe headache develops just converted into physical a few hour before the exam. symptoms -*expressing psychological conflict through physical or physiological alteration. y Teenager forbidden to see X-Expression of an rated movies is tempted to do so emotional conflict through by friends and develops the development of a blindness, and the teenager is physical symptom, usually unconcerned about the loss of sensorimotor in nature. sight. -*redirection of emotional y A person punches a punching bag feeling from one idea, after an argument. person, or object to y Child who is harassed by bully at another. school mistreats a younger sibling. y A boy is angry because he has just been punished by his mother for drawing on his bedroom walls. He begins to play war with his soldier

CONVERSION REACTION

DISPLACEMENT

DISSOCIATION

-*unconscious separation y of painful feeling and emotion for an acceptable ideas, situation or object. -Dealing with emotional y conflict by a temporary alteration in y consciousness or identity. y

FANTASY

IDENTIFICATION

INTROJECTION

-*gratifying frustrated desires by imaginary achievements. -*creating an inner world when the real world becomes too painful, difficult, or stressful. -*an attempt to fashion oneself. To think, feel, and act like an idealized other. -modeling actions and opinions of influential others while searching for identity , or aspiring to reach a personal, social, or occupational goal. -*a deeper form of identification. A person tries to identify with another and assumes behavior and attitudes , and most aspect of the person s life and personality. -accepting another person s attitudes, beliefs, and values as one s own.

y y

toys and has them fight with each other. A wife talking about her expensive debts of her husband as if they are nothing o be concerned. Amnesia that prevents recall of yesterday s auto accident Adult remembers nothing of childhood sexual abuse. A man brought to the emergency room by the police and is unable to explain who he is and where he lives or works. Focusing on pleasant mental pictures A client day dreams during an intense group therapy.

y A adolescent dresses like a rock star and mimics his behavior. y When I get out of hospital, I want to be a nurse like you. y Nursing student becoming a critical care nurse because this is the specialty of an instructor she admires. y Movie Talented Mr. Ripley. y Person who dislikes guns becomes an avid hunter, just like a best friend. y 8 yo Jimmy tells his 3yo sister, Don t scribble in your book of nursery rhymes. Just look at the pretty pictures. Thus expressing his parent s values.

PROJECTION

RATIONALIZATION

-*It is an act of displacing own undesirable actions or feeling to another person: simply BLAMING OTHERS. -*it is the attribution of one s undesirable impulses onto another. -*also known as Scapegoating or finger pointing -this is the main defense mechanism of paranoid and antisocial personality. -*using logical excuse to cover up emotions or thoughts. -*intellectual way to diminish traumatic emotions like pain or disturbing thoughts like guilt. -*also called as the sour grapes defense -*also called over compensation -*acting oppositely to what the person really feels.

y I was not given the position because they don t like me. y I become an alcoholic because my father is also an alcoholic. y Man who has thought about same-gender sexual relationship, but never had one, beats a man who is gay. y Person with many prejudices loudly identifies others a bigots. y A young woman who denies she has sexual feelings about a coworker accuses him without basis of trying to seduce her. y I failed the examination because the questions are so difficult and are not in our discussion. y Student blames failure on teacher being mean. y Man says he beats his wife because she doesn t listen to him. y John fails an examination and complains that the lectures were not well organized or clearly presented. y The unattractive person who advocates that beauty contest should be banned. y Miss Marla, who unconsciously hates her mother, continuously tells the staff how wonderful her mother is. y Woman who never wanted to have children becomes a supermom. y Person who despises the boss tell everyone what a great boss she is. y A 4yo begins to wet with his pants following the birth of his

REACTION FORMATION

REGRESSION

-*the backward turning to earlier pattern of behavior

REPRESSION

to solve personal problem. -*retreat to an earlier and more comfortable level of adjustment. -moving back to a previous developmental stage to feel safe or have needs met. -*the earliest type of defense mechanisms -*the basis of all the dense mechanism and the dynamic behind much of forgetting. -*considered the principal defense in early years. -*unconsciously forgetting -*is when someone continuously tries to forget or withhold something, or make the choice to avoid thinking about it. -*it is working on conscious mechanism -*going back or attempting to restore or repair unconscious guilt feelings.

y y y

y y

y y y

SUPPRESSION

RESTITUTION

SUBLIMATION

-*diversion of consciously y unacceptable instinctual drives into personally and socially accepted areas -* change action y

baby brother. A man, who has a problem, lies down in a fetal position. 5yo asks for a bottle when new baby brother is being fed. Man pouts like a 4yo if he is not the center of his girlfriend s attention. A student whose cell phone was snatch doesn t remember the details of the incident. Woman has no memory of the mugging she suffered yesterday. Woman has no memory before age 7, when she was removed from abusive parents. Mr. R does not recall hitting his wife when she is pregnant. A rape victim consciously forgetting about the experience. Student decides not to think about a parent s illness to study for a test Woman tells a friend she cannot think about her son s death right now. The head nurse is short tempered toward a new nurse and then lets her leave early. Nurse was not able to take care of her mother suffering from cancer and after her mother s death volunteered to give care for cancer patients. An adolescent arrested once for stealing later opens a business installing security system in banks. Person who has quit smoking sucks on hard candy when the urge to smoke arises.

SUBSTITUTION

UNDOING

y Treating a child after being punished. y Person who cheats on a spouse brings the spouse a bouquet of roses. y Man who is ruthless in business donates large amounts of money to charity. y Larry makes a passionate declaration of love to Sue on a date. At their next meeting he treats her formally and distantly. COMPARTMENTALIZATION -*separation of y A person attending a church and incompatible aspect of the overly religious but a drug psyche from each other to pusher. maintain psychological comfort, behavioral manifestations showing the inconsistency. -**(opposite of sublimation) from good to bad WITHDRAWAL -*removing self form situation that stimulate or remind painful thoughts and feelings.

-*replacement of an unacceptable need, attitude, or emotion with one that is more acceptable -* change goal -replacing the desired gratification with one that is more readily available. -*also known as restitution -*is making amends for behavior that one thinks is unacceptable. This is an attempt to reduce guilt thoughts and feelings. -*doing something to counteract or receive guilt feeling. -*making-up-for

y Person goes for a 15min walk when tempted to eat junk food. y Ed has an impulsive and physically aggressive nature. He tries out for the football team and becomes a star tackle. y A woman rushes into marriage following breakup with her boyfriend. y Woman who would like to have her own children opens a day care center.

INTELLECTUALIZATION

SPLITTING

BLOCKING DISTORTION

-*Forms: silence , isolating , running away, engaging in substance abuse - it would lead to loneliness and alienation. -*when withdrawal is paired with fantasy, it can be paralyzing. It is deathly combination an ingredient of psychosis (autism) -*separating the emotion aroused by an event from ideas or opinions about the event because the emotion itself is too painful to accept. -*using only logical explanation without feeling or an affective component. - acknowledging the facts but not the emotions. -excessive reasoning of logic is used to avoid experiencing disturbing feelings. -*the tendency to view others a either good or bad. -viewing people and situations as either all good or all bad. Failure to integrate the positive and negative qualities of oneself. -* Temporarily inhibiting thinking. -* Altering external reality to meet one s inner needs.

y Parents sudden death He would not have waned to live disabled. y Person shows no emotional expression when discussing serious car accident. y A woman avoid dealing with her anxiety in shopping malls by explaining that shopping is frivolous waste of time and money.

y A friend tells you that you are the most wonderful person in the world one day and how much she hates you the next day. y Tendency to see a person bad if he didn t gave you what you wanted.

y Hallucinations y Wish-fulfilling delusions