6.9 Therapeutic Communication Techniques

Therapeutic Communication

Therapeutic communication is at the foundation of the health professional–client relationship. It differs from conversations with friends, peers, family, and colleagues. Therapeutic communication has a specific purpose within the healthcare context. It is intended to develop an effective interpersonal health professional–client relationship that supports the client’s well-being and ensures holistic, client-centred, quality care (Kwame & Petrucka, 2021).

The word “therapeutic” is related to the word therapy: it means having a restorative and healing effect on the mind and body and doing no harm. It is essential to consider how you communicate and how this affects the client.

The following example shows how a health professional student can effectively use therapeutic communication.

Ms. Z. is a health professional student who enjoys interacting with clients in an acute care environment. When she goes to their rooms, she greets them and introduces herself and her role calmly. She kindly asks clients about their illness experiences and notices their reactions. She does her best to provide a safe space to build trust and enhance recovery (Xue & Heffernan, 2021. She treats clients professionally by respecting boundaries and listening to them nonjudgmentally. She addresses communication barriers and respects clients’ personal and cultural beliefs. She notices clients’ health literacy and ensures they understand her messages and client education. As a result, clients trust her and feel as if she cares about them, so they feel comfortable sharing their healthcare needs with her (Abdolrahimi et al., 2017)

Active Listening and Attending Behaviours

As discussed previously, listening is an essential part of communication. The three main listening types are competitive, passive, and active. Competitive listening happens when we are focused on sharing our point of view instead of listening to someone else. Passive listening occurs when we are not interested in listening to the other person and assume we understand what the person is communicating correctly without verifying. During active listening, we communicate verbally and nonverbally that we are interested in what the other person is saying while verifying our understanding with the speaker. Active listening is essential to facilitate your understanding of and the integration of clients’ experiences, preferences, and health goals into their care. You might show that you are an active listener by eye contact and open posture. You can also use facilitation strategies that show active listening and encourage the client to elaborate, such as nodding and responding by saying “uh huh,”  “tell me more,” or restating what the client said and then verifying if our understanding is correct. This feedback process is the main difference between passive listening and active listening.

Therapeutic Communication Techniques

Therapeutic communication techniques are specific methods to provide clients with support and information while focusing on their concerns. Health professionals assist clients in setting goals and selecting strategies for their care plan based on their needs, values, skills, and abilities. It is essential to recognize the client’s autonomy to make decisions, maintain a nonjudgmental attitude, and avoid interrupting. Depending on the developmental stage and educational needs of the client, appropriate terminology should be used to promote client understanding and rapport. When using therapeutic techniques, health professionals often ask open-ended statements and questions, repeat information, or use silence to prompt clients to work through problems independently; a variety of such techniques are described below (American Nurse, 2023).

Clear and Simple Language

Avoiding or limiting medical and professional language clients may not understand is best. Remember, knowledge is power; using language others may not understand reinforces subordination and exclusion. By speaking simply and clearly, you include clients regardless of their professional or educational point of reference.

Use of a Broad Opening Remark

This gives the patient the freedom to choose what he/she wishes to talk about, for example, “Please tell me more about yourself.”

Open-Ended Questions

This type of question allows the patient to discuss their views. In this way, what the patient sees as essential, their intellectual capacity, and how well-orientated they become apparent. This encourages the patient to say more and does not limit answers to yes or no. There are two techniques you can use. Open-ended questions begin with who, what, when, where, and how. Probing questions that elicit additional information include questions that begin with “Tell me more …”

Examples:

“How did you experience the pain?”

“When did you start feeling dizzy?”

“Tell me more about the accident?”

Clarification

This helps the health professional to understand and the client to communicate more clearly.

Example:

“What do you mean by everybody?”

“Just to clarify, what do you mean by everybody?”

Paraphrasing

This conveys an understanding of the client’s basic message.

Example:

“From what I hear you saying, the most important problem is your mobility.”

“The lack of affordable housing is your main concern.”

Sharing Observations

This shows that you know what is happening to the patient and encourage them to talk about it.

Example:

“I notice you limp when you walk. Are you in pain?”

Summarizing

Organizing and checking what the client said, especially after a detailed discussion. This technique indicates that a specific part of the discussion is ending and that they should do so if the client wishes to say any more.

Example:

“You went for a walk and then felt the sharp pain in your lower back, which radiated down your leg. Is that right?”

Silence

Silence is a strategy that aids active listening. It can be beneficial when the client is talking about something personal or struggling to find the words they want to say. Sometimes silence can be uncomfortable, and health professionals want to fill the void with words. It is better to show interest and understanding and give the client time to think about how they best want to say what they want. Silence also allows a health professional to observe the client. However, health professionals should avoid silences that last too long because they can make the client anxious.

Example:

If the client feels awkward about taking too much time to think, you can say, “It is ok. Take your time.”

Honesty

Be honest. Part of therapeutic communication involves being authentic and truthful. To do so, you should be straightforward with clients and compassionately talk to them. If discussing a problematic or emotionally laden topic, demonstrate compassion by sitting down, maintaining eye contact, and being aware of your vocal intonation.

Unconditional Positive Regard

Accept and respect that each client has the agency to believe and behave how they want or feel is best. You do not have to agree or approve, but your acceptance of their self-determination should not be conditional on its alignment with your beliefs or behaviours. This approach involves accepting that clients are generally doing their best. Avoid judging or blaming them for their beliefs, behaviours, or conditions. You should avoid questions that begin with “why,” as this can imply blame. For example, avoid “Why do you smoke?” You can reframe this inquiry to be positive.

Example:

“Tell me the reasons that you smoke.”

“Tell me the reasons that you exercise.”

Permission Statements

Use permission statements to open conversations that may be difficult. Permission statements are a combination of statements and questions that suggest to the client that an experience or feeling is expected or normal.

Examples:

“Often, children your age experience changes in their body that they have questions about.”

“Clients that have experienced your type of surgery often have questions about sex. What if any questions do you have for me?”

“Many people your age begin to experience problems with urinary incontinence. Have you had any issues?”

Ask One Question at a Time

Ask one question at a time so the client understands it, and you are more likely to receive a clear answer. You should avoid asking multiple questions at once because this can confuse clients. Here is an example: “Tell me about your support system. Your brother seems like he is a great help, right? Do you have anyone else to support you?”

Example: Instead of multiple questions, try it this way.

“Tell me about your support system?” – then, wait for an answer. You can probe with follow-up questions depending on what the client says.

Work Collaboratively

Work collaboratively with the client during the interview so that they are an active agent with self-determination. Using a relational inquiry approach and working collaboratively, you can focus on what is important to the client. Focusing on what is important to the client involves providing information they identify as relevant. Ask the client if they are interested in learning more about a topic.

Nontherapeutic Responses

Health professionals and health professional students must be aware that certain nontherapeutic communication techniques should avoid as they do not assist in the recovery of the client and do not have any therapeutic value.

Closed Questions

These questions require only a single word when specific information is needed. If this question is used often, the client is less inclined to give the information and may interpret it as an interrogation. Closed questions begin with “Have you?” “Should you?” Would you?” or “Do you?.”

Example:

“Do you have pain in your arm?”

“Did you drive to this appointment?”

Closed-ended questions require context to be deemed appropriate. They are relevant when a client has difficulty speaking, a health professional is attending an emergency or has limited time to acquire information. Otherwise, open-ended questions should be used.

“Why” Questions

These questions demand that the client explain behaviours, feelings, or thoughts they often do not understand. These questions are often asked early in a conversation when the health professional cannot even be certain that the client wants to explain themselves to you. They also may be considered judgmental or blaming the client based on the tone often used in conjunction with what is being asked.

Example:

“Why are you upset?”

It is better to rephrase the question as “You seem upset. What is on your mind?”

Passing Judgment

The health professional passes judgment on the client’s behaviour, thoughts, or feelings and, in doing so, places themselves in the position of an adversary or a person who knows better and more.

Example:

“As a Christian, I do not think you should terminate this pregnancy.”

Health professionals should avoid this technique and ask questions for understanding. “Tell me how you feel about terminating this pregnancy?”

Giving Advice

The health professional tells the client how they should feel, think or act. This implies that the health professional knows the correct information better than the patient. This is particularly problematic when the advice is based on limited assessment and knowledge of the patient and the situation.

Example:

“I think you must …”

Instead, health professionals should use open-ended or empathetic responses.

Defensiveness

The health professional tries to defend someone or something the client criticized. This places the nurse and the client on opposite sides and does not promote further openness on the part of the client.

Example:

“We are very short-staffed, so we cannot help everyone at the same time.”

Instead, a more therapeutic response would be, “I apologize for the wait. I know your appointment was at 3:00, and it is 4:30. You are next to see the social worker.”

Changing the Subject

Changing the subject when someone tries to communicate with you demonstrates a lack of empathy and blocks further communication. A client may interpret this as indicating that you do not care about them or what they say.

Example:

“Let’s not talk about your family problems; it is time for your walk now.”

A more therapeutic response would be, “After your walk, let’s talk more about what is going on with your family.”

Sympathy

Sympathy focuses on feeling compassion for a client’s situation from your perspective.

Example:

“I am sorry this is happening to you.”

A more therapeutic response would be an empathetic response. “This has been a difficult time for you. Tell me how you are coping?”

False Reassurance

False reassurance is when a health professional assures or comforts the client about something not based on fact. People tend to automatically respond when someone voices fear or anxiety by assuring them that everything will be okay.

“It will be okay” when a client says, “I am scared I might die.”

This kind of response is not honest and does not open up communication. It is more effective and honest to say, “Tell me more.”

Watch the following videos for another example of false reassurance and how to avoid it.

Watch: False Reassurance Video

Video Transcript (see Appendix B 6.9.1)

Watch: How to Avoid False Reassurance Video

Video Transcript (see Appendix B 6.9.2)

Activity: Check Your Understanding

References

Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electronic Physician, 9(8), 4968–4977. https://doi.org/10.19082/4968

American Nurse. (2023). Therapeutic communication techniques. https://www.myamericannurse.com/therapeutic-communication-techniques/

Xue, W., & Heffernan, C. (2021). Therapeutic communication within the nurse-patient relationship: A concept analysis. International Journal of Nursing Practice, 27(6), e12938.  https://doi.org/10.1111/ijn.12938

Media Attributions

Therapeutic Communication-End of Life Virtual Simulation was created by Chippewa Valley Technical College as part of the Open RN project and is licensed under CC BY 4.0.

Therapeutic Communication-New Mom with Substance Abuse Virtual Simulation was created by Chippewa Valley Technical College as part of the Open RN project and is licensed under CC BY 4.0.

Therapeutic Communication -Sexual Orientation Virtual Simulation was created by Chippewa Valley Technical College as part of the Open RN project and is licensed under CC BY 4.0.

Image Attributions

Figure 1.1. beautiful african nurse taking care of senior patient in wheelchair by agilemktg1. In the Public Domain.

Attribution Statement

Content adapted, with editorial changes, from:​

Sibaya, M. N. (n.d.). Effective communication in nursing. Libre Texts. https://med.libretexts.org/Bookshelves/Nursing/Nursing_(Ulutasdemir)/03%3A_Effective_Communication_in_Nursing

Licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.