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Flashcards in Therapeutic Communication Deck (33):

Phases of a therapeutic nurse-patient relationship

– preinteraction
– orientation
– working
– termination



– Before first contact

– Self-understanding

– Self-assessment


Introductory or Orientation Phase

– Includes pt’s reason for seeking help


Orientation Phase

  • Formulating a response
  • Exploring feelings


Formulating a contract

*Establish trust, understanding, acceptance, open communication, & contract
*Nurse-Pt contract
» Names
» Roles
» Responsibilities
» Expectations
» Purpose
» Meeting place and time 
» Conditions for termina


Exploring feelings:

Includes exploring perceptions, thoughts, feelings, & actions


Working Phase

  • Most of therapeutic work is carried out during this phase
  • Explore stressors
  • Promote the development of insight
  • Master anxieties
  • Increase independence & self-responsibility
  • Develop constructive coping mechanisms
  • Focus is on behavioral change


Termination Phase

  • May be most difficult & most important
  • Learning is maximized for both patient & nurse
  • Exchange feelings & memories & evaluate pt. progress & goal attainment
  • Consider: what are the criteria for determining readiness for termination
  • Patient behavior may regress


Nonverbal Communication

  • Physical Appearance
  • Body Movement & Posture
  • Touch
  • Facial expression
  • Eye behavior
  • Vocal cues or paralanguage


Facilitative Communication

  • Communication that facilitates the development of a therapeutic nurse-patient relationship
  • Communication is verbal & nonverbal
  • Meaning: 7% by words, 38% by paralinguistic cues (voice), & 55% by body cues.


  • 70 to 90% of all communication is nonverbal



– Use with great care
– Easily misinterpreted as invasion or sexual overture
– Can illicit an aggressive response
– Think about the flight or fight response of anxiety


3 elements of communication

  • Perception: receiver
  • Evaluation: receiver
  • Transmission: response to sender from receiver, aka - feedback


Why Therapeutic Communication Techniques?

  • Preserves self-respect
  • Understanding precedes giving information or advice
  • Common courtesy
  • Make request and wait for response


Therapeutic communication technique examples

  • Listening
  • Broad openings
  • Restating
  • Clarification & validation
  • Reflection
  • General leads Placing the event in time or sequence
  • Sharing perceptions
  • Theme identification
  • Silence
  • Making observations
  • Encouraging description of perceptions Encouraging comparison
  • Focusing
  • Accepting
  • Recognizing
  • Offering self
  • Exploring
  • Presenting reality
  • Voicing doubt
  • Verbalizing the implied attempting to translate words into feelings formulating a plan of action


Non-Therapeutic Communication

  • Belittling feelings
  • Judging
  • Requesting an explanation
  • Giving Advice
  • Changing topics
  • Probing
  • Rejecting
  • Defending
  • Indicating an external source of power
  • Giving Reassurance


Responsive Dimensions

  • Genuiness
  • Respect
  • Empathy (how does this differ from sympathy?)
  • Concreteness (how might this vary during different stages of the therapeutic relationship)


Action Dimensions

  • Confrontation
  • Immediacy
  • Nurse self-disclosure
  • Emotional catharsis
  • Role playing



  • Discrepancy between self-concept & self-ideal
  • Discrepancy between verbal & nonverbal 
  • Discrepancy between pts expressed experience of self and the nurses experience of the pt.
  • Effective confrontation is associated with empathy



  • Focus on pts function in nurse-pt relationship 
  • Requires sensitivity to feelings & willingness/ability to deal with feelings


Nurse self-disclosure

– Use judiciously

– Always for pts benefit


Emotional catharsis

– Cues from pt indicate readiness


Therapeutic Impasses

  • Resistance Transference Countertransference
  • Boundary violations

– Role – Time – Place & space – Self-disclosure


Peplau (1991) identified several subroles within the role of the nurse, which are?

  1. Stranger
  2. The Resource Person
  3. The Teacher
  4. The Leader
  5. The Surrogate
  6. The Technical Expert
  7. The Counselor


The Stranger Subrole

The nurse is at first a stranger to the client. The client is also a stranger to the nurse.

Priniciples: (1) accepting the patient as he is; (2) treating the patient as an emotionally able stranger and relat- ing to him on this basis until evidence shows him to be otherwise.


The Resource Person subrole

the nurse explains, in language that the client can understand, information related to the client’s health care.


The Teacher subrole

nurse identifies learning needs and provides information required by the client or family to improve the health situation.


The Leader subrole

According to Peplau, “democratic leadership in nursing situations implies that the patient will be permitted to be an active participant in designing nursing plans for him”


The surrogate subrole

Outside of their awareness, clients often perceive nurses as symbols of other individ- uals. They may view the nurse as a mother figure, a sibling, a former teacher, or another nurse who has provided care in the past.


The technical expert subrole

The nurse understands various professional devices and possesses the clinical skills necessary to perform the interven- tions that are in the best interest of the client.


The counselor subrole

The nurse uses “interpersonal techniques” to assist clients to learn to adapt to difficulties or changes in life experiences. Peplau (1991) stated, “Counseling in nursing has to do with helping the patient to remember and to understand fully what is happening to him in the present situation, so that the experience can be integrated with, rather than dissociated from, other experiences in life


Conditions Essential to Development

of a Therapeutic Relationship

  • Rapport
  • Trust
  • Respect
  • Genuiness
  • Empathy



occurs when the client unconsciously displaces (or “transfers”) to the nurse feelings formed toward a person from his or her past

  • Interferes with the therapeutic relationship.



refers to the nurse’s behavioral and emotional response to the client.