Therapeutic Communication Skills

STIK IJ
Bahasa Inggris VI

Heny Ratnawati S.Pd., M.Pd

 What is Therapeutic Communication?
What is function of therapeutic communication
skills for the nurse and patient?
What is the benefit of therapeutic
communication?
What is the role of therapeutic communication
skill?
How to be therapeutic nurse?
What the different therapeutic and non
therapeutic communication?
 Therapeutic communication involves the
interpersonal communication between
the patient and the nurse. This
communication is intended to help the
patient. The skills required in therapeutic
communication are delicate and far
numerous than those required in general
interpersonal interaction, and mastering
of therapeutic techniques helps the nurse
understand the patient better.
Therapeutic communication includes
five levels:

1. interpersonal communication
2. transpersonal communication
3. Small-group
4. intrapersonal communication
5. Public communication
 1. interpersonal communication - Face to face
interaction between the nurse and another person.

2. transpersonal communication- interaction that

occurs within a persons spiritual domain.

3. Small-group communication- interaction that occurs

when a small number of people meet and share a
common goal. (The latter not widespread in alba- nia)

4. intrapersonal communication- Powerful form of

communication that occurs within an individual.

5. Public communication- interaction with an audience

(nurses are required to use eye contact, gestures, etc).
 types of communication:
active listening
Share observations
Share empathy
Share hope
Share humor
Sharing feelings
Use touch
Use silence
 active listening- attentive to what the patient is saying
verbally and non-ver- bally.
Share observations- make comments on how the
individual looks, sounds or acts.
Share empathy: be sensitive to the patient.
Share hope- conveys a sense of possibility.
Share humor- has a positive effect on an individual.
Make sure the patient un- derstands what is being said.
Sharing feelings- help patients to share feelings by
observing and encouraging communication.
Use touch- brings the sense of caring by holding a
patients hand.
Use silence it is useful in allowing the patient to think
and gain some insight into the situation. listening is
crucial.
Therapeutic communication techniques
Asking relevant questions
Providing information
Paraphrasing. (Restating)
Clarifying.
Focusing.
Summarizing.
Self disclosing.
Confronting.
 Asking relevant questions. ask questions one at a time,
to explore the topic be- fore going on.
Providing information. Provide information that the
patient needs to know.
Paraphrasing. Restating the patients message so that
s/he knows that the nurse is listening.
Clarifying. assess whether the patient understood the
information.
Focusing. Focus on key issues in the conversation.
Summarizing. Brings a sense of closure to the
conversation.
Self disclosing. it is a way of showing the patient that the
information is under- stood and shows respect for the
patient.
Confronting. Helps the patient realize his/her
inconsistencies in feelings, atti- tudes, or beliefs.
 Non-therapeutic communication
techniques
Asking personal questions.
Giving personal opinions.
Changing the subject tends to block further
communication.
Automatic responses show that the nurse is not
taking the situation seriously.
False reassurance which is not supported by
facts may do more harm than good.
Sympathy is subjective. it prevents a clear picture
of the patients situation.
 Asking for explanation. Questions can cause
resentment.
Approval or disapproval. These may send the
message that the nurse has the right to make
judgments.
Defensive responses. The patient might feel that
s/he has no rights to an opinion.
Passive or aggressive responses. Passive
responses avoid the issues and aggressive
responses maybe confrontational.
Arguing. it might imply that the patient is lying or
misinformed.
 types of questions
1. Open-ended questions make the patient tell
his/her full story about the health problem. The
nurse establishes concern about the patient and
may encourage the patient to add more
information by saying: is there anything else?
2. Closed-ended questions are in fact limited to one
or two word answers such as "yes" or "no".
However these are used when the nurse wants to
know a specific answer to a question.
3. Focused questions come in use when there is an
established, strong relationship.
Therapeutic Communication Techniques Examples

1. Using silence The client says: "We drink and smoke a lot
here." The student thinkshow can that
bedrinking alcohol in a state hospital?
But says nothingusing silencethe
client then says: "yes we drink a lot of
cokes and smoke a lot."
2. Accepting "Yes" or "I follow what you said"

3. Giving Recognition "I notice you combed your hair."

4. Offering self "I'll sit with you awhile."

5. Using Broad Openings "What would you like to talk about?"

"Tell me what's bothering you."
6. Using General Leads (using neutral "Go on. " Ummm..I am listening"
expressions to encourage continued "Tell me about it"
talking by the client)

7. Placing he event in time or sequence "Was this before or after?"

"What seemed to lead up to?"

8. Making Observations "You appear tense"

"I notice you are biting your lips."

9. Encouraging Description of Perceptions "What do you think is happening to you

right now?"
10. Restating Client: "I can't sleep. I stay awake all
night."
Nurse: "You have difficulty sleeping"
11. Reflecting Patient: "Do you think I should tell the
doctor?"
Nurse: "Do you think you should tell the
doctor?"
12. Focusing "This point seems worth looking at
more closely."
"You said something earlier that I want
you to go back to."
13. Exploring "Would you describe that more fully."

14. Giving Information "My name isI am a student nurse.."

15. Seeking Clarification "What would you say is the main point of
what you said?"
16. Presenting Reality "Your mother is not hereI am a nurse."
Patient: "Did you bring my car today?"
Nurse: "No, you do not have a car. I drove
my car here today."

17.. Voicing Doubt "That's hard to believe."

"Really?"
 Kinds of Therapeutic
Verbal
Non Verbal
 Components of nonverbal
communication
Physical appearance and dress
Body movement and posture
Touch
Facial expressions
Eye behavior
Vocal cues or paralanguage
 TECHNIQUES OF THERAPEUTIC
COMMUNICATION
Therapeutic Technique
1. Offering Self
making self-available and showing interest and concern.
I will walk with you
2. Active listening
paying close attention to what the patient is saying by observing both
verbal and non-verbal cues.
Maintaining eye contact and making verbal remarks to clarify and
encourage further communication.
3. Exploring
Tell me more about your son
4. Giving broad openings
What do you want to talk about today?
5. Silence
Planned absence of verbal remarks to allow patient and nurse to think
over what is being discussed and to say more.
 6. Stating the observed
verbalizing what is observed in the patient to, for validation and to encourage
discussion
You sound angry
7. Encouraging comparisons
asking to describe similarities and differences among feelings, behaviors, and
events.
Can you tell me what makes you more comfortable, working by yourself or
working as a member of a team?
8. Identifying themes
asking to identify recurring thoughts, feelings, and behaviors.
When do you always feel the need to check the locks and doors?
9. Summarizing
reviewing the main points of discussions and making appropriate conclusions.
During this meeting, we discussed about what you will do when you feel the urge
to hurt your self again and this include
10. Placing the event in time or sequence
asking for relationship among events.
When do you begin to experience this ticks? Before or after you entered grade
school?
 11. Voicing doubt
voicing uncertainty about the reality of patients statements, perceptions and
conclusions.
I find it hard to believe
12. Encouraging descriptions of perceptions
asking the patients to describe feelings, perceptions and views of their situations.
What are these voices telling you to do?
13. Presenting reality or confronting
stating what is real and what is not without arguing with the patient.
I know you hear these voices but I do not hear them.
I am Lhynnelli, your nurse, and this is a hospital and not a beach resort.
14. Seeking clarification
asking patient to restate, elaborate, or give examples of ideas or feelings to seek
clarification of what is unclear.
I am not familiar with your work, can you describe it further for me.
I dont think I understand what you are saying.
15. Verbalizing the implied
rephrasing patients words to highlight an underlying message to clarify statements.
Patient: I wont be bothering you anymore soon.
Nurse: Are you thinking of killing yourself?
 16. Reflecting
throwing back the patients statement in a form of question helps the patient
identify feelings.
Patient: I think I should leave now.
Nurse: Do you think you should leave now?
17. Restating
repeating the exact words of patients to remind them of what they said and to let
them know they are heard.
Patient: I cant sleep. I stay awake all night.
Nurse: You cant sleep at night?
18. General leads
using neutral expressions to encourage patients to continue talking.
Go on
You were saying
19. Asking question
using open-ended questions to achieve relevance and depth in discussion.
How did you feel when the doctor told you that you are ready for discharge
soon?
20. Empathy
recognizing and acknowledging patients feelings.
Its hard to begin to live alone when you have been married for more than thirty
years.
 21. Focusing
pursuing a topic until its meaning or importance is clear.
Let us talk more about your best friend in college
You were saying
22. Interpreting
providing a view of the meaning or importance of something.
Patient: I always take this towel wherever I go.
Nurse: That towel must always be with you.
23. Encouraging evaluation
asking for patients views of the meaning or importance of something.
What do you think led the court to commit you here?
Can you tell me the reasons you dont want to be discharged?
24. Suggesting collaboration
offering to help patients solve problems.
Perhaps you can discuss this with your children so they will know how
you feel and what you want.
25. Encouraging goal setting
asking patient to decide on the type of change needed.
What do you think about the things you have to change in your self?
 . Encouraging formulation of a plan of action
probing for step by step actions that will be needed.
If you decide to leave home when your husband beat you again what will you do
next?
27. Encouraging decisions
asking patients to make a choice among options.
Given all these choices, what would you prefer to do.
28. Encouraging consideration of options
asking patients to consider the pros and cons of possible options.
Have you thought of the possible effects of your decision to you and your
family?
29. Giving information
providing information that will help patients make better choices.
Nobody deserves to be beaten and there are people who can help and places to
go when you do not feel safe at home anymore.
30. Limit setting
discouraging nonproductive feelings and behaviors, and encouraging productive
ones.
Please stop now. If you dont, I will ask you to leave the group and go to your
room.
 31. Supportive confrontation
acknowledging the difficulty in changing, but pushing for action.
I understand. You feel rejected when your children sent you here but if
you look at this way
32. Role playing
practicing behaviors for specific situations, both the nurse and patient play
particular role.
Ill play your mother, tell me exactly what would you say when we meet
on Sunday.
33. Rehearsing
asking the patient for a verbal description of what will be said or done in a
particular situation.
Supposing you meet these people again, how would you respond to them
when they ask you to join them for a drink?.
34. Feedback
pointing out specific behaviors and giving impressions of reactions.
I see you combed your hair today.
35. Encouraging evaluation
asking patients to evaluate their actions and their outcomes.
What did you feel after participating in the group therapy?.
 36. Reinforcement
giving feedback on positive behaviors.
Everyone was able to give their options when we talked
one by one and each of waited patiently for our turn to
speak.
Avoid pitfalls:
Giving advise
Talking about your self
Telling client is wrong
Entering into hallucinations and delusions of client
False reassurance
Clich
Giving approval
Asking WHY?
Changing subject
Defending doctors and other health team members.
 Non-therapeutic Technique
1. Overloading
talking rapidly, changing subjects too often, and asking for more information than
can be absorbed at one time.
Whats your name? I see you like sports. Where do you live?
2. Value Judgments
giving ones own opinion, evaluating, moralizing or implying ones values by using
words such as nice, bad, right, wrong, should and ought.
You shouldnt do that, its wrong.
3. Incongruence
sending verbal and non-verbal messages that contradict one another.
The nurse tells the patient Id like to spend time with you and then walks away.
4. Underloading
remaining silent and unresponsive, not picking up cues, and failing to give feedback.
The patient ask the nurse, simply walks away.
5. False reassurance/ agreement
Using clich to reassure client.
Its going to be alright.
 6. Invalidation
Ignoring or denying anothers presence, thoughts or feelings.
Client: How are you?
Nurse responds: I cant talk now. Im too busy.
7. Focusing on self
responding in a way that focuses attention to the nurse instead of the client.
This sunshine is good for my roses. I have beautiful rose garden.
8. Changing the subject
introducing new topic
inappropriately, a pattern that may indicate anxiety.
The client is crying, when the nurse asks How many children do you have?
9. Giving advice
telling the client what to do, giving opinions or making decisions for the client,
implies client cannot handle his or her own life decisions and that the nurse is
accepting responsibility.
If I were you Or it would be better if you do it this way
10. Internal validation
making an assumption about the meaning of someone elses behavior that is not
validated by the other person (jumping into conclusion).
The nurse sees a suicidal clients smiling and tells another nurse the patient is in
good mood.
 Other ineffective behaviors and responses:
Defending Your doctor is very good.
Requesting an explanation Why did you do
that?
Reflecting You are not suppose to talk like
that!
Literal responses If you feel empty then you
should eat more.
Looking too busy.
 Appearing uncomfortable in silence.
Being opinionated.
Avoiding sensitive topics
Arguing and telling the client is wrong
Having a closed posture-crossing arms on chest
Making false promises Ill make sure to call you
when you get home.
Ignoring the patient I cant talk to you right now
Making sarcastic remarks
Laughing nervously
Showing disapproval You should not do those
thing
 Therapeutic Communication
Techniques
1. Using silence
2. Accepting
3. Giving Recognition
4. Offering self
5. Using Broad Openings
6. Using General Leads (using neutral expressions to
encourage continued talking by the client)
7. Placing he event in time or sequence
8. Making Observations
9. Encouraging Description of Perceptions
10. Restating
11. Reflecting
12. Focusing
 13. Exploring
14. Giving Information
15. Seeking Clarification
16. Presenting Reality
17.. Voicing Doubt
18. Seeking Consensual Validation
19. Verbalizing the Implied
20. Encouraging Evaluation (asking for the client's view of
the meaning or importance of something)
21. Attempting to Translate Into Feelings
22. Suggested Collaboration
23. Summarizing
24. Encouraging Formulation of a Plan of Action
25. Identifying themes ..asking client to identify recurrent
patterns in thoughts, feelings, and behaviors
 Studi Kasus 1
Ms.Edward baru menerima terapi dengan obat baru
untuk schizophrenia, dia menanyakan pada Anda
tentang tujuan pengobatannya dan efek samping yang
mungkin timbul. Saat Anda tanya apakah dokternya
telah menjelaskan tentang obat tersebut, nampaknya
ia belum memahami tujuan dan efek samping obatnya.
Obat tersebut memiliki sejumlah efek samping,
beberapa di antaranya bisa serius. Menurut laporan
Ms. Edward saat ia bertanya tentang efek samping
kepada dokternya, dokter hanya menjawab, Saya
mempunyai banyak pasien yang memakai obat ini dan
mereka baik-baik saja. Anda khawatir Ms. Edward
akan menolak menggunakan obat tersebut jika Anda
menceritakan efek sampingnya. Apa yang seharusnya
dikatakan kepada Ms. Edward.

 Studi Kasus 2
James Bently, 17 tahun, seorang klien apotek Anda
didiagnosis epilepsi dan mendapatkan resep fenitoin.
Setelah melakukan tanya jawab dengannya, Anda
mendapati bahwa ia menganggap epilepsi itu menakutkan,
dan tak percaya dengan diagnosis dokternya. Catatan medis
menunjukkan adanya pola ketidakpatuhan, yang
diekspresikan pasien dengan keyakinannya bahwa ia tidak
memerlukan obatnya. Anda telah memberikan edukasi
dengan baik tentang fenitoin dan pentingnya pemakaian
yang konsisten untuk mengontrol kejang, tapi ia tetap tidak.
patuh. Ia juga tetap menyetir mobil sendiri dan baru-baru
ini mengalami kecelakaan. Ayahnya, yang terakhir
mengambilkan resep untuk James tidak pernah menyadari
penolakan anaknya atas epilepsinya ataupun
ketidakpatuhan terhadap obatnya. Apakah sebaiknya Anda
memberitahu ayahnya tentang ketidakpatuhan James?
Bagaimana dengan polisi atau dokternya?
 Studi Kasus 3
Anda bekerja sebagai farmasis di apotek. Anda
memperhatikan Megan, 17 tahun, anak dari teman
dekat Anda menerima resep untuk kontrasepsi oral dan
untuk mengatasi penyakit menular seksual (PMS).
Ternyata Megan telah bergaul dengan sekelompok
siswa dimana orang tuanya telah melarangnya untuk
bergabung. Anda sangat peduli terhadap Megan dan
ingin tahu apakah dia menggunakan kontrasepsi oral
yang dan menggunakan kondom terlebih dahulu yang
dapat melindungi PMS. Ketika Megan memasuki
apotek untuk mengambil resep dia terganggu dan
menolak untuk berbicara, jika Anda berada di pihak
orangtua, Anda ingin tahu tentang resep itu. Anda
yakin bahwa Megan dalam masalah dan butuh
bantuan keluarganya.
 Studi Kasus 4
Nancy berusia 19 tahun, seorang mahasiswa. Dia membawa
resep untuk Plan B. Resep ini digunakan untuk kontrasepsi
post-coital darurat. Farmasis yang bertugas pada waktu itu
adalah Jeff, menolak untuk melayani resep tersebut. Nancy
menjadi bingung dan memohon dengan sangat kepada Jeff
untuk melayani resep tersebut karena hanya apotek tersebut
yang terdekat dari kampus serta yang menerima asuransi
dan dia tidak tahu harus ke apotek mana untuk menebus
resep tersebut. Dengan sedih Nancy menjelaskan pada Jeff
bahwa alasan dia membutuhkan resep tersebut karena dia
telah diserang dan diperkosa ketika ke asrama setalah pesta.
Jeff tetap bersikukuh dan merekomendasikan Nancy untuk
memperoleh konseling. Pasien tersebut meninggalkan
apotek dengan resep yang tak dilayani dalam keadaan gusar
dan emosional. Sehari setelah dia menghubungi dan
berbicara kepada manajer Jeff, dia menjelaskan situasi dan
permintaan agar Jeff dipecat. Apakah Jeff telah benar dengan
menolak untuk melayani obat? Apa sebenarnya yang harus
Jeff lakukan kepada pasien?
 Studi Kasus 5

Ny. Jones, merupakan pelanggan apotek Anda yang

menderita penyakit dalam tahap akhir, datang ke apotek
membawa sebuah resep untuk obat lethal dose dan
menjelaskan keinginannya untuk mengakhiri hidup. Dia
menyatakan bahwa dia perlu beberapa penjelasan tentang
cara pakainya. Negara tempat Anda melakukan praktek
baru-baru ini telah memberikan izin Death with Dignity
Act, yang mana melegalkan pelayanan obat yang
digunakan untuk mengakhiri hidup pada orang yang
membutuhkan. Anda memiliki penilaian moral, etika, dan
agama yang kuat untuk membantu mengakhiri hidup dan
merasa jika Anda tidak bisa melayani resep tersebut.
Apakah Anda telah benar jika menolak untuk melayani
obat? Apa yang seharusnya Anda lakukan? Apakah prinsip
etika yang terlibat dalam kasus ini? Apa yang akan Anda
katakan kepada pasien?
 Beberapa dari kasus pasien di atas menggambarkan
keputusan yang harus dibuat berdasarkan aspek
hukum dan prinsip etik. Kemampuan anda untuk
memilih serangkaian aksi yang tepat dalam situasi
tersebut berdasarkan apa yang anda pahami tentang
prinsip etik yang terlibat. Aspek hukum pada kasus-
kasus tersebut dilindungi oleh negara dan hukum
pemerintahan. Akan tetapi, banyak elemen yang tidak
spesifik pada hukum dan peraturan tetapi melibatkan
dasar prinsip etik dalam pembuatan keputusan pada
pelayanan pasien termasuk beneficence, autonomy,
dan honesty. Persoalan lain yang didapat dari prinsip-
prinsip tersebut dan bagian yang penting dalam
konseling pasien adalah informed consent,
confidentiality, dan fidelity. Hal itu merupakan konsep
yang akan didiskusikan pada bagian akhir dalam
makalah ini.