Communication and the Therapeutic Relationship

Chapter 10

Nursing 411Mental Health Nursing

Self-awareness

Process of understanding one’s own beliefs, thoughts, motivations, biases, and physical and emotional limitations, and recognizing how they affect others with whom we interact.

Self-awarenessText Box 10.1

BiologicGender, age, body weight, height, and other observed physical characteristicsGenetic makeup, chronic illness, or physical disability

PsychologicalPsychological makeupTraumatic experiences

SocialSociocultural valuesAcknowledge cultural heritage

Understanding Personal Feelings

Avoid projecting personal bias on patient.

Ask for feedback from people you know and trust.

Behavior change can follow serious introspection if there is a willingness to change.

CommunicationTherapeutic communication.

Ongoing process of interaction in which meaning emerges.

Verbal communication.Spoken word, underlying emotion, context, connotation.

Nonverbal communication.Gestures, expressions, body language.

Empatheic linkages.Direct communication of feelings.

Communication and the Therapeutic Process

Therapeutic Communication: Ongoing process of interaction.

Focuses on the patient and patient-related issues

Signs of slipping into a social relationshipTelling patient about personal social lifeTelling patient about frustrating experiences that relieve stressLetting patient believe that relationship is a friendship

Principles of Therapeutic Communication

Patient focus of interaction.Attitude sets the tone.Use self-disclosure cautiously and for a purpose.Avoid social relationships.Maintain patient confidentiality.Assess level of understanding.Implement intervention from a theoretical basis.

Principles of Therapeutic Communication

Maintain a nonjudgmental interactionGuide patient to reinterpret experiences rationallyTrack verbal interaction with clarifying statements. Avoid changing the subject (unless in the best interest of client).

Techniques of Verbal Communication

(Table 10.2)AcceptanceConfrontationDoubtInterpretationObservation

Open-ended statementsReflectionRestatementSilenceValidation

Listening

On what patient statements, questions saysUses open-ended activeFocusing Avoid changing subjectPositive body language

PassiveSitting quietlyLetting patient talkBoring body language

Closed body and closed attitude.

Open body and open attitude.

Selecting a Technique

Listen to verbal and non-verbal

Decide goal of communicationClarifyProblem-solveSupport

Therapeutic Communication Concepts

Rapport: interpersonal harmony characterized by understanding and respect.Validation: checking out one’s own thoughts or feelings with another.

Empathy: ability to experience, in the present, the situation as another did at some time in the past.

Boundaries: defining limits of persons, objects, or relationships.

BoundariesPhysical: body space zones

Social:Parent-child relationshipsRomantic relationship

Psychological:Nurse-patient relationshipProblems when:

Professional relationship turns into social oneNeeds of nurse are met at expense of patient.

Defense Mechanisms(table 10-4)

Automatic psychological process protecting the individual against anxiety and from awareness of internal or external dangers/stressors.

Defense MechanismsProjectionProjective identificationRationalizationReaction formationRepressionSelf-assertion

Self-observationSplitting Acting outAffiliationAltruismAnticipation

Defense Mechanism (cont.)

Autistic fantasyDevaluationDisplacementDissociationHelp-rejectingHumor

IdealizationAutistic fantasyDenial SublimationSuppressionUndoing

Analyzing Interactions

Process Recordings

Analysissymbolismthemescommunication blocks

Nurse-Patient Relationship(Table 9.4)

Orientation Phasefirst meetingconfidentialitytesting the relationship

Working Phaseidentification of problemsproblem solving

Resolution Phaseproblems resolverelationship ends