Therapeutic communication

What a therapeutic response does

It keeps the client talking about what they raised. That is the whole test. A response that answers, reassures, advises or redirects has ended the conversation, however kind it sounds.

• Open questions: "Tell me more about that."
• Reflecting: repeating the feeling back so the client hears it was received.
• Clarifying: "What do you mean when you say you cannot cope?"
• Offering self and presence: "I will sit with you."
• Silence, used deliberately rather than because nobody knew what to say.

What closes it down

• False reassurance: "I am sure it will be fine." It answers a question the client did not ask.
• Advice, which usually opens with "What you should do is". It moves the problem from the client to the nurse.
• Why questions: they ask a distressed person to justify a feeling.
• Changing the subject, including by offering a tissue and moving to the discharge plan.
• Approval and disapproval: both make the nurse the judge of what the client says next.
• Defending a colleague or the organization when a client is complaining.

Three situations that come up

• Hopelessness: reflect it and ask. "There is no point in any of this" needs "Tell me what feels pointless right now" — and, if there is any suggestion of self-harm, a direct question about whether they are thinking of ending their life. Asking directly does not plant the idea.
• Anger: acknowledge it, keep your voice level, maintain a safe distance and an exit, and do not take it personally or argue the facts.
• A client who asks the nurse to keep a secret: never promise before hearing it. Information that affects safety has to be shared, and a promise made in advance cannot be kept.