Therapeutic Communication

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Therapeutic Communication Counseling

• Dianna Spies Sorenson, Ph.D., RN, CNS

N-760 Health Promotion Disease Prevention
Counseling Individuals Families in Advanced
Practice Nursing
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Key elements of interpersonal communication
within a therapeutic relationship

• connectedness
• commitment
• intentionality
• goal-focused

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Non-APN
Illness
Normal
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APN
Usual Health
Illness
Successful Health
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Communication Theories
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Watzlawick, Beavin, Jackson

• Cannot NOT communicate
• Content/relationship
• Punctuation
• Symmetrical/Complementary
• ???????? // ????????
• Digital/Analogic
• Feedback
• Metacommunication

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Knapp

• Social penetration
• Breadth - number of topics
• Depth - degree of intimacy

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Berne
Parent
Parent
Adult
Adult
Child
Child
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Therapeutic Communication Generic Support

• Relationship established as a therapeutic
  communicator alone is therapeutic
• Empathy alone is therapeutic

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Therapeutic Communication
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8 Therapeutic Communicator Functions

• Models functional communication
• firmly state case
• clarify qualify messages
• ask for feedback from others
• be receptive to feedback from others

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Therapeutic Communicator, cont.

• - Assists others to learn to communicate directly
  clearly
• - Points out discrepancies
• - Spells out nonverbal messages
• - Spells out double-level messages
• - Creates a non-threatening atmosphere
• - Excludes no one
• - Builds self-esteem

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Empathy
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Empathy Review

• Use empathy to
• Build relationship
• Enter their world of understanding
• Reflect clients, so they can see themselves act
  on it
• Allow an opportunity for client to correct your
  interpretation

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Empathy Review

• Reflects affect
• Reflects view point
• Offers analytic thinking

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Empathy Review

• Remember, anger is a secondary emotion try to
  identify the primary emotion (i.e. fear,
  sadness, etc.)

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Empathy Review

• 1 - State the feeling, e.g. You feel scared...
• 2- State the reason for the feeling e.g.
  ...because youve been left out in the past...
• 3 - State what their behavioral rxn is e.g.
  this made you interrupt the meeting.

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Advanced Therapeutic Communication and Counseling
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Therapeutic Communication Advanced Practice
Nursing

• Advanced assessment
• Mutual goal setting planning
• Nursing interventions, including counseling
  techniques, collaboration case managed
  referrals
• Deliberative progress evaluation

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Initiating the Relationship
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In The Beginning.....

• Start where the clients are
• their goals
• their perceptions
• their fears
• their beliefs

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LISTEN TO

• Point of view
• Experience (content)
• Behaviors
• Affect

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Vague Problem
Vague Solution
Worthless Plan
Boredom
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Common Counseling Pit Falls
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The Bottomless Pit

• Searching the past to explain the present
• What happened to them Vs. what they have done
  about it
• Assessments, esp.. paper/pencil
• Reluctance resistance
• Therapist staying comfortable
• Therapist self-disclosure

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Boundaries see module on Professional
Boundaries

• Physical
• Psychological
• Emotional

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Goal Setting Reminder

• Remind clients that they need to
• Look at the implications of their goals
• Make sure they are realistic
• Is what they want REALLY what they want?

The only thing worse than not getting what you
want is getting what you want (author uk)
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The only thing worse than not getting what you
want is getting what you want (author uk)
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Egans Model Application
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Role Playing

• Break into pairs take turns telling each other
  about a recent situation that created a conflict
  within yourself. Use each scenario as a clinical
  vignette and analyze it using Egans model of
  counseling.
• NOTE the analysis process you will practice here
  is similar to the expectations of the mid-term
  and final examinations

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Vignette Analysis

• What is the key experience?
• What are the behaviors?
• What is the affect?

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Vignette Response

• Formulate and empathetic response
• What are the individual/family strengths?
• What resources were underused/not used?
• Formulate problem identification probes who,
  what, when, where, how, why

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Vignette Response, Cont.

• What are potential sources of reluctance?
• Develop a summarizing statement.
• What are the potential points of leverage?
• Formulate an action-focused statement.