6 THERAPEUTICCOMMUNICATION 115
a moment in time. Nurses develop empathy by gath-
ering as much information about an issue as possible
directly from the client to avoid interjecting their per-
sonal experiences and interpretations of the situa-
tion. The nurse asks as many questions as needed to
gain a clear understanding of the client’s perceptions
of an event or issue.
Active listening and observation help the nurse to
- Recognize the issue that is most important to
the client at this time. - Know what further questions to ask the
client. - Use additional therapeutic communication
techniques to guide the client to describe his
or her perceptions fully. - Understand the client’s perceptions of the
issue instead of jumping to conclusions. - Interpret and respond to the message
objectively.
VERBAL COMMUNICATION SKILLS
Using Concrete Messages
The nurse should use words that are as clear as pos-
sible when speaking to the client so that the client can
understand the message. Anxious people lose cogni-
tive processing skills—the higher the anxiety, the
less ability to process concepts—so concrete mes-
sagesare important for accurate information ex-
change. In a concrete message, the words are explicit
and need no interpretation; the speaker uses nouns
instead of pronouns—for example, “What health symp-
toms caused you to come to the hospital today?” or
“When was the last time you took your antidepres-
sant medications?” Concrete questions are clear, di-
rect, and easy to understand. They elicit more accurate
responses and avoid the need to go back and rephrase
unclear questions, which interrupts the flow of a ther-
apeutic interaction.
Abstract messages,in contrast, are unclear pat-
terns of words that often contain figures of speech that
are difficult to interpret. They require the listener to
interpret what the speaker is asking. For example, a
nurse who wants to know why a client was admitted
to the unit asks, “How did you get here?” This is an ab-
stract message: the terms “how” and “here” are vague.
An anxious client might not be aware of where he or
she is and reply, “Where am I?” or might interpret this
as a question about how he or she was conveyed to the
hospital and respond, “The ambulance brought me.”
Clients who are anxious, from different cultures, cog-
nitively impaired, or suffering from some mental dis-
orders often function at a concrete level of comprehen-
sion and have difficulty answering abstract questions.
The nurse must be sure that statements and questions
are clear and concrete.
The following are examples of concrete and ab-
stract messages:
Abstract (unclear): “Get the stuff from him.”
Concrete (clear): “John will be home today at 5 pm,
and you can pick up your clothes at that time.”
Abstract (unclear): “Your clinical performance
has to improve.”
Concrete (clear): “To administer medications
tomorrow, you’ll have to be able to calculate dosages
correctly by the end of today’s class.”Using Therapeutic
Communication Techniques
The nurse can use many therapeutic communication
techniques to interact with clients. The choice of tech-
nique depends on the intent of the interaction and the
client’s ability to communicate verbally. Overall the
nurse selects techniques that will facilitate the inter-
action and enhance communication between client and
nurse. Table 6-1 lists these techniques and gives ex-
amples. Techniques such as exploring, focusing, re-
stating, and reflecting encourage the client to discuss
his or her feelings or concerns in more depth.
In contrast, there are many nontherapeutic tech-
niques that nurses should avoid (Table 6-2). These re-
sponses cut off communication and make it more dif-
ficult for the interaction to continue. Many of these
responses are common in social interaction such as
advising, agreeing, or reassuring. Therefore it takes
practice for the nurse to avoid making these typical
comments.Interpreting Signals or Cues
To understand what a client means, the nurse watches
and listens carefully for cues. Cuesare verbal or non-
verbal messages that signal key words or issues for the
client. Finding cues is a function of active listening.
Cues can be buried in what a client says or can be acted
out in the process of communication. Often cue words
introduced by the client can help the nurse to know
what to ask next or how to respond to the client. The
nurse builds his or her responses on these cue words or
concepts. Understanding this can relieve pressure on
students who are worried and anxious about what
question to ask next. The following example illustrates
questions the nurse might ask when responding to a
client’s cue:
Client: “I had a boyfriend when I was younger.”
Nurse: “You had a boyfriend?”(reflecting)
“Tell me about you and your boyfriend.”(encour-
aging description)
“How old were you when you had this boyfriend?”
(placing events in time or sequence)
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