6 THERAPEUTICCOMMUNICATION 119
Table 6-2
NONTHERAPEUTICCOMMUNICATIONTECHNIQUES
Techniques Examples Rationale
Advising—telling the client
what to do
Agreeing—indicating accord
with the client
Belittling feelings
expressed—Misjudging
the degree of the client’s
discomfort
Challenging—demanding
proof from the client
Defending—attempting to
protect someone or
something from verbal
attack
Disagreeing—opposing the
client’s ideas
Disapproving—denouncing
the client’s behavior or
ideas
Giving approval—
sanctioning the client’s
behavior or ideas
Giving literal responses—
responding to a figurative
comment as though it
were a statement of fact
Indicating the existence of
an external source—
attributing the source of
thoughts, feelings, and
behavior to others or to
outside influences
“I think you should.. .”
“Why don’t you.. .”
“That’s right.”
“I agree.”Client:“I have nothing
to live for... I wish
I was dead.”
Nurse:“Everybody gets
down in the dumps.” OR
“I’ve felt that way myself.”“But how can you be
President of the United
States?”
“If you’re dead, why is your
heart beating?”“This hospital has a fine
reputation.”
“I’m sure your doctor
has your best interests
in mind.”“That’s wrong.”
“I definitely disagree
with.. .”
“I don’t believe that.”
“That’s bad.”
“I’d rather you wouldn’t.. .”“That’s good.” “I’m glad
that.. .”Client:“They’re looking in
my head with a television
camera.”
Nurse:“Try not to watch
television.” OR “What
channel?”
“What makes you say
that?”
“What made you do that?”
“Who told you that you
were a prophet?”Giving advice implies that only the nurse knows
what is best for the client.
Approval indicates the client is “right” rather
than “wrong.” This gives the client the impres-
sion that he or she is “right” because of agree-
ment with the nurse. Opinions and conclusions
should be exclusively the client’s. When the
nurse agrees with the client, there is no oppor-
tunity for the client to change his or her mind
without being “wrong.”
When the nurse tries to equate the intense and
overwhelming feelings the client has expressed
to “everybody” or to the nurse’s own feelings,
the nurse implies that the discomfort is tempo-
rary, mild, self-limiting, or not very important.
The client is focused on his or her own worries
and feelings; hearing the problems or feelings
of others is not helpful.
Often the nurse believes that if he or she can
challenge the client to prove unrealistic ideas,
the client will realize there is no “proof”
and then will recognize reality. Actually
challenging causes the client to defend the
delusions or misperceptions more strongly
than before.
Defending what the client has criticized implies
that he or she has no right to express impres-
sions, opinions, or feelings. Telling the client
that his or her criticism is unjust or unfounded
does not change the client’s feelings but only
serves to block further communication.
Disagreeing implies the client is “wrong.”
Consequently the client feels defensive about
his or her point of view or ideas.Disapproval implies that the nurse has the right
to pass judgment on the client’s thoughts or
actions. It further implies that the client is
expected to please the nurse.
Saying what the client thinks or feels if “good”
implies that the opposite is “bad.” Approval,
then, tends to limit the client’s freedom to
think, speak, or act in a certain way. This can
lead to the client’s acting in a particular way
just to please the nurse.
Often the client is at a loss to describe his or her
feelings, so such comments are the best he or
she can do. Usually it is helpful for the nurse to
focus on the client’s feelings in response to
such statements.The nurse can ask, “What happened?” or “What
events led you to draw such a conclusion?”
But to question “What made you think that?”
implies that the client was made or compelled
to think in a certain way. Usually the nurse
does not intend to suggest that the source is
external but that is often what the client
thinks.(continued)