comprehend what the nurse is saying. Likewise, a
client with panic disorder may be too anxious to focus
on the nurse’s communication. Although clients with
mental disorders frequently give incongruent mes-
sages because of their illness, the nurse must con-
tinue to provide consistent, congruent messages. Ex-
amining one’s own behavior and doing one’s best to
make messages clear, simple, and congruent help to
facilitate trust between the nurse and the client.
Genuine Interest
When the nurse is comfortable with himself or her-
self, aware of his or her strengths and limitations,
and clearly focused, the client will perceive a genuine
person showing genuine interest.Clients with
mental illness can detect when someone is exhibit-
ing dishonest or artificial behavior such as asking a
question and then not waiting for the answer, talk-
ing over the client, or assuring the client everything
will be all right. The nurse should be open and hon-
est and display congruent behavior. Sometimes, how-
ever, responding with truth and honesty alone does
not provide the best professional response. In such
cases, the nurse may choose to disclose to the client
a personal experience related to the client’s current
concerns. Doing so helps to develop trust and allows
the client to see the nurse as a real person with per-
haps similar problems. The client then may choose
to reveal more information to the nurse. This self-
disclosure, revealing personal information (e.g., bio-
graphicaldata, ideas, thoughts, feelings), can enhance
openness and honesty. Nevertheless the nurse must
not shift emphasis to the nurse’s problems rather than
the client’s problems.
Empathy
Empathyis the ability of the nurse to perceive the
meanings and feelings of the client and to communi-
cate that understanding to the client. It is considered
one of the essential skills a nurse must develop. Being
able to put himself or herself in the client’s shoes does
not mean that the nurse has had the same exact ex-
periences as the client. Nevertheless, by listening and
sensing the importance of the situation to the client,
the nurse can imagine the client’s feelings about the
experience. Both the client and the nurse give a “gift
of self” when empathy occurs—the client by feeling
safe enough to share feelings, and the nurse by listen-
ing closely enough to understand. Empathy has been
shown to positively influence client outcomes. Clients
tend to feel better about themselves and more under-
stood when the nurse is empathetic (Reynolds & Scott,
1999; Kunyk & Olson, 2001).
92 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP
Several therapeutic communication techniques,
such as reflection, restatement, and clarification, help
the nurse to send empathetic messages to the client.
For example, a client says, “I’m so confused! My son
just visited and wants to know where the safety de-
posit box key is.”Using reflection, the nurse responds,
“You’re confused because your son asked for the safety
deposit key?”The nurse using clarification responds,
“Are you confused about the purpose of your son’s
visit?”From these empathetic moments, a bond can be
established to serve as the foundation for the nurse–
client relationship. More examples of therapeutic com-
munication techniques are found in Chapter 6.
The nurse must understand the difference be-
tween empathy and sympathy(feelings of concern or
compassion one shows for another). By expressing
sympathy, the nurse may project his or her personal
concerns onto the client, thus inhibiting the client’s
expression of feelings. In the above example, the
nurse using sympathy would have responded, “I know
how confusing sons can be. My son confuses me, too,
and I know how bad that makes you feel.” The nurse’s
feelings of sadness or even pity could influence the re-
lationship and hinder the nurse’s abilities to focus on
the client’s needs. Sympathy often shifts the empha-
sis to the nurse’s feelings, hindering the nurse’s abil-
ity to view the client’s needs objectively.Acceptance
The nurse who does not become upset or respond
negatively to a client’s outbursts, anger, or actingEmpathy vs. sympathy