6 THERAPEUTICCOMMUNICATION 127
help the client by using techniques such as clarification
and placing an event in time or sequence.
ASKING FOR CLARIFICATION
Nurses often believe that they always should be able
to understand what the client is saying. This is not
always the case: the client’s thoughts and communi-
cations may be unclear. The nurse never should as-
sume that he or she understands; rather, the nurse
should ask for clarification if there is doubt. Asking
for clarification to confirm the nurse’s understanding
of what the client intends to convey is paramount to
accurate data collection.
If the nurse needs more information or clarifica-
tion on a previously discussed issue, he or she may
need to return to that issue. The nurse also may need
to ask questions in some areas to clarify information.
The nurse then can use the therapeutic technique of
consensual validation, which means repeating his or
her understanding of the event that the client just de-
scribed to see if their perceptions agree. It is impor-
tant to go back and clarify rather than working from
assumptions.
The following is an example of clarifying and
focusing techniques:
Client: “I saw it coming. No one else had a clue
this would happen.”
Nurse: “What was it that you saw coming?”(seek-
ing information)
Client: “We were doing well, and then the floor
dropped out from under us. There was little anyone
could do but hope for the best.”
Nurse: “Help me understand by describing what
‘doing well’ refers to.”(seeking information)
“Who are the ‘we’ you refer to?”(focusing)
“How did the f loor drop out from under you?”
(encouraging description of perceptions)
“What did you hope would happen when you
‘hoped for the best’?”(seeking information)
CLIENT’S AVOIDANCE OF
THE ANXIETY-PRODUCING TOPIC
Sometimes clients begin discussing a topic of minimal
importance because it is less threatening than the
issue that is increasing the client’s anxiety. The client
is discussing a topic but seems to be focused elsewhere.
Active listening and observing changes in the intensity
of the nonverbal process help to give the nurse a sense
of what is going on. Many options can help the nurse to
determine which topic is more important:
- Ask the client which issue is more important
at this time. - Go with the new topic because the client has
given nonverbal messages that this is the
issue that needs to be discussed.
3. Reflect the client’s behavior signaling there
is a more important issue to be discussed.
4. Mentally file the other topic away for later
exploration.
5. Ignore the new topic, because it seems that
the client is trying to avoid the original topic.
The following example shows how the nurse can
try to identify which issue is most important to the
client:
Client: “I don’t know whether it is better to tell or
not tell my husband that I won’t be able to work any-
more. He gets so upset whenever he hears bad news.
He has an ulcer, and bad news seems to set off a new
bout of ulcer bleeding and pain.”
Nurse:“Which issue is more difficult for you to
confront right now: your bad news or your husband’s
ulcer?”(encouraging expression)
Guiding the Client in Problem-Solving
and Empowering the Client to Change
Many therapeutic situations involve problem-solving.
The nurse is not expected to be an expert or to tell the
client what to do to fix his or her problem. Rather the
nurse should help the client explore possibilities and
find solutions to his or her problem. Often just help-
ing the client to discuss and explore his or her per-
ceptions of a problem stimulates potential solutions
in the client’s mind. The nurse should introduce the
concept of problem-solving and offer himself or her-
self in this process.
Virginia Satir (1967) explained how important the
client’s participation is to finding effective and mean-
ingful solutions to problems. If someone else tells the
client how to solve his or her problems and does not
allow the client to participate and develop problem-
solving skills and paths for change, the client may fear
growth and change. The nurse who gives advice or di-
rections about the way to fix a problem does not allow
the client to play a role in the process and implies
that the client is less than competent. This process
makes the client feel helpless and not in control and
lowers self-esteem. The client may even resist the
directives in an attempt to regain a sense of control.
When a client is more involved in the problem-
solving process, he or she is more likely to follow
through on the solutions. The nurse who guides the
client to solve his or her own problems helps the client
to develop new coping strategies, maintains or in-
creases the client’s self-esteem, and demonstrates the
belief that the client is capable of change. These goals
encourage the client to expand his or her repertoire
of skills and to feel competent; feeling effective and
in control is a comfortable state for any client.
Problem-solving is frequently used in crisis inter-
vention but is equally effective for general use. The
problem-solving process is used when the client has