THERAPEUTIC COMMUNICATION AND INTERPERSONAL RELATIONASHIP

INTRODUCTION

Communication refers to the reciprocal exchange of information, ideas, belief, feelings and attitudes between
persons. Communication is very significant in nursing.

DEFINITION:

1. Communication is a process by which information is exchanged between individuals through a common

system of symbols, signs or behaviour.
- Webster's New Collegiate Dictionary.
2. "The nurse directs the communication towards the patient to identify his current health problems, plans,
implements & evaluates the action taken".
-Bimla Kapoor, 2002.
IMPORTANCE OF THERAPEUTIC COMMUNICATION:
1.The importance of therapeutic communication is that it allows the patient to express thoughts, concerns and
emotions in a safe non threatening environment.
2.Establish a therapeutic nurse patient's relationship
3.Identify the most important patient's needs
4.Asses the patient's problems.
THERAPEUTIC GOALS OF NURSE PATIENT COMMUNICATION:
1. Self-realization, self acceptance and an increased genuine self-respect.
2. A clear sense of personal identity and an improved level of personal integration.
3. An ability to form intimate, interdependent, interpersonal relationships with a capacity to give and receive
love.
4. Improved functioning and increased ability to satisfy needs achieve realistic personal goals.
FUNCTION OF A NURSE IN THERAPEUTIC NURSE PATIENT INTERACTION:
1. Allows the patient to express his thoughts and feelings and relates these to observed and reported
interactions.
2. Clarifies the areas of conflict and anxiety.
3. Identifies and maximizes the patients ego strengths and encourages socialization and family relatedness.
4. Corrects the communication problems.
5. Modifies maladaptive behavior patterns.
PURPOSES OF NURSE PATIENT COMMUNICATION.
1.They identify a specific problem or area of conflict and express desire to reason it out and change.
2. The nurse helps the patient to cope with the present problems.
3. The reason for patient's hospitalization.
4. Identify patient's perception of present problems.
5. Collect the information from the patient himself.
6. The nurse helps the patient to try out new patterns of behaviour.
8. The nurse helps the patient to communicate.
TYPES OF COMMUNICATION
People communicate in various ways there are:-
1.Verbal communication.
2.Written / non verbal
3.Meta communication
1.VERBAL COMMUNICATION:-It involves the spoken word. It is an exchange using the elements of
language. Taken alone verbal communication can convey the factual information accurately and efficiently.
2.NON VERBAL COMMUNICATION:- Nonverbal communication includes everything that doesn't involve
the spoken or written word.
Types of nonverbal behaviors:-
Following are the brief description of five categories of nonverbal communication.
1.Vocal cues or paralinguistic cues
2. Action cues
3. Object cues
4. Space
5. Touch
1. Vocal cues or paralinguistic cues:- Include all nonverbal qualities of speech.e.g. pitch, tone of voice,
loudness or intensity, rate and rhythm of talking, and unrelated nonverbal sounds such as laughing, groaning,
nervous coughing and sounds of hesitation.

2. Action cues:-Are body movements, sometime referred as kinetics. They include automatic reflexes, posture,
facial expression, gestures, mannerisms and actions of any kind.

3.Object cues:-Are the speakers intentional and nonintentional use of all objects.dress, furnishings, and
possessions all communicates something to the observer about the speaker's sense of self.

4.Space:-Provides another nature to the clue to the nature of relationship between two people. The zone of
space includes

1. Intimate space: up to 18 inches. This allows maximum interpersonal sensory stimulation.

2. Personal space: 18 inches to 4 feets used for closed relationship.
3. Social consultative space: 9-12 feets.less personal and less interpersonal.
4. Public space: 12 feets and more. Used in speech giving and other public occasions.
5.Touch:-Involves both personal space and action touch can express a desire to connect with the person as a
way of meeting them or relating to them it can be a conveying something to the person as a way of meeting
them or relating to them.
Methods of nonverbal communication

1.Rapport:- the harmonious feeling experienced by two people who hold one another in mutual respect,
acceptance, and understanding.
2.Empathy :-Empathy is that degree of understanding, which allows one person to experience how, another
feels in a particular situation.
3.Body Language - Remember that actions speak louder than words. A person will generally pay more
attention to what you do than what you say. There are following message of non verbal .
 Facial expressions
 Gestures/mannerisms
 Eye behaviors
 Walk.
 Silence
3.META COMMUNICATION:- It is an implicit but integral part of the message and is an interpersonal
bridge between verbal and nonverbal components communication . It refers to how the message should
understand by the receiver.

ELEMENTS OF COMMUNICATION:-
There are 5 types of component or elements is following:-

SENDER

RECEIVER

MESSAGE

CHANNELS

FEEDBACK

1. SENDER:- It is also called communicator.It is the originator of the message. he must know-his
objectives clearly defined, his audience (its interest and needs), his message, channels of
communication, his professional ability and ties and limitations. The process of getting the purpose
translated into the code is called encoding.

2. RECEIVER:- The receiver is the target of the communication and must be able to understand or
decode the message. This can be a single person or a group.

3. MESSAGE:-A message is the information which the communicator transmits to the receiver, to
receive, understand, accer and act upon. It may be in the form of words, picture signs.

4. CHANNELS OF COMMUNICATION :- By channel is implied the "physical bridges" or the

media of communication between the sender and receiver.Media Systems - the total communication
effort is based on 3 media systems.

a. Interpersonal communication:- the most common channel of communication is the interpersonal

or face to face communication.

b. Mass media:- mass media have the advantage of reaching a relative larger population in a shorter
time than is possible with other means.

c. Folk media :- Every community has its own network of traditional or folk media such as
folkdances, singing dramas etc. These are important channels of communication close to the cultural
values of the rural population.

5.FEEDBACK:- means that the sender and receiver use one another reaction to produce further
messages.

FACTOR AFFECTING COMMUNICATION:- There are many types of factor which is affect the
communication process.

 Time
 Group reaction
  Perception
 Culture
 Distance
 Environment
 Position
 Misunderstanding
 Language
COMMUNICATION WITH INDIVIDUALS AND IN GROUPS:-
COMMUNICATION WITH INDIVIDUAL:-

DEFINITION:- Interpersonal communication is the process by which people exchange information

through verbal and non-verbal messages.
Interpersonal communication skills includes :-
 communication skills
 verbal communication
 assertiveness
 non-verbal communication
 listening skills
FUNCTION OF THE INDIVIDUAL COMMUNICATION:
 Promoting effective coordination.
 Motivating individual own self.
 Creating a supportive working climate.
 Facilitating teamwork and collaboration.
FOUR PRINCIPLES OF INDIVIDUAL COMMUNICATION:-
 It's inescapable
 It's irreversible
 It's complicated
 It's contextual
1.It's Inescapable: You cannot not communicate. Even your body sends a message when you are silent.
2. Its Irreversible: Once you've said something (verbally or non- verbally), it's out there. You can't reword it
or ask to take it back.
3. It's complicated: Words are actually symbols, given different meaning by different people in different
circumstances.
4.It's Contextual: Psychological, cultural, situational, rational and environmental. When and where you
speak will have a bearing on the meaning of your message and how received.
GATEWAYS TO EFFECTIVE INTERPERSONAL COMMUNICATION:-
Tuckman Model And Team 19 Gateways in Effective Interpersonal Communication Effective interpersonal
communication would help make the communication process effortless and smooth.
1. Transparency
2. Clarity In Communication
3. Multiple Channels To Interact
4. Feedback

1) Transparency:- As the leader of the team if you are not transparent m what you do, interpersonal
communication can never be effective.
2) Clarity in communication:- As a leader subordinate or peer you should keep mind that preciseness and
clarity in what you communicate ae important because if you are not clear interpersonal communication
would fail.
3.) Channel:- Channel between message sender & message receiver.
1. Personal presence and action
2. Visual/non-verbal communication
3. Words: person to person, groups
4. Messages in written format
5. Telephone, Fax and e-mail
4) Feedback Clarity in communication:- If the team members are not open to receiving or giving feedback
the team would feel demoralized hampering the interpersonal communication.
TO DEVELOP GOOD INTERPERSONA SKILLS:-
1. Communicate Clearly
2. Beam
3. Practice Active Learning
4. Bearing People Together
5. Resolve Conflict
6 .Maintain Good Emotional Balance
COMMUNICATION IN GROUP
DEFINITION:- Group communication is a mode of communication in an organization, between employers
and employees, and employees in teams/groups.
IMPORTANCE OF GROUP COMMUNICATION
1. Sharing Ideas
2. Solving Problems
3. Democratic Engagement Making Friends
4. Learning About Each Other
5. Developing A Sense Of Group Identity
PURPOSE OF GROUP COMMUNICATION:-
 To share and exchange information and ideas.
 To collect information or feedback on any project/policy/scheme
 To arrive at a decision on important matters
 To solve a problem which is of concern to the organization as a whole
CHARACTERISTICS OF GROUP COMMUNICATION
 Clear purpose
 Open Communication
 Clear Roles and Assignments
 External Resources
 Functional Diversity
 Self Assessment
TYPES OF GROUP COMMUNICATION
1. Small Group Communication
2. Large Group Communication
1.Small Group Communication:-Small group communication refers to interactions among three or
more people who are connected through a common purpose, mutual influence, and a shared
identity.Small group communication often takes place in the workplace when coworkers need to
solve a problem with ideas for a project.
2.Large Group Communication:- Large group communication is a general description for
organizational communication as a communication context describing large numbers of individuals
who are members of a group.
STRUCTURE AND NETWORK OF GROUP COMMUNICATION:-
 Wheel Network
  Chain Network
 Circle Network
 All channel Network
1.Wheel Network: In such network manager plays the vital role to spread information. Here the
primary communication occurs between the members and the group manager and then group
manager shares the information with all. It is the feature of a typical work group.
2. Chain Network: Here each member communicates with the person above and below. It reflects
upward & downward communication and exists in a vertical hierarchy.
3. Circle Network: Here each member communicates with the people on both sides. It is generally
found in case of committee or task force.
4.All Channel Network: Here all members of the group communicate with all other members.

THERAPEUTIC COMMUNICATION TECHNIQUES

1. Listening
2. Broad Openings
3. Questioning
4. Restating
5. Clarification
6. Reflection
7. Focusing
8. Sharing Perception
9. Silence
10. Humour
11. Informing
12. Suggesting
13. Role Playing
1. LISTENING: -
Listening is an active process of receiving information and examining reaction to the
messages received.
It is not simply hearing.
It is essential to reach any understanding of the patient.
It is the first rule of therapeutic-nurse relationship.
The patient should be talking more than the nurse during the interaction.
Listening is sign of respect.
2. BROAD OPENINGS: -
Here the nurse is encouraging the patient to select topics for discussion.
Patient should be welcomed to the communication with warmth and respect.
Patient should feel that nurse is ready to listen.
E.g. What are you thinking about?
Can you tell me more about that?
What shall we discuss today?
Domination of the interaction by the nurse or rejecting the responses by the nurse results in
poor therapeutic relationship.
3. QUESTIONING: -
The nurse skillfully asks open-ended questions during the initial admission.
Interviewing skills are necessary to avoid asking too many personal questions in one session.
Questions should be to achieve relevance and depth.
Eg. Tell me how you feel now?
4. RESTATING
Nurse is repeating of the main thought the patient has expressed.
It also indicates that the nurse is listening.validating, reinforcing or calling attention to what has been
said.
Usually a part of patient's statement is repeated.
When restating patient should not feel the nurse is judgmental or defending.
E.g. "Your mother left you when you were 5 year old?
5. CLARIFICATION:
The nurse makes specific question to help clear up a specific point patient makes by attempting
to put in to words vague ideas or unclear ideas of the patient.
Patient's verbalizations may not be clear when overwhelmed with emotions.
Nothing should be allowed to pass to the patient that nurse does not hear or understand.
e.g. "I am not sure what you mean. Could do tell me about it again?
Failure to probe and assumed understanding result in poor communication.
6. REFLECTION.
By reflection nurse is directing back the patient's ideas feeling, questions or content.
Reflection lets the patient know that the nurse has heard what was said and understand the
content.
Reflection of the feelings let the patient know that the nurse is aware of what the patient is
feeling.
7. FOCUSING: -
Focusing helps the patient expand o a topic of importance and also helps in analyzing in
detail.
It helps the patient talk about life experiences or problem areas and accepts the responsibility
for improving them.
If the goal is to change thoughts, feelings or beliefs, the patient must first identify and down
them.
It allows the patient discuss central issues and keeps the communication goal-directed.
8. SHARING PERCEPTIONS: -
It involves asking the patient to verify the nurse's understanding of what the patient is
thinking or feeling.
For example, nurse is interviewing an alcoholic patient: Patient: My wife and children are so
good.
They love me. But I do not know what happened to me. I can't care them. I can't stop
drinking.
9. SILENCE:-
Here, the nurse use lack of verbal communication for a therapeutic reason.
It allows the patient to think and gain insights.
Silence on the part of nurse has varying effects. Depending on how the patient perceives it
10. HUMOUR-
Humour is basic part of our personality and has a place in therapeutic nurse-patient
relationship.
It is the discharge of energy through the comic enjoyment of imperfect.
It may be helpful with a patient experiencing mild to moderate anxiety.
Humour should be consistent with social and cultural values.
11. INFORMING:-
Informing or giving information is nurse shares simple facts with the patient.
This skill is use in patient education like when to take medication, necessary precautions and
side effects.
"i think you need to know more about your medication works" informing should not fall in to
giving advice
12. SUGGESTING:-
Suggesting is the presentation of alternate ideas. As a therapeutic technique, it is useful
intervention in the working phase of the relationship. Suggesting or giving advice can be
non-therapeutic.
Patient may take nurse's advice and still have an unsuccessful outcome, the patient returns to
blame nurse.
13. CONFRONTATION: -
Confrontation involves anger and aggression. The therapeutic dimension is assertiveness
rather than aggression.
Confrontation is an attempt by the nurse to make the patient aware of incongruence in is or
her feelings, attitudes, beliefs, and behaviors. It may also help in discovery of ambivalent
feelings in the patient.
The nurse must be ready to work with the patient through the crisis after confronting the
patient. With out this commitment the confrontation lack therapeutic potential and may
damage nurse-patient relationship.
14. ROLE PLAYING: -
Role playing involves acting out a particular situation.
It increases patient's insight in to human relations can deepen the ability to see the situation
from another person's point of view. Role playing can be used for attitude change and to
promote self-awareness.
TOUCH THERAPY
DEFINITION:-
Touch is a powerful communication tool. It can elicit both Negative and positive reactions, depending
on the people Involved and the circumstances of the interaction. It is a Very basic and primitive form
of communication and the Appropriateness of its use is culturally determined.
CATEGORIES OF TOUCH
Touch can be categories according to the message communicated;
1. FUNCTIONAL -PROFESSIONAL
2. SOCIAL-POLITE
3. FRIENDSHIP-WARMTH
4. LOVE-INTIMACY 5. SEXUAL-AROUSAL
1. FUNCTIONAL-PROFESSIONAL: This type of touch is impersonal and business. It is used to
accomplish a tasks.
2.SOCIAL-POLITE. This Type Of Type Touch Is Still Rather Impersonal, But It Conveys An
Affirmation Or Acceptance Of The Other Person
3.FRIENDSHIP-WARMTH:- Touch At This Level Indicates A Strong Liking For The Other
Person, A Feeling That He Or She Is Friend.
4.LOVE-INTIMACY: This type of touch conveys an emotional attachment or attraction for
another person.
THERAPY:-
 The therapist uses a light touch or holds his/her han above the body; the client is usually
seated in a massage chair.
  The therapist uses meditation to identify the energy field around a patient's body, and then to
center and strengthen the connection to the patient's energy field using their hands.

 The therapist does this by scanning the body from head to toe.

 Their hands are typically held in a horizontal position, side by side with their thumbs
touching and their palms facing the patient in a butterfly-like shadow.

 Again, there is no direct touch between healer and patient.

 The practitioner will sense the blockages in the body in hot and cold sensations.
Therapeutic touch is considered safe because of its gentle, non-invasive approach.
THE FOLLOWING BENEFITS:
 A sensation of enveloping warmth from the therapist's touch
 A totally relaxed state
 The feeling of vibrations of energy coursing through the entire body
 Intense euphoria and feelings of peace
 A kaleidoscope of color and beautiful light
 An intense sense of clarity, inner peace
BARRIER OF COMMUNICATION WITH SPECIFIC REFERENCES TO
PSYCHOPATHOLOGY:-
Barriers to therapeutic communication
Several common obstacles interfere with effective communication . although these communication
roadblocks interfere with the exchange of ideas, most of them can be overcome.
Language:-
The most prominent communication barrier is language. Many clients speak english as a second
language, and a smaller proportion are hearing impaired or deaf. These groups present nursing
with the greatest challenge. Some agencies have interpreters available to translate important
information.
Cultural considerations:-
Specific cultural considerations can provide important insight into effective communication. For
example, as a result of political religious or ethnic persecution or to obtain better economic or
educational opportunities individuals have left their countries of origin.
Age and development level
Age differences may pose communication problems. With aging can come loss of hearing,
eyesight, or cognition. In addition the elderly hold values that may be different than those of
younger people. Children do not think abstractly and reaching their level of understanding
requires a more concrete approach. In both cases, relating on the clients level is necessary for
understanding.
Level of health:-
An individual with depression may speak little because of the level of illness, and initiating and
maintaining communication may be difficult.
Knowledge level:-
Communication is affected by the amount and kinds of facts the client has at hand. The nurse
assesses the clients fund of knowledge and educational background at the time of admission.
Time:-
Counseling takes time, and the need to hurry blocks communication. Therefore, plan to interview
when neither you nor the patient is pressured. Hectic times to avoid include changes of shift,
visitations, doctors rounds or when other appointments are pending.
Daydreaming or self talk
People speak at a rate of 125 to 150 words a minute. However, they have he ability to listen to
800 words per minute.
The nurses or clients feelings:-
Whenever the nurse or client becomes anxious communication changes. Talking about or
listening to disturbing experiences or information is uncomfortable.

SUMMARY:- Therapeutic communication is a method of communication that helps healthcare

professionals establish a connection with patients to promote their well-being. It's a vital part of
nursing and can be used across multiple disciplines.
Summarizing demonstrates active listening to clients and allows the nurse to verify information.
Ending a discussion with a phrase such as “does that sound correct?” Gives clients explicit
permission to make corrections if they're necessary.
 BIBLIOGRAPHY
1. BHASKARA RAJ D. ELAKKUVANA, DEBR'S MENTAL HEALTH(PSYCHIATRIC) NURSING,
PUBLISHED BY MANJUNATH S. HEGDE PROPRIETOR, EMMESS MEDICAL PUBLISHERS,
FIRST EDITION 2014 FIRST REPRINT 2017, PAGE NO. 219-221.

2.NEERJA KP, ESSENTIAL OF MENTAL HEALTH AND PSYCHIATRIC NURSING, PUBLISHED

BY JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD, FIRST EDITION 2008, PAGE NO. 266-
270.
3.SREEVANI R, A GUIDE TO MENTAL HEALTH & PSYCHIATRIC NURSING, PUBLISHED BY
JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD, FOURTH EDITION 2016, PAGE NO.163-
165.

4.GUPTA RAM KUMAR, A TEXT BOOK OF MENTAL HEALTH NURSING, PUBLISHED BY

JAYPEE MEDICAL PUBLISHERS (P) LTD, PAGE NO. 200-202.

5.TOWNSEND C. MARY, PSYCHIATRIC MENTAL HEALTH NURSING, PUBLISHED BY F.A

DAVIS COMPANY, 9TH EDITION, PAGE NO.903

6 DEBR'S , A TEXT BOOK OF , MENTAL HEALTH NURSING PUBLISHED BY EMMESS

MEDICAL PAGR NO 95-115.
 SUBJECT:- MENTAL HEALTH NURSING
SEMINAR
ON
THERAPEUTIC COMMUNICATION

SUBMITTED TO SUBMITTED BY
MRS. VASHITA PADHIAR MS. REENA SAHU
HOD(ASSOCIATE PROFESSOR) Msc. NURSING 1ST YEAR
MENTAL HEALTH NURSING MENTAL HEALTH NURSING
GOVT. COLLEGE OF NURSING GOVT. COLLEGE OF NURSING
JAGDALPUR(C.G.) JAGDALPUR(C.G.)

HAND OUT