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Therapeutic Communication - Psychiatric Intervention

Therapeutic Communication involves the giving and receiving of information, and thus includes three elements: the sender, the message, and the receiver. The sender prepares or creates a message when a need occurs and sends the message to a receiver or listener, who then decodes it. The receiver may then return a message or feedback to the initiator of the message.

The therapeutic relationship is not concerned with the skills of the mental health professional but rather the attitudes and the relationship between the mental health professional and the client. This relationship comes out of the creation of a safe environment, conducive to communication and trust.

Core Elements of a Therapeutic Relationship
■ Communication/rapport – It is important to establish a connection before a relationship can develop. Encouraging the client to speak, using open-ended questions, is helpful. Asking general (not personal) questions can relax the client in an initial session. It is important to project a caring, nonjudgmental attitude.
■ Trust – A core element of a therapeutic relationship is trust. Many clients have experienced disappointment and unstable, even abusive relationships. Trust develops over time and remains part of the process. Without trust, a therapeutic relationship is not possible. Other important elements are confidentiality, setting boundaries, consistency.
■ Dignity/Respect – Many clients have been abused and humiliated and have low self-esteem. If treated with dignity through the therapeutic relationship, clients can learn to regain their dignity.
■ Empathy – Empathy is not sympathy (caught up in client’s feelings) but is, rather, open to understanding the “client’s perceptions” and helps the client understand these better through therapeutic exploration.
■ Genuineness – In some way genuineness relates to trust because it says to the client: I am honest and I am a real person. Again, it will allow the client to get in touch with her/his “real” feelings and to learn from and grow from the
relationship.

Therapeutic Communication Techniques
1. Reflecting - Reflects back to clients their emotions, using their own words. Example: C: John never helps with the housework. MHP: You’re angry that John doesn’t help.

2. Silence - Allows client to explore all thoughts/feelings; prevents cutting conversation at a critical point or missing something important. Example: Professional nods with some vocal cues from time to time so client knows MHP is listening, but does not interject.

3. Paraphrasing - Restating using different words to assure you have understood the client; helps clarify. Example: C: My grandkids are coming over today and I don’t feel well. MHP: Your grandkids are coming over, but you wish they weren’t, because you are not well. Is that what you are saying?

4. Making observations - Helps client recognize feelings he/she may not be aware of and connect with behaviors. Example: MHP: Every time we talk about your father you become very sad.

5. Open-ended/broad questions - Encourages client to take responsibility for direction of session; avoids yes/no responses. Example: MHP: What would you like to deal with in this session?

6. Encouragement - Encourages client to continue. Example: MHP: Tell me more… uh huh…and then?

7. Reframing - Presenting same information from another perspective (more positive). Example: C: I lost my keys, couldn’t find the report, and barely made it in time to turn my report in. MHP: In spite of all that, you did turn your report in.

8. Challenging idea/belief system - Break through denial or fixed belief. Always done with a question.. Example: MHP: Who told you that you were incompetent? Where did you get the idea that you can’t say no?

9. Recognizing change/recognition - Reinforces interest in client and positive reinforcement (this is not a compliment). Example: MHP: I noticed that you were able to start our session today rather than just sit there.

10. Clarification - Assures that MHP did not misunderstand; encourages further exploration. Example: MHP: This is what I thought you said…; is that correct?
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