THERAPEUTIC

COMMUNICATION
By:

Rika Sarfika, S.Kep., Ners, M.Kep

Bagian Keperawatan Jiwa Komunitas
FKep UNAND Padang

Learning Objectives
Menjelaskan tujuan komunikasi terapeutik
Mengidentifikasi keterampilan komunikasi verbal terapeutik dan
nonterapeutik
Mendiskusikan keterampilan komunikasi non verbal seperti
ekspresi wajah, body languange, intonasi suara, eye contact, dan
memahami makna dan kontek tingkat komunikasi
Discuss boundaries in therapeutic communication with respect to
distance and use of touch
Distinguish between concrete and abstract messages
Given a hypothetical situation, select an effective therapeutic
response to the client

Konsep Dasar
Communication is the process that people use to exchange
information
Messages are simultaneously sent and received on two levels:
verbally through the use words and nonverbally by behaviors
that accompany the words (Devito, 2013)
Verbal communication consists of the words of person uses to
speak to one or more listeners. content is the literal words that a
person speaks. Context is the environment in which
communication occurs and can include the time and the physical,
social, emotional, and cultural environments. context includes
the situation or circumstances that clarify the meaning of the
content of the message
Non verbal communication is the behavior that accompanies
verbal content such as body language, eye contact, facial
expression, tone of voice, speed and hesitations in speech,
grunts and groans, and distance from the listeners. Non verbal
communication can indicate the speaker's thoughts, feelings,

Cont.....
Process denotes all nonverbal messages that the speaker uses to give
meaning and context to the message. the process component of
communication requires the listeners to observe the behaviors and sounds
that accent the words and to interpret the speaker's nonverbal behaviors
to assess whether they agree or disagree with the verbal content
A congruent massage is conveyed when content and process agree. ex: if
the client says i know i haven't been myself. i need help. ekspresi
wajahnya menunjukkan kesedihan, asli dan nada yang tulus
incongruent message when what the speker says and what he or she
does do not agree. contoh: if the client says i'm here to go help, but has
a rigid posture, clenched fist, and a agitated and frowning facial
expression and snarls the words through clenched teeth, the messages is
incongruent ------------------ the process or observed behavior invalidates
what the speaker says (content)
Non verbal process represents a more accurate message than does verbal
content.

What is the therapeutic

communication???
Therapeutic communication is an interpersonal
interaction between the nurse and the client during
which the nurse focuses on the client's specific needs to
promote an effective exchange of information (Videbeck,
2014).

Komunikasi Terapetik membantu perawat

dalam mencapai tujuan:
Membentuk hubungan terapeutik perawat-klien
Mengidentifikasi masalah yang dialami klien pada saat itu (the cliencentered goal)
Mengkaji persepsi klien terhadap masalah yang dialaminya, termasuk
tindakan yang dilakukan (perilaku dan pesan) dari orang yang terlibat dan
pikiran klien dan perasaan tentang situasi, orang lain, dan diri sendiri
Memfasilitasi ekspresi dari emosi klien
Melatih klien dan keluarga keterampilan yang dibutuhkan klien
Mengenali kebutuhan klien
Mengimplementasikan rencana intervensi untuk memenuhi kebutuhan klien
Memandu klien untuk mengidentifikasi rencana tindakan terhadap harapan
kepuasan dan penerimaan sosial

Privacy dan Respecting boudaries

Privasi diperlukan tapi tidak selalu diterapkan dalam komunikasi terapeutik
(ex: setting room)
Proxemics is the study of distance zones between people during
commnuication. People from the US, Canada, and many Eastern European
nations generally observe four distance zones
1. Intimate zone (0 - 18 inches between people): this amount of space is
comfortable for parents with young children, people who mutually desire
personal contact, or people whispering. invasion of this intimate zone by
anyone else is threatening and produces anxiety
2. Personal zone (18-36 inches): between family and friends
3. Social zone (4 - 12 feet): Social, work, and business settings
4. Public zone (12 - 25 feet): between a speaker and an audience, small
group, and other informal function
the therapeutic communication interaction is most comfortable when nurse

Touch
As intimacy increase, the need for distance decrease.
Knapp (1980) identified five types of touch:
1. functional-professional touch --------digunakan dalam
pemeriksaan atau prosedur, spt mengkaji turgor kulit atau
tukang pijat melakukan pijat
2. social-polite touch -------- digunakan dalam salam, spt jabat
tangan atau air kisses
3. friendship-warmth touch ----------- melibatkan salam pelukan,
menepuk bahu
4. love-intimacy touch -------------- meliputi pelukan erat dan
kisses antara lovers atau kerabat dekat
5. sexual-arousal touch ------------- digunakan oleh lovers

Active learning and observation

Active learning adalah menahan diri dari aktivitas
mental klien dan fokus pada apa yang dikatakan klien
Active observation adalah memperhatikan tindakan
nonverbal klien ketika berkomunikasi dengan nya

Verbal Communication Skills

Using concrete messages
Using therapeutic communication techniques

Concrete Message
When speaking to the client, the nurse should use words that are as
clear as possible so that the client can understand the massage
Anxious people lose cognitive processing skills ---- the higher the
anxiety, the less the ability to process concepts -----so concrete
massage are important for accurate information exchange
In a concrete massage, the words are explicit and need to
interpretation; the speaker uses nouns instead of pronouns
Concrete questions are clear, direct, and easy to understand
Example:
What health symptoms caused you to come to the hospital today?
When was the last time you took your antidepressant medications?

Abstract Messages
Are unclear patterns of words that often contain figures
of speech that are difficult to interpret ------- they require
the listener to interpret what the speaker is asking
Example:
a nurse who wants to know why a client was admitted to the
unit asks, how did you get here? ----------- the terms how
and here are vague
An anxious client might not be aware of where he or she is
and might reply where am i? or might interpret this as a
question about how he or she was conveyed to the hospital
and respond

Contoh pesan abstrak (tidak

jelas)
Get the stuff from him.

Your clinical performance has

to improve

Contoh pesan konkrit (Jelas)

John will be home today at
5pm, and you can pick up your
bclothes at that time
To administer medications
tomorrow , you'll have to be
able to calculate dosages
correctly by the end of today's
class

Therapeutic cummunication technique

Therapeutic communication
technique

Examples

Accepting --- indicating reception

yes
i follow what you said

Broad opening ----allowing the client to take

the initiative in introducing the topic

is there something you'd like to

talk about?
where would you like to begin?

Consensua validation -------Searching for

mutual understanding, for accord in the
meaning of the words

tell me whether my
understanding of it agrees with
yours
Are you using this word to convey
that..?

Encouraging description of perceptions

-------- asking the client to verbalize what he or
she perceives

Tell me when you feel anxious

what is happening?
what does voice seem to be

Cont.........
Therapeutic Communication technique

Examples

Encouraging comparison ------ asking that

similarities and differences be noted

what it something like...?

have you had similar exeriencees?

Encouraging expression ------- asking the client to

appraise the quality of his or her experiences

What are you feelings in regard to...?

Does this contribute to your distress?

Exploring ------- delving further into a subject or an

idea

Tell me about that

Would you describe it more fully
What kind of works

Focusing ------ Concentrating on a single point

This point seems worth looking at more

closely
of all the concerns ypu've mentioned,
which is most troublesome?

Formulating a plan of action ------ asking the

client to consider kinds of behavior likely to be
appropriate in future situations

what could you do let your anger out

harmlessly?
next time this comes up, what might
youd do to handle it?

Cont....
Therapeutic Communication
Technique

Examples

General ------ giving encouragement to continue

Go on
and then?
Tell me abot it

Giving information ----- acknowledging, indicating

awaraness

Good morning. Mr.S...

You've finished your list of things to
do
I notice that you've combed your
hair

Making observations ----- verbalizing what the

nurse perceives

You appear tense

Are you uncomfortable when...?
I notice that you've biting your lip

Offering self ----- making one self available

i'll sit with you awhile

i'll stay here with you
i'm interested in what you think

Placing event in time or sequence ------ clarifyng

the relationship of events in time

what seemed to lead up to...?

Was this before or after..?

Cont.....
Therapeutic Communication
technique

Examples

Presenting reality ----offering for consideration

that which is real

I see no one else in the room

That sound was a car backfiring
your mother is not here, i am a nurse

Reflecting ----directing client actions, thoughts,

and feelings back to client

Clien: Do you think i should tell the

doctor..?
Nurse : do you think you should..?
Cleint : my brother spends all my money
and then has nerve to ask for more.
Nurse:This causes you ti feel angry?

Restating ----- repeating the main idea expressed

Clien : i can't sleep. i stay awake all night

Nurse: you have difficulty sleeping
Client:i,m really mad, i'm really upset
Nurse:you've really mad and upset

Seeking information ----- seeking to make clear

i'm not sure that i follow
that which is not meaningful or that which is vague have i need you correctly
Silence------- absence of verbal communication,
which provides time for the client to put thoughts
or feelings into words, to reganin composure, or to

Nurse says nothing but continues to

maintain eye contact and conveys interest

Cont.....
Therapeutic Communication
technique

Examples

Suggesting collaboration ---- offering to share, to

strive, and to work with the client for his or her
benefit

perhaps you and i can discuss and

discover the triggers for you anxiety

Summarizing ---organizing and summing up that

which has gone before

have i got this straight?

you've said that...

Translating into feelings ------ seeking to verbalize

client's feelings that he or she expresses only
indrectly

Client: i'm dead

Nurse: are you suggesting that you feel
lifeless?

Verbalizing the ilmplied ---- voicing what the client Client: i can't talk to you or anyone, it's
has hinted at or suggesting
waste of time
Nurse: do you feel that no one
understands?
Voicing doubt ------ expressing incertainty about the isn;t that unusual?
reality of the client's perceptions
Really?
That's hard to believe.

Avoiding Nontherapeutic Communication

Technique

Examples

Advising ----- telling the client what to do

i think you should...

why don't you....

Agreeing ------ indicating accord with the

client

that's right
i agree

Belittling feelings expressed ------misjudging the degree of the client's

discomfort

Client : i hve nothing to live for ..... i wish i

was dead
Nurse: everybody gets down in the dumps,
or i've felt that way my self

Challenging ------ demanding proof from

the client

but how can you be president of the united

states?
if you're dead, why is your heart beating?

Defending ------- attempting to protect

someone or something from verbal attack

this hospital has a fine reputation

i'm sure your doctor has your best
interests in mind

cont.......
Technique

Examples

Disagreeing ----- opposing the client's ideas

that's wrong

Disapproving ------denouncing the client's

behavior or ideas

that's bad

Giving approval -------sanctioning the client's

behavior or ideas

that's good

Giving literal responses -------responding to

figurative comment as though it were a
statement of fact

Client: they're looking in my head with a

television camera
Nurse: try not to watch television or what
channel?

Indicating the existance of an external

source ------attributing the source of thoughts,
feelings, and behavior to others or to outside
influences

what makes you say that?

Interpreting ----- asking to make conscious

that which is unconscious; telling the client the
meaning of his or her experience

what you really mean is....

Cont....

Technique

Examples

Introducing an unrelated topic ----changing the subject

client : i'd like to die.

nurse:did you have visitors last evening?

Making stereotyped comments ----- offering

meaningless cliches or trite comments

it's for your own good

Probing ------ persistent questioning of the

client

now tell me about this problem. you know i

have to find out

Reassuring ------- indicating there is no reason

for anxiety or other feelings of discomfort

i wouldn't worry anout that

Rejecting ------refusing to consider or showing

contempt for the client's ideas or behaviors

let's not discuss....

Requesting an explanation -----asking the

client to provide reasons for thoughts, feelings,
behaviors, events

why do you think that?

Testing ------appraising the client's degree of

insight

do you know what kind of hospital this is?

Using denial -----refusing to admit that a

problem exists

client: i'm nothing

nurse:of course you're something
---everybody's something

Interpreting Signals or Cues

To understand what a client means, the nurse watches and listens carefully for
cues
Cues (overt and convert) are verbal or nonverbal messages that signal key
words or issues for the client
Finding cues is a function of active listening
Cues can be buried in what clients says or can be acted out in the process of
communication
Often, cue words introduced by the client can help the nurse to know what to
ask next or how to respond to the client
The nurse builds his or her responses on these cue words or concepts
Understanding this can relieve presure on students who are worried and
anxious about what question to ask next
Example:
Client: i'had a boyfriend when i was younger
Nurse: you had a boyfriend? (reflecting) tell me about you and your

Nonverbal Communication Skills

Facial Expression ----- expressive , impassive dan
confusing
Body Language ------ gesture, posture, movemennt,
and body positions
Vocal Cues ------ voice volume, tone pitch, intensity,
emphasis, speed and pauses augment the sender's
messages
Eye Contact ----- humor, interest, puzzlement, hatred,
happiness, sadness, horror, warning, and pleading
Silence

Understanding the Meaning of Communication

Understanding context
Understanding spirituality
Cultural considerations

Thank You