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, needs, and
values that he or she acts out mostly unconsciously
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 clien-centered 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 and client are 3 -
6 feet apart”
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 “is there something you'd like to talk
in introducing the topic about?”
“where would you like to begin?”
Consensua validation -------Searching for mutual “tell me whether my understanding of it
understanding, for accord in the meaning of the words agrees with yours”
“Are you using this word to convey that..?”
Encouraging description of perceptions -------- asking the “Tell me when you feel anxious”
client to verbalize what he or she perceives “what is happening?”
“”what does voice seem to be saying?”
 Cont.........
Therapeutic Communication technique
Encouraging comparison ------ asking that similarities and
differences be noted
Encouraging expression ------- asking the client to appraise the
quality of his or her experiences
Exploring ------- delving further into a subject or an idea
Focusing ------ Concentrating on a single point
Formulating a plan of action ------ asking the client to consider
kinds of behavior likely to be appropriate in future situations
Examples
“what it something like...?”
“have you had similar exeriencees?”
“What are you feelings in regard to...?”
Does this contribute to your distress?”
“Tell me about that”
“Would you describe it more fully”
“What kind of works”
“This point seems worth looking at more closely”
“of all the concerns ypu've mentioned, which is
most troublesome?”
“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 “Good morning. Mr.S...”
awaraness “You've finished your list of things to do”
“I notice that you've combed your hair”
Making observations ----- verbalizing what the nurse “”You appear tense”
perceives “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 “what seemed to lead up to...?”
relationship of events in time “Was this before or after..?”
“When did this happen?”
Cont.....
Therapeutic Communication technique
Presenting reality ----offering for consideration that
which is real
Reflecting ----directing client actions, thoughts, and
feelings back to client
Restating ----- repeating the main idea expressed
Seeking information ----- seeking to make clear that
which is not meaningful or that which is vague
Silence------- absence of verbal communication, which
provides time for the client to put thoughts or feelings
into words, to reganin composure, or to continue talking
Examples
“I see no one else in the room”
“That sound was a car backfiring”
“your mother is not here, i am a nurse”
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?”
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
“i'm not sure that i follow”
“have i need you correctly”
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 “perhaps you and i can discuss and discover the
work with the client for his or her benefit triggers for you anxiety”
Summarizing ---organizing and summing up that which has gone “have i got this straight?”
before “you've said that...”
Translating into feelings ------ seeking to verbalize client's feelings Client: “i'm dead”
that he or she expresses only indrectly Nurse: “are you suggesting that you feel lifeless?”
Verbalizing the ilmplied ---- voicing what the client has hinted at Client: “ i can't talk to you or anyone, it's waste of
or suggesting time”
Nurse:” do you feel that no one understands?”
Voicing doubt ------ expressing incertainty about the reality of the “isn;t that unusual?”
client's perceptions “Really?”
That's hard to believe.”
Avoiding Nontherapeutic Communication
Technique
Advising ----- telling the client what to do
Agreeing ------ indicating accord with the client
Belittling feelings expressed ------- misjudging the
degree of the client's discomfort
Challenging ------ demanding proof from the client
Defending ------- attempting to protect someone or
something from verbal attack
Examples
“i think you should...”
“why don't you....”
“that's right”
“i agree”
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”
“but how can you be president of the united states?”
“if you're dead, why is your heart beating?”
“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 “that's bad”
ideas
Giving approval -------sanctioning the client's behavior or “that's good”
ideas

Giving literal responses -------responding to figurative
comment as though it were a statement of fact
Indicating the existance of an external source ------
attributing the source of thoughts, feelings, and behavior
to others or to outside influences
Client: “they're looking in my head with a television
camera”
Nurse:” try not to watch television” or “ what channel?”
“what makes you say that?”

Interpreting ----- asking to make conscious that which is “what you really mean is....”
unconscious; telling the client the meaning of his or her
experience
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 “it's for your own good”
cliches or trite comments
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 “i wouldn't worry anout that”
other feelings of discomfort
Rejecting ------refusing to consider or showing contempt for “let's not discuss....”
the client's ideas or behaviors
Requesting an explanation -----asking the client to provide “why do you think that?”
reasons for thoughts, feelings, behaviors, events
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 boyfriend”
(encouraging description) “how old were you when you had this boyfriend?” (Placing events
in time or sequeces)
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