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Lack of Therapeutic Communication in Mentally Ill Clients

Submitted by on December 17, 2017 – 6:25 PM

psycTherapeutic communication is a process which mainly focuses on emotional, physical and psychological health of a client. Therapeutic communication can also be used to support client and to gather information (Therapeutic Communication and Behavioral Management, 2016).

Therapeutic communication is a face-to-face process in which nurse uses verbal or non-verbal communication.  It also includes specific strategies to help client for better understanding such as to ventilate feelings and to convey respect. (Therapeutic communication, 2016).It also aims to modify behavior, and to provide health education. (Integrated Publishing, 2016).


The main reason of selecting this topic is that I observed this issue in mental health setting. I realized that mentally ill clients don’t need the kind of care which the physically ill clients need except the therapeutic communication which is really important to help them to ventilate their feelings.


I had encountered a patient in one of the psychiatric hospitals, who was suffering from Schizophrenia.  During history, patient verbalized physical symptoms that were not directly linked with mental health.  At this stage proper communicational skill plays a key role to provide effective care to client through verbal and non-verbal gestures.  At this I reflected that there is a lack of communication between nurse and the clients which hinder effective care to the client.


There is also a kind other than therapeutic communication is a non-therapeutic communication which can be a hinder in nurse client relationship it includes:
•       Asking personal questions
•       Giving personal opinions
•       Defensive responses it gives patient the sense that he has no right to give opinion
•       Passive or aggressive responses, these kinds of responses are also the causes of end of relation.
•       Arguing, it might show that patient is lying
•       False reassurance trust cannot be buildup
•       Changing the subject, this can resist the communication.


There are four phases of therapeutic communication
•       Pre-interaction phase: it is the first phase of communication in which nurse collects all the information from the resources.
•       Orientation Phase: it is the phase of first interaction and of building rapport, collecting basic information.
•       Working phase: nurse and client now developing a personal and social relationships. Nurse now encourage patient’s independence
•       Termination Phase: it is the end of nurse client relationship by mutual understanding when nurse feels she have achieved her goals.


BarnLund’s model of transaction consists of two people who are playing the roles of senders and receivers each.  This transaction model is fairly affected by the environment in which communication is taking place for example, the same message cannot be perceived by phone as it is perceived face-to-face.  It is also influenced by the other factors which include values, attitudes, culture, knowledge and etc.


There are some barriers due to which the nurse-client relationship fails.  These barriers includes psychological barrier which further includes personality or disability, whereas physical barrier includes environmental issues or any other impairments.  Social barriers include values, cultures socio-economic status.  Non-verbal gestures are same among countries but the verbal communication differs according to the culture, values traditions and etc.


Therapeutic communication is the process by which the sense of security comes because it allows clients to ventilate their feelings out.  It also improves the client’s emotional conflicts. Impacts of therapeutic communication are it encourages positive interaction, by showing respect, empathy and being non-judgmental are the ways due to which client may express his/her feelings.


Therapeutic communication also allows the patient to be more open related to their symptoms and the difficulties they are facing.  It also helps a nurse to evaluate that whether her client is getting proper treatment. Psychologist John S. Westfield says that empathy is the element which helps a client to develop honesty, self-confidence (Hickson, 2015).   Therapeutic communication aim is to the re-establish the confidence, it also enhances the decision-making ability of the client.


The aim of therapeutic communication is not only to gather information but we also give them education.  Psychotherapist Richard A Singer said that help clients to grow in those areas in which they like to (Hickson, 2015).   If you will impose your idea then there is a chance that therapeutic process may get affected.  Similarly if the client will focus on his/her own areas of interests there is a more likely chance that they will easily cope with their disorder.


The proper therapeutic process helps client to move towards the positive change.  The good communication skills are:
•       Listening: Listening is the most important element for therapeutic communication because when we listen to the client it gives them space to express their feelings.  Many nurses think that listening is not as much but Stevenson said that if nurse is doing nothing and just listening to the client so it will also leave a therapeutic effect. (Stevenson, 2008, p.110).  No doubt it is difficult just to listen actively to the client’s feelings but listening actively makes them feel like they are respected and accepted.
•       Paraphrasing: Paraphrasing is the expressing in our own words what the client had shared.  It is a necessary tool as it shows that the nurse had listened client what he said.  It is also used to clarify and understand the message given by the client.
•       Summarizing: It includes the sum up of the information which client has given.  It is usually longer than the paraphrasing.  It also gives the chance to the client to clarify the misunderstanding and also if they want to add something further.
•       Questioning: A good therapeutic relation always consist of open-ended questions which always starts from “when, what, how, where and who”.  It always invites the full descriptive answers from the clients whereas the close ended questions limits the client’s answer.  Therefore we should ask open-ended questions.
•       Non-verbal communication: Understanding of nonverbal messages or body language also plays an important part in therapeutic relation with mentally ill clients (Carton et al., 1999).   It includes
•       Eye contact (starring, poor eye contact)
•       Facial expressions (smiling, frowning)
•       Voice (tone, volume)
•       Body movement (postures, gestures)
•       Appearance (such as dressing)
•       Physiological changes (rapid breathing, perspiring)


Other than these things the SOLER position is also used for therapeutic space. Egan (2010, p.135)
S: sitting at an appropriate angle while taking interview
O: open posture in which arms and legs should not be crossed
L: leaning forward
E: Eye contact maintained
R: relaxed posture


For the better therapeutic relation nurse should remember the following things:
•       The nurse should have to build trust, rapport for the good therapeutic relation.
•       Using silence
•       active listening
•       Accepting
•       give respect
•       Offering self
•       Focusing
•       exploring
•       Presenting reality
•       Formulating plan of action, escalating when unmanageable stressors. Techniques to reduce anger and anxiety.


In conclusion, as therapeutic communication plays a vital role to assess client problem and help to plan care according to need.  As a health care provider we should be aware between therapeutic and non-therapeutic communication which help to build trustworthy relation among them.  As in my scenario due to improper communication skills which may hinder in diagnose the problem.



  1. Hickson, A. (2015). What Are the Benefits of Therapeutic Communication?
  2. Integrated Publishing, I. (2016). THERAPEUTIC COMMUNICATION
  3. Scholarly Paper: Communication and Therapeutic Nurse-Patient Relationship. (2011). Sa Rah Sheen.
  4. therapeutic communication. (2016).
  5. Therapeutic Communication and Behavioral Management | National Commission on Correctional Health Care. (2016).
  6. Therapeutic Communication in Psychiatric Nursing. (2016).
  7. Townsend, M. (2008). Essentials of psychiatric mental health nursing. Philadelphia: F.A. Davis Co.
    Therapeutic communication. (2013) (7th ed., p. 463).,d.d2s



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