Therapeutic Communication
What helps, what blocks, and defense mechanisms
Therapeutic techniques
| Open-ended questions | "What has been on your mind today?" |
| Broad openings | "Where would you like to start?" |
| Restating / reflecting | "You feel angry that no one visits." |
| Clarifying | "I'm not sure I follow. Can you tell me more?" |
| Focusing | "Let's talk more about the argument." |
| Offering self | "I'll sit with you for a while." |
| Silence | Gives time to think and feel |
| Presenting reality | "I don't hear voices, but I can see you're frightened." |
| Summarizing | "Today we talked about…" |
Communication blocks (avoid)
| False reassurance | "Don't worry, everything will be fine." |
| Asking "why" | "Why did you do that?" (sounds judgmental) |
| Giving advice | "If I were you, I'd…" |
| Approval / disapproval | "That's good." / "You shouldn't feel that way." |
| Changing the subject | Moving away from the patient's feelings |
| Minimizing | "Everyone feels that way sometimes." |
| Defending | "The doctor is very good; she wouldn't do that." |
| Closed or yes/no questions | Use only when you need specific facts (e.g., suicide risk) |
On exams, the best answer usually acknowledges feelings and invites the patient to say more.
The nurse–patient relationship (Peplau)
- Orientation: build trust, set the contract (time, purpose), explain confidentiality and its limits (danger to self or others), plan for the ending.
- Working: explore problems, practice coping skills.
- Termination: review progress, discuss feelings about ending. Begin preparing from day one.
- Boundaries: no personal relationships, gifts, or sharing personal problems; therapeutic self-disclosure only if it helps the patient.
Defense mechanisms
| Denial | Refusing to accept reality |
| Projection | Blaming others for your own feelings |
| Displacement | Taking feelings out on a safer target |
| Rationalization | Giving acceptable excuses |
| Regression | Returning to earlier behavior |
| Repression / suppression | Unconscious / conscious pushing away of thoughts |
| Reaction formation | Acting the opposite of what you feel |
| Sublimation | Channeling impulses into acceptable activity (healthy) |
| Intellectualization | Focusing on facts to avoid feelings |
Memory hook
Suppression is sure (conscious, chosen). Repression is removed from awareness (unconscious). Displacement: the boss yells at you, you yell at the dog.