up to you? Also, keep in mind that your patients are individuals; if you sense that a
particular patient may not respond well to a certain technique, you are probably right.
(1) Reflection. Repeating content or feelings. You might simply repeat
what the patient has said, to give him time to mull it over or to encourage him to
respond. Or, and often more effectively, you can reflect on what you think the patient is
feeling. "It sounds like you're concerned about your family." or "I don't think you're very
happy about this." By reflecting on his feelings, you may be encouraging him to talk
about something he may have been hesitant to bring up himself. Or you may be
helping the patient to identify his own feelings about something.
(2) Restating. Rephrasing a question or summarizing a statement. "You're
asking why these tests are needed?" or "In other words, you think you're being treated
like a child."
(3) Facilitation. Occasional brief responses, which encourage the speaker
to continue. A nod of the head; an occasional verbal cue, such as "go on" or "I see;"
and maintaining eye contact throughout the conversation all imply that you are listening
and that you understand.
(4) Open-ended questions. Questions that encourage the patient to
expound on a topic. If you want to encourage the patient to speak freely, you might ask
"How are you feeling?" rather than "Are you in pain?"
(5) Closed-ended questions. Questions, which focus the patient on a
specific topic. If you want a short, straight answer, ask a question which will allow only
for a direct response, such as "When was your accident?" or "Do you have pain after
(6) Silence. A quiet period that allows a patient to gather his thoughts. Of
course, this would be an occasional practice, used when you feel that the patient could
use a little time to think about his response to a question or just to think.
(7) Broad openings. A few words to encourage the patient to further
discuss a topic; for example, "and after that..." or "you were saying..."
(8) Clarification. Statements or questions that verify a patient's concern or
point. "I'm a bit confused about...Do you think you could go over that again please?"
1-17. THERAPEUTIC COMMUNICATION
a. Practicing therapeutic communication is in many ways simply developing a
good bedside manner. When your patient asks you a question or discusses something
with you, be careful to respond in a helpful and caring manner. By encouraging the
patient to speak up, you are probably helping him/her to decrease his level of stress and