Non-therapeutic techniques

Non-therapeutic techniques

Defending

“No one here would lie to you.”

“You have a very capable physician.  I’m sure he only has your best interests in mind.”

Correction: “I will try to answer your questions and clarify some issues regarding your treatment.”

1. Attempting to protect someone or something from verbal attack.

2. To defend what the client has criticized is to imply that he or she has no right to express ideas, opinions, or feelings.

3. Defending does not change the client’s feelings and may cause the client to think the nurse is taking sides with those being criticized and against the client.

Requesting an explanation

“Why do you think that?”

“Why do you feel this way?”

“Why did you do that?”

Correction: “Describe what you were feeling just before that happened.”

1. Asking the client to provide the reason for thoughts, feelings, behavior, and events. 

2. Asking “why” a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.

Indicating the existence of an external source of power

Client: “I have nothing to live for.  I wish I were dead.”

Nurs: “Everybody gets down in the dumps at times.  I feel that way myself sometimes.”

Correction: “You must be very upset. Tell me what you are feeling right now.”

1. Attributing the source of thoughts, feelings, and behavior to others or to outside influences.

2. This encourages the client to project blame for his or her thoughts or behaviors upon others rather than accepting the responsibility personally.

Belittling feelings expressed

“I’m fine, and how are you?”

“Hang in there.  It’s for your own good.”

“Keep your chin up.”

Correction: “The therapy must be difficult for you at times.  How do you feel about your progress at this point?”

1. When the nurse misjudges the degree of the client’s discomfort, lack of empathy and understanding may be conveyed.

2. The nurse may tell the client to “perk up” or “snap out of it.”  This causes the client to feel insignificant or unimportant. 

3. When one is experiencing discomfort, it is no relief to hear that others are or have been in similar situations.

Making stereotyped comments

1. Clichés and trite expressions are meaningless in a nurse-client relationship. 

2. For the nurse to make empty conversation is to encourage a like response from the client.

Using denial

Clients: “I’m nothing.”

Nurs: “Of course you’re something.  Everybody is somebody.”

Correction: “You’re feeling like no one cares about you right now.” (a form of making an observation, making the person feel acknowledged)

When the nurse denies that a problem exists, he or she blocks discussion with the client and avoids helping the client identify and explore areas of difficulty.

Interpreting

“What you really mean is . . .”

“Unconsciously you’re saying . . .”

With this technique the therapist seeks to make conscious that which is unconscious, to tell the client the meaning of his experience.

Correction: The nurse must leave interpretation of the client’s behavior to the psychiatrist.  The nurse has not been prepared to perform this technique, and in attempting to do so, may endanger other nursing roles with the client.

Introducing an unrelated topic

Client: I don’t have anything to live for.”

Nurs: “Did you have visitors this weekend?”

1. Changing the subject causes the nurse to take over the direction of the discussion. 

2. This may occur in order to get to something that the nurse wants to discuss with the client or get away from a topic that he or she would prefer not to discuss.

Correction: The nurse must remain open and free to hear the client, to take all that is being conveyed, both verbally and nonverbally.