Editing Mental Health and Psychosocial Nursing (section)

== Therapeutic Communication ==

=== Core Techniques ===
{| class="wikitable"
! Technique !! Example
|-
| Open-ended questioning || "Tell me what has been happening at home."
|-
| Broad opening || "Where would you like to begin today?"
|-
| Reflecting || "You feel angry when your family visits."
|-
| Restating || Client: "I can't sleep." Nurse: "You are having trouble sleeping."
|-
| Clarifying || "I'm not sure I follow. Can you give me an example?"
|-
| Exploring || "Tell me more about that argument."
|-
| Focusing || "You mentioned your son. Let's stay with that."
|-
| Silence || Allows the client to organize thoughts; sit attentively and wait.
|-
| Offering self || "I will sit with you for a while."
|-
| Making observations || "You are pacing and clenching your fists."
|-
| Presenting reality || "I do not hear the voices, but I understand they are frightening to you."
|-
| Seeking consensual validation || "Tell me what you mean when you say you feel empty."
|-
| Voicing doubt || "That is hard for me to imagine. It seems unlikely to me."
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| Verbalizing the implied || Client: "It's useless to talk." Nurse: "Are you feeling that no one understands?"
|-
| Summarizing || "So far we have talked about your sleep and your job. Is that right?"
|}

=== Nontherapeutic Responses ===
These block communication and are almost always the wrong NCLEX answer.
* '''False reassurance''': "Everything will be fine." Dismisses feeling and closes the topic.
* '''Giving advice''': "If I were you, I would leave him." Removes autonomy.
* '''Approval or disapproval''': "That was a good decision." Makes the client dependent on the nurse's judgment.
* '''Asking "why"''': Demands justification and provokes defensiveness. Use "what" and "how" instead.
* '''Changing the subject''' and '''minimizing''': "Let's talk about something happier." "Other people have it worse."
* '''Defending''' staff or the institution, '''challenging''' a delusion with logic, and '''requesting explanations''' the client cannot give.
* '''Closed-ended questions''' when exploration is needed, and '''stereotyped comments''' such as "Keep your chin up."

=== Test-Taking Application ===
On both licensure exams, the best therapeutic response usually:
# Stays with the client's feeling rather than the content of the story.
# Is open-ended and invites the client to continue.
# Does not reassure, advise, judge, or redirect.
# Is honest, including when the honest statement is "I do not share that experience."

Exception: when the stem contains a physical safety issue, an airway or hemodynamic problem, a suicidal plan with means, or escalating violence, safety outranks exploration. Answer the safety need first.

=== Communication Across Culture and Ability ===
Use professional interpreters, not family members, for clients with limited English proficiency. Address the client, not the interpreter. Recognize that eye contact, personal space, expression of pain, and openness about mental illness vary widely by culture; assess rather than assume. For clients who are deaf, provide a qualified sign language interpreter. For clients with aphasia or cognitive impairment, use short sentences, one idea at a time, and allow extra processing time.