So this is going to be the my first medical instalment. I would like to just say that though I am a healthcare professional, I am not a doctor.
My disciplines are mainly focused in interventions, wound care, pain management, and comfort measures as my specializations are in communication, dementia, and palliative care.
I have cared for people as young as 11 months old, and as old as 103. It is a common misconception that my specific profession - I’m not naming it because it varies from country to country - is that I deal exclusively with the elderly. That is incorrect, most of my palliative patients didn’t live to see 40. My dementia clients were between 50 and 100. My wound care clients were often people who had developed pressure wounds due to another illness that confined them to their bed.
Anyway! That’s enough about me.
What Is Therapeutic Communication?
It is a type of communication that is specifically used in healthcare that is a collection of communication techniques to prioritize the overall well-being of the patient. To focus on their physical, mental, and emotional needs in order to converse effectively and provide essential information. In this method open-ended and clarifying questions are used in addition to redirecting and allowing silence to allow the patient time to work through their thoughts and feelings.
I want to make it very clear that these conversations are not about you. I mean that, you do not matter. This is about your conversation partner. Therapuetic communication is used to encourage people to be authentic in their interactions. Policing their thoughts and language is one thing you NEVER do. Do not use these methods as a way to platform your thoughts and ideas with others. These techniques put people in very vulnerable positions, and they are turning to YOU to be their safe space. Leave your ego at the door. Please.
The Techniques
- Active Listening
I always put this one first, because, to me, it’s the most important. Offering affirmative non-verbal communication such as nods or sounds of agreement, in addtion to showing genuine interest in the conversation encourages the continuation of communication. Peppering in things like ‘and then what happened?’ or ‘that’s very interesting, could you explain a little bit more' or 'I don't follow, could you explain?' People are more likely to talk to you if you show that you are genuinely interested in what they have to say.
- Silence
Occasionally silence is necessary, especially when it comes to difficult topics. In my years working in palliative this is one I reached for a lot. There are no comforting platitudes you can offer someone at end of life - nor should you. Offer them your company, and silence. Hold their hand or touch their shoulder, if they allow, and show them with your actions that you are there for the other person. It gives us an opportunity to work through information and emotion when we take a few breaths to consider quietly. I always allow the individual I’m sharing space with to break the silence. Sometimes, I don’t need to say anything, they just need to let the wheels turn for long enough to run out their emotions, and come to terms with their reality. I am comfortable in silence, I don't need to fill it, and I am perfectly happy to let someone know that I am here for them. With my full attention and focus, and a soft smile of companionship.
- Clarifying
It’s ok to ask for clarification when you don’t understand something. We often speak in a way that may be ambiguous to another person that doesn’t know us intimately. Asking 'what do you mean' or ‘would you mind explaining that to me?’ or 'Could you rephrase that, I think I misunderstood.' It also helps you understand the individual better, and get a more thorough understanding of their thought process and the way in which they communicate. Some may not like to hear this, but its appropriate to adjust your expectations and way in which you communicate out of respect. Especially when you are the one asking them to trust you with their space.
- Recognition
Recognizing an accomplishment without overt praise let’s people know you’re paying attention, and that you are acknowledging their hard work. It encourages someone to continue the correct behaviour without making them feel the pressure to perform.
- Acceptance
It is necessary to acknowledge what another says to you. Not agree, just acknowledge so they know you’re listening to them. Remember that acceptance is not the same as agreement. You can ascent your understanding without agreeing to a viewpoint. Remember, it’s about them, not you. A good example is that I can understand why people get angry about being misgendered, but that doesn't mean that I agree with the behaviour or the way they handle educating others. I can understand it, but I don't agree. Distinctions make the world go round. I know it seems like I am really harping on this, but I have seen the ego get in the way so often that I feel like it really needs to be made clear.
- Offering Self
Offer your time to another builds rapport, and let’s them know that their company is valuable to you. It can be something as simple as sharing space in the same room while you do separate activities. It can be helping them pick out a paint color. It can be anything just make yourself available. If they show interest, then make plans, but its a simple and powerful thing to offer yourself and your time.
- Giving Broad Openings
Conversations work best when one person leads and the other follows the process everything to its natural conclusion. Offering a simple 'what's up?' or 'what's on your mind today?' gives the other person an opening - an offer. This exchange might sound familiar, and many of us respond with 'good, and you?' After millions of these exchanges, we are all very observant of the way people respond. We can generally get a pretty good idea of how they are really doing. This is your opportunity. Don't let it end there. Add to it to allow them to take control of the conversation. 'I'm well, thank you for asking. Had to take the kids to the doctor's this morning! How did you spend your morning?' If your conversation partner really wants to talk about what's on their mind, they will latch onto your verbal 'serve'. Bumping it back with some context for their tone. You'd be surprised how many complete strangers will engage with you when you give them an opening.
- Placing the Event in Time or Sequence
Why? And how does this help me communicate better? Let me give you a personal anecdote. I had a palliative client and they were furious that someone had stolen her watch. I mean this dying woman attained the strength of ten men and hefted a chair across the room. Don't mess with the elderly, I'm telling you. Me being me I walked over to the client and put my hand on her shoulder and said 'where did you see it last?' while the nurse next to me is mouthing 'what are you doing?' and shaking her head. Rage evaporated. Why? I showed compassion. She's pissed off because she's dying and she has lost complete control over her life, and the one thing that she does have control over is when she puts on and takes off her watch by herself. It was the only task she could do by herself - unless she hulked out I guess and threw furniture in a rage. She was scared, devastated, and then furious. I was affirming her feelings by letting her know that I wasn't afraid of her, I didn't care that she got upset, and that I genuinely wanted to correct this. I did all of that by doing 3 things: approached, comforted, and engaged. This is a huge preamble, but it was necessary to make this point. She remembered where the watch was, because she was able to go from 10 to 0, and think clearly about the events of the day. Surprising right?
Intermission
Half-way there! Go get some water.
- Making Observations
I do this constantly. 'I noticed you've been quiet, are you alright?' or 'that looks like it hurts, have you had it looked at?' To some, this may seem confrontational. It's not, you're making an observation. You're not demanding they explain themselves. You're letting them know that you're concerned. Distinctions. They get to choose how they respond to you, but this gives them an opening to reflect and decide what and if they want to disclose something.
- Encouraging Descriptions of Perception
Nothing is worse than having your reality invalidated. It's your reality, and you see the world a specific way. It's who you are. So it's inexcusable to gatekeep reality. This is very specific to hallucinatory symptoms in healthcare, but I feel like we can dig a little more into this one. I say that because the general idea is transferable. I want to understand how my partner sees a situation even if they are objectively wrong about it. That doesn't matter. Leave your hang-ups at the door and your ego in the car. This is their story, and you don't get to decide how they tell it.
- Encouraging Comparisons
This one is pretty straight forward. Comparing one situation to another in conversation can help your conversation partner to gain a better objective understanding of their present situation. Good? Good. Let's continue.
- Summarizing
This works two-fold. First, you are letting the person know that you have been listening. Second, it allows them to correct you or themselves. It is extraordinarily effective in many work situations, and it often prevents the possibility of error. It is much like clarifying an entire timeline much rather than just one point.
- Reflecting
I offer advice on very minor aspects of situations. Stressed out? Here's a grounding technique. Need someone to talk to? I have break in 15 minutes. I do not ever offer advice on large decisions. I will offer advice on how to get to the answer they may want, but I don't tell people what to do. I'll give an example. When you don't know if your partner is mad and you voice this to me, I will ask what makes them think that. Requiring them to reflect on what the root might be, much rather than the sudden emotion. I ask them what they think they should do. What did they do in previous scenarios that might have been similar.
- Focusing
Sometimes people off-handedly mention something, and it raises your eyebrows. You can choose to focus on it if it concerns you. There is nothing wrong with that. Your partner may not realize that it’s an issue they are avoiding. It gently encourages them to confront it for a moment to decide if it’s worth speaking on.
- Confronting
You should only use this technique if you have an established rapport with someone and have their trust. Trust is important, because then they know that your points are coming from a place of caring. It occasionally may be important for the well-being of another to disagree with them, present them with reality, or challenge their assumptions. Confrontation, when used correctly, can help your partner identify and work towards break destructive routines or better understand the reality of their present situation.
- Voicing Doubt
Very different from telling someone they are wrong. It is a gentle course correction when someone is making baseless assumptions because they are living in their emotions. Don’t invalidate, ask them to reevaluate!
- Offering Hope and/or Humour
The value of positivity cannot be overstated. Approaching every and any situation with a level of levity and good humour often helps to alleviate some of the weight of a difficult situation. It’s is a very difficult to apply technique if you haven’t worked in healthcare. That isn’t to toot my own horn, it’s a reality. Most people shy away from difficult situations, and try to say things to make themselves feel better. As a medical professional, you are required to confront those naturally uncomfortable situations all day, every day. You attain a very specific type of humour, and it really does help to make the lives of your patients better. It perpetuates continuous positivity in the face of a difficult situation.
There you have it! I know it was a large read, but I hope that you found this interesting or informative. Let me know if you enjoy this type of content, because I really enjoy doing it.
Freyja 🧚🏻♀️