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“If you want peace, you don’t talk to your friends. You talk to your enemies.”

–Desmond Tutu


  • Explore the therapeutic communication cycle

  • Distinguish between verbal and nonverbal communication

  • Explore communication contexts

  • Identify criteria for successful communication

  • Explore fundamental elements of communication

  • Discuss therapeutic communication techniques

  • Explore ways to establish trust and therapeutic rapport

  • Examine therapeutic interdisciplinary team communication

Noted psychiatrist Jurgen Ruesch proposed that communication could be defined as all processes by which one human being influences another (Kneisl & Trigoboff, 2009). He proposed further that communication is necessary for human survival. According to Ruesch, communication exists in many forms, both verbal and nonverbal. Communication is also one of the most difficult skills to master. It can take a lifetime of practice to perfect the skill of successful communication.

Therapeutic communication is defined more specifically as the set of communication techniques used by caregivers to focus on a patient’s needs and to promote the continuous process of healing and change (Townsend, 2015).

Research indicates that therapeutic communication can reduce depressive symptoms and promote the emotional healing process (Curtis et al., 2016). Therapeutic communication can also foster increased insight and improved feelings of self-worth. Finally, therapeutic communication is the central element of the de-escalation techniques used to calm agitated patients and prevent violence (Lavelle et al., 2016). It uses holistic concepts of mental health, wellness, and recovery.

Therapeutic communication involves several key goals. One of these goals is to encourage verbalization to promote emotional equilibrium and inner peace. Another is to encourage problem-solving and enable decision-making for patient-centered care (Sheldon, 2005). Yet another is to facilitate a therapeutic nurse-patient relationship. This promotes optimal recovery outcomes.


Research indicates that a significant number of inpatient violence incidents are triggered by poor communication skills among staff (Lanza, Kayne, Hicks, & Milner, 1991). The core of de-escalation training is developing good therapeutic communication skills to promote cooperation and avoid events that trigger violence. Using therapeutic communication skills can help nurses prevent patients from becoming agitated in the first place, thereby reducing the risk of inpatient violence.

Figure 5.1 illustrates the communication cycle. This cycle begins with an individual forming an idea. The idea is then “encoded,” or placed into words, and transmitted in the form of a message to another person. This second person receives the message and interprets its content. The person then replies to the message with feedback, which prompts the formation of new ideas, thus beginning the cycle anew. This same cycle applies for therapeutic communication. The difference is that therapeutic communication specifically involves communicating in a respectful, gentle, and less provocative manner—in effect speaking to the patient using kindness, courtesy, and respect to prevent or defuse the escalation cycle. It is not so much what the nurse says as how the ...

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