Silence
Sitting quietly (or walking with the client) and waiting attentively until the client is able to put thoughts and feelings into words)
General Leads
“Perhaps you would like to talk about…”
“Would it help to discuss your feelings?”
“Where would you like to begin?”
“And then...what?”
“I follow what you are saying.”
Broad Openings
“I’d like to hear more about that.”
“Tell me about...”
“How have you been feeling lately?”
“What brought you to the hospital?”
“What is your opinion?”
“You said you were frightened yesterday. How do you feel now?”
Restating or Paraphrasing
Client: “I couldn’t manage to eat any dinner last night- not even the dessert.”
Nurse: ‘You had difficulty eating yesterday.”
Client: “Yes, I was very upset after my family left.”
Seeking Clarification
“I’m not sure that I understand what you mean.”
“Would you please say that again?”
“Tell me more about that.”
• Nurses can also clarify their own message with statements.
“I meant this rather than that.”
“I guess I didn’t make that clear- I’ll go over it again.”
Consensual Validation
Client: “My husband never gives me any presents.”
Nurse: “You mean he has never given you a present for your birthday or Christmas?”
Client: “Well-not never. He does get me something for my birthday and Christmas, but he never thinks of giving me anything any other time.”
Suggesting Collaboration
“Do you want us to help…together we’ll look for a solution”
Offering Self
“I’ll stay with you until your daughter arrives.”
“We can sit here quietly for a while; we don’t need to talk unless you would like to.”
“I’ll help you dress to go home.”
Emphaty
“Its no easy being a father of nine children”
Voicing Doubt
“I find it difficult to see that there is a person under your bed.”
Giving Information
“Your therapy is scheduled for 11 AM tomorrow.”
“You may experience nausea after taking this medication.”
“I do not know the answer to that, but I will find out from Mrs. King, the nurse in charge.”
Giving Recognition
“You trimmed your beard and mustache and washed your hair.”
“I notice you keep squinting your eyes. Are you having difficulty seeing?”
“You walked twice as far today with your walker.”
Placing Event in Time or Sequence
Client: “I vomited this morning.”
Nurse: “Was that after breakfast?”
Client: “I feel that I have been here for weeks.”
Nurse: “You were admitted to the unit on Monday, and today is Tuesday.”
Presenting Reality
“That telephone ring came from the program on television.”
“That’s not a dead mouse in the corner; it is a discarded washcloth.”
“Your magazine is here in the drawer. It has not been stolen.”
Focusing
Client: “My wife says she will look after me, but I don’t think she can, with the children to take care off, and they’re always after her about something- clothes, homework, what’s for dinner that night.”
Nurse: “You are worried about how well she can manage.”
Reflecting
Client: “What can I do?”
Nurse: What do think would be helpful?”
Client: Do you think I should tell my husband?
Nurse: You seem unsure about telling your husband.”
Summarizing
“During the past half hour we have talked about...”
Planning
“Tomorrow afternoon we may explore this further.”
“In a few days, I’ll review the actions and effects of lithium.”
Role Playing
Nurse: “I’ll be your father, show me how would you confront me the next time I scold you”
Rehearsing
“Supposing you were left at home alone again, what would you do?
Identifying Themes
“When do you feel that there are other people in the room aside from me?”
Exploring
“Tell me more about your friends.”
Encouraging Goal Setting
“Tell me you’re the things that you want to change such as your weaknesses”
Encouraging Decisions
“Which do you prefer, listening to a song or singing?
Encouraging Evaluation
“How did you feel after expressing what you have on your mind?”
“How did you feel after confronting him?”
“What is the reason you don’t want to meet your parents?”
Encouraging Description of Perception
“What are your thoughts about the accident?”
Questioning
“How would you feel if she comes back?”
Non-therapeutic Responses
Stereotyping
“Two-year old brats.”
“Women are complainers.”
“Men don’t cry.”
“Most people don’t have pain after this type of surgery.”
Overloading
Nurse: ”I am your nurse today, hello, how are you, how do you feel……(in a fast pace)
Underloading
The patient is finished talking and the nurse doesn’t give feedbacks
Value Judgement
“It’s not right to use those words in here”
Invalidation
Client: Is it ok if I….
Nurse: (chats down notes as if she heard nothing)
Disagreeing
Client: “I don’t think Dr Broad is a very good doctor. He doesn’t seem interested in his patients.”
Nurse: “Dr. Broad is head of the Department of Psychiatry and is an excellent therapist.”
Defending
Client: “Those night nurses must just sit around and talk all night. They didn’t answer my light for over an hour.”
Nurse: “I’ll have you know we literally run around on nights. You’re not the only client, you know.”
Challenging
Client: “I felt nauseated after that red pill.”
Nurse: Surely you don’t think I gave you the wrong pill?”
Client: “I feel as if I am dying.
Nurse: “How can you feel that way when your pulse is 60?”
Incongruence
Nurse: “I’m really concerned with you”(while gazing at other people or objects)
Probing
Client: “I was speeding and didn’t see the stop sign.”
Nurse: “Why were you speeding?”
Client: “I didn’t see the doctor when he was here.”
Nurse: “Why not?”
Testing
“Who do you think you are?” (enforces people to admit their status is only that of client)
“Do you think I’m not busy?” (forces the client to admit that the nurse really is busy)
Changing Topics and Subjects
Client: “I’m separated from my wife. Do you think I should have sexual relations with another woman?”
Nurse: “I see that you are 36 and that you like gardening. This sunshine is good for my roses. I have a beautiful rose garden.”
Reassuring
“You’ll feel better soon.”
“I’m sure everything will turn out all right.
“Don’t worry.”
Giving Approval
“That’s good ”
“You should do that.”
“What you did was Right ”
Giving Advice
Client: “Should I move from my home to a nursing home?”
Nurse: “If I were you, I’d go to a nursing home, where you’ll get your meals cooked for you.”
Focusing on Self
Nurse: “Do you have a pet? I have a pet once and his name was……..
Internal Validation
Nurse: “our patient is now feeling well, we can release his restrain ” (a previously manic patient is now calm because he only wants to be released from the restrain and would resume his activity after restrain is gone)
