03 Therapeutic Communication

Purposeful communication

Therapeutic communication is purposeful and respectful. It helps a person express concerns, feel heard, and participate in care; it is more than being friendly. The caregiver listens and responds in ways that support the person's needs while maintaining a professional relationship.

Communication should be adapted to the person and situation. Clear, respectful responses can support care without minimizing concerns, judging the person, or making promises beyond the caregiver's role.

Listening and responding

Active listening involves giving the person attention, noticing verbal and nonverbal cues, and checking that you understood correctly. Face the person when appropriate, reduce distractions, avoid interrupting, and allow time for a response. Adapt eye contact and personal space to the person's culture, preferences, and comfort. Use plain language and the person's own words when possible.

Useful listening and response techniques include:

• Open-ended questions: Invite more than a yes-or-no answer. For example: “What has been hardest for you today?”

• Restating or paraphrasing: Repeat the main idea in your own words. For example: “You’re worried the medication is making you feel worse.”

• Reflection: Tentatively name a feeling. For example: “It sounds like you feel disappointed.”

• Clarification: Check an unclear statement. For example: “When you say you can’t go on, what do you mean?”

• Silence: Allow a pause for thought or emotion. Remain attentive rather than rushing to fill it.

• Offering information: Give relevant, understandable facts without overwhelming the person. Invite questions and check understanding, such as by asking the person to explain the plan in their own words.

Responding with empathy

Empathy acknowledges another person's experience without claiming to know exactly how they feel. A response such as “That sounds frightening. Would you like to tell me more?” recognizes the person's experience and invites them to share more if they choose.

Avoid minimizing, judging, arguing, giving false reassurance, or quickly changing the subject. Instead of saying “Don’t worry,” acknowledge the concern and ask what is most concerning right now.

Maintaining professional boundaries

A therapeutic relationship has a clear purpose: the person's care and well-being. Maintain privacy, follow role and workplace policies, use approved communication channels, and avoid personal disclosures or promises that exceed your role.

Be alert to becoming overinvolved or distant. If a boundary becomes unclear, address it respectfully and seek appropriate guidance. Boundaries protect the person and help manage the power difference in care.

If someone asks for your personal phone number, respond warmly and clearly: “I can’t share my personal number, but you can reach the care team through the clinic’s usual contact process.”

Navigating challenging interactions

Adapt your response to what the person is expressing and to any immediate care or safety concerns.

• Silence or very brief answers: Give the person time, maintain a calm presence, and offer a gentle invitation, such as: “We can take our time. What feels okay to talk about?” Do not pressure the person to disclose.

• Tears or visible distress: Acknowledge what you observe and let the person choose what they need. You might ask: “I can see this is upsetting. Would you like a moment, or would you like to tell me what’s on your mind?”

• Anger or frustration: Keep your voice steady and listen for the concern. Set limits if needed: “I want to understand what’s wrong. I can talk with you, but I can’t continue while you’re threatening me.” Follow workplace safety procedures if anyone may be at risk.

• Refusal or disagreement: Avoid arguing or coercing. Explore the person's perspective and offer clear choices where possible, such as: “Can you tell me what concerns you about this?”

• Confusing or unrealistic statements: Do not ridicule or argue. Calmly ask what the person means, acknowledge the feelings expressed, and respond to immediate care needs. Seek clinical support when the statement raises concern or is outside your role.

Adapting care to the person

A trauma-informed approach emphasizes safety, trust, collaboration, and choice, and aims to avoid retraumatization. These priorities support adapting communication to the person and situation.

Across interactions, combine attentive listening with clear, empathic responses and appropriate boundaries. Use open questions, reflection, clarification, and purposeful silence; avoid judgment and false reassurance. In challenging interactions, remain respectful, set limits when needed, and seek support when safety or role limits require it.