Every interaction between a nurse and a patient is an opportunity to help or to harm. Therapeutic communication is a set of evidence-based techniques that help patients express their thoughts and feelings, feel understood, and take part in their care. It is used in every specialty, not only mental health.
This guide lists 15 therapeutic communication techniques with example phrases, eight common non-therapeutic responses to avoid, and practical tips for anxious, angry, grieving and confused patients.
Imagine a patient the night before surgery says, “I’m not sure I’ll wake up.” One nurse replies, “Don’t be silly, you’ll be fine,” and leaves. Another sits down and says, “It sounds like you’re frightened about the anaesthetic. Tell me more.” The patient talks about his father, who died during an operation years ago. The nurse explains the safety checks and asks the anaesthetist to visit. He sleeps that night. Same question; completely different outcome.
15 therapeutic communication techniques
| Technique | Purpose | Example |
|---|---|---|
| 1. Active listening | Show full attention | Face the patient, nod, maintain appropriate eye contact |
| 2. Silence | Give time to think and feel | Pause for a few seconds after a difficult question |
| 3. Open-ended questions | Encourage expression | “How have you been feeling since the diagnosis?” |
| 4. Broad openings | Let the patient choose the topic | “What would you like to talk about?” |
| 5. Restating | Show you heard | “You said you can’t sleep.” |
| 6. Reflecting feelings | Name emotions | “You sound worried about going home.” |
| 7. Clarifying | Check understanding | “I’m not sure I follow. Do you mean…?” |
| 8. Focusing | Explore one important issue | “Let’s talk more about the pain in your chest.” |
| 9. Exploring | Go deeper | “Tell me more about that.” |
| 10. Offering self | Show availability | “I’ll sit with you for a while.” |
| 11. Giving information | Reduce uncertainty | “The test will take about 20 minutes. I’ll be here.” |
| 12. Acknowledging | Recognise effort | “You walked to the window today. That’s progress.” |
| 13. Summarising | Review key points | “So, your main worries are pain and who will feed your dog.” |
| 14. Encouraging description of perceptions | Understand the patient’s experience | “What is it like for you when the voices start?” |
| 15. Voicing doubt / presenting reality | Gently challenge misperceptions | “I understand you see insects; I don’t see them, but I can see you’re frightened.” |
8 non-therapeutic responses to avoid
| Response | Example | Why it harms | Try instead |
|---|---|---|---|
| False reassurance | “Everything will be fine.” | Dismisses fears; may be untrue | “What worries you most?” |
| Giving advice | “If I were you, I’d…” | Takes away autonomy | “What options have you considered?” |
| Asking “why” | “Why did you stop your tablets?” | Sounds accusing | “What made it hard to take your tablets?” |
| Changing the subject | “Let’s check your blood pressure.” | Signals discomfort | Stay with the topic for a moment |
| Minimising | “Lots of people have it worse.” | Invalidates feelings | “This is really hard for you.” |
| Judging | “That was a silly thing to do.” | Creates shame | Neutral, curious questions |
| Defending | “Our staff are excellent.” | Dismisses complaints | “Tell me what happened.” |
| Medical jargon | “Your Hb is low and you need a TX.” | Confuses and excludes | Plain language; check understanding |
Communicating in difficult situations
The anxious patient
Use a calm voice, short sentences and simple information. Anxiety reduces the ability to take in information, so repeat key points and check understanding.
The angry patient or relative
Stay calm, acknowledge feelings (“I can see you’re upset”), listen without interrupting, avoid defensiveness, and focus on what you can do. Keep yourself safe: stand near the exit and call for help if needed.
The grieving family
Offer presence, use the person’s name, allow silence and tears, avoid clichés (“they’re in a better place”), and give practical information gently.
The confused patient
Introduce yourself each time, use simple sentences, one question at a time, and gentle orientation. See communication in dementia care.
Patients who speak another language
Use professional interpreters, speak to the patient (not the interpreter), and avoid using children as interpreters.
Non-verbal communication
- Sit at eye level when possible.
- Open posture, relaxed facial expression.
- Appropriate touch, respecting culture and consent.
- Minimise distractions: put the computer or phone aside.
Where the techniques come from
Much of nursing’s understanding of therapeutic relationships comes from Hildegard Peplau’s interpersonal relations theory, which describes the phases of the nurse-patient relationship.
Frequently asked questions
What is therapeutic communication?
Purposeful communication techniques that help patients express feelings, feel understood and participate in care.
What is an example of therapeutic communication?
Reflecting feelings: “You sound worried about going home.”
Why should nurses avoid asking “why”?
It can sound judgmental and make patients defensive.
Is false reassurance always wrong?
Saying “everything will be fine” when you cannot know it dismisses fears. Honest support is better.
But do nurses have time for therapeutic conversations?
Therapeutic communication does not require long conversations. A single reflective statement or open question during routine care can change how a patient feels. It often saves time by reducing anxiety, conflict and repeated call bells.
Your next step: On your next shift, replace one “Don’t worry” with “What worries you most?” and notice what the patient tells you.
Related: Peplau’s theory · Emotional intelligence in nursing · Dementia communication
Sources: Peplau HE. Interpersonal Relations in Nursing (1952); nursing communication textbooks; NICE guidance on patient experience in adult NHS services (CG138).
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