Therapeutic Communication

Defined

When someone close to us is in a heightened state of emotion, the thoughts being heard internally may drown out or alter the ideas we are trying to share. They may also find it difficult to accurately identify the intentions and emotion behind our words. Because of this, it is important to choose the language, topics, and tones we use carefully, and speak in a way that facilitates mutual respect and understanding (Potter, 2020).

If that someone is struggling, how we choose to interact in those critical moments can define the path they take to either grow past the event or decline in functioning over time. If we withhold our compassion, meet them with shame or neglect, or deny them timely help, there is a possibility that a crisis can develop into a chronic mental health challenge (Weiner, 2010).

A helpful strategy in communication is building a foundation of trust. We can do this through the perspective of unconditional positive regard (UPR). UPR uses a foundational attitude of active, positive acceptance and a goal of preserving the dignity and self-respect of all parties involved. Within this environment, value judgments are suspended and the self worth of the person in focus is emphasized. This person is encouraged to identify parts of their life where they can employ proactive acts of self-determination to improve their condition or meet their goals (Potter, 2020). For more information on UPR, click here.

Strategies of Effective Communication

How we carry our bodies, and manage our own emotions, during these conversations is paramount in demonstrating we are safe people who are available to help. Consider using the strategies below prior to, during, and after the conversation (Potter, 2020):

Offer the Self - this is how we can show that we are willing and available to provide support. ‘I am here for you if you need me.’, ‘I want to know how I can help you.’
Empathy - the conscious act of viewing the situation from the perspective of the person we are talking to. Here we attempt to feel the emotions, needs and experiences in order to develop a deeper connection and understanding.
Neutrality - placing aside our own perspectives, we attempt to engage the person we’re speaking to objectively and without passing judgment. The goal here is to hear and accept the information provided without approving or disapproving. Allowing what is said to be true from their perspective and creating space to test out thoughts, feelings and behaviors without generating consequences.
Self-Disclosure - though we may be tempted to relate to the person we’re talking to by sharing our own similar stories in-depth, this act tends to turn the conversation away from them and toward us. Alternatively, we share short talking points that directly relate to what we’re hearing that describe how we reacted, how we felt, what our opinion was and what we experienced. This is in an effort to build connection and to provide an alternative perspective on complex situations.
Suggest Ways to Collaborate - here we think of ways that the person we are talking to can elicit help from others in order to reach their goals. We’re not passing them off, but instead reminding them of the people in their lives who can act as a support and a resource to remind them they are not alone.

Compassionate and productive dialogue is facilitated by active listening. Consider the list of techniques below when trying to show those close to us that we are engaged in what they are trying to say (Potter, 2020):

Use a Broad Opening - start the conversation with an observation and a request to learn more. ‘I can see that you’re upset. May I ask why?’, ‘You don’t seem like yourself right now, has something changed?’, ‘You’ve been angry/withdrawn/frustrated lately. Can we talk about it to see if I can help?’
Active Listening - here we turn off or tune out distractions and give our full attention to the person speaking. Do not rush them, and participate fully in the conversation at hand. We use our words and body language to communicate our interest.
Make Eye Contact - using eye contact ensures we communicate that we are paying attention.
Use Incomplete Sentences and Brief Questions - this creates a gap in the conversation that shows we are listening and that we want more information, while making room for them to add their input and keeping them on track. ‘You were in 3rd period…’, ‘You saw it in the house and…’, ‘Who was with you?’, ‘Then what happened?
Make an Observation - there we think about what their body language is telling us, and share the observation we're making with them. ‘I can see the tension in your shoulders’, ‘Telling me that made you tear up’, ‘You keep looking at the clock and door’.
Use Open-Ended Questions - this tool aids us in opening up dialogue, while allowing the person we’re talking to to define their focus and direction. ‘How did you feel after that happened?’, ‘What caught your attention when you were there?, ‘Who do you usually want to talk to about moments like that?’
Repetition - this is where we simply reflect what was said to us in an effort to reflect back that we are present and listening. ‘You were alone in the room for hours.’, ‘You are worried that there is permanent damage done that can’t be undone.’, ‘You feel intimidated/isolated/unable to stop.’
Paraphrase Their Words - here we can communicate that we heard them, internalized their words, and have our own understanding of what they meant. ‘You felt isolated in that moment and wanted to run out of there’, ‘The bullies at school kept following you and you felt trapped’, ‘The words I said reminded you of a fight we had and that made you feel defensive.’
Use of Silence - as much as we want to fill in the words others are trying to find, when we do so, we take away their voice and their agency, while communicating a lack of care and patience. Fight the urge to fill in the gaps, and let them linger. This creates room for the person we’re listening to to add more without pressure.

When engaged in conversation with someone who is struggling, it is important not to let the conversation revolve around negative self-perceptions or thoughts that are damaging or unproductive. This can lead to rumination and perseveration, which serve to enhance unpleasant emotions. To prevent this, we can use insight oriented techniques that direct the conversation toward self-reflection and understanding. Examples of insight oriented techniques are described in detail below (Potter, 2020):

Encourage Comparison - ask the person to think of events in the past that are similar or different to what they are experiencing now. Did they react the same or differently? Did they feel the same or differently? What important factors were the same in those events? What important factors were different?
Encourage Detailing Perception - ask them to elaborate on what they smelled, heard, felt, saw or thought. This allows a deeper understanding of what stood out to the story-teller about the event and what gave the event importance.
Identify Themes - make observations about patterns or commonalities within the problems being presented or within the reactions to the problems being described. Consider framing themes using the following language: ‘I've heard you describe your coworkers as ‘out to get you’ a few times so far. Can we talk more about what's made you feel that way?’, ‘You’ve shared the idea of feeling alone or isolated from your classmates a few times, and I can see how much that hurts you.’, ‘You seem to feel very strongly about your friend moving away and it has brought up memories of other friends who have moved.’
Present Reality - we are not trying to dismiss their reality, but instead find a reality that we can all agree on in order to create a foundation of understanding. This does involve a slight confrontation, and the presentation of the world as we see it. Consider the following phrases: ‘You’ve shared that you feel your neighbor is intrusive and disrespectful. I’m seeing these intrusions as an attempt to connect with you by someone who wants to get to know you better. Maybe there is compromise there?’, ‘I can see that the chore chart is making you feel negative emotions. My reality is that I need help from you. If we don’t use the chore chart, what tool can help meet both our needs?’
Reflect - here we think about what aspects of the conversation or their body language stood out to us as unclear or conflicting. If we don’t understand what they meant at certain points in the conversation, it may be true that they don’t fully understand what they meant either. Ask about those inconsistencies to elicit an alternative explanation and perspective. ‘You said you felt disappointed, but your body language told me you were angry. Can we talk about that?’
Reframe - now we use our own perspective to reframe the content of the conversation. For example: ‘I hear you say that you’re giving up by ending this relationship, but it seems to me that you are choosing to invest in your relationship with yourself instead.’, ‘The loss of this career path was difficult, but I’ve seen you make time for yourself in a way that reduces the stress you carry each day.’
Translate Their Body Language into Feelings - because we are a third party observer, we have a unique perspective on their body language and tone. Consider acknowledging those cues to them in the form of a statement. ‘You looked defeated when you described your fight with your spouse to me just now.’, ‘It sounded to me like you feel a strong sense of guilt over how your time spent with your friend went.’
Verbalize Implications - here we take time to interpret the indirect messages and impressions felt from the information being shared with us. ‘Once you started this new job, it seems like you felt inadequate or unworthy. Is that the case?’, ‘I heard you when you mentioned that you were angry at your spouse for remarrying. Is it possible you felt left behind or replaced?’
Voice a Sense of Doubt - though not always easy, it is important to push back on some forms of negative thinking in order to communicate that we don’t endorse their train of thought. For example: ‘I don’t agree that you failed your family, because I see that you did…’, ‘I’m not seeing your actions the same way you are, I see you as having done well because…’, ‘You seem to think it was all your fault, but I think others had a role to play that you’re not considering fully.’

Within these conversations are opportunities to direct future efforts and reduce the sense of totality and finality that can come from crisis level thinking. Consider providing information about what actions or experiences they may benefit from and make plans with them. Suggest options for next steps, and provide hope for the future. Consider using humor to lighten the mood and relieve tension (Potter, 2020). For information on how to use humor most effectively, click here.