Let's take a moment since shutting someone down is terribly
It is the moment when if you feel, I have to make this
person hurry up,
that's the moment that you have to step back and step away.
What are some other non-therapeutic techniques,
one in particularly, that we just spoke about?
It starts with an A and ends with a G. There's a V-I-S in
Yes, advising. We do not give advice.
What about approving and disapproving?
What if a person, as you're speaking to them says to you,
"You know, I always wanted to stop drinking."
The therapeutic response would be,
"Oh, you always wanted to stop drinking, hmm?"
Not, "Oh, that is so good. I am so proud of you, what a
You always wanted to stop drinking, that's great."
Approving what someone says is not therapeutic.
Again, it will make that person want to please you.
They will start telling you what they think you want to
It will take the spotlight off of their recovery
and make them want you to like them.
The same goes for disapproving.
"So you always wanted to stop drinking, did you?"
"Well, no, that's why I'm in detox now."
"Uh, it's terrible that you couldn't stop.
I mean, it's a good thing you are starting now, but boy, oh,
That disapproving actually will start reinforcing
that that person has done something wrong.
That it will reinforce their negative self-image.
So, approving and disapproving,
and advising are very non-therapeutic techniques.
If there is a patient and the patient is not giving you the
that you are looking for, and you continually ask that
what do you think might happen? Think about yourself.
Think about people around you.
If you are studying for an exam and someone says, "Did you
read chapter 12?"
And you say, "Well, not yet." "What do you mean not yet?
Why didn't you do it?" "Well, I didn't have time." "Why
didn't you have time?
You don't think that this is your priority?
Don't you think you should be reading?" "Well, I didn't have
"Well, what else are you doing?"
What will happen is that starts increasing agitation
and you are moving towards having some aggressive behaviors
So avoid persistent questioning.
There's another non-therapeutic skill that quite often,
every single one of us,
at some point in our professional life engages in, and that
Assuming that you know this patient so well, that you know
what they need.
Or assuming that you know what they're going to say.
Assuming anything immediately closes the door to learning.
One of the things that I often like to say is knowing stops
It is the antithesis to learning.
If I think I know something, I'm closed off to learning more
Assuming comes right before that, "I think I know what
you're going to say."
We never know what another person is going to say.
The moment that we are able to actually grow as
and help reassure our patients is when we are listening to
as though their story was so unique that we had never, ever
We want to make sure that we respect that individualistic
person in front of us.
Understanding, that their struggle,
their experience is something that belongs to them and them
It's not because they're woman that they feel this way.
"Oh, yeah, all women do that. Oh, yeah.
He's not doing that, that's - men are so difficult."
Avoid making stereotypical comments
because those stereotypical comments,
although, you may be saying them very innocently,
might be taken very poorly by the person you are speaking
If a person tells you that it's so hard for them,
that they've tried to quit smoking and they can't quit,
and the reason they can't quit is because no matter what
they've done in the past
it hasn't work, and they know it won't work in the future
and it'd just waste their time. You don't want to support
those denials of success
that that patient is telling you.
You want to be able to explore rather than support the
"So I hear you say that you wasted time in the effort to
So what I think I'm hearing is that you're choosing the
that may have lung cancer over the present which is a really
And then let them talk. Let them clarify.
"No, that's not what I'm saying." Do not deny what they are
"I loved my mother. I didn't mean to hit her it was a
Don't deny their reality.
"I hear you say that you loved your mother
and that it was a mistake to hit her.
So how does that feel to know that you hit her?"
If they tell you, "It feels terrible, it feels awful because
I love her."
Don't interpret that. Don't - you can, you can say," I hear
you say it feels terrible
because you love her." Do not interpret what that person has
Interpreting would sound more like this.
"Wow, you love your mother and then you hit her and you feel
because inside you really wanted to hug her
and you weren't able to hug her and once that hand went up,
you just lost control of it and it landed on her chin
instead of holding her."
That's interpreting what they're saying.
You are now changing their experience
and changing reality and supporting a reality that may or
may not exist.
One thing for novice psychiatric nurses that we often see,
is a patient will bring up something that they are not
If it is violence, if it is sexual abuse,
often times we are uncomfortable with what we are hearing.
If you are uncomfortable to a point where you feel
that you cannot follow the patient's story anymore,
rather than changing topics, recognize that this is too
uncomfortable for you.
Perhaps it's bringing up something in yourself and you
cannot be therapeutic,
and allow the person the right have someone who can listen
to the story
and listen to that story therapeutically.