Prep U Ch. 6: Therapeutic Communication - ML5
The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message? ~"At what time did you take the last dose of the antianxiety drugs?" ~"If you just learn how to breathe, you can manage better." ~"When did you last take drugs?" ~"How can you make your anxiety better?"
Correct response: "At what time did you take the last dose of the antianxiety drugs?" Explanation: Concrete messages use explicit wording and need no interpretation. Asking the client about the time of the last dose of the antianxiety drugs conveys the most accurate information. Asking the client about when the client stopped taking the drugs fails to specify the type of drug, and using the word "when" will not help the client give the accurate response. Asking the client when the client took them last would confuse the client, as "them" may not be interpreted as drugs.
The nurse manager is discussing therapeutic communication with a group of staff nurses. The nurse manager asks the staff nurses, "What is the purpose of using therapeutic communication?" Which statement by the nurse identifies the purpose of using therapeutic communication? ~"Communicate that the nurse is listening." ~"Explore the idea or experience." ~"Help the client feel at ease." ~"Help the client reframe thoughts about treatment."
Correct response: "Explore the idea or experience." Explanation: Therapeutic communication's purpose is to explore and delve further into the subject or idea. Especially helpful with clients who tend to remain on a superficial level of communication. Communicating that the nurse is listening, helping the client feel at ease, and helping the client reframe thoughts about treatment are not purposes of therapeutic communication.
A nurse is assessing an elderly client with a cardiac disorder. Which statement given by the client conveys an abstract message? Choose the best answer. ~"The sudden onset of my chest pain got my spouse extremely stressed out." ~"The chest pain is severe enough to disable me from doing my work." ~"I suddenly had dull pain around the jaw and neck region." ~"I don't really know how it all started. It just happened."
Correct response: "I don't really know how it all started. It just happened." Explanation: Abstract messages are those messages that do not convey the meaning of the message clearly. The information given by the client is not explicit and will need to be interpreted. The statement that the client didn't know how it started may not be clearly interpreted for the meaning of "it." The statement that the chest pain was severe enough to disable the client gives a concrete message. The statement that the client suddenly had dull pain around the jaw and neck region conveys a concrete message. The statement that the sudden onset of chest pain got the client's spouse extremely stressed out conveys a concrete message.
The client tells the nurse, "My mom is coming in to see me today," while sighing and looking out the window. The nurse states, "You don't seem very excited about the visit, is everything OK?" The client affirms. Using therapeutic communication, how should the nurse respond? ~"I need to know why you are sad." ~"Why are you sad about your mother's visit?" ~"Is your mother giving you trouble for being here?" ~"I'm concerned that you are not exicited about your mother's visit, We can talk if you want."
Correct response: "I'm concerned that you are not exicited about your mother's visit, We can talk if you want." Explanation: Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's needs to promote an effective exchange of information. Skilled use of therapeutic communication techniques helps the nurse understand and empathize with the client's experience. "Why are you sad about your mother's visit?," "I need to know why you are sad" and "Is your mother giving you trouble for being here?" are not examples of therapeutic communication.
A psychiatric-mental health nurse has been off of work for the past 4 days, as per the normal work schedule on the unit. On the nurse's first day back, a longterm client says, "I haven't seen you around here since Thursday. How was your time off?" What is the nurse's most appropriate response? ~"If you had to guess, what do you think I might have done on my days off?" ~"I'm not at liberty to talk about my personal life outside of work, unfortunately. How have you been?" ~"I've been off for the past four days. What have you done since I last saw you?" ~"How do you like to spend your time when you're able to do whatever you like?"
Correct response: "I've been off for the past four days. What have you done since I last saw you?" Explanation: The nurse should avoid self-disclosure. Whenever possible, it is more therapeutic to redirect the conversation rather than setting an explicit boundary. Saying, "How do you like to spend your time when you're able to do whatever you like?" redirects the conversation but is less therapeutic because the nurse has ignored the client's question. Asking the client to speculate serves no therapeutic purpose.
The nurse has entered a client's room and observed that the client has removed the mattress from the bed and is closely scrutinizing the spaces in the bed frame. Which statement is most likely to elicit an explanation of the client's behavior? ~"What's wrong with your bed?" ~"It looks like you're searching for something. Is that right?" ~"What are you looking for in the bed? There's nothing hidden there." ~"Are you having any delusions or hallucinations right now?"
Correct response: "It looks like you're searching for something. Is that right?" Explanation: When communicating, it is important to make an observation and then seek clarification and encourage the client to explore his or her behavior. This is more conducive to therapeutic communication than making an assumption about a client's actions or motives or explicitly attributing actions to delusions or hallucinations.
A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic? ~"It sounds like you're feeling unappreciated." ~"Why do you say I don't listen to you?" ~"I listen to you." ~"It sounds like you're overreacting somewhat."
Correct response: "It sounds like you're feeling unappreciated." Explanation: Reflecting feelings is an effective way to show empathy and facilitate the client's further disclosure. Avoid "why" questions, which cause defensiveness, avoid belittling the client's feelings, and do not defend against the client's belief.
The nurse is engaging in an interpersonal interaction with the daughter of an older adult client who has dementia. As the client's daughter is sharing her concerns about bringing her father home, she begins to cry. Which response from the nurse demonstrates therapeutic communication? ~"A community care nurse will be there to help." ~"You are worried that your father is dying." ~"Your other family members will be willing to help." ~"This is overwhelming for you, it is okay to cry."
Correct response: "This is overwhelming for you, it is okay to cry." Explanation: In order to promote an effective exchange of information with the client's daughter and ensure therapeutic communication is taking place, the nurse should facilitate the client's daughter's expression of emotion. The statement, "This is overwhelming for you, it is okay to cry" focuses on the client's specific needs and encourages dialogue. The statement, "A community care nurse will be there to help," is nontherapeutic because the nurse is offering reassurance, and this indicates there is no reason for anxiety or other feelings of discomfort. The nurse making the statement, "You are worried about your father dying," is nontherapeutic because it introduces an unrelated topic. By stating this, the nurse has missed the opportunity to facilitate the client's daughter's expression of emotion. By making the statement, "Your other family members will be willing to help," the nurse uses a nontherapeutic communication technique because she is offering advice and telling the client's daughter what to do.
When a novice psychiatric nurse shares with the nurse manager that talking about sexual abuse with clients is very uncomfortable, which would be the most effective response from the nurse manager? ~"I can take that client off of your assignment this shift." ~"Have you ever been sexually abused?" ~"It would be great if you could attend an in-service on therapeutic communication." ~"What specifically makes you uncomfortable?"
Correct response: "What specifically makes you uncomfortable?" Explanation: It is important for the novice nurse to identify what it is about discussing sexual abuse that is anxiety-producing so that those issues can be addressed and resolved. Asking this question will assist the novice nurse in engaging in self-reflection that can lead to a greater awareness of self and thus enhance the ability to be therapeutic. Suggesting the nurse have such abuse victims released from the nurse's care ignores the problem and minimizes the nurse's therapeutic effectiveness. Arranging for training is appropriate only if it is discovered that the problem relates to a lack of skills related to the nurse's therapeutic communication techniques. While prior sexual abuse may be the cause of the nurse's discomfort, it is not appropriate for the nurse manager to initiate this discussion in that manner.
A nurse is seeing a client who has recently been discharged from the hospital for a suicide attempt. When asked about the quality of her relationship with her husband, the client becomes silent, diverts eye contact and says, "It's okay." What is the nurse's best response? ~"I am glad to hear that." ~"What you are saying and how you say it does not seem to match." ~"A good relationship is a sign of recovery." ~"I don't think you are telling me the truth."
Correct response: "What you are saying and how you say it does not seem to match." Explanation: A congruent message is conveyed when content and process agree. In this case, what the client is saying verbally does not agree with the nonverbal communication. The nurse uses an objective statement of their observation as the first step in the therapeutic interaction. The nurse is effectively engaging in active observation. The nurse's statement, "I am glad to hear that" or "A good relationship is a sign of recovery" indicates the nurse has not engaged in active observation of the client's nonverbal communication. Although the nurse's statement, "I don't think you are telling me the truth" addresses the nurse's active observation of the client's nonverbal communication and incongruence of the message, it is not presented in a therapeutic way.
Choose the most therapeutic response to the client's statement, "All I feel like doing is screaming as loudly as I can." ~"I wish you could try to be more positive." ~"Who has made you so upset?" ~"Please calm down; everything is going to be better." ~"You look like you are very angry this morning."
Correct response: "You look like you are very angry this morning." Explanation: Replying that the client looks very angry this morning provides reflection of the client's affect (angry) and is making an observation. Telling the client to calm down is a platitude, telling the client that there is nothing to be upset about denies the client's feelings, and urging the client to be positive is stated in terms of the nurse's needs and ignores the feelings of the client. Reflection of the client's feelings, mood, and affect is therapeutic in assisting the client to understand himself or herself.
Which statement by the nurse reflects the use of a therapeutic statement? ~"I understand your husband passed away. I couldn't bear that." ~"You look upset. Would you like to talk about it?" ~"You look very sad. How long have you been this way? Have you been taking care of yourself?" ~"I'd like to know more about your children. Tell me about them."
Correct response: "You look upset. Would you like to talk about it?" Explanation: The correct answer reflects validation of the client's feelings and further exploration. Asking about the client's children seeks more information, while discussing the death of the client's husband reveals personal information and a nonhelpful personal reflection by the nurse. Asking multiple questions may be confusing.
Which statement by the nurse reflects the use of a therapeutic statement? ~"I'd like to know more about your children. Tell me about them." ~"You look very sad. How long have you been this way? Have you been taking care of yourself?" ~"You look upset. Would you like to talk about it?" ~"I understand your husband passed away. I couldn't bear that."
Correct response: "You look upset. Would you like to talk about it?" Explanation: The correct answer reflects validation of the client's feelings and further exploration. Asking about the client's children seeks more information, while discussing the death of the client's husband reveals personal information and a nonhelpful personal reflection by the nurse. Asking multiple questions may be confusing.
The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart? ~12 to 25 feet ~0 to 18 inches ~18 to 36 inches ~3 to 6 feet
Correct response: 3 to 6 feet Explanation: The therapeutic communication interaction is most comfortable when the nurse is 3 to 6 feet away from the client.
A client has recently been diagnosed with cancer. The client says, "What did I do wrong to get such a disease?" Which nonverbal processes, along with the client's statement, would convey a congruent message? [Select all that apply.] ~A sarcastic tone of voice ~A fearful tone of voice ~A cheerful expression ~A sad facial expression ~An erect, confident posture
Correct response: A sad facial expression AND A fearful tone of voice Explanation: A process refers to the nonverbal messages that the speaker uses to give meaning and context to the overall message. The client is diagnosed with cancer and is grieving. Thus, a sad facial expression and a fearful tone of voice are congruent with having been diagnosed with the disease and worrying about the impending health problems. A cheerful expression, a sarcastic tone of voice, and an erect, confident posture are incongruent with the client's statement to the nurse.
Which form of messaging contain figures of speech that are difficult to interpret and can be a barrier to communication? ~Overt cue ~Abstract ~Cliché ~Proverb
Correct response: Abstract Explanation: Abstract messages are unclear patterns of words that often contain figures of speech that are difficult to interpret. They require the listener to interpret what the speaker is asking and so can be a barrier to communication. A cliché is an expression that has become trite and generally conveys a stereotype. Proverbs are old accepted sayings with generally accepted meanings. An overt cue is a clear statement of intent.
"Get the stuff from him" is an example of which type of message? ~Clear ~Direct ~Abstract ~Concrete
Correct response: Abstract Explanation: "Get the stuff from him" is an example of an abstract message. In concrete messages, words are explicit and need no interpretation. Concrete messages are clear, direct, and easy to understand.
When interviewing a young adult Asian client who immigrated to the United States as a child, the nurse best addresses the impact that culture has on the client's perceptions and beliefs by doing what? ~Inquiring how the client feels symptoms should be managed ~Researching the physiological and emotional response to anxiety traditionally exhibited by Asians ~Assessing to what degree the client has embraced the American culture ~Asking the client to explain what the client thinks is causing the client's panic attacks
Correct response: Assessing to what degree the client has embraced the American culture Explanation: By assessing the client's degree of cultural assimilation/acculturation, incorrect assumptions regarding the impact of culture on the client's perceptions and beliefs will be minimized. While the other options provided are not inappropriate, none is the best tactic that addresses the impact that culture has on the client's perceptions and beliefs.
A nurse engaged in an interaction with a client recognizes body space zones. Which would the nurse identify as the individual's personal zone? ~Surrounding and protecting an individual from others, especially outsiders ~The most distant boundary that can be used for recognizing intruders ~Beginning at the boundary of the intimate zone and ending at the social zone ~Extending outward from the border to the public zone
Correct response: Beginning at the boundary of the intimate zone and ending at the social zone Explanation: The four zones are intimate, personal, social, and public. The personal zone begins at the boundary of the intimate zone and ends at the social zone. The intimate zone varies widely in different cultures. The social zone begins at the end of the personal zone and ends at the public zone. The public zone begins at the end of the social zone and extends outward.
Which therapeutic communication technique is being utilized when the nurse asks the client, "Is there something you'd like to talk about?" ~Broad opening ~Accepting ~Exploring ~Focusing
Correct response: Broad opening Explanation: This is an example of a broad opening, which allows the client to take the initiative in introducing the topic. Accepting is indicating reception. Exploring is delving further into a subject or idea. Focusing is concentrating on a single point.
A client expresses to the nurse that the client has been unable to sleep due to work. The nurse asks the client, "Do you mean that the work in the office is causing stress, which is why you are not able to sleep?" Which type of therapeutic communication technique is this conversation indicative of? ~Consensual validation ~Broad openings ~Encouraging comparison ~Accepting
Correct response: Consensual validation Explanation: The nurse's statement indicates that the nurse is trying to create mutual understanding about the client's concern, to prevent any misunderstanding. This type of communication is an example of consensual validation. Accepting is a type of communication in which the nurse indicates receiving the message that the client wanted to convey. Broad openings are a type of communication through which the nurse tries to encourage the client to express his or her concerns and feelings. Encouraging comparison is a type of communication technique in which the nurse explains the similarities and differences in a situation that the client can relate to.
Which term is used to refer to signals that encourage effective communication? ~Metaphors ~Concrete messages ~Cues ~Abstract messages
Correct response: Cues Explanation: A cue is a verbal or nonverbal message that signals keywords or issues for the client. An abstract message is an unclear pattern of words that often contain figures of speech that are difficult to interpret. In a concrete message, words are explicit and need no interpretation. A metaphor is a phrase that describes an object or situation by comparing it to something else familiar.
When the nurse states, "Tell me more about that," the nurse is utilizing which communication technique? ~Focusing ~Formulating a plan of action ~Exploring ~Accepting
Correct response: Exploring Explanation: Exploring is delving further into a subject or area. Focusing is concentrating on one simple point. Accepting is indicating reception. Formulating a plan of action is asking the client to consider kinds of behavior likely to be appropriate in future situations.
A nurse is engaged in a therapeutic relationship with a client. What should the nurse do in order to ensure therapeutic communication takes place? [Select all that apply.] ~Use self-disclosure frequently for empathy ~Focus on the client during the interaction ~Give the client advice about what to do ~Ensure the client's confidentiality ~Employ theoretically based interventions
Correct response: Focus on the client during the interaction, Ensure the client's confidentiality, AND Employ theoretically based interventions Explanation: A nurse engaged in therapeutic communication with a client should follow the principles of therapeutic communication: making the client the primary focus of the interaction; using self-disclosure cautiously and only when it serves a therapeutic purpose; maintaining client confidentiality; implementing interventions from a theoretic base; and avoiding the giving of advice.
A group of students is reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which as the first component of the process? ~Message encoding ~Formulation of an idea ~Message transmission ~Message reception
Correct response: Formulation of an idea Explanation: With verbal communication, typically the person formulates an idea, encodes a message, and then transmits the message with emotion. The message is then received and decoded, and a response is made.
The nursing instructor is teaching about the importance of communication in nursing and relates it to the family. Which statement by a student nurse would indicate that the teaching has not been effective? ~Verbal communication is important. ~Nonverbal communication is not meaningful. ~Communication theory concerns the sending and receiving of verbal and nonverbal messages. ~All communication consists of two levels.
Correct response: Nonverbal communication is not meaningful. Explanation: Communication theory concerns the sending and receiving of both verbal and nonverbal messages. All nonverbal communication is meaningful, and it is just as important as verbal communication. All communication consists of two levels: content (what is said) and relationship (of those interacting).
Which zone is a distance that is comfortable between family and friends who are talking? ~Public ~Intimate ~Personal ~Social
Correct response: Personal Explanation: The personal zone is the distance that is comfortable between family and friends who are talking. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The public zone is an acceptable distance between a speaker and an audience.
During a therapy session, the nurse asks the client, "Tell me more about your relationship with your parents." The nurse is using which nontherapeutic communication technique? ~Probing ~Confrontation ~Clarification ~Reflecting
Correct response: Probing Explanation: An example of probing is "tell me more about your relationship with your parents." Reflecting feelings occurs when one identifies feelings that are being expressed. Confrontation is challenging a participant. Clarification is a restatement of the interaction.
Which form of nonverbal communication would be least effective for the nurse to engage in to demonstrate interest in and acceptance of the client? ~Facing the client at eye level ~Leaning slightly forward toward the client ~Sitting behind a desk ~Keeping arms and legs uncrossed
Correct response: Sitting behind a desk Explanation: Sitting behind a desk imposes a barrier between the nurse and the client and is therefore the least effective technique listed here. Therapeutic nonverbal communication uses positive body language, such as sitting at the same eye level as the client with a relaxed posture that projects interest and attention. Leaning slightly forward also helps engage the client. Generally, the nurse should not cross the arms or legs during therapeutic communication because such postures erect barriers to interaction; uncrossed arms and legs project openness and a willingness to engage in conversation.
Which type of touch, according to Knapp, is used in greeting, such as a handshake? ~Love-intimacy ~Friendship-warmth ~Functional-professional ~Social-polite
Correct response: Social-polite Explanation: Social-polite touch is used in greeting, such as a handshake. Functional-professional touch is used in examination or procedures. Friendship-warmth touch involves a hug in a greeting. Love-intimacy touch involves tight hugs and kisses between lovers or close relatives.
The nurse is sitting behind a table while speaking to a client on the other side of the table. What is the most appropriate reason for this nurse's action? ~The client can communicate freely. ~The client may be physically expressive. ~The client may have difficulty maintaining spatial boundaries. ~The client can open up easily.
Correct response: The client may have difficulty maintaining spatial boundaries. Explanation: Sitting behind a table while speaking to a client makes the setting formal. This setting would most likely be required when dealing with clients who have difficulty maintaining boundaries. Such a formal setting would make the client more uncomfortable. In such settings, the client may not be able to share feelings freely or to open up easily. It is not appropriate for the nurse to use this kind of setting if the client is willing to express individual feelings.
During client assessment, the nurse asks the next question as soon as the client finishes answering the previous question. Which most likely explains why the nurse is interacting with the client this way? ~The nurse has difficulty with conducting an assessment. ~The nurse is accurately observing the client's nonverbal communication. ~The nurse may lack confidence in therapeutic communication. ~The nurse can gain information about the client without wasting time.
Correct response: The nurse may lack confidence in therapeutic communication. Explanation: Asking questions as soon as the client finishes answering responding to the previous question is an indicator the nurse is not actively listening to the client's responses. This reflects the nurse's limited confidence in the ability to utilize therapeutic communication skills. The nurse may not understand the client's concerns and may need to spend more time completing the assessment. The nurse should ensure the client is given an adequate amount of time to speak, and the nurse should listen actively and attentively.
The nurse is talking with the client and demonstrates concern for the way the client is feeling by using verbal affirmations and paraphrasing to show understanding. What communication techniques are being used by the nurse? ~self disclosure ~self awareness ~empathetic linkages ~active listening
Correct response: active listening Explanation: Active listening is refraining from other internal mental activities and concentrating exclusively on what the client says. Self disclosure, empathetic linkages and self awareness are not communication techniques. Empathetic linkages are the communication of feelings. Self-awareness is having a clear perception of your personality, including strengths, weaknesses, thoughts, beliefs, motivation and emotions. Self-disclosure is communication by which one person reveals information like thoughts, feelings, aspirations, goals, failures, successes, fears and dreams, as well as one's likes, dislikes and favorites.
A group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication? ~gestures ~emotion underlying the words ~body language ~expressions
Correct response: emotion underlying the words Explanation: Verbal communication, which is principally achieved by spoken words, includes the underlying emotion, context, and connotation of what is actually said. Nonverbal communication includes gestures, expressions, and body language.
A nursing student is caring for a client who has been arrested for child abuse. The nurse is very curious about what the client must have done to get into so much trouble, so the nurse asks the client to tell the nurse about the various activities that got the client arrested. This is an example of: ~excessive probing. ~lack of awareness. ~genuineness and caring. ~gathering assessment data.
Correct response: excessive probing. Explanation: Excessive probing is usually nontherapeutic, except in the process of collecting a history. The here and- now is what the client is experiencing and what the nurse can assist the client in changing.
A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to: ~permit clients to gather their thoughts. ~demonstrate passive listening. ~allow the nurse to determine an appropriate response. ~encourage self-reflection by the nurse.
Correct response: permit clients to gather their thoughts. Explanation: By maintaining silence, the nurse allows the client to gather the client's thoughts and to proceed at the client's own pace. Silence may help the nurse determine an appropriate response or engage in self-reflection, but it is more directed toward allowing the client to focus. Silence does not reflect passive listening. Passive listening involves sitting quietly and letting the client talk, rambling without focusing, or guiding the thought process
The nurse wears a cross and has a Facebook page displaying pictures of the family, home and updates on what the nurse is currently doing. These actions are examples of what? ~exploitation ~self-disclosure ~self-awareness ~social zone
Correct response: self-disclosure Explanation: The most important principles of therapeutic communication is to focus the interaction on the patient's concerns. Self-disclosure is telling the client personal information. The nurse can determine how much personal information, if any, to disclose. In revealing personal information, the nurse should be purposeful and have identified therapeutic outcomes. Self-awareness, social zone and exploitation are not principles of therapeutic communication.
Which is often considered the most difficult yet most effective communication technique? ~silence ~reflecting ~clarifying ~restating
Correct response: silence Explanation: Although restating, reflecting, and clarifying are effective therapeutic communication techniques, one of the most difficult but often most effective communication techniques is the use of silence during verbal interactions. By maintaining silence, a nurse allows the client to gather thoughts and to proceed at his or her own pace.
The nurse indicates interest in and acceptance of the client by all of the following except: ~facing the client. ~sitting behind a desk. ~slightly leaning toward the client. ~maintaining a nonthreatening eye contact.
Correct response: sitting behind a desk. Explanation: Sitting behind a desk does not indicate interest in and acceptance of the client by the nurse.
The nurse is engaging in assertive communication when which communication approach is used? [Select all that apply.] ~using direct language ~expressing feelings attached to the concern ~standing up to speak to someone when the other person is seated ~using "I" statements ~not saying anything about someone's behavior until is problematic
Correct response: using direct language, using "I" statements, AND expressing feelings attached to the concern (not 'standing up to speak to someone when the other person is seated') Explanation: Assertive communication requires that the nurse express an emotion, and use "I" statements and direct, honest language. Using assertive communication is intended to help the nurse say "no" in a polite but firm manner. The other person should feel less defensive over a conflict because the nurse does not use blaming or confusing language. Standing up to speak to someone when that person is still seated is aggressive and demonstrates nontherapeutic nonverbal communication. To use assertive communication effectively, the nurse must use eye contact. Not saying anything until the other person's behavior becomes very problematic indicates the nurse is being passive in his communication. In order to to be assertive, the nurse should address the behavior early and in a clear, honest way.
The nurse is caring for a client who is very confused. In addition to verbal communication with the client, which intervention should the nurse use? ~speaking louder so the client can hear ~using gentle touch during activities of daily living ~providing instructions to the client for feeding oneself ~displaying a flat affect so the client will not misinterpret the nurse
Correct response: using gentle touch during activities of daily living Explanation: The nurse should supplement verbal communication with therapeutic nonverbal communication, including gentle touch, to reinforce caring feelings for the confused client. Providing instructions for feeding oneself and speaking louder are aspects of verbal communication and, in addition, would not be helpful. Displaying a flat affect is not an aspect of therapeutic nonverbal communication.