Non-Therapeutic Communication (What to Avoid)

Knowing what NOT to say is just as important as knowing what to say. Non-therapeutic responses block communication, invalidate feelings, and damage the nurse-client relationship. The NCLEX frequently tests your ability to identify these harmful communication patterns.

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The Most Common Non-Therapeutic Responses

1. "Why" Questions

"Why did you do that?" is one of the most harmful questions a nurse can ask. "Why" questions:

• Demand justification for feelings or behaviors
• Imply judgment or disapproval
• Create defensiveness
• Put clients on the spot

Instead of: "Why didn't you take your medication?" Use: "Tell me about what happened with your medication."

Instead of: "Why are you crying?" Use: "I see you're upset. Tell me what's going on."

Exam tip: On the NCLEX, if an answer option begins with "Why," it is almost always incorrect.

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2. False Reassurance

False reassurance minimizes the client's concerns and shuts down communication by offering empty comfort.

Examples of false reassurance:

• "Don't worry, everything will be fine."
• "I'm sure it's nothing serious."
• "Things always work out in the end."
• "Many people go through this and they're okay."

Why it's harmful:

• Dismisses legitimate fears
• Prevents further expression of feelings
• May not be true (and the client knows it)
• Implies the nurse is uncomfortable with the topic

Instead of: "Don't worry, you'll be fine." Use: "Tell me more about what's worrying you."

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3. Giving Advice

"You should..." takes decision-making away from the client and places the nurse in an inappropriate position of authority over personal choices.

Examples of advice-giving:

• "You should talk to your husband about this."
• "If I were you, I would..."
• "The best thing to do is..."
• "You need to stop smoking."

Why it's harmful:

• Removes client autonomy
• May not be appropriate for the client's situation
• Can create dependence on the nurse
• Crosses professional boundaries

Instead of: "You should exercise more." Use: "What are your thoughts about increasing physical activity?"

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4. Closed-Ended Questions

Closed-ended questions require only a yes or no answer, limiting the depth of the client's response.

When closed-ended questions are appropriate:

• Emergency situations requiring quick yes/no information
• Clarifying specific details after open-ended discussion
• When the client is cognitively impaired and needs simple questions

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5. Changing the Subject

Changing the subject signals discomfort and communicates that the client's concerns are not important.

Example:

• Client: "I'm really scared about my surgery tomorrow."
• Non-therapeutic: "Let's talk about your discharge plans instead."

This response abandons the client's expressed fear and redirects to the nurse's agenda.

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6. Offering Cliches or Stereotyped Responses

Cliches are automatic, meaningless phrases that offer no real comfort or understanding.

Examples:

• "It's always darkest before the dawn."
• "Every cloud has a silver lining."
• "God never gives you more than you can handle."
• "Time heals all wounds."

Why they're harmful: They are generic, impersonal, and avoid genuine engagement with the client's unique situation.

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Comparison: Therapeutic vs. Non-Therapeutic Responses

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Additional Non-Therapeutic Patterns

Approval/Disapproval

• Approval: "That's a great idea!" (Creates dependence on nurse's judgment)
• Disapproval: "You shouldn't feel that way." (Invalidates emotions)

Nurses should remain neutral rather than evaluating client decisions.

Defending

Defending the healthcare provider or institution when the client expresses dissatisfaction.

• Client: "The doctor never listens to me."
• Non-therapeutic: "Dr. Smith is an excellent physician."
• Therapeutic: "You feel unheard by your doctor. Tell me more."

Probing

Probing pushes for information the client is not ready to share.

• "You need to tell me exactly what happened."
• "Why won't you talk about this?"

Belittling Feelings

• "Everyone feels that way sometimes."
• "That's nothing compared to what some patients go through."

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Why Nurses Fall Into Non-Therapeutic Patterns

Understanding these triggers helps nurses catch themselves before responding non-therapeutically.

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On the Exam

When selecting the best response on NCLEX, eliminate options that contain:

• "Why" questions
• "Don't worry" or similar false reassurance
• "You should" or advice-giving
• Cliches or stereotyped phrases
• Responses that change the subject
• Defensive statements about providers or the hospital

Remember: The correct answer almost always invites further expression and validates the client's experience.