# A client with major depressive disorder quietly states, "I don't see the point in going on anymore." Which responses demonstrate therapeutic communication? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568907&lang=en  
> language: en  
> subject: Crisis Intervention  
> category: PSI

## Question

A client with major depressive disorder quietly states, "I don't see the point in going on anymore." Which responses demonstrate therapeutic communication? Select all that apply.

1

Quickly change the subject to the discharge plan to avoid further distress

2

Acknowledge the statement and ask directly, "Are you having thoughts of suicide right now?"

3

Say, "At least you are in the hospital where you are safe. Try to focus on the positives"

4

Say, "Don't talk like that. You have so much to live for. Think about your family"

5

Ask, "Why are you feeling this way? You have everything anyone could want"

6

Sit at eye level, maintain a calm presence, and say, "Tell me more about what you mean"

## Explanation

Use a calm, nonjudgmental presence and an open-ended invitation to encourage disclosure (Choice 6). Ask directly about suicide because direct questioning does not create suicidal thoughts and is necessary for immediate safety assessment (Choice 2). Changing the subject avoids a critical cue (Choice 1). Forced positivity and clichés minimize distress (Choices 3 and 4). A challenging why-question and comparison with what others want can sound accusatory and invalidate the client's experience (Choice 5).

## In-depth explanation

Therapeutic Communication Core
1. Open-ended questions: "Tell me more...", "What was that like?"
2. Reflection: restate feelings
3. Silence: allow processing
4. Validation: "That sounds really painful"
5. Direct safety question when suicidal cues: "Are you thinking of suicide?"

Common Non-Therapeutic Pitfalls
- "Don't talk like that" — minimizing
- "Why...?" — sounds accusatory
- "At least..." — minimizes/forced positive
- "You have so much to live for" — cliché closes communication
- Changing the subject — abandons the client
- Giving advice / personal opinion
- Comparing to others

Direct Suicide Inquiry
Asking directly does NOT increase risk; it is required and reassuring. After "yes," assess plan, means, intent, timing → activate safety plan, 1:1 observation, remove means, notify provider.

Memory Tip
"Sit-Listen-Reflect-ASK directly"

## Clinical scenario

Scenario
Adult client with major depressive disorder states quietly, "I don't see the point in going on anymore."

Therapeutic Response
1. Sit at eye level, calm presence
2. Open-ended: "Tell me more about what you mean"
3. Validate without judgment
4. Ask directly: "Are you thinking of suicide?"
5. If yes → assess plan/means/intent → safety plan + 1:1 + remove means + notify provider

Avoid
- "Don't talk like that"
- "Why are you feeling this way?"
- "At least you are here"
- Changing subject
- Cliché reassurance

## Key concepts

- **Therapeutic Communication** — Purposeful, client-centered communication using open-ended questions, active listening, silence, reflection, validation, and clarification to support disclosure and the therapeutic relationship. Core skills: sit at eye level, maintain calm presence, avoid giving advice or personal opinion, and use language that invites rather than closes the conversation.
- **Direct Suicide Risk Inquiry** — When a client expresses hopelessness or suicidal cues, the nurse must ask directly using clear language ("Are you thinking of suicide?") rather than euphemisms. Direct inquiry does NOT plant the idea — research consistently shows it is safe and often relieving. After acknowledgment, assess plan, lethality of means, intent, and timing; activate safety plan, ensure 1:1 observation, remove means/contraband, and notify the provider.
- **Non-Therapeutic Communication Patterns** — Common patterns that block disclosure and harm the therapeutic relationship: minimizing ("Don't talk like that"), giving false reassurance ("Everything will be fine"), giving advice or personal opinion, "Why" questions that sound accusatory, comparing to others, changing the subject, defending self/staff/institution, stereotyped or cliché responses ("You have so much to live for"), and probing without invitation. Recognizing and avoiding these is foundational to NCLEX therapeutic communication items.

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