Communication

Working definition: communication is successful not when a message is sent, but when it is received and understood as intended — meaning is co-created by both parties.

The communication process

The sender–receiver (transmission) model describes communication as a sequence of steps. Each link can fail, which is why misunderstanding is so common:

Sender (initiates) → Encoding (converts ideas into symbols, words, gestures) → Message → Channel (medium: voice, writing, gestures) → Receiver (receives and interprets) → Decoding → Feedback (response to sender) — all within a Context (situation, environment, relationship, culture).

Two additions matter in practice. Noise is any interference at any stage (a crackling phone line, a headache, jargon). Feedback makes communication a loop rather than a one-way broadcast, so the sender can correct course.

The whole sequence can be drawn as a feedback loop:

Types of communication

Verbal — use of spoken or written words; oral (face-to-face, phone) and written (reports, notes, messages). Verbal messages carry content, but tone and choice of words also carry relationship cues.
Non-verbal — transmission of messages without words: body language, facial expressions, gestures, posture, eye contact, tone of voice, touch, appearance and personal space. Non-verbal signals often leak emotions that words conceal and can contradict the spoken message.

A useful rule of thumb attributed to Mehrabian is that, for messages about feelings and attitudes, tone and non-verbal cues can weigh more heavily than the literal words — a reminder that patients read us as much as they hear us.

Barriers to communication

Barriers can arise at any stage of the process and are often layered.

Physical — noise, distance, interruption.
Psychological — stress, fear, prejudice.
Language — different language, jargon.
Cultural — different beliefs and values.
Emotional — anger, anxiety, low mood.
Perceptual — different interpretations.
Organisational — lack of time, workload.
Physiological — hearing loss, speech problems.
Other — lack of interest/attention, inappropriate non-verbal signals.

Common misconception: repeating a message more loudly does not overcome a semantic or emotional barrier. You must change channel, clarify vocabulary, or address the feeling first.

The barriers that arise at each stage can be grouped as follows:

Effective communication

Clear, simple language · appropriate tone and volume · two-way communication · active listening · empathy and respect · appropriate non-verbal cues · consideration of cultural and individual differences · giving and receiving feedback · no interruption · confidentiality.

Central to all of this is active listening — not merely staying quiet, but genuinely working to understand. Its behaviours include:

Attending — facing the speaker, open posture, appropriate eye contact.
Reflecting and paraphrasing — "So what you're saying is…".
Clarifying and summarising — checking understanding before moving on.
Withholding judgement — allowing the speaker to finish without rebuttal.

Therapeutic communication

Therapeutic communication is purposeful, planned and patient-centred communication that helps understand a person's problems, reduces anxiety and builds trust — with the goal of promoting health and participation in therapy. Unlike everyday chat, it is intentional and directed toward the patient's needs.

Its principles: show genuine interest · use open-ended questions · listen actively · empathize · be non-judgmental · show respect and acceptance · maintain appropriate eye contact · use simple, clear language · provide encouragement and support · maintain professional boundaries · ensure confidentiality.

Open-ended questions ("How have things been since we last met?") invite narrative and detail, while closed questions ("Did you sleep well?") produce yes/no answers useful for confirming facts. Skilled interviewers move from open to closed as the picture sharpens.

A therapeutic exchange alternates between the patient and the clinician:

The patient–therapist relationship

A professional, collaborative relationship based on trust, respect, understanding and effective communication, aimed at the best possible therapeutic outcomes. Research consistently shows that the therapeutic alliance — the emotional bond plus agreement on goals and tasks — predicts outcome across many therapies, often as much as the specific technique used. Rogers' core conditions of empathy, unconditional positive regard and genuineness (see Treatment of Psychological Disorders [blocked]) are the humanistic foundation of this bond.

Importance of good communication

Accurate assessment and diagnosis · builds trust and rapport · reduces anxiety and fear · improves cooperation and adherence to therapy · better understanding of instructions · helps set realistic goals.

Where communication shapes how people appraise and cope with demands, see Stress [blocked]; where emotional expression and regulation are central, see Emotion [blocked].

Key takeaways

Communication succeeds only when the message is understood as intended, not merely transmitted.
The sender–receiver model (encode → message → channel → decode → feedback, in context) shows where misunderstandings arise.
Verbal and non-verbal channels operate together; non-verbal cues can confirm or contradict words.
Barriers are physical, psychological, language, cultural, emotional, perceptual, organisational and physiological — and are often layered.
Active listening and open-ended questions are core skills of therapeutic communication.
A strong therapeutic alliance (bond + agreed goals and tasks) is one of the best predictors of outcome.

Sources & further reading