NCLEX · Therapeutic Communication

A client with depression says: 'I've been feeling a little better this week. I actually cleaned my apartment for the first time in months.' The nurse's MOST therapeutic response is:

Correct answer

'That sounds like a meaningful step. How did it feel to accomplish that?'

  1. A 'Wonderful! You'll be back to normal in no time!'
  2. B 'That's good — make sure you keep it up or you'll feel bad again.'
  3. C 'That sounds like a meaningful step. How did it feel to accomplish that?'
  4. D 'You should have cleaned it sooner — it probably contributed to your depression.'

Why this is the answer

THERAPEUTIC RESPONSE TO PROGRESS IN DEPRESSION: The best response: (1) VALIDATES the significance without overpromising ('meaningful step' acknowledges it without guaranteeing recovery); (2) EXPLORES the client's experience ('How did it feel?') — opens conversation about whether the client noticed a change in their mood, what the accomplishment meant to them, and helps them identify their own recovery resources; WHAT'S WRONG WITH THE OTHERS: 'You'll be back to normal in no time' — false reassurance; recovery from depression is not linear; sets the client up for disappointment and guilt if they have a setback; 'Keep it up or you'll feel bad again' — threatening and adds pressure; depression already involves guilt; this comment instrumentalizes the achievement and threatens; 'You should have cleaned sooner' — blaming, shaming; depression causes avolition (inability to initiate activities), not laziness — this comment lacks understanding of the illness. STRENGTHS-BASED APPROACH: Exploring what the accomplishment felt like helps the client build their own narrative of recovery.
Source: NCLEX-PN Test Plan: Psychosocial — Therapeutic Communication, Progress and Recovery