A nurse is caring for a 20-year-old college student who has a 2-year history of bulimia nervosa. She tells the nurse, "l know my eating binges and vomiting are not normal, but I cannot do anything about them." Which of the following is a therapeutic response by the nurse?

Reflecting the client's expressed feelings back to her — as in the response beginning with 'It seems like you are feeling helpless about this behavior' — is the most therapeutic communication technique here. This approach validates the client's emotional experience, demonstrates empathy, and opens the door for further exploration without passing judgment or offering unsolicited advice. It acknowledges what the client has just said and invites her to elaborate, which is central to a therapeutic nurse-client relationship. The response telling the client she should stop because she is destroying her health is non-therapeutic because it is authoritarian, judgmental, and dismissive; it offers no empathy and is likely to make the client feel shamed, which can worsen disordered eating behavior. Saying 'I'm proud of you for recognizing that this behavior is not normal' shifts the focus away from the client's emotional state and places the nurse in a position of authority and evaluation, which is not therapeutic; praise can also inadvertently reinforce seeking the nurse's approval rather than intrinsic motivation. Asking 'Do you have any idea why you do this?' is a probing question that can feel confrontational or blaming, suggesting the client should already know the cause of her illness. Reflection of feelings, by contrast, meets the client where she is emotionally and facilitates open, honest dialogue essential in caring for clients with eating disorders.