Running head: STUDENT'S CRITIQUE INTERPERSONAL SKILLS
A Critique and Analysis of a Student's Interpersonal Skills
Trina Skinner
Stenberg College
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STUDENT'S CRITIQUE INTERPERSONAL SKILLS
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A Student's Own Critique of Interpersonal Skills
The intent of this essay is to provide the writer an opportunity to analyze and reflect on
his/her use of interpersonal skills throughout an audio-taped interview with a self-selected
subject in the interest of identifying the presence/lack of various micro-skills essential within the
construct of any therapeutic relationship.
The context of the audio-taped interview consists of the writer attempting to gain insight
into the subject’s, referred to by the initials (S.N.), experience with the Mental Health system.
(S.N.) is a diagnosed paranoid schizophrenic, currently in his mid-fifties, diagnosed in his early
twenties at the start of the 1970’s. (S.N.) spent many years institutionalized in the Forensic Unit
of Riverview Hospital (Riverside) for the criminally insane in the early years of his diagnosis
following an incident in which he was convicted of attempted murder for stabbing a man what
was deemed a paranoid delusion. Throughout his institutionalization and following release from
custody, (S.N.) has experienced firsthand the developmental change that has occurred within the
B.C. Mental Health system from the 1970’s to the present. The writer’s motivation for selecting
(S.N.) as the subject for the interview is two-fold, on one hand the writer viewed it as a rich
opportunity to get a glimpse into a person’s unique experience as a client of Mental Health
services throughout his entire adult life. Secondly, this interview offers (S.N.) the opportunity to
be ‘heard’ and tell his story from his perspective, without the interviewer dictating the structure
of the interpersonal communication.
Prior to recording the writer explained to (S.N.) that he was free to discuss whatever he
wished and also expressed interest in his experience with Psychiatric Nurses as well as his
overall view on the B.C. Mental Health system in terms of evolution from his diagnoses to the
present.
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
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Analysis
“For the most part the nurses in the Forensic unit seemed to be in a transient life. Didn’t
last long, I think it was hard on their brains as well” (S.N.). In this instance the writer missed an
opportunity to pose an open question for exploration into client’s perspective, for example: Did
you feel then that it was difficult to establish trusting/therapeutic one- to- one relationships with
the RPN’s in the Forensic Unit given these circumstances?
“There was a high turn-over of nurses…always seemed to be as a stepping stone, seems
to be get your experience and get a better job” (S.N.). Writer’s response, “Okay”, nods head: use
of minimal prompts, indicates “I am with you” (Burnard, 2005, p.139). The writer missed a good
opportunity to apply the skill of building empathy here, an appropriate empathetic response
would have been: It sounds as though you feel the nurses were not fully invested in the
treatment/care of the patients, but rather used their experience in the Forensic Unit as a means to
further their career- I could understand this being very frustrating, contributing to a lack of much
needed support for yourself and other patients. (Reynolds, n.d.) states that “Empathy is essential
in order to create an interpersonal climate that is free of defensiveness. This enables individuals
to talk about their perception of need…When nurses assist patients to find solutions to personal
problems, in a manner that reflects their preferences, favorable health outcomes will occur.”
(p.327).
“However, these days seems to be more forward thinking I do see a psychiatrist
occasionally…” (S.N.). Writer missed opportunity to apply skill of Reflection: ‘echoing’, “the
process of reflecting back the last few words…that the client has used, in order to encourage him
to say more” (Burnard, 2005, p.154). An appropriate response could have been: You feel that
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
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there is more “forward thinking” in regards to the current state of the mental health system vs.
the 1970’s when you spent time in the Forensic Unit?
“He’s told me that what they wanna do these days is to integrate people more into the
community, rather than isolate/segregate them from the community” (S.N.).
Skill missed by writer: Open question to obtain further information on client’s point of view,
(Burnard, 2005, p.150). An adequate question may have been: How do you feel about this
approach described by your psychiatrist regarding people with mental health issues adopting a
more pro-active role in their treatment/illness management, in contrast to your experience with
the biomedical approach you experienced in the 1970’s?
“I’ve been sort of what you would say independent for long enough that I haven’t really
been in contact with the mental health system much” (S.N.). Skill missed: Open question to
clarify client’s statement. “Open questions …encourage the client to say more, to expand on his
story or to go deeper” (Burnard, 2005, p.150) When you say “independent for long enough” what
exactly does this mean?
“I was at the ------- clubhouse and it seems like that’s gone a little downhill because when
there was people there who were suffering from you know, schizophrenia or manic depression it
was a place where you could go and encourage each other” (S.N.). In this instance the writer
missed an opportunity to apply Catalytic Intervention: which includes “encouraging further self
exploration, self-directed living, learning and problem-solving in the client” (Sloan & Watson,
2001, p.208). An appropriate application of this intervention would be to pose the question: It
sounds like a very healthy environment where you felt supported and helped to maintain your
mental /overall health. Do you feel that an alternative community-based program would be
beneficial to you at this point, are you interested in exploring that option?
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
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“I saw myself 30 years ago…I was in the Forensic I said- you know study, work
here/there for extra money and take care of my health, exercise and that- so I had a 30 year
vision and that’s what worked out…so it’s sort of what you do, what you don’t do and where you
end up. You know you gotta make up your mind” (S.N.). Writer missed opportunity to utilize the
skill of Supportive Intervention: “to be supportive is to validate or confirm the worth of the
client's person, qualities, attitudes or actions” (Sloan & Watson, 2001, p.208).
An appropriate response of this nature could have been: I think it’s wonderful and commend you
on working hard to achieve the goals you set out for yourself upon your release from the
Forensic Unit.
Writer’s question posed to (S.N.) : “My question for you I think is because I think a lot of
people although they don’t understand schizophrenia, like, I’ve known before I ever got
interested in psychiatric nursing that a problem with schizophrenia is feeling ‘better’ and going
off the meds, and then things get ‘messy’? (S.N.) response: “Been there, done that, ended up
back in the hospital, not doing it again!” The writer made an attempt to apply catalytic
intervention through the use of an open question for further inquiry. The writer lacked the skill of
‘Concreteness’ in posing this question and was unclear and vague in her attempt to convey to
(S.N.) exactly what she was inquiring in a clear and concise way. “Concreteness refers to the
idea that the counselor should be clear and explicit in her dealings with the client and should help
the client to express himself clearly.” (Burnard, 2005. P. 108). A more effective question would
have been “What is your input on the perceived notion of schizophrenics “feeling better” and
going off their meds in relation to personal experience or otherwise. Do you have any insight you
would like to share on this topic?”
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
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Reflection
The writer found this assignment on interpersonal skills/therapeutic communication
extremely fruitful in establishing a ‘starting point’ to gauge her natural interpersonal relation
skills with limited insight into all that is necessary to function as an effective psychiatric nurse in
regards to specific micro-skills in conjunction with knowledge/proper application of psychiatric
nursing theory. Prior to embarking on this assignment the writer felt she was beginning to
develop a baseline understanding of the foundation on which psychiatric communication is
formed.
Working through each stage of this assignment to produce the final product was a
valuable learning experience in providing the writer the opportunity to truly evaluate where her
strengths lie in terms of therapeutic communication skills, and more importantly to identify the
writer’s weaknesses and areas that require further development, which at this early stage are
plentiful. Regardless of the interview being a ‘mock’ counseling session, the communicative
interaction between the interviewer/ interviewee was genuine and therefore enabled the writer to
establish a deep understanding of her own innate abilities as an effective communicator as well
as drawing out the barriers that prevent therapeutic communication.
The writer made a point of establishing an appropriate environment prior to the interview
start based on behavioral aspects of listening outlined by (Burnard, 2005), particularly in
applying Egan’s ‘SOLER’ method “as a means of identifying and remembering the sorts of
counselor behavior that encourage effective listening” (Burnard, 2005, p. 139). The writer was
surprised and pleased with her ability to implement this method in particular reference to
effective body language and use of eye contact. In the past these are areas the writer felt she was
not particularly skilled in. It was obvious by the subject’s willingness to talk with comfort and
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
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ease that the writer was applying these vital aspects of active listening effectively. That being
said, as the writer considers herself fairly comfortable interacting socially with people from all
walks of life.
In this case, where the interaction was being recorded and in an attempt to utilize
appropriate communication skills while maintaining a natural flow of conversation, the writer
was surprised at her inability to formulate direct, relevant questions to be stated clearly. The
writer also experienced difficulty in determining when/where to interject herself into the session
as the subject was very eager to speak and be heard, the writer felt some apprehension attempting
to interrupt and pose specific questions to redirect the context of the interview, mainly based on
fear of the subject feeling disrespected and ‘shutting down’ on her. Ultimately the writer
concluded in this situation that it was more important to allow (S.N.) to speak freely and actively
listen and attend to him/his needs than to practice utilizing as many of her newly learned
communication skills as possible throughout the interview process. The writer felt using (S.N.)
as an object to practice skilled communication on, rather than valuing him from a humanistic
perspective contradicted the whole purpose of our developing these scared skills vital to any
therapeutic relationship in psychiatric nursing.
In conclusion, the writer found the entire process extremely enlightening and has gained
valuable insight into herself and her strengths and weaknesses in regards to effective
communication/interpersonal skills. The writer feels confident that these skills will only grow
and develop stronger as time moves forward and opportunity to practice present themselves and
are taken full advantage of.
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
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Therapeutic Relationship Analysis transcription Grid STUDENT: Trina Skinner
Client response Student
Skill used
Skill missed
Better phrase
response
When you say “as
well as what they
were doing”, are
you referring to
their provision of
care of patients on
the Forensic Unit?
Did you feel as
though their
academic focus
interfered with the
construct of the
nurse/client
relationship? Is this
interpretation
accurate?
My experience with
RPN’s was a lot of
them took extra
courses as well as
what they were
doing
“Mmhhmm”
For the most part
the nurses in the
Forensic unit
seemed to be in a
transient life.
Didn’t last long, I
think it was hard on
their brains as well
“Mmhhmm”
Active
Catalytic
listening and
Intervention
attending skills
applied/
minimal use of
prompts
Did you feel then
that it was difficult
to establishing
trusting/therapeutic
one- to- one
relationships with
the RPN’s in the
Forensic Unit given
these
circumstances?
There was a high
turn-over of
nurses…always
seemed to be as a
stepping stone,
seems to be get
your experience and
get a better job.
“Okay”
Use of minimal Empathy
prompts
Building
It sounds as though
you feel the nurses
were not fully
invested in the
treatment/care of
the patients, but
rather used their
experience in the
Forensic Unit as a
means to further
their career- I could
understand this
being very
frustrating,
contributing to a
lack of much
needed support for
yourself and other
patients.
Nodded head
Use of
Minimal
prompts
SOLER
method
applied
Nodding
Checking in,
“I am with
you”
Reflection
‘echoing’
Questions to
clarify and
check for
understanding
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
It came down to a
thing of looking
into one’s self to
find out well,
what’s more
important? I came
to the conclusion
I’ll take my meds
and I’ll get through
this
“Mmhhmm”
I don’t know what
the system does
these days but back
then if you were put
in with the criminal
asylum they would
over-medicate you
Just to keep you Question to
from behaving
clarify/gather
a certain way?
more
information
That’s what it was
called, it was called
‘behavior
modification
through drug
therapy’
Which was
basically…
Drug ‘em, tranq
‘em
Soler method
Checking in,
“I am with
you”
9
Questions to
clarify
Check for
understanding
I just want to
clarify what it is
you are referring to
when you say, “get
through this” Are
you referring to
your time in the
Forensic Unit?
When you say
“looking into one’s
self’ are you
referring to the
concept of
spirituality or how
would you describe
the process of
“looking into one’s
self”?
Why do you feel
yourself and other
patients were
‘overmedicated’?
What do you
believe was the
objective behind
this method of
‘treatment’?
Okay, ya,
mmhmm
Attempt to
check for
understanding
Listening and
attending
Wait for client
to further
elaborate on
topic.
Empathy
Building
I imagine it must
have been a very
frightening
experience,
healthcare
professionals
making no attempt
to understand the
nature of a patient’s
behavior, simply
sedating you to the
point you could no
longer function
adequately.
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
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Client response
Student
response
Skill used
However, these
days seems to be
more forward
thinking I do see a
psychiatrist
occasionally…
“Mmhhmm”
Use of minimal Reflection
prompts
‘echoing’
“I am with
you”
Question to
gather more
information
You feel that there
is more “forward
thinking” in regards
to the current state
of the mental health
system vs. the
1970’s when you
spent time I the
Forensic Unit?
He’s told me that
what they wanna do
these days is to
integrate people
more into the
community, rather
than
isolate/segregate
them from the
community
Active
listening and
attending
Question for
exploration/to
obtain further
information on
client’s
perspective
How do you feel
about this approach
described by your
psychiatrist
regarding people
with mental health
issues adopting a
more pro-active
role in their
treatment/ability to
adopt methods that
function to enhance
a client’s daily
living, as opposed
to your experience
with the biomedical
approach you
experienced in the
1970’s?
I’ve been sort of
what you would say
independent for
long enough that I
haven’t really been
in contact with the
mental health
system much.
Active
listening and
attending
Use of open
question to
clarify client’s
position
When you say
“independent for
long enough” what
exactly does this
mean?
“Mmhmm”
Skill missed
Better phrase
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
I was at the ------clubhouse and it seems
like that’s gone a little
downhill because
when there was people
there who were
suffering from you
know, schizophrenia
or manic depression it
was a place where you
could go and
encourage each other
“Okay”
Then the ‘hard drug
addicts’- that they
need something, okay?
Maybe it’s a job at a
brewery or you know
maybe it’s something
to keep them
‘up’…whatever they
need but it is certainly
not
tranquilizers…(contin
ues on this course of
verbal expression)
“Mmhhmm”
A person may still
have a disability, so
I’m not saying anyone
should have more or
less benefits- I’m just
saying let’s look at 30
years from now, where
are we going with
this?
“Mmhhmm”
Active
listening and
attending
11
Catalytic
Intervention
It sounds like a
very healthy
environment where
you felt supported
and helped to
maintain your
mental /overall
health. Do you feel
that an alternative
community-based
program would be
beneficial to you at
this point, are you
interested in
exploring that
option?
I am not sure I
understand what
you are
communicating
here.
Are you saying that
once people with
substance abuse
problems started
attending meetings
it disrupted the
group dynamic and
you found the
support group less
effective/that
environment no
longer met your
needs?
Active
listening and
attending
continued but
I feel as
though I am
losing the
client’s focus
at this point
Concreteness
Checking in,
“I am with
you”
Do I understand
Checking for
based on your
understanding previous statements
Help the client
express
himself
clearly
Check for
understanding
Reflection
‘echoing’
RE: ‘drug addicts’
and their presence
in the ‘clubhouse’
it is your belief that
community support
programs for the
mentally ill should
be less generalized
and more specific
to a client’s
individual
diagnoses?
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
Client response
Student
response
I saw myself 30 years
ago… I said- you know
study, work here/there
for extra money and
take care of my health,
exercise and that- so I
had a 30 year vision
and that’s what worked
out…so it’s sort of
what you do, what you
don’t do and where you
end up. You know you
gotta make up your
mind.
I think the biggest think
for me to swallow was I
gotta take my
medication and once I
got over that hurdle I
was fine.
Skill used
12
Skill missed
Better phrase
“Mmhhmm”
Supportive
intervention
I think it’s wonderful
and commend you on
working hard to
achieve the goals you
set out for yourself
upon release from the
Forensic Unit.
“Yeah”
Question for
exploration/to
obtain further
information
Reflection
Can you recall how
you came to this
conclusion that it was
absolutely necessary
you take your
medication, what it
was that guided you
“over that hurdle”
initially?
Concreteness
What is your input on
the perceived notion
of schizophrenics
“feeling better” and
going off their meds
in relation to personal
experience or
otherwise. Do you
have any insight you
would like to share on
this topic?
(problem with
recording
device)
My question for
you I think is
because I think a
lot of people
although they
don’t understand
schizophrenia,
like, I’ve known
before I ever got
interested in
psychiatric
nursing that a
problem with
schizophrenia is
feeling ‘better’
and going off the
meds, and then
things get ‘messy’
Question to
provoke
exploration/
further
information
I experienced
an inability to
be ‘clear and
explicit’ in my
dealings with
the client in
order to help
the client
express
himself
clearly
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
Been there, done that,
ended up back in the
hospital, not doing it
again!
I know it’s a hard
question what…I
just want to be clear
in what I am asking
you, what sort of
made you decide
like okay I need to
take this medication,
like this is a part of
my life, like, and not
fight…
13
Concreteness
Open question
for
I was vague/
exploration
unclear and
non-concise in
expressing my
question
What ultimately led
you to decide that it
was critical to your
overall health and
quality life that you
take your medication
consistently?
STUDENT'S CRITIQUE INTERPERSONAL SKILLS
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References
Burnard, P. (2005). Counselling Skills for health professionals (4th ed.). Cheltenham, United
Kingdom: Nelson Thornes.
Reynolds, B. (n.d.). Chapter 37: Developing Empathy. In P. Barker (Ed.), Pshychiatric and
Mental Health Nursing: the craft of caring (2nd ed., pp. 321-328). London, United
Kingdom: Hodder Arnold.
Sloan, G., & Watson, H. (2001). John Heron’s six category analysis: towards understanding
interpersonal relations and progressing the delivery of clinical supervison for mental
health nursing. Retrieved from:
http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2002015059&site=eho
st-live
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