Interpersonal Process Analysis Student: Date: Patient’s Initials: PT Unit: 3 Clinical Instructor: Current Legal Status (Vol, 5150, 5250, 30 day, T-Con, LPS-Conservatorship): Voluntary Multiaxial Diagnostic System: Axis I (Clinical Disorder): Major Depressive Disorder Axis II (Personality Disorder / Mental Retardation): Borderline Personality Disorder Axis III (General Medical Conditions): None Axis IV (Psychosocial and Environmental Problems): Relational, Financial Axis V (Global Assessment of Functioning Scale): 45 1. Description of the client: Age? Sex? Ethnicity? Marital Status? What precipitated hospitalization? Number of days in the hospital? Mental Status, etc. Client is a 43-year-old Caucasian female. She is in a stable relationship of 10 years with a same-sex partner, and has co-parented her partner’s 2 sons, ages 20 and 23. Client was admitted to Kaiser Mental Health Center in Unit 3 on May 4, 2010, for major depressive disorder and suicidal ideation with a plan to overdose on her antidepressants. She demonstrates good insight into her condition and asked for help from her out-patient psychiatrist. Her support system is very limited, consisting only her partner and two step-sons. Her partner has medical limitations and prevents her from visiting her in the hospital. Client come from a family with a long history of verbal abuse and violence. She stated that she was molested by an uncle for several years. She stated that she has been suffering from depression “all my life,” This is her third hospitalization. She attempted suicide last year by overdose. Her upper arms, neck, and the visible portion of her torso are covered with scarring. History of alcohol abuse since age 20. She reports 3 distinct periods of sobriety. Currently she has been clean and sober for 4 years. Reports financial difficulties due to partner’s illness adds stress to the relationship. 2. Description of environmental setting where interaction took place. Explain the reasons for a supportive or non-supportive environment. (e.g. noise, distractions, light, temperature, etc.). The interaction too place in the day room, and lasted approximately 40 minutes. The client was sitting alone in a corner eating while writing on her journal. A large group of patients was crowded around the center table discussing a project they wanted to work on, and the other patients and staff were coming and going. This environment may not have been supportive. However, we were able to converse privately without being negatively affected by the milieu. 03/2011 NURS 214L Psychiatric/ Mental Health Nursing 1 Student: Interpersonal Process Analysis Student: Client Verbal (quotes) and Nonverbal Communication (behavior, tone of voice, eye contact, mannerisms, etc.) List at least 5 interactions Verbal (quotes) and Nonverbal Communication (behavior, tone of voice, eye contact, mannerisms, etc.) Goal for each interaction (realistic and measurable) Goal: My primary goal at that moment was to help the client feel better and be comfortable talking with me as well as build rapport. Verbal: “You’re really upset, aren’t you? Is there something you’d like to talk about?” Nonverbal: I was leaning forward, attempting to make eye contact and speaking in a soft gentle voice. Communication Techniques Verbal: “I was just writing some things in my journal, and I became so sad and emotional and I don’t know why.” Nonverbal: She dropped her hands from her face and gestured at the notebook, wiping her nose and eyes with a tissue. She placed her hands in her lap, she made brief eye contact with me. She made no attempt to withdraw from my presence, even though I was well within her personal space. Identify communication technique used define your communication technique Was the communication therapeutic or non-therapeutic? Which defense and coping mechanisms did the client use? Rationale based on your client. Interpreting; Non-Therapeutic I was interpreting her unexpressed feelings with her nonverbal behavior as well as her verbal communication. Close ended; Non-Therapeutic. She could only answer with a single response. Defense: Isolation of Affect; The client had painful and trouble some feelings during her journaling and that thought was brought up from conscious awareness by crying. Coping: Adaptive; Selfassertion Solves problems by expressing thoughts and feelings in direct ways through journaling and speaking to nursing student. Goal: Verbal: Nonverbal: 03/2011 Date: Critique and Analysis (effective or not effective? Could have said…) Document your thoughts and feelings during the interaction. Was your goal accomplished? Not Effective. I started off with my observation that she seemed upset and asked a close-ended question and made my own interpretation. I could have used “making observation” and said “You seem really upset, what can I do to help you feel better?” I was a little nervous approaching her at first because she was tearful while writing on her journal. I was not sure if I was intruding. She responded willingly to my question, even though it was not therapeutic. She also did not appear to resent my intrusion into her journaling. Since she did not pull away or show indication of discomfort at my proximity, I felt more comfortable speaking with her and continue my interaction and accomplish my goal. Verbal: Nonverbal: NURS 214L Psychiatric/ Mental Health Nursing 2 SUMMARY 1. Evaluation: After analyzing the interaction, provide a description on how the interaction progressed. Identify the reasons for successful process or unsuccessful process. What did you learn from the interaction with your patient? 2. How did you personally feel about the interaction? What would you change if you had to redo the interaction? 03/2011 NURS 214L Psychiatric/ Mental Health Nursing 3