Explain why it is not a therapeutic communication strategy.
Clinical Interview Paper
My client is a 52-year-old African American male who was taken to the emergency department (ED) at Mount Sinai Hospital on 8/15/20 due to an overdose of aspirin. This is his second psychiatric admission. His last admission was at St. Elizabeth’s Hospital three years ago for major depression. Client’s current diagnosis is major depressive disorder (MDD) without history of substance use. His medical problems include hypertension and asthma. He is currently taking albuterol, amlodipine, and sertraline. He works full-time as a mechanic and is presently living with his wife. He considers his 22-year-old married daughter to be his support system. The clinical interview took place in the client’s bedroom. His roommate was not in the room at the time. I asked if I could turn on the light and the client agreed. He then sat down on the edge of his bed, while I positioned myself by the door and sat down on a nearby chair facing him. There were no interruptions during our conversation.
Process Recording
| Student Nurse (direct quotes) | Client (direct quotes; include verbal and nonverbal ways of communication) | Communication Techniques
– Identify specific technique(s) used. – State whether the technique is therapeutic or not, with a brief explanation.
|
Student’s Thoughts & Feelings
– If nontherapeutic, state the alternate response (I could have said, :….). |
| “Good Morning, Mr. JH.”
|
“Who are you, and where the devil am I? (gazes around with a confused look on his face, quickly sits on the edge of the bed). | Therapeutic: Giving recognition. Explain why it is therapeutic. | I was feeling nervous. He had attempted suicide, and I didn’t know if I could help him. Initially, I was feeling somewhat overwhelmed. |
| “I am Nancy. I am a student nurse from the college, and you are at Mt. Sinai Hospital. I would like to spend some time with you today.”
|
“What am I doing here? How did I get here?” (spoken in a loud, demanding voice). | Therapeutic: Giving information. Explain why it is therapeutic.
Therapeutic: Offering self. Explain why it is therapeutic.
|
I felt a bit intimidated when he raised his voice.
|
| “You were brought in by your wife last night after swallowing a bottle of aspirin. You had to have your stomach pumped.”
|
“Oh … yeah” (silence for 2 minutes, shoulders slumped while staring at the floor). | Must be filled in | I was uncomfortable with the silence, but since I did not have anything useful to say, I stayed with him in silence for the 2 minutes. |
| “You seem upset, Mr. JH. What are you thinking about?”
|
“Yeah, I just remembered I wanted to kill myself” (said in a low tone almost to himself). | Must be filled in | I began to feel sorry for him, he looked so sad and helpless. |
| “Oh, Mr. JH, you have so much to live for. You have such a loving family.”
|
“What do you know about my life? You want to know about my family? My wife is leaving me, that’s what” (faces the nurse with an angry expression on his face and speaks in a loud tone).” | Nontherapeutic: Minimizing feelings. Explain why it is not a therapeutic communication strategy.
. |
I felt overwhelmed. I did not know what to say. His talking about killing himself made me nervous. I could have said, “Tell me more about that” (exploring). |
| “I didn’t know. You must be terribly upset by her leaving.”
|
“Yes, I am. After 25 years of marriage, she now decides to leave me. Wouldn’t you feel the same if you were in my situation?” (angry tone of voice). | Must be filled in | I really felt for him, and now I thought that encouraging him to talk more about this could be useful for him. |
| “Yes, I would. Why does she want to leave?”
|
“I don’t know. You have to ask her” (still with an angry tone). | Nontherapeutic: Agreeing.
Explain why it is not a therapeutic strategy. Nontherapeutic: Use of “why” question. Explain why it is not therapeutic strategy |
I thought that agreeing with him would make him feel better. I could have remained neutral, neither agreeing nor disagreeing with the client.
I shouldn’t have used “why” in my question . I could have said, “What do you think is the reason for her decision to leave?”
|
| “Can you tell me what you think might be the reason?’
|
“No … I don’t know” (voice is softer with a sad affect). | Must be filled in | I wanted to explore his marital situation, but I should have used an open-ended question. I could have said, “What do you think might be her reason for deciding to leave?”
|
| “Have you tried going to a marriage counselor?”
|
“That doesn’t work”
(shaking his head). |
Must be filled in | I wanted to offer the client some suggestions, and although he did not simply respond with a “yes” or “no,” I should have said, “What have you and your wife done to help resolve your marital issues or problems?’
|
| “What makes you say that counseling does not work?”
|
“I really feel tired and would like to rest now”
(voice got softer). |
Must be filled in
|
I could tell that Mr. JH was not ready to open up about his feelings and thoughts.” |
| “Okay, Mr. JH, you can rest now. Before I leave, I just need to ask if you are still thinking of harming yourself?”
|
“No” (avoids eye contact but firm with his response). | Must be filled in | I was nervous about asking if he had suicidal ideations, but I knew that I had to ask. |
| “Thank you for talking to me. If you need anything, let me know.”
|
“Okay, thank you” (starts to stand up with a flat affect).
|
Must be filled in | I wished Mr. JH could have talked more about his feelings and thoughts, but I realize that he was not ready to do so, especially with a student nurse.” |
It was an anxiety-provoking experience for me to engage in a 1:1 conversation with a client diagnosed with mental illness. Oftentimes, I was not sure of what to say, especially since Mr. JH looked angry. I tried to apply the therapeutic strategies that I learned but it was quite difficult to do so. I feel that I was good at active listening since I was really paying attention to what the client was saying, both verbally and non-verbally. I was observing his body language to better understand how he was feeling. I also used the technique of making observations to determine if I was being accurate. I provided my client information about myself and recognized him as I started my interaction with him. At the end of our conversation, I made sure I offered my assistance to Mr. JH. I really wanted to explore Mr. JH’s life situation with his wife, but instead of using open-ended questions, I ended up using closed-ended type of questioning. I also should avoid putting my client on a defense by asking the “why” questions. As a healthcare provider, I should remain unbiased when my client asks for my personal opinions. I have learned so much based on my clinical interview with Mr. JH. I hope that I can be more effective and confident in my future interactions with my clients.