Running Head: Interpersonal Process Analysis

Valerie Reese
Interpersonal Process Analysis
West Coast University

Interpersonal Process Analysis

Student: Valerie Reese

Date: 04/16/2016

Clinical Instructor: Dr. Brown

Unit: 4 (Duel Disorder)

Patient Initials:

Current Legal Status: Voluntary

ME

Multiaxial Diagnostic System: Axis I (Clinical Disorder): Schizoaffective Disorder, Bipolar

Disorder, Major Depression, and PTSD
Axis II (Personality Disorder/Mental Retardation): N/A
Axis III (General Medical Conditions): Obesity, GERD, and Asthma
Axis IV (Psychosocial and Environmental Problems): Problems with primary support
Axis V (Global Assessment of Functioning Scale): 30

Description of Patient
A 35 year old Caucasian of non-Hispanic decent and was admitted to the mental hospital
13 days ago on normal nutrition status. Patient is female and married with three children. My
clients children currently reside with her parents. Patient admitted to the mental institute due to
an emotional phone call from father informing her that her children and ex-husband do not want
her in their lives. Her father also informed her she is no long allowed to visit her children. News
resulted in a suicide attempt with a gun. My client was dressed in a pink shirt, black yoga pants,
socks provided by the facility. Patient had blond hair, black metal frame glasses, and had clean
yellow skin. Her appearance was groomed and neat with an exception of her messy bun. ME was
cooperative, friendly, and labile. Her mood was positive but slightly anxious throughout the
conversation. She also spoke at a normal rate with a soft, light tone. Patient revealed she has
experienced visual and auditory hallucinations. Patient was very goal oriented had a grasp of her
surroundings. Her memory recall was intact. However, her concentration was short before
medication and high afterward.
Environment Description
The Patient interaction took place at 8:15 am at the group table in her unit. The table was
a rectangular shape, light brown wood, and table about the size of a dinner table. There were
four chairs, two on each horizontally, on each side. The walls were bare and white with a white
erase board on the left side of room. The board had phone call times and what the group
activates were for the day. The room was fill with soft cushioned chairs in a semi-circle facing the
TV right above the table and away from the nurses station. The TV secured inside a plastic case
on a low volume with the remote being held at the nurses station. The room was very clean to
the point you could even see your refection on the white laminated tile floor. The temperature
was slightly chilly with a clean and fresh scent. The environment was calm, fairly quiet, with
normal lighting. The environment was supportive for conducting an interview. It was quiet which
limited chance of miscommunication promoting a positive start in the nursing process. The client
seemed comfortable and relaxed due to the calm and low stimulating surrounding. There was
limited distractions making it easier to keep my patients attention. The temperature was chilly
which could potential cause my patient to become uncomfortable and distracted.

Interpersonal Process Analysis

Student

Patient

Verbal and
Nonverbal

Interpersonal Process Recording

Communication Rationale
Techniques

Verbal and
Nonverbal

Communication
technique
Therapeutic or
nontherapeutic
Defense and coping
mechanisms used

Based on your patient

Goal: Introduce

Technique:

Rationale: A closed

myself

Closed-ended
question
Type: Nontherapeutic
Defense: Palliative

ended question
minimizes the response
and information
received from the
patient. The patient did
not maintain eye
contact with me to
prevent to reduce the
amount of anxiety she
was feeling. The
patients willingness to
talk is a good coping
technique to help
manage emotions.

Verbal: Hello, My
name is Valerie. I
am a student nurse
at WCU. Do you
mind if I talk with
you?

Nonverbal:

Verbal: Sure we
can talk. My name is
Melanie. The floor is
yours.
Nonverbal: On
and off eye contact,
no facial expression,
and shakes my hand.

Coping:
Willingness to talk

Smiling, making eye

contact, extending
hand for a
handshake, and
light soft tone.

Critique and
Analysis

Effective or not effective

Could have said.
Thoughts
Was your goal met and
why

Analysis: Effective
Critique: I could have
said. Hello, my name is
Valerie. I am a nursing
student at WCU. Would you
be open to an interview with
me?
Thoughts: How I asked
for an interview reminded
me of how someone with
authority asks to speak to
you when youre in trouble. I
felt like it gave my patient
that impression and caught
her off guard.
Goal met: Yes

Why?: I was able to

introduce myself and
received an introduction
from the patient.

Goal: Find out how

the patient is feeling
today.
Verbal: How are
you feeling today
Mrs. Melanie?

Nonverbal:
Smiling, sitting
across from patients
with feet flat on the
ground and leaning
forward.

Verbal: Im
feeling good. I am
actually really excited
because I get
discharged today!
Nonverbal: Large
grin on patients face,
conducting a mini
dance, and
maintaining strong
eye contact.

Technique:

Rationale: The

Encouraging
expression of feelings
Type: Therapeutic

patient is being
discharge after getting
help, complying with
the program and
medications, and
utilizing its resources to
assume a better and
healthier mental status.

Defense: Adaptive
Coping: Dancing

Analysis: Effective
Critique: I could have
said. How are you feeling
most days instead of
nearing it down to today
Thoughts: I happy to
hear my. patient was being
discharge. This urged me to
find out how long she had
been hospitalized.

Goal met: Yes

Why?: The patient
revealed how she was
feeling today and expressed
her feeling nonverbally.

Interpersonal Process Analysis

Goal: Discover
reasoning for
hospitalization
Verbal: I can
see youre very
excited about your
discharge. Can you
tell me what
brought you to the
facility?

Nonverbal:
Maintained strong
eye contact.

Verbal: I tried to
shoot myself but Im
the one that checked
myself in here.
Nonverbal: Facial
expression became
flat, patient looked
downward at the table
and began to draw
something on the
table with her finger.

Technique:

Rationale: Patient

Exploring
Type: Therapeutic

went from maintaining

strong eye contact to
avoiding eye contact. I
feel the patient did not
want to acknowledge
her suicidal attempt but
unconsciously
emphasized she was
voluntarily admitted. By
emphasizes a voluntary
status she minimizes
the severity of the
event and somewhat
puts down those who
are involuntary.

Defense:
Omnipotence and
minimizing

Coping:
Drawing/tracing
something onto the
table to alleviate
anxiety and distract
herself from her
thoughts and feeling.

Analysis: Effective
Critique: I felt as if I
somewhat belittled her
excitement because I
quickly moved to the next
question. I should have took
a little more time with her
excitement and shown
genuine excitement for her.
Thoughts: I felt as the
patient felt her situation
was not as serious because
she took the actions to get
help. It came across as she
was putting herself above
others due to her legal
status. (voluntary vs
involuntary)
Goal met: Yes

Why?: ME told me the

Goal: Find out the
events that led up
to the attempted
suicide.
Verbal: That
very big step in
positive direction.
Can you tell me
what led up to this
event?

Nonverbal:
Placed hands on the
table to promote a
relaxed and unjudgmental tone.

Verbal: Well,
(pauses) my dad
called me and told me
I aint gone see my
kids anymore and
they dont want
nothing to do with
me. He was saying
some really bad
things about me and I
got extremely sad and
overwhelmed. I was
already drinking so
hearing that made my
mind start racing. Its
like I blacked out. I
just knew there was a
gun in house and I
wanted to shoot
myself. (Long pause)
I dont remember
everything I just
remember wanting to
shoot myself and
getting the gun. Can
we talk about
something else now?

Nonverbal:
Patient began
bouncing left leg up
and down rapidly
(restless leg), made
eye contact, low soft
voice, troublesome/
concerning facial
expression.

Technique: Giving

Rationale: The

Recognition
Type: Therapeutic

patient does not

remember everything
about that night. She
says she blackout out
right when she got the
gun. ME seems as if she
purposely does not
remember this critical
time. This might be her
attempt to surpass the
situation like a type of
denial. She clearly is
still emotional about
the situation because
she quickly wanted to
change the subject. She
is avoiding facing her
feelings and coming to
terms with the events.

Defense:
Dissociation
Coping: Avoidance
mechanism.

reasoning behind her

hospitalization
Analysis: Effective

Critique: I could have

giving more
acknowledgement to her
regarding seeking help. I
acknowledge it and quickly
followed up with another
question. I should have
paused or used silence
before asking another
question.

Thoughts: At this
moment, I learned a lot
about my patient and from
her perspective. I gave me a
close look on how she feels
about the situation and if
she has come to terms with
it. However, I felt as if she
blocked out a section of the
event as a way to cope with
it.
Goal met: Yes

Why?: I was able to find

out what happened before
the event and what led up
to her attempted suicide.

Interpersonal Process Analysis

Goal: Make the
patient feel
comfortable and
show genuine care.
Verbal: Yes of
course we can talk
about something
else. Just know I am
here if you decide
you want to talk
about it.

Nonverbal:
Leaned forward
towards patient
made eye contact
while nodding my
head.

Verbal: Thank
you. I think I can talk
about it later after I
talk my meds. I just
cant without my
meds.

Technique: Using

Rationale: ME

active listening
Type: Therapeutic

looked away trying to

avoid eye contact with
me. She seemed like
she was trying to make
herself feel
comfortable. ME had a
prescription for anxiety
medication that she
sought out to calm her.
She can correctly
identify her anxiety
level and take the
necessary steps to
reduce it.

Defense: Palliative
Coping: Medication
compliance

Nonverbal:
Reached and touched
my hand while
thanking me, small
quick smile while
making eye contact,
quickly broke eye
contact and looked
towards the nursing
station.

Analysis: Not effective

Critique: I could have
informed my patient at the
beginning of the interview
that if she felt
uncomfortable and
overwhelmed at any point
that we could take a break. I
also should identified her
coping techniques so when
she did feel emotional or
overwhelmed I could
encourage and participate
in her techniques.
Thoughts: I feel that ME
felt that I genuinely cared
about her wellbeing. She
seemed to able to identify
when she is becoming
overwhelmed and anxious.
She knows she needs her
medication and has a good
understanding of what her
meds are for and what they
do.
Goal met: NO

Why?: Although the

patient reached out and
touched my hand she
quickly looked away
attempting to distract
herself. She might have felt
it was slightly awkward but
it felt like more of a defense
mechanism.

Evaluation

As the interview progressed, I felt it was going in a positive direction. After my

patient received her medication, she came back to continue the interview. I began with
identifying coping and hobbies she enjoys and ending in how close she is with the
patients in the facility. We were able to talk about the night of her suicide again with
success. She also confided her life story starting at the age of five. I think the interview
was a success because the patient confided in me, trusted me, and I was able to get
answers to all my questions and more. I learned that you cant rush an interview and I
truly takes time for a patient to warm up to you. I learned the kindness goes a long with
patients and they will be more willing to engage and open. After the interview, I went to
fill out my worksheet and noticed questions I did not ask. This helped me identify other
questions I needed to ask and also create a flow/order for my questions.

Thoughts and areas of Improvement

Interpersonal Process Analysis

I was extremely nervous to conduct an interview on my own at first but I was

happy with my results. I need to improve my introduction and giving recognition for
patients making progress. I did not utilize silence in moments that would have made a
tremendous difference. This is one of the biggest areas I want to improve in. I want to
improve my flow of my interviews, helping patients feel comfortable and cared about,
and feel confident about my interviews. I think with a few more weeks of practice I will
be able to accomplish and improve these areas.

References

Halter, M. J., & Varcarolis, E. M. (2014). Varcarolis' foundations of psychiatric mental health nursing: A
clinical approach (7th ed.). St. Louis, MO: Elsevier. pg. 150- 163 and pg. 283