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Harrison

Process Recording #1 Template


Follow the PR Directions Sheet Carefully
DATE: 2/5/16
Client Dx: Major depression, PTSD
Age: 51
Los: 35 days
Dialogue
SN: Hello. I am a
nursing student at
and I am assigned to
this unit until 1:15
pm today. Im here
to listen and observe
the clients here today.
Lets talk.

Non Verbal
Communication
SN: Open
posture, eye
contact, smile

Technique
Introductory
Statement

Student
Feelings
Nervous

Student
Thoughts
I hope she
wants to talk
to me.

T/
N
T

Anxious
Relived

I hope she
opens up.

Client: hunched
forward, looking
down at a piece of
paper

Analysis
3) I felt nervous when I approached the
client but she seemed to open up when I
appeared confident, so I felt like I
needed to maintain a confident
appearance throughout the interview.
4) Client is looking down and avoiding
eye contact indicating that she feels
uncomfortable

Client: Okay
SN: Tell me what
brought you here?
Client: I was on a CR
for a petty
misdemeanor, when
my doctor changed my
medicine to Latuda I
didnt know night
from day.

SN: Took a seat


Open
in a private area. Question/
Legs cross arms General Lead
at my side.
Client: looking
down, scribbling
on paper. No eye
contact

2) Self-improvement- I should have


asked her more about her medication
and compliance. I should have used
clarification and asked What did you
mean by you didnt know day from
night? Or How did the medication
make you feel?
3) I started off feeling very anxious so I
didnt know what to say to start off the
interview so I went with what I learned

Harrison

SN: What do you


mean by a CR?

SN: Sitting in
chair, legs
crossed, leaning
forward.

Client: Conditional
release. I was put on a
conditional release for
a petty theft. I wasnt
always like this I used
to be a vice president
of a computer
company.

Made eye contact


for a brief
moment. Slight
head tilted. Using
hands as she
speaks.

SN: Always like this?


Client: Yes I was able
to travel all over the
world and meet
important people. So
Ive always had major
depression so did my
mother. I also have
PTSD. My doctor said
that if I had one more

SN: Slightly
leaning forward.
Open posture,
eye contact,
smile.
Looking up then
down with hair in
front of face,
Starts Fidgeting
with pen in hand.

Clarifying

Interested Whats a
T
CR? I hope I
dont sound
stupid She
finally looked
up at me and
might be more
engaged now
that shes
teaching me
something

Open ended
question;
Restatement

Encourag
ed

If I
acknowledge
her success
and give
praise then
that will help
build rapport
to ask more
difficult
questions

in class by asking her why she was here.


This opening got the conversation off to
a good start.
4) The client is still avoiding eye
contact, flat affect and no emotional
response. I need to ask questions to get
more information about her diagnosis.
1) Patient shows slight insight because
she knows the reason for her current
admission.
3) I was curious and felt interested in
learning about the CR and what brought
her to the facility so my questions was
genuine.
4) The client finally made eye contact
and is engaged. She made eye contact
and used her hands when explaining her
past success. She felt pride in her past
accomplishments, which encouraged me
to give her praise.
3) I felt that giving her praise and
acknowledging her past
accomplishments would open up the
window for an exchange on a deeper
level facilitating a positive interaction.
She opened up more verbally.
4) I feel discouraged when she looked
down and started fidgeting because she
looks uncomfortable sharing her history
with me and then it makes me feel
uncomfortable moving forward. I felt
uncomfortable but I escaped my own

Harrison
stressful thing, that I
would have a nervous
breakdown.

SN: Tell me more


about your
depression and
PTSD.

SN: Slightly
leaning forward.
Open posture,
eye contact,
smile.
Client: Its a long story Using slight
but I was very
hand gestures
successful, I met the
owner of GE, general
electric on one of my
Client: Looking
flights. I flew all over down at a blank
the place. My
composition
husband didnt like it
book, Hair over
he was very abusive. I eyes, Tapping pen
got into a really bad
in hand. Leaning
car accident and my
forward.
back is always in
really bad pain so I
couldnt work
anymore. I was also
diagnosed with
melanoma at that time.
Then I was diagnosed
with colon cancer and

insecurities by encouraging her to keep


going by restating stressful Things.

Open
statement;
focused

Intrigued
Skeptical

Wow! When T
it rains it
pours. It
seems like a
lot of things at
once. I
wonder if its
true? How is
she still
alive?

1) Patient exhibits good remote memory


by demonstrating events that occurred a
long time ago.
3) My initial thoughts were how could
someone be faced with so much
adversity? I felt sympathy and empathy
to her situation. I also began to question
if she was being truthful and if she was a
reliable historian. So I decided to
remain neutral and refrain from
judgment and that I could look at her
chart after the interview for verification.
It was the perfect time to focus in one of
the subjects to get more insight.
4) Her non-verbal communication
makes her look uncomfortable. However
she elicits no emotions in regards to her
past trauma so I decided to express my
empathy to establish rapport and
encourage her to explore her emotions.

Harrison
given 6 months to live.

Dialogue
SN: That must have
been a very difficult
time for you.
Client: Yes, I was
expecting to die. I was
told I had only 6
months to live because
of the colon cancer. I
was on a 2-year
waiting list to get a
procedure to save my
life. I thought I was
going to die so thats
when I started meth
because it gave me
energy. Then a few
months later, I met this
doctor who told me if I
get admitted into the
emergency department
at the hospital where
they do the procedure
to remove the cancer
then they would have
to take me in. So, I
went to the mainland,

Non Verbal
Communication
SN: Legs
crossed leaning
forward,
maintain eye
contact, elbow
on knee fist
under chin.
Client:
Intermittent eye
contact and hand
gestures. Slightly
leaning forward.
Both feet on the
ground.

Technique
Expression of
empathy

Student
Feelings
Intrigued
Shocked

Student
Thoughts
What a
story! I dont
even know
what to say
because every
follow up
question that
is coming to
my mind is
non
therapeutic

T/
N
T

Analysis
3) I had a loss of words at this point. I
felt that she had overcome an impending
tragedy and I assumed she would be
grateful for a second chance at life.
However, she continued to abuse drugs.
I didnt understand so I had paraphrased
what she had said because I feel it
contributed positively to the interview
because I was able to explore her drug
use in depth.
4) No facial expressions or emotion
noted. Speaks very softly and puts head
down further when speaking of her drug
abuse. This indicates to me that she feels
ashamed or is afraid of being judged.

Harrison
got into the emergency
and they did the
procedure and I lived.
I continued to do meth
after that and been in
and out of recovery.

SN: Legs
SN: You thought you crossed leaning
were going to die and forward,
you felt helpless so
maintain eye
you started smoking
contact, elbow
meth and it made you on knee fist
feel better.
under chin.
Client: Yes. It was
only for a couple
months maybe a year.

SN: You sound


disappointed over
your meth use, how
has it affected your

Paraphrase

Unsure

I think her use


is longer then
a couple
months.
Shes very
open about
everything
and seems to
be short when
we talk about
Meth.

1) Patient has insight into drug use


demonstrated by her ability to
acknowledge the reason for her use.
3) Her refusal to show or elicit emotion
confuses me. So I have to address the
emotions I think she should have so she
can verify my assumption, or tell me
Im wrong and explain to me how she
really feels.

Hopeful

I think She
feels ashamed
and guilty.
What can I
tell her to

1) Patient is able to demonstrate insight


of how her drug use affected her life.
She is self-aware.
4) Uses hand gestures when defending
her. She feels guilty and continues to

Client: Looking
down, leaning
forward,
intermittent eye
contact

SN: Open
posture, leaning
forward
maintain eye
contact

ROF

Harrison
life?
Client: Yeah, I wasnt
always like this. I was
very successful. I was
the VP of a computer
company. But I
relapsed and went to
jail it destroyed my
family. My children
moved to California
and my sister doesnt
talk to me anymore.

SN: It must be
difficult for you.
Addiction is classified
as a disease. Is their a
possibility your
family would be
willing to participate
in your recovery by
going to therapy so
they can understand
the addiction?
Client: I dont know
maybe my children
would now that Im
divorced. My husband
was abusive and

make her feel


better? No
clichs!
Maybe I
shouldnt say
anything. Ill
be quiet,
Therapeutic
silence. No
Im going to
try to make
her feel better
about her self.

Client: Moves
hair out of face.
Intermittent eye
contact. Uses
hand gestures

SN: Open
posture, leaning
forward
maintains eye
contact. Tapping
my feet
Client: Moves
hair out of face.
Intermittent eye
contact. Uses
hand gestures

Closed
Question/
Communicati
on error

Discoura
ged

Did I just give


advice? And a
closed
question?
Okay I think
its time to
move on to
the next topic.

emphasize that she wasnt always like


this, possibly justifying her use through
rationalization.

2) Communication error- closed


question In an attempt to give
information about her disease and offer
her hope of reconciling with her sister, I
ended up making a communication error
by asking a closed question. I should
have explored her plan to stay sober by
asking, Tell me how you plan to stay
sober after you get discharged from
Kahi Mohala?
3) I felt discouraged after I realized I
made the mistake of making a closed
ended question. I became uncomfortable
and decided to focus in on another topic.

Harrison
controlling and he
affected my whole life.
SN: Between your
husband, your
melanoma and your
PTSD which would
you like to discuss?
Client: Well, I have
PTSD because of my
husband abusing me
for 20 years.

SN: Adjusting
posture, leaning
forward,
maintain eye
contact.

Focusing

Anxious

I feel like
Im losing her
attention, I
hope she
doesnt get
bored and
leave

3) Because her answers are getting short


and she seems uninterested, I started to
feel more anxious that she was getting
annoyed with all of these deep
questions, but because she has so many
factors that attribute to where she is
today I needed to focus in on at least one
more topic.
4) No signs of emotion when she speaks
of abuse. Shes repressing her emotions
to avoid anxiety.

Closed
Question/
Communicati
on error

Frustrate
d

Another
Communicati
on error! At
least shes
elaborating

1) Patient is aware of the symptoms of


her diagnosis and how it has affected
her.
2) Communication error; closed
question instead of asking if she had any
flash backs or hallucinations I should
have rephrased it by stating How does
having PTSD hindered your ability to
function? This question is open-ended
and allows the patient to explore the
impact her mental illness has had on her
life.
3) Im frustrated with myself because I
am having difficulty coming up with
open ended questions to get the

Client:
Intermittently
looks toward the
clock and the
nursing station.
Tapping pen on
paper, leaning
forward

SN: Have you


experienced any flash
backs or
hallucinations?

SN: leaning
forward,
maintain eye
contact.

Client: I have really


bad nightmares about
my husband. A couple
months ago I was
admitted to the
hospital for pneumonia
and when I woke up I
saw him standing over
my hospital bed. It
was really scary.

Client: Looks
down, stops
tapping pen,
blank stare.

Harrison
information I want and its making it
difficult for me to continue the
interview.
4) Patient verbalizes feeling fear. While
she blankly stares out past me she
appears to be reminiscing ask she speaks
of her hallucination.
Dialogue
SN: You dont show
any emotion when
you talk about your
husband, how do you
feel about him now?
Client: Were divorced
now. He took half of
my money and tried to
get my childrens half
as well. I dont know
hes in the mainland
now.
SN: I see youve been
through a lot, how do
you feel now?
Client: Well I feel
optimistic. I finally
contacted my children
and I even have a
grand child now. They
are going to visit me

Non Verbal
Communication
SN: leans
forward,
maintains eye
contact

Technique

Student
Feelings
Open question Curious,
Concerne
d

Student
Thoughts
Why isnt she
angry?
Maybe shes
completely
detached.
Maybe shes
following the
steps, made
amends and
forgave?

T/
N
T

Open question Hopeful

She has
plans for the
future! I
wonder what
they are?

Client: Maintains
eye contact, no
expression

SN: Sitting
upright slightly
leaning forward,
maintains eye
contact
Client: Makes eye
contact, slight
smile looks back
down

Analysis
3) I am confused as to why she has no
emotion about a man who I feel has
ruined her life. PTSD can cause
detachment so I do not feel like I will be
able to elicit any emotion from her at
this point. My thoughts contributed
negatively to my interview because she
wasnt able to express her feelings
toward this man who abused her for 20
years.

4) Patient finally smiles when speaking


of her future plans. Her feelings of
optimism are congruent with her
expression.

Harrison
after I make some
changes.

You said your going


to change some
things, What things
you are going to
change?
I have court next week
and I find out if Im
going to get
discharged to a
halfway house. I have
a bed their already so
if it goes well I can
stay there for a while.
After that I will be
moving into a house
with a nurse and I plan
on staying their long
term. I gave her my
deposit already and
shes left my room
open.

I have to go now.

SN: Makes eye


contact smiles,
leans forward

Open question Curious


Clarifying

I wonder
where she
plans on
going after
this

Unsure

I hope she

Client: Leans
forward, smiles,
regularly makes
eye contact

Stands up grabs

1) Patient demonstrates insight because


she is aware and has initiated the steps
needed toward discharge and plans for
her future living situation.
4) Her smile, tone of voice and eye
contact indicates hope for her future.

3) I thought she was exhausted with the

Harrison
Thank you.
Oh ok. Well, thank
you for your
cooperation and
honesty. I really
appreciate it. It was
nice talking to you.
Goodbye

cushion on seat
and walks to
room
Stands up,

didnt leave
because of
me

conversation and wanted to go.

Harrison