Date: 9/6/14

Clt. Age: 42yo

Clt. Gender: Female
Date of interaction: 9/6/14
Diagnoses: Axis I substance induced mood disorder, PTSD, anxiety disorder, Axis II cluster B traits, Axis IV problems with support group and
chronic mental illness, Axis V 61-70 mild symptoms, suicidal ideation, OD
Length of Stay (LOS) on the day of the interaction: 2 days

Dialogue

Good morning! Do you mind if I sit

with you for breakfast?

Pts NonVerbal
Communica
tion
Behaviors
Smiles

Communicat
ion
Technique

Student
Feelings

Student
Thoughts

Nervous

I hope Im not
bothering her.

Nervous

Should I explain
more about
myself?

T/N
Psychodynamics.
Therapeutic or
nontherapeutic

Analysis
Student nurse selfreflection

Smiles
No, I dont mind.

Thank you. My name is Grace, by

the way. Im a student nurse from
KCC.
My name is *omitted*.

Shivers

Introductory
statement

Therapeutic

2. I probably could
have explained more
about why we
(students) were there.
4. Because the patient
was smiling, I was
encouraged to go on
and continue my
conversation with her,
especially since it was
my first mental health
patient.

Are you cold? Youre shivering.

Shakes head

Closed
question.
Simple
observation
statement

Oops I just asked

a yes/no
question.

Non-therapeutic

Furrows
brows

Restatemen Confused
t. Openended
question

Is she delusional
or is she being
serious?

Therapeutic

No, Im not shivering. Im having a

small seizure. Although, it is very
cold in here.

A small seizure?
Yeah, I was born with a birth defect
so last year I had a carotidsubclavian bypass surgery. My
carotid artery was connected to my
aorta. But Standford messed up so I
get these mini seizures now.
Oh wow. That must be hard.
Yeah, I used to blackout a lot. It
stopped after the surgery but now I
feel like a burden to my boyfriend.
What do you mean when you say
you are a burden to your
boyfriend?
I cant really move my arm
anymore. Stanford messed up and
damaged my brachial plexus. I
became a burden to my boyfriend.

Raises
eyebrows

Expression
of empathy

Psychodynamics:
low anxiety level,
maybe due to
medications.

Therapeutic

Nods head
Tilts head

Clarification Surprised
question,
openended
question

Wow she knows

a lot of medical
terms.

Therapeutic

1, 2, & 5. Are you

cold? was not
therapeutic, but
Youre shivering
was. I think I should
have said, You must
be cold. Youre
shivering.
2. I probably could
have used a clarifying
statement here, such
as I dont really
understand what you
mean by that.

3. I think raising my
eyebrows prompted
the patient to explain
more.

Mmhmm.

Nods head

I became really dependent on him

Looks down
because I cant use my left arm. I
cant even drive anymore so I have
to rely on him to take me
everywhere. Its hard for him. So he
gets frustrated and really angry and
then we fight.
It must be difficult having to rely on
someone else.
Well he broke up with me yesterday
and flew back to California. After
that I drank a lot of alcohol and took
a bunch of pills. But I immediately
regretted doing it because Im
Christian. So I called my dad and my
best friend and they took me to the
hospital.
Oh?
Yeah, I thought about God right
after I did that so thats why I called
my dad. When I get out of here, Im
planning on going back to church. I
used to go to church every Sunday.

Raises
eyebrows

Minimal
encourager

Empathetic

Therapeutic

3. I think my nodding
prodded her to explain
a bit more about being
a burden.
4. I began to
sympathize with her
when she looked
down at the table.

Expression
of empathy

Minimal
encourager

Excited

Is she trying to
say that she tried
to take her own
life? Did I just
find out why
shes here?!

Therapeutic.

Surprised that
she called her
dad and her
friend. She didnt
really want to
die.

Therapeutic

Psychodynamics:
patient is very
open at this
point in the
therapeutic
relationship
stage.

3. Sometimes, a
minimal encourager
and/or a small gesture
really helps to open up
the conversation. I feel
that a minimal
encourager was
appropriate here.

So I hear you saying that you took a Nods

bunch of pills and drank alcohol
after your boyfriend broke up with
you yesterday, but you regret doing
it because youre Christian.

Paraphrasing

Skeptical

Is she really that

religious?

Psychodynamics:
patient is still
very calm and
eager to talk,
showing no S&S
of diagnoses.

Yeah, I really regret it.

How are you feeling today

compared to yesterday?
I feel a lot better; Im not depressed
anymore. I think its a good thing
that we broke up because we dont
have the same values. He doesnt
believe in God.
You look content.
Yeah, Ive been with him for 20
years and it took me this long to see
how bad this relationship was, but I
do realize it. I hit rock bottom but
now Im ready to move forward
with my life.

Therapeutic

Smiles

Openended
question

Curious

Smiles,
leans
forward on
table

Reflection
of feelings

Pleased

Therapeutic

Seems like there

is a complete
change of mood
within such a
short period of
time. She may
relapse when she
goes home.

Therapeutic

2. I used the
paraphrasing
technique here, but I
could have used a
different technique
such as reflection of
feelings. I could have
said, It sounds like
you were really upset
when your boyfriend
broke up with you.
3. I almost sound like I
didnt believe her;
maybe because I was
feeling skeptical.
4. The patient began
to smile brightly so I
responded by saying,
You look content in
hopes that she would
elaborate.

What do you mean by hitting rock

bottom?
Recently I became homeless and I
lost my business. I used to own
several standup paddleboard shops
in California. Then this past Easter I
died. My heart stopped beating but
somehow God saved me. Ive been
thinking a lot these past few days,
and I see how much God loves me.
So it took all of these difficult
events this past year like becoming
homeless, losing your own
business, and your surgery
complications for you to find God
again. And now that your boyfriend
is out of state, you will be able to
focus on yourself.
Yeah, I want to focus on myself
now. God has plans for my future. I
just need to pray about it.

Clarification
question.
Open-ended
question

Hand
gestures
Nods

Summarizing

Confused

Does she mean

her breakup?

Therapeutic

Therapeutic
Psychodynamic:
patient has been
continuously
smiling
throughout
conversation.
Actions/behavior
is opposite of
expected for
diagnoses.

2. I think I could have

summarized
everything we talked
about in a better way.
She mentioned several
times that she felt like
a burden, so I
shouldve
incorporated that into
my summarization.

* Professor Chat and I later discussed with the patient about medication and compliance, discharge plans, and follow up care.