Interpersonal Process Recording

Student nurses verbal and nonverbal communication Student nurses perceptions, thoughts, and feelings Clients verbal and nonverbal communication Therapeutic & non-therapeutic techniques used and rationale/Evaluation of therapeutic response Using silence. Therapeutic- I wanted to give her the opportunity to go into more detail if she desired. She continued to speak until she was finished her thought Restating. Therapeutic- I wanted her to elaborate more on her actions. None Defense mechanisms

Can you tell me a little about what brought you to the hospital? Sitting across the table, directly in from of client. So you were looking in the mirror when cutting yourself?

Anxious to learn more about how her disorder manifested itself through her.

Not really sure, just feeling really bad, really low; cutting myself while looking in mirror Looking away, no eye contact made Yes, because I wanted to see blood She looked up at me when she spoke.

Baffled. I could not imagine anyone consciously harming themselves while watching.

None

How does that make you feel?

Curious to determine what motivates her.

Relieves pressure. Roger told me to cut. Hes the mean one. No eye contact

Exploring. Therapeutic- I am trying to delve into the subject more to gain a better understanding.

Projection

Do you have other personalities who talk to you?

I wanted to see if she would discuss the other personalities.

Yes. The doctor said that I have dissociative disorder.

Exporing. Therapeutic- I want her to elaborate. (During shift report, the nurse stated that her personalities included a man named Roger and a little girl).

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Do you know any of the others names?

Excited that she may talk about or even bring up one of the other personalities.

No, no names of others. I just know Rogers name, or I might have named him myself. No eye contact

Exploring. Therapeutic- Trying to get her to open up and give more detail about other personalities.

None

Do you cut all the time or do certain things happen to make you cut?

I dont know. I just get low and feel bad like theres no tomorrow. No eye contact

Accepting. Therapeutic- I want her to know that I am not judgemental about her actions.

Rationalization

Have you ever contemplated suicide?

Worried that she might be suicidal. I would hat for her to make an attempt after talking with me.

Has Roger ever told you to hurt anyone else?

Curious to find out how closely she follows commands of Roger.

Yes, but not since I have been in here (hospital). I try not to think about suicide because my daughter told me she would be devastated if I did. My roommate, Rick says he would blame himself. Glances up briefly Yes, but I never have. No eye contact

Using silence. Therapeutic- I do not know what to say.

Denial. Client is currently on suicide precautions.

Accepting. Therapeutic- I want her to know that I am regarding what she is saying.

None

Why do you hurt yourself when he tells you to?

I feel indifferent to her response.

Sometimes I feel like I aint nobody and Ill cut, even though it hurts like hell. No eye contact

Requesting an Explanation. Non-therapeutic- It seems to me that if she can ignore his commands sometimes, she can ignore them all the time

Rationalization

Can you elaborate? I dont understand how you can cut yourself when it causes you pain. Sitting up in seat, leaning forward.

I am totally bewildered at this point.

Its like if you have a balloon filled up with pain; stick it with a pin and when it bursts, the pain is released. Using hands to explain analogy; gives direct eye contact. Several times. Last time I got 127 stitches. Time before that I got 60. Heres my gunshot wound. I shot myself because I had low self-worth. These two scars are from the time I was hallucinating that I had worms wriggling and itching in my veins. I cut my arms and held them down so the blood could drain. I called the ambulance cause I didnt want to die. Client is pulling up sleeves and pointing to different scars on arms Yes. I hear a radio a lot, but I cant make out what it saying. I see words but I cant read them; they dont spell anything. I have gotten used to it though. Ill ask someone else if they see it and if they dont, I know its just my hallucinations. Ive seen smoke once while I was driving and almost wrecked. Client is looking up, over my shoulder as if she sees something on the wall.

Seeking clarification and validation. Therapeutic- I need to know that I am understating her correctly; that she cuts herself to make herself feel better, even though it hurts.

Rationalization

Have you ever been in the hospital before?

Using silence. Therapeutic-Once I ask her this question, she begins talking almost non-stop about all the times shes cut her self. I let her go one until shes finished.

None

Do you have hallucinations? Sitting across the table, directly in from of client.

Exploring. Therapeutic- I want to know more about her hallucinations.

None

Do you still drive?

I need to know if she is still on the road. Id hate to be on I-40 with her and she has a hallucination.

Yes, not far. Just to King. Usually 5 miles, but Im careful. Brief eye contact

Accepting. Therapeutic- I just nod my head

None