Mental Health week2

Interaction

Nurse’s Thoughts and Feelings

Communication Technique/Evaluation

Karyn: You mentioned that you were at an event and you commented that you “needed a drink.” Tell me more about what was happening. (SOLER)

Alan: (nodding) I was perturbed. I felt like I was stuck at this event. There was supposed to be entertainment but it got canceled due to rain, and suddenly I noticed people were drinking and smoking. It brought back a lot of memories. (looks down)

I wasn’t sure if Alan was willing to talk about this, but I thought it was important to facilitate his looking at his behavior in response to this experience.

I was glad that Alan was open to discussing this experience, but he said so many things in this short statement that I had to be thoughtful about what to follow up on.

Technique: Exploring

Evaluation: This approach was effective. Alan talked more about the event and was able to articulate some thoughts and feelings as well.

Karyn: So you felt perturbed and stuck…. (looking up, not making direct eye contact)

I was thinking that I don’t usually explore feelings right off the bat because I believe it’s better to help someone fully describe events and thoughts first (or at least it’s less threatening). But I’ve interacted with Alan many times, he’s been through rehab, sober for 7 years, and he’s pretty comfortable talking about feelings.

Technique: Reflecting

Evaluation: This technique was effective. Alan began to process his thoughts about why he might be feeling perturbed and stuck. I think I may have been not making direct eye contact because of my perception that feelings can be a little more threatening for some people to talk about.

Alan: Yeah, but it didn’t last long. Maybe it had something to do with the fact that there was nothing else going on and it seemed like the whole thing became about drinking. But then I just blacked it out.

My immediate thought was that I want to tell him to go to an AA meeting or call his sponsor, but I was trying to incorporate a motivational interviewing strategy, and that meant it would be better to help him explore his motivation for how to respond to this experience. I didn’t know what he meant by “blacked it out,” but I felt uncomfortable when he said that.

Karyn: What do you mean when you say you blacked it out? (SOLER)

I thought this was an important statement to clarify because it might help him explore how he behaved in response to this event.

Technique: Clarifying

Evaluation: Asking this question was effective. Alan talked at length about his thoughts and feelings.

Alan: (silent for several seconds) I do need to go back to an AA meeting. I mean, am I different than other people? I know there are other people out there that have to be struggling with the same kind of things. When I was in rehab, my mom and her boyfriend were always there taking me to meetings. My sister went, too … (silent for several more seconds) I know it’s important (silence) … about 75% of the people I went to rehab with are back out there using again.

Alan seemed to be thinking a lot about this and was responding with several different thoughts, so I felt like it was important to just use silence and facilitate his reflection. I thought Alan seemed to be genuinely considering a behavior change.

Karyn: You said that you need to go back to a meeting and that they are important. Is it more helpful to go to meetings when you just start thinking about needing a drink, or do you think that meetings are only necessary after you actually take a drink?

I knew that Alan had not been going to meetings regularly for the last couple of years, even though he acknowledges their importance, so I wanted to know more about whether he thought behavior change (such as going to AA meetings) was necessary at this point.

Technique: Restating, focusing

Evaluation: Restatement was effective. The way I chose to focus was probably leading Alan to choose the “right” answer, and that makes it harder to evaluate whether he is just telling me what I want to hear or is really motivated. It might have been better to use the technique of formulating a plan of action.

Alan: Oh no, you’ve got to go long before you take that first drink. (silence)

People told me when I was in rehab that they could tell I was really listening in meetings … the meetings were helpful … (silence), and I just reconnected with my sponsor on Facebook, so I need to get back to a meeting to see him.

Alan seemed like he was thinking about what is important to him, so I continued to remain silent to facilitate that process.

Karyn: You’ve identified three reasons why you believe you need to go to a meeting: because they are helpful to you, because you want to find out if others are struggling with the same kinds of thoughts that you are, and because you need to reconnect with your sponsor. Do you have a plan in mind for how to follow through with that?

I was thinking that he talks about needing to go to AA, and I was feeling anxious about wanting him to commit to that, but at the same time, I recognized that the motivation for change and commitment to a plan of action has to come from him.

Technique: Summarizing, formulating a plan of action

Evaluation: I think the techniques were effective, although Alan may not be ready to formulate an action plan at present.

Alan: Well, I haven’t done it yet. I guess I’m still just thinking about it.

I was appreciating his honesty and thinking that this is the challenge of motivational interviewing: accepting where the individual is at while continuing to explore and facilitate his or her motivations for behavior change.

NURSE VERBAL (NONVERBAL)

PATIENT VERBAL (NONVERBAL)

NURSE’S THOUGHTS AND FEELINGS CONCERNING THE INTERACTION

ANALYSIS OF THE INTERACTION

Do you still have thoughts about harming yourself? (Sitting facing the patient; looking directly at patient.)

Not really. I still feel sad, but I don’t want to die. (Looking at hands in lap.)

Felt a little uncomfortable. Always a hard question to ask.

Therapeutic. Asking a direct, closed-ended question about suicidal intent to elicit specific information.

Tell me what you were feeling before you took all the pills the other night. (Using SOLER techniques of active listening.)

I was just so angry! To think that my husband wants a divorce now that he has a good job. I worked hard to put him through college. (Fists clenched. Face and neck reddened.)

Beginning to feel more comfortable. Patient seems willing to talk, and I think she trusts me.

Therapeutic. Exploring. Delving further into the patient’s feelings to help her better understand her experience.

You wanted to hurt him because you felt betrayed. (SOLER)

Yes! If I died, maybe he’d realize that he loved me more than that other woman. (Tears starting to well up in her eyes.)

Starting to feel sorry for her.

Therapeutic. Attempting to translate words into feelings to convey active listening.

Seems like a pretty drastic way to get your point across. (Small frown.)

I know. It was a stupid thing to do. (Wiping eyes.)

Trying hard to remain objective.

Nontherapeutic. Sounds disapproving. Better to have pursued patient’s feelings.

How are you feeling about the situation now? (SOLER)

I don’t know. I still love him. I want him to come home. I don’t want him to marry her. (Starting to cry again.)

Wishing there was an easy way to help relieve some of her pain.

Therapeutic. Focusing on patient’s current feelings to assess current mental status.

Yes, I can understand that you would like things to be the way they were before. (Offered patient a tissue.)

(Silence. Continues to cry softly.)

I’m starting to feel some anger toward her husband. Sometimes it’s so hard to remain objective!

Therapeutic. Conveying empathy to support caring and connectedness.

What do you think are the chances of your getting back together? (SOLER)

None. He’s refused marriage counseling. He’s already moved in with her. He says it’s over. (Wipes tears. Looks directly at nurse.)

Relieved to know that she isn’t using denial about the reality of the situation.

Therapeutic. Reflecting on the patient’s expressed feelings to encourage the patient to recognize and clarify their perceptions.

So how are you preparing to deal with this inevitable outcome? (SOLER)

I’m going to do the things we talked about: join a divorced women’s support group, increase my job hours to full time, do some volunteer work, and call the suicide hotline if I feel like taking pills again. (Looks directly at nurse. Smiles.)

Positive feeling to know that she remembers what we discussed earlier and plans to follow through.

Therapeutic. Formulating a plan of action to set the foundation for problem-solving.

It won’t be easy. But you have come a long way, and I feel you have gained strength in your ability to cope. (Standing. Looking at patient. Smiling.)

Yes, I know I will have hard times. But I also know I have support, and I want to go on with my life and be happy again. (Standing, smiling at nurse.)

Feeling confident that the session has gone well; hopeful that the patient will succeed in what she wants to do with her life.

Therapeutic. Presenting reality, making observations, and giving recognition to support patient’s progress in problem-solving.