Dialogue

Pts Non Verbal

CommunicationBehaviors

Communi
cation
Techniqu
e

Student
Feelings

Student
Thoughts

T/N
Psychodyna
mics.
Therapeutic
or
nontherapeu
tic

Analysis
Student nurse self-reflection

SN: Hi [insert
clients name],
Im Amy, a
student nurse. I
was assigned to
work with you,
and I will be here
until about 11:00
A.M.

Made eye contact,

sat down beside
client when sensed
it was welcomed
but maintained
space between us
(spatial
boundaries),
turned toward
client (open
posture)

Introductor
y
statement

Nervous

I wonder if
she is
welcoming
the
conversation.
I remember
her seeming
angry &
anxious the
last clinical
day.

Therapeutic

4) I interpreted the clients nonverbal communication of

making eye contact with me for
that short time as the client
being open to the conversation,
so I sat down next to her.

General
lead

Nervous

I wonder if
she still
wants to
continue to
talk even
though it is
obvious that
she is
disappointed
about not

Therapeutic

3) My feeling of nervousness
may have contributed
negatively to the interview
because I may have transferred
my nervous energy to the client
so should always be aware of
the energy I may be bringing to
the milieu and try to keep it as
therapeutic as possible.

Clt: Hi, Im [insert

clients name].

SN: You said you

are being
Discharged
Tuesday? Lets
talk about that
Clt: Yeah, but I am
not going home; Im
going to another

Only made eye

contact for short
time when
introduced
myself/first sat down.
Client went back to
drawing right after
we began conversing
(closed position).
Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.
Client continued
drawing and looking

facility in Utah on
the mainland for
substance abuse
and behavior
problems.

down at sketchbook.
Her tone of voice
sounded
disappointed.

SN: Tell me how

you feel about
being transferred
to this other
facility?

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.

Clt: I dont want to

go to the mainland.
I just want to go
home. I feel
overwhelmed
because I just found
out recently that I
have to go to this
facility. I wish I
could just go to
Bobby Benson on
island.
SN: You said this
mainland facility
specializes in
substance abuse
and behavior
problems.
Clt: Silent

going
home.

Openended

Hopeful

Please open
up to me;
please open
up to me;
please open
up to me!

Therapeutic

Paraphrasi
ng

Curious

I want to
gain insight
into the
reasons
behind this
client being
transferred
to this type
of facility.

Therapeutic

Client continued
drawing and looking
down at sketchbook.

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.
Client continued
drawing and looking
down at sketchbook.

SN: How has

using substances
impacted your
life?
Clt: I dont even
think I have a
substance problem,
but I tested positive
for cocaine and
alcohol when I
came here. I was
arrested for
shoplifting, so my
parents brought me
here and were
wondering if I was
on something so
requested to have
me tested here.

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.

Openended

Frustrate
d

Empathi
c
stateme
nt

Disappoint
ed

Client made eye

contact with me
while I asked the
question but then
began to look down
at her sketchbook &
draw again.

SN: It must be
difficult to accept
this transfer
when you dont
think you have a
substance abuse
problem.

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.

Clt: I hate my
parents.

Client looking down

and drawing when I
said this, but then
she made eye
contact with me
when she replied.

How can
you not
have a
substance
abuse
problem
when you
are being
sent to a
facility all
the way on
the
mainland
that will
specifically
address and
help you
work on
your
substance
abuse
problem?
How can I
address the
contradictio
n that the
client stated
she does not
have a
substance
abuse
problem but
is being sent
to a facility
for her
substance

Therapeutic

3) My non-verbal
communication of maintaining
eye contact even though the
client was looking down at her
sketchbook and drawing may
have contributed positively to
the interview because the client
seemed to notice my interest in
her situation when she looked
up from her sketchbook and
slowly began to open up.

Therapeutic

2) Suggestion for
improvement of self: Instead
of just making an empathic
statement, I could have
addressed the contradiction that
exists between the factual
information that the client
tested positive for cocaine and
alcohol when she arrived/is
being transferred to a substance
abuse facility and the statement
the client made about not
having a substance abuse
problem. I was not sure how to

abuse?

SN: You feel

angry with your
parents because
they brought you
here.
Clt: I just hate
them now after
sending me to
Utah.
SN: It must be
frightening to be
transferring to
another facility
so far away and
so soon.
Clt: Yes, it is.
Another thing is
that my parents just
told me yesterday
during a family

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.
Client continued
drawing and looking
down at sketchbook.
Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.
Client continued
drawing and looking
down at sketchbook.

Reflecti
on of
feeling

Concerne
d

Empathi
c
stateme
nt

Concerne
d

There are a
lot of deeply
imbedded
issues to
address
here. I
wonder if I
can
remember
all this for
my PR!
I can only
imagine how
she must
feel about
having to be
transferred
to a facility
all the way
in Utah.

do this therapeutically. I thought

that by stating the connection I
made about the clients thought
regarding her behavior (that she
does not have a substance
abuse problem) with her
feelings about the transfer, this
would prompt the client to open
up about the reality of her
substance abuse. It may have
helped to use a Checkout here
too; I could have asked
something like, Is that right?
Therapeutic

Therapeutic

meeting that I had

to go. I started
yelling and
swearing and got
knocked down a
level and cannot
use a straightener
now before I go.
SN: It seems like
it was an
unexpected
transfer.
Clt: They had been
talking about it for a
while, but I was told
that its for sure
yesterday. The
social worker put
me on elopement
precautions.

SN: Elopement
precautions?
Do you want to
run away from
the facility?

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.

Empathi
c
Stateme
nt

Concerne
d

I can only
imagine.

Therapeutic

Restateme
nt;
Communic
ation errorclosedended
question

Worried

I wonder if
she is
getting
defensive
because I

Therapeutic
restatemen
t, Nontherapeutic

Client continued
drawing and looking
down at sketchbook.

Continued to
maintain eye
contact & open
position even
though client

2) Suggestion for
improvement of self: After
the client told me about the
negative reaction she exhibited
after she heard she was going to
be transferred, I should have
addressed her behavior of
yelling and swearing instead of
making an empathic statement.
I could have asked an
evaluating question like, what
does this type of behavior mean
to you? or after thinking about
it, how does it affect you now?
This would have hopefully
begun a separate discussion
about the second reason why
this client is being transferred to
this other facility: to address her
behavioral problem.
problem.
1) Communication errorclosed-ended question.
5) Alternate response: This
question is a closed-ended

Clt: No. She asked

me if I was planning
to run away, and I
told her I wouldnt
tell her if I was
planning to
anyway.

SN: What do you

mean when you
say you got
knocked down a
level?
Clt: Based on what
level you have, you
can do different
things. I want to use
the straightener
before I leave but
cant now because of
the way I reacted
during the meeting. I
want to make a good

looking down and

drawing.

asked her
about the
elopement
precautions
so directly. I
am just
concerned
for her
safety.

Client, looked up
from her sketchbook
when I asked her this
& made eye contact
with me. Her tone
sounded somewhat
irritated.

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.
Client continued
drawing and looking
down at sketchbook.

Openclarifyin
g

Nervous

Oh no, I
better
change the
subject from
the
elopement
precautions
to the level
system
because she
seems
defensive.

-closedended
question &
not
allowing
client
enough
time to
respond to
restatemen
t before
asking
another
question.

Therapeutic

question that could be answered

with a yes or no. It could have
been turned into an open-ended
question by stating something
like, tell me about the
elopement precautions you were
placed on?, which would have
allowed the client to elaborate.
Also, I should have allowed the
client time to reply to the
restatement before asking
another question.
4) I interpreted the clients tone
when she answered this
question as irritated, so I
changed the focus of the
conversation from the social
worker putting her on
elopement precautions to the
level system.
2) Suggestion for
improvement of self: Instead
of making an empathic
statement here, I could have
maybe used a minimal
encourager like go on to see if
she had anything more to say
about it instead of just asking
her a question.

impression.

SN: Oh?
Clt: Yeah, I think
being able to
straighten my hair
would help me feel
less anxious about
leaving.

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.

Minimal
encourag
er

Curious

Using a
straightener/
having some
control over
her
appearance
must help
reduce her
anxiety that
is arising
from all
these
uncontrollabl
e factors in
her life.

Therapeutic

Paraphra
s-ing;
Openfocused

Confide
nt

I think I
have an
understandin
g of what my
client is
communicati
ng to me.

Therapeutic
; nontherapeutic
: not
allowing
the client
enough
time to
respond to
paraphrase
before
asking
another
question

Openended

Intereste
d

Lets tie all

of this

Therapeutic

Client continued
drawing and looking
down at sketchbook.

SN: [Clients
name], I hear you
saying that being
told you will be
transferred is
making you feel
overwhelmed,
angry, and
anxious.
Tell me more
about your
anxiety.
Clt: Well, the
doctor said I have
it.
SN: What
medications are

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.
Client continued
drawing and looking
down at sketchbook.

Continued to
maintain eye

5) Alternate response: allow

time for client to respond to
paraphrase before asking
another question.

you taking for

your anxiety?
Clt: Im taking
three medicines,
but they arent for
anxiety.

SN: Uh-huh
Clt: I know one is
Zoloft, Dexmeth
something, and
melatonin.

SN: Oh okay,
well, I learned in
class that some
antidepressants
can help with
anxiety as well.
Clt: Oh yeah, I
remember my
doctor saying that
too.

contact & open

position even
though client
looking down and
drawing.
Client looked up from
her sketchbook and
looked at the ceiling
as if to think about
the medications.
Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing; silence
Client continued
drawing and looking
down at sketchbook.
Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.
Client looked up from
her sketchbook and
made/maintained
eye contact with me
while I spoke.

together;
her reaction
to the
transfer; her
diagnosis of
anxiety; and
the
medications
she is taking
for it.
Minimal
encourag
er

Intereste
d

I wonder
what she
knows about
the
medication
she is
taking.

Therapeutic

[Providing
informatio
n]

Insightf
ul

I wonder if
my client is
receptive to
the
information I
am giving
her and that
I can teach
her
something
or at least
reinforce
teaching she
seems to

Therapeutic

SN: You said you

were on dexmeth
something? You
were diagnosed
with ADHD or
ADD as well?
Clt: Yes, ADD,
ODD, and anxiety.

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.

Commu
n-ication
errorclosedended
question

Curious

Client continued
drawing and looking
down at sketchbook.

have already
received.
Oops, those
were two
closedended
questions. I
wonder if
she thinks I
am asking
too much.

drawing and looking

down at sketchbook.

SN: How has your

anxiety impacted
your daily life?
Clt: It is not that
bad. Like, if I go to
lunch, I would look
for my friend and
want her to be
there, but that
doesnt mean Im
not going to eat
lunch if she is not
there. I think that is

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.
Client shifted in chair
and continued to
draw/look down at
her sketchbook.

Nontherapeutic
: closedended
question &
not
allowing
client
enough
time to
respond to
one
question
before
asking
another.

Openfocused

Worried

Please open
up to me
about your
anxiety. She
replied so
shorty
earlier when
I asked her
to tell me
about her
anxiety.

Therapeutic

1) Communication errorclosed-ended questions.

5) Alternate response: These
closed-ended questions could be
answered with a yes or no. I
could have asked something
like, tell me what you know
about the purposes of these
medications you are taking?
This is an open-ended question
that could have better assessed
the clients knowledge of the
reasons she is taking the
medications. I also should have
allowed time for the client to
respond to one question at a
time.
4) I interpreted my clients nonverbal behavior of shifting in her
chair when I asked about her
anxiety a second time as her
being nervous and
uncomfortable, so after she
seemed to minimize the impact
it has on her daily life, I changed
the subject.

normal. It is not
that bad.
SN: Oh okay, tell
me what you
have learned
since you have
been here that
can help you in
those situations
where feel
anxious?
Clt: Nothing. The
only thing that
helps me is talking
to my friends.

SN: Oh, I
remember you
saying something
about how you
wanted to see
your friends in
Acute last
Saturday in the
goal-setting
meeting. I hear
you saying that
friends are very
important to
you.
Clt: Yeah, talking

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.

Openended

Hopeful

I wonder if
my client is
able to see a
difference in
herself due
to personal
growth she
has made
while here.

Therapeutic

Paraphrasi
ng

Understan
d-ing

Friends are
very
important to
her. I wonder
if she will
find the
support she
needs in the
facility she is
being
transferred
to.

Therapeutic

Client continued
drawing and looking
down at sketchbook

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.
Client continued
drawing and looking
down at sketchbook.

to friends is how I
cope.
SN: Oh okay. Tell
me how you feel
now compared
when you were
first admitted.
Clt: I dont feel
much different. No
one even talks to
me. I used to have
friends in Acute but
not in Residential.
There used to be a
student doctor here
that would talk to
me, but she
finished here.
SN: Well, I hope
talking with me
helped a little.
How else can I
help you to
reduce your
anxiety today?
Clt: Can you just
come with me to
ask Linda if I can
use the
straightener?
SN: Yes, lets go
ask her.
Clt: Thanks so

Continued to
maintain eye
contact & open
position even
though client
looking down and
drawing.

Openended

Hopeful

Please note
some
improvemen
t in yourself!
Personal
growth is so
important!

Therapeutic

[Offerin
g self]

Relieved

I wonder if I
made a
difference in
her life
today.

Therapeutic

Happy

I think I
made a
difference in
her life.

Client continued
drawing and looking
down at sketchbook.

Continued to
maintain eye
contact & open
position
Client looked up and
made eye contact
with me. Her eyes
seemed to brighten.

Continued to
maintain eye
contact & stood up
as the client stood

much!

SN: Well, I am
going to see if my
instructor is here
now. She told us
she would come
around eleven. It
was so nice
talking to you. I
wish you the best
at the new
facility. Thank
you so much!
Clt: Thank you.

up.
Client stood up &
started walking
toward the nurse,
Linda.
Walked wit her to
meet Linda and
then turned to her
& made eye
contact.
Client turned toward
me & made eye
contact

Gratitud
e

I wonder if
this
conversation
assisted in
allowing the
client to gain
more insight
into her
current
situation.