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A Critique and Analysis of a Student's Interpersonal SkillsTrina SkinnerStenberg CollegeA Student's Own Critique of Interpersonal SkillsThe intent of this essay is to provide the writer an opportunity to analyze and reflect on his/her use of interpersonal skills throughout an audio-taped interview with a self-selected subject in the interest of identifying the presence/lack of various micro-skills essential within the construct of any therapeutic relationship. The context of the audio-taped interview consists of the writer attempting to gain insight into the subject’s, referred to by the initials (S.N.), experience with the Mental Health system. (S.N.) is a diagnosed paranoid schizophrenic, currently in his mid-fifties, diagnosed in his early twenties at the start of the 1970’s. (S.N.) spent many years institutionalized in the Forensic Unit of Riverview Hospital (Riverside) for the criminally insane in the early years of his diagnosis following an incident in which he was convicted of attempted murder for stabbing a man what was deemed a paranoid delusion. Throughout his institutionalization and following release from custody, (S.N.) has experienced firsthand the developmental change that has occurred within the B.C. Mental Health system from the 1970’s to the present. The writer’s motivation for selecting (S.N.) as the subject for the interview is two-fold, on one hand the writer viewed it as a rich opportunity to get a glimpse into a person’s unique experience as a client of Mental Health services throughout his entire adult life. Secondly, this interview offers (S.N.) the opportunity to be ‘heard’ and tell his story from his perspective, without the interviewer dictating the structure of the interpersonal communication. Prior to recording the writer explained to (S.N.) that he was free to discuss whatever he wished and also expressed interest in his experience with Psychiatric Nurses as well as his overall view on the B.C. Mental Health system in terms of evolution from his diagnoses to the present. Analysis“For the most part the nurses in the Forensic unit seemed to be in a transient life. Didn’t last long, I think it was hard on their brains as well” (S.N.). In this instance the writer missed an opportunity to pose an open question for exploration into client’s perspective, for example: Did you feel then that it was difficult to establish trusting/therapeutic one- to- one relationships with the RPN’s in the Forensic Unit given these circumstances?“There was a high turn-over of nurses…always seemed to be as a stepping stone, seems to be get your experience and get a better job” (S.N.). Writer’s response, “Okay”, nods head: use of minimal prompts, indicates “I am with you” (Burnard, 2005, p.139). The writer missed a good opportunity to apply the skill of building empathy here, an appropriate empathetic response would have been: It sounds as though you feel the nurses were not fully invested in the treatment/care of the patients, but rather used their experience in the Forensic Unit as a means to further their career- I could understand this being very frustrating, contributing to a lack of much needed support for yourself and other patients. (Reynolds, n.d.) states that “Empathy is essential in order to create an interpersonal climate that is free of defensiveness. This enables individuals to talk about their perception of need…When nurses assist patients to find solutions to personal problems, in a manner that reflects their preferences, favorable health outcomes will occur.” (p.327).“However, these days seems to be more forward thinking I do see a psychiatrist occasionally…” (S.N.). Writer missed opportunity to apply skill of Reflection: ‘echoing’, “the process of reflecting back the last few words…that the client has used, in order to encourage him to say more” (Burnard, 2005, p.154). An appropriate response could have been: You feel that there is more “forward thinking” in regards to the current state of the mental health system vs. the 1970’s when you spent time in the Forensic Unit?“He’s told me that what they wanna do these days is to integrate people more into the community, rather than isolate/segregate them from the community” (S.N.). Skill missed by writer: Open question to obtain further information on client’s point of view, (Burnard, 2005, p.150). An adequate question may have been: How do you feel about this approach described by your psychiatrist regarding people with mental health issues adopting a more pro-active role in their treatment/illness management, in contrast to your experience with the biomedical approach you experienced in the 1970’s? “I’ve been sort of what you would say independent for long enough that I haven’t really been in contact with the mental health system much” (S.N.). Skill missed: Open question to clarify client’s statement. “Open questions …encourage the client to say more, to expand on his story or to go deeper” (Burnard, 2005, p.150) When you say “independent for long enough” what exactly does this mean? “I was at the ------- clubhouse and it seems like that’s gone a little downhill because when there was people there who were suffering from you know, schizophrenia or manic depression it was a place where you could go and encourage each other” (S.N.). In this instance the writer missed an opportunity to apply Catalytic Intervention: which includes “encouraging further self exploration, self-directed living, learning and problem-solving in the client” (Sloan & Watson, 2001, p.208). An appropriate application of this intervention would be to pose the question: It sounds like a very healthy environment where you felt supported and helped to maintain yourmental /overall health. Do you feel that an alternative community-based program would be beneficial to you at this point, are you interested in exploring that option?“I saw myself 30 years ago…I was in the Forensic I said- you know study, work here/there for extra money and take care of my health, exercise and that- so I had a 30 year vision and that’s what worked out…so it’s sort of what you do, what you don’t do and where you end up. You know you gotta make up your mind” (S.N.). Writer missed opportunity to utilize the skill of Supportive Intervention: “to be supportive is to validate or confirm the worth of the client's person, qualities, attitudes or actions” (Sloan & Watson, 2001, p.208). An appropriate response of this nature could have been: I think it’s wonderful and commend you on working hard to achieve the goals you set out for yourself upon your release from the Forensic Unit. Writer’s question posed to (S.N.) : “My question for you I think is because I think a lot of people although they don’t understand schizophrenia, like, I’ve known before I ever got interested in psychiatric nursing that a problem with schizophrenia is feeling ‘better’ and going off the meds, and then things get ‘messy’? (S.N.) response: “Been there, done that, ended up back in the hospital, not doing it again!” The writer made an attempt to apply catalytic intervention through the use of an open question for further inquiry. The writer lacked the skill of ‘Concreteness’ in posing this question and was unclear and vague in her attempt to convey to (S.N.) exactly what she was inquiring in a clear and concise way. “Concreteness refers to the idea that the counselor should be clear and explicit in her dealings with the client and should help the client to express himself clearly.” (Burnard, 2005. P. 108). A more effective question would have been “What is your input on the perceived notion of schizophrenics “feeling better” and going off their meds in relation to personal experience or otherwise. Do you have any insight you would like to share on this topic?”ReflectionThe writer found this assignment on interpersonal skills/therapeutic communication extremely fruitful in establishing a ‘starting point’ to gauge her natural interpersonal relation skills with limited insight into all that is necessary to function as an effective psychiatric nurse in regards to specific micro-skills in conjunction with knowledge/proper application of psychiatric nursing theory. Prior to embarking on this assignment the writer felt she was beginning to develop a baseline understanding of the foundation on which psychiatric communication is formed. Working through each stage of this assignment to produce the final product was a valuable learning experience in providing the writer the opportunity to truly evaluate where her strengths lie in terms of therapeutic communication skills, and more importantly to identify the writer’s weaknesses and areas that require further development, which at this early stage are plentiful. Regardless of the interview being a ‘mock’ counseling session, the communicative interaction between the interviewer/ interviewee was genuine and therefore enabled the writer to establish a deep understanding of her own innate abilities as an effective communicator as well as drawing out the barriers that prevent therapeutic communication. The writer made a point of establishing an appropriate environment prior to the interview start based on behavioral aspects of listening outlined by (Burnard, 2005), particularly in applying Egan’s ‘SOLER’ method “as a means of identifying and remembering the sorts of counselor behavior that encourage effective listening” (Burnard, 2005, p. 139). The writer was surprised and pleased with her ability to implement this method in particular reference to effective body language and use of eye contact. In the past these are areas the writer felt she was not particularly skilled in. It was obvious by the subject’s willingness to talk with comfort and ease that the writer was applying these vital aspects of active listening effectively. That being said, as the writer considers herself fairly comfortable interacting socially with people from all walks of life. In this case, where the interaction was being recorded and in an attempt to utilize appropriate communication skills while maintaining a natural flow of conversation, the writer was surprised at her inability to formulate direct, relevant questions to be stated clearly. The writer also experienced difficulty in determining when/where to interject herself into the session as the subject was very eager to speak and be heard, the writer felt some apprehension attempting to interrupt and pose specific questions to redirect the context of the interview, mainly based on fear of the subject feeling disrespected and ‘shutting down’ on her. Ultimately the writer concluded in this situation that it was more important to allow (S.N.) to speak freely and actively listen and attend to him/his needs than to practice utilizing as many of her newly learned communication skills as possible throughout the interview process. The writer felt using (S.N.) as an object to practice skilled communication on, rather than valuing him from a humanistic perspective contradicted the whole purpose of our developing these scared skills vital to any therapeutic relationship in psychiatric nursing. In conclusion, the writer found the entire process extremely enlightening and has gained valuable insight into herself and her strengths and weaknesses in regards to effective communication/interpersonal skills. The writer feels confident that these skills will only grow and develop stronger as time moves forward and opportunity to practice present themselves and are taken full advantage of. Therapeutic Relationship Analysis transcription Grid STUDENT: Trina SkinnerClient responseStudent responseSkill usedSkill missedBetter phraseMy experience with RPN’s was a lot of them took extra courses as well as what they were doing“Mmhhmm”Nodded headUse of Minimal promptsSOLER method appliedReflection ‘echoing’Questions to clarify and check for understandingWhen you say “as well as what they were doing”, are you referring to their provision of care of patients on the Forensic Unit? Did you feel as though their academic focus interfered with the construct of the nurse/client relationship? Is this interpretation accurate?For the most part the nurses in the Forensic unit seemed to be in a transient life. Didn’t last long, I think it was hard on their brains as well“Mmhhmm”Active listening and attending skills applied/ minimal use of promptsCatalytic InterventionDid you feel then that it was difficult to establishing trusting/therapeutic one- to- one relationships with the RPN’s in the Forensic Unit given these circumstances?There was a high turn-over of nurses…always seemed to be as a stepping stone, seems to be get your experience and get a better job.“Okay”NoddingUse of minimal promptsChecking in, “I am with you”Empathy BuildingIt sounds as though you feel the nurses were not fully invested in the treatment/care of the patients, but rather used their experience in the Forensic Unit as a means to further their career- I could understand this being very frustrating, contributing to a lack of much needed support for yourself and other patients.It came down to a thing of looking into one’s self to find out well, what’s more important? I came to the conclusion I’ll take my meds and I’ll get through this“Mmhhmm”Soler methodChecking in, “I am with you”Questions to clarifyCheck for understandingI just want to clarify what it is you are referring to when you say, “get through this” Are you referring to your time in the Forensic Unit?When you say “looking into one’s self’ are you referring to the concept of spirituality or how would you describe the process of “looking into one’s self”?I don’t know what the system does these days but back then if you were put in with the criminal asylum they would over-medicate youJust to keep you from behaving a certain way?Question to clarify/gather more informationWhy do you feel yourself and other patients were ‘overmedicated’?What do you believe was the objective behind this method of ‘treatment’?That’s what it was called, it was called ‘behavior modification through drug therapy’Which was basically…Attempt to check for understandingListening and attendingWait for client to further elaborate on topic.Drug ‘em, tranq ‘emOkay, ya, mmhmmEmpathy BuildingI imagine it must have been a very frightening experience, healthcare professionals making no attempt to understand the nature of a patient’s behavior, simply sedating you to the point you could no longer function adequately.Client responseStudent responseSkill usedSkill missedBetter phraseHowever, these days seems to be more forward thinking I do see a psychiatrist occasionally…“Mmhhmm”Use of minimal prompts“I am with you”Reflection ‘echoing’Question to gather more informationYou feel that there is more “forward thinking” in regards to the current state of the mental health system vs. the 1970’s when you spent time I the Forensic Unit?He’s told me that what they wanna do these days is to integrate people more into the community, rather than isolate/segregate them from the communityActive listening and attendingQuestion for exploration/to obtain further information on client’s perspectiveHow do you feel about this approach described by your psychiatrist regarding people with mental health issues adopting a more pro-active role in their treatment/ability to adopt methods that function to enhance a client’s daily living, as opposed to your experience with the biomedical approach you experienced in the 1970’s?I’ve been sort of what you would say independent for long enough that I haven’t really been in contact with the mental health system much. “Mmhmm”Active listening and attendingUse of open question to clarify client’s positionWhen you say “independent for long enough” what exactly does this mean?I was at the -------clubhouse and it seems like that’s gone a little downhill because when there was people there who were suffering from you know, schizophrenia or manic depression it was a place where you could go and encourage each other“Okay”Active listening and attendingCatalytic InterventionIt sounds like a very healthy environment where you felt supported and helped to maintain your mental /overall health. Do you feel that an alternative community-based program would be beneficial to you at this point, are you interested in exploring that option?Then the ‘hard drug addicts’- that they need something, okay? Maybe it’s a job at a brewery or you know maybe it’s something to keep them ‘up’…whatever they need but it is certainly not tranquilizers…(continues on this course of verbal expression)“Mmhhmm”Active listening and attending continued but I feel as though I am losing the client’s focus at this pointConcretenessHelp the client express himself clearly Check for understandingI am not sure I understand what you are communicating here. Are you saying that once people with substance abuse problems started attending meetings it disrupted the group dynamic and you found the support group less effective/that environment no longer met your needs?A person may still have a disability, so I’m not saying anyone should have more or less benefits- I’m just saying let’s look at 30 years from now, where are we going with this?“Mmhhmm”Checking in, “I am with you”Checking for understandingReflection ‘echoing’Do I understand based on your previous statements RE: ‘drug addicts’ and their presence in the ‘clubhouse’ it is your belief that community support programs for the mentally ill should be less generalized and more specific to a client’s individual diagnoses?Client responseStudent responseSkill usedSkill missedBetter phraseI saw myself 30 years ago… I said- you know study, work here/there for extra money and take care of my health, exercise and that- so I had a 30 year vision and that’s what worked out…so it’s sort of what you do, what you don’t do and where you end up. You know you gotta make up your mind.“Mmhhmm”Supportive interventionI think it’s wonderful and commend you on working hard to achieve the goals you set out for yourself upon release from the Forensic Unit.I think the biggest think for me to swallow was I gotta take my medication and once I got over that hurdle I was fine.“Yeah”(problem with recording device)Question for exploration/to obtain further informationReflectionCan you recall how you came to this conclusion that it was absolutely necessary you take your medication, what it was that guided you “over that hurdle” initially?My question for you I think is because I think a lot of people although they don’t understand schizophrenia, like, I’ve known before I ever got interested in psychiatric nursing that a problem with schizophrenia is feeling ‘better’and going off the meds, and then things get ‘messy’Question to provoke exploration/further informationConcretenessI experienced an inability to be ‘clear and explicit’ in my dealings with the client in order to help the client express himself clearlyWhat is your input on the perceived notion of schizophrenics “feeling better” and going off their meds in relation to personal experience or otherwise. Do you have any insight you would like to share on this topic?Been there, done that, ended up back in the hospital, not doing it again!I know it’s a hard question what…I just want to be clear in what I am asking you, what sort of made you decide like okay I need to take this medication, like this is a part of my life, like, and not fight…Open question for explorationConcretenessI was vague/ unclear and non-concise in expressing my questionWhat ultimately led you to decide that it was critical to your overall health and quality life that you take your medication consistently?ReferencesBurnard, P. (2005). Counselling Skills for health professionals (4th ed.). Cheltenham, United Kingdom: Nelson Thornes.Reynolds, B. (n.d.). Chapter 37: Developing Empathy. In P. Barker (Ed.), Pshychiatric and Mental Health Nursing: the craft of caring (2nd ed., pp. 321-328). London, United Kingdom: Hodder Arnold.Sloan, G., & Watson, H. (2001). John Heron’s six category analysis: towards understanding interpersonal relations and progressing the delivery of clinical supervison for mental health nursing. Retrieved from: ................
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