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Process Recording Template
Follow the PR Directions Sheet Carefully
Date: September 7, 2016
Clients Dx: Adjustment disorder
Age: 18
LOS: 6 days
Dialogue
Hi, my name is
Aja. Im a
student nurse
at KCC and I
will be
working with
you from 8:30
am to 12:30
pm.
Ok. Are you
going to talk to
me? My story is
crazy, like, you
probably
wouldnt
believe
everything Ive

Non Verbal
Technique
Communicatio
n
Sits down next
Introductory
to client.
statement
Talking while
writing
something down
on a paper.
Turns away from
her paper and
faces me.
Leans in.

Student
Feelings
Surprised

Student
Thoughts
-This patient is
very direct
-It sounds like
she has a lot to
say but I dont
know how
much of it is
going to be
true.
-Im didnt
think she
would be so
talkative

T/N
T

Analysis
4. At first I felt that I was
bothering her because she was
writing something while I was
talking to her so I felt ignored.
Then I felt intimidated when
she started talking to me
because she was so direct.

been through.

What do you
mean when
you say that I
wouldnt
believe
everything
youve been
through?
Imagine any
type of abuseIve
experienced
that. Abuse and
death. I
watched my
dad die.

Tilts head,
maintains eye
contact
Leans very
closely to me
Backs away
from patient

-Clarifying
statement
-Active
listening

Skeptical
Intimidated

-Shes
T
probably
exaggerating
but she must
have gone
through
something
very traumatic
in order to be
here.
-I think shes
leaning so
close to me
because she
knows that I
dont really
believe her yet
and is trying to
make me
uncomfortable

I hear you
saying that you
have been
abused and
have seen

Straightens up
in chair, leans
forward
-Leans back into
chair

Paraphrasing
-Open
focused
question

Perplexed

-How can she

say that it
doesnt make
her sad but its
obviously part

2. I shouldve used offering

self which would have
redirected the conversation
from the beginning and
established that we were
talking about the current
hospitalization. I could have
said, I have some information
to obtain. Lets sit here so that
we can discuss your current
hospitalization.
3. I felt skeptical that she was
being honest and not
exaggerating. Despite open
body language, my tone may
have indicated this skepticism
to which the patient responded
by leaning very closely to me.
4. The patient leaning so
closely towards me wasnt
threatening but still made me
uncomfortable so I backed
away from her.

someone die.
How is this
affecting you
right now
(Long pause) It
doesnt make
me sad unless I
really think
about it but
those are some
of the reasons
why Im here.
Why youre
here?
I told my step
mom that I was
going to kill
myself. Its a
long story. And
actually, I dont
call her my step
mom because
shes the one
that abused me
all these years.
And now Ive
lost my foster
home too so its
just me.

-Appears in
thought as she
looks around the
room when
thinking of an
answer
-Shrugs when
she talks about
these issues not
making her sad
Furrows brow
Restatement
in concern, tilts
head toward
client
Leans forward in
her chair, rests
hands on knees
and maintains
eye contact
Gestures to
herself when she
says, its just
me.

of the problem
if thats part of
the reason
shes here?
-It seems like
shes just
trying to act
tough

Curious

-The client is
very casual
when talking
about wanting
to commit
suicide.
-Her mood is
euthymic
considering
she is talking
about very
serious issues
in her life
-I feel curious
because I want
to understand
how she can
be so casual
while talking
about these
issues

2. I used a restatement but I

could have used a clarifying
question instead to improve
the flow. I could have said,
what do you mean when you
say that those are some of the
reasons youre here?

You mentioned
wanting to kill
yourself. Do
you still feel
that way?
Um, not
anymore. Now
I only think
about hurting or
killing myself
when I go to
therapy.
Can you and I
contract for
safety?
Yes
You said that
you feel
suicidal when
you go to
therapy. Tell
me more about
your feelings
of self-harm.
Yeah I do. Its
not so much
regular therapybecause I like
going to group
with my
friends. Its
going to sex
therapy that

Furrow brow in
concern, leans
in
Half-smiles
when she says
not anymore

Closed
ended
question

Worry
followed by
reassurance

Maintains eye
contact, stirs in
chair
Looks directly at
me, stands up;
crosses legs and
sits back down

Focusing
statement

Interested

-I hope that
this
conversation
doesnt trigger
something to
give her
positive SI
-I think she
can sense my
concern and
smiled in a
way to
reassure me
that she
currently does
not have SI
-I think were
making
progress
because she
has
acknowledged
the specific
therapy that
gives her
anxiety. I want
to see where
this
conversation
will go.
-She seems
uncomfortable
because she is

3. I think the patient detected

my concern when I leaned in
so she half-smiled in a way to
reassure me

4. Her body language

(fidgeting in the chair,
repositioning herself) indicated
that she was uncomfortable but
I felt that we were making
progress so we just continued
discussing it further.

makes me feel
like that.
Go on.
I told you I was
abused right?
My therapist
makes me talk
about all that
stuff from my
past that I dont
like to
remember. Plus,
Ive had a lot of
different
therapists and
the new one
just left me.

starting to
fidget in her
chair.
Relaxes into
chair, gestures
with hand to
continue
Stirs in her chair
to uncross her
legs and leans
forward onto her
knees again.
Resumes
undivided eye
contact
Breaks eye
contact and
looks away

Minimal
encourager

Curious
Uncomfortable

-What does
T
she mean
when she says
the therapist
left her?
-If I went
through a
traumatic
experience, I
dont think I
would want to
talk about it
and have to
relive it.
-Sounds like
she would
rather suppress
her feelings
rather than
discuss them.
-Why is she
starting to
stare at me?
-Is she on
sexual
precautions
due to the
staring or is
this innocent

4. The client started to lean

closer to me when she was
talking. Throughout the
conversation she was staring at
me for longer periods of time.
I didnt know what to make of
this behavior but I eventually
had to break eye contact
because it was starting to make
me feel uncomfortable.

behavior?

You mentioned
that your
therapist
reminds you of
your past and
that she just
left you.
Which of these
would you like
to talk about
first?
Well, I mostly
feel suicidal
because I did a
lot of bad
things in the
past. Talking
about it just
makes me
relive all of that
guilt. Im mad
at the therapist
because she left
recently. I just
met her and
told her my
entire life story
and a couple
days later she

Crosses legs,
tries to not
make
prolonged eye
contact
Backs up into
the chair, sits up
and gets very
animated when
discussing this
phone call.

Focusing
question

Vulnerable
Sympathetic

-I dont want
to make too
much eye
contact with
her if shes
going to keep
staring at me
-That sounds
like a very
difficult and
unfortunate
situation to be
in. I cant
imagine not
having a
family and
being
constantly let
down.

3. I stopped making prolonged

eye contact with the client
because I felt uncomfortable.
She reacted by backing up into
her chair and away from me.
4. When the patient sat up and
backed up, I felt more at ease
talking to her because I think
she realized that she was
making me feel
uncomfortable.

called and said

that she
couldnt work
with me. So
now Im even
more alone.
You mentioned
feeling guilty
when you go to
therapy, and
feeling alone.
Which of these
would you like
to talk about
first?
(Long pause)
Well, I feel
guilty when I
go to therapy
because I know
that I did a lot
of bad stuff but
I dont know
what I can do to
forgive myself
and move on. I
feel alone
because I have
a hard time
trusting people.
The one person
I did trust was
my dad but he

Leans sideway
against arm
rest, crosses
legs; rests head
on hand
Begins tearing
up when talking
about her father
Frowns, leans
forward in
chair and rests
chin in hands

Focusing
statement

Sympathetic

-She looks sad. T

I hope Im not
making her
uncomfortable
by asking her
these questions
-I shouldnt
have asked
this question
because now
shes crying
-I dont know
if this is
helping her or
hurting her

4. When the patient started

crying while talking about her
dad, I started to compare my
life with hers and started to get
emotional. I think she
responded to my nonverbal
cues (frowning, leaning
forward) by continuing to talk
about him.

diedHe was
my hero. Can
you imagine
seeing this big
guy go from
being super
strong, to just
lying dead in a
bed and all
weak?
I hear you
saying that you
dont know
how to forgive
yourself and
trust others.
Since you
dont know
what you can
do to change
these feelings
right now,
what are some
positive things
you can do
instead of
hurting
yourself?
(Long pause) I
have been
working on
communicating
with staff. If I

Sits up in chair,
eye contact
with client
Breaks eye
contact, appears
deep in thought.
Looks off into
the distance
while trying to
form an answer.

Paraphrasing
Open
focused
question

Satisfied

-The client
seemed
genuinely
introspective
and took time
to think about
her answer
before
responding

2. I used paraphrasing but I

could have used reflection of
feeling so that they client
could better understand her
behavior. I could have said
you dont like therapy
because it reminds you of your
past and you dont know how
to move on yet.

get sad I will

talk to them. I
can participate
in group or do
distracting
activities or
things that
make me feel
important.
Talking to staff
has helped me
deal with my
anger since Ive
been here.
How do you
manage your
anger?
Before not so
good. Im still
mad at my step
mom and my
brother for
hurting me. I
used to molest
other little kids.
It was wrong
but I didnt
know any
different. Now,
since being here
the nurses are
teaching me
different things

Stirs in chair
while
maintaining eye
contact with me.
Widens eyes in
response to the
clients answer

Open
focused
question

Shocked

-She talks
about
molestation so
casually!
-How do I act
unfazed by
this?

to do when I get
angry or
frustrated and I
know that I can
talk to them if I
start to get
annoyed.
Those sound
like positive
changes!
Today we
talked about
your feelings
about therapy,
some
alternative
things you can
do when you
feel guilty and
alone, and
ways to deal
with your
anger. Is there
anything I
missed that
you would like
to talk about
today?
I dont think so.
My goal for the
day is to stay
positive and
talk to staff if I

Smiles. Sits up
in chair, crosses
legs.
Appears deep in
thought while
she forms a
response. Smiles
and stands up to
walk back to
classroom

Summarizin
g

Successful

-The patient
seemed to put
a lot of
thought into
her answers
and I felt that
we had a
meaningful
conversation.
Overall, she
was able to
identify
problem
feelings and
ways to
manage them.

start to get
angry. Right
now I still dont
know what I
can do to stop
myself from
feeling guilty
when I go to
therapy but I
know it has to
be something
better than
wanting to hurt
myself. As far
as feeling
alone, I am
trying to get in
touch with
family in New
York that I can
stay with so Im
keeping my
fingers crossed
that I wont be
alone for much
longer. I know
that I have a lot
to work on but I
feel hopeful
that one day I
can be normal.