John

Process Recording #1
Date: 5 February 2016
Client Dx: ADHD, ODD
Age: 15
Los: Day 3
Dialogue

Non Verbal
Communication

Technique

N: Hi, my
name's
Sam, I'm a
student
nurse with
KCC.
Thanks
for this
interview.
It should
take about
10 to 15
minutes.
How are
you
feeling?

N: sitting with
arms resting on
thighs, fingers
touching, slight
hand-wave,
direct eye
contact, leaning
forward

(+)
Introductory
Statement &
(+) General
Lead

C: sitting
upright, good eye
contact, looking
around

Student
Feelings

Nervous,
eager

Student
Thoughts

T/N

I hope this T
goes okay
and I get
what I
need. Do a
proper
intro, try
not to be
lame about
it. Start it
off openended.
Keep it
open.

Analysis

3. I think focusing my
thoughts here were
instrumental in guiding
my actions, allowing me
to perform my goal of a
solid intro. This in turn
helped set a solid flow
for the rest of the
interview.

John
C: I'm
feeling
good.
N: Good?
C: Yeah,
well kind
of. Okay I
guess.
N: Okay?

N: head shrug
to side,
maintaining eye
contact

(+)
Restatement

C: looking down,
side-to-side, then
back at me
N: lean forward (+)
even more
Restatement

C: Uh huh,
I'm okay
now but
yeah I felt
bad about
what I did.

C: fidgety, looks
away off to side
then down and
back up

N: What
you did?

N: furrowing
brow

C: I hit my
mom and
stuff, that's
how come
I'm here.
Also 'cause

C: touches leg,
face drops, pulls
leg up onto chair
and holds it,
breaks eye
contact, looks off

(+)
Restatement

Curious

Maintain
T
therapeutic
communica
tion. Be
genuinely
interested.

Concerned

Hmm,
seems like
he's got
something
else going
on, better
keep
probing to
find out
what it is.

Curious,
Anxious,
Somber

I wonder
what he
did.
Am I
using too
many
estatemens
?

1. I'm consciously using

restatement here as
therapeutic
communication to keep
focus on my client. I
want to know what he's
thinking per CBT
approach.
1. I sense my client has
more to say AEB his
verbal response of
mixed feelings. I want to
go even deeper by
following-up on these
cues, so I utilize
restatement again.

4. I interpreted my
client's non-verbals as
nervous, ashamed and
guilty. He appeared
reluctant to share and I
think he likely felt
vulnerable, potentially
opening himself up to
judgement/criticism.

John
I've got
to side
ADHD and
I'm defiant.
N: So
what I
hear you
say is
you're
feeling
bad?

N: nodding,
slightly leans
back

(+)
Paraphrasin
g

Relieved

(+) Open
ended
question

Concerned, Wonder
T
Sympatheti what his
c
relationship
with his
mom is
like?

C: re-establishes
eye contact, face
gets serious

C: Yeah
because I
know I
shouldn't
have and
stuff but I
mean we
just don't
get along.
N: You
guys don't
get along?
C: Not at
all, like we
always
argue and
stuff.

N: leans
forward,
touches hand to
face, slightly
rests chin in
hand
C: moves leg
back down to
ground

Oh dang
that's
intense,
and
familiar.
Sounds
kinda like
my teens.
Oh man
glad he
gets it and
feels
remorse.
That's a
good sign.

1. Having established my
client's mental illness in
his own words in the last
exchange, I want to hone
in on his feelings (per
CBT approach), identify
and understand the
reasons why he feels the
way he does. Gain
insight for me and gauge
his insight into himself.

1. I want him to explain

further what he means.

John

Dialogue

Non Verbal
Communication

Technique

Student
Feelings

N: How
long have
you guys
been
arguing?

N: leans back in
seat, rests one
hand on leg,
other hand
makes a motion

(+) Open
ended
question

1. This is a data collecting

question meant to get a
better picture of my client's
history and assess possible
triggers for his getting
upset, angry, defiant.

C: Um, I
don't know,
I started
getting
upset with
her a few
years ago,
like 2 or 3.
N: So wait
how old
are you
then?

C: looks up as if
wondering then
back at me,
bends forward in
seat

Interested When did T

this fighting
start?
Maybe it'll
give me
more
clues.
Ok so not
too long
ago.

(-) Closed
question

Surprised

C: I'm 15.

C: perks up in
seat

2. I think I should have *self

improvement* asked this
question earlier on in the
interview, and also should
have probably *self
improvement* maintained a
more neutral non-verbal

N: surprised
look crosses
face, shoulders
tense

(a) Nontherapeutic
, asking
closed-

Student
Thoughts

Oh wow
he's only
15. I
wouldn't
have
guessed
that. Oh

T/N

Analysis

John

N: Ok, so
N: shoulders
around 12, relax, leans
13?
forward slightly
C: Yeah,
she's
different
ever since
she came
back from
Afghanista
n.

C: crosses legs,
uncrosses legs,
good eye contact

question
(b) I know
closedquestions
give only
limited
informatio
n,
potentially
missing
vital
informatio
n. It's
better to
ask openended in
these
situations.
(-) Closed
question
(a) Nontherapeutic
asking
closedquestion
(b) I know
closedquestions
give only
limited
informatio
n,

boy I
remember
15, seems
like we
have some
things in
common.

Inquisitiv
e

Ah ha, so
all this
started
around
puberty.
Maybe all
this is
related to
that.

response rather than a

surprised one because that
might make a client think
you are judging them for
their age, response, etc. and
it is crucial to remain
nonjudgmental.
*Alternative* Tell me how
old you are.

2. I think I could have

gotten the same information
but by *self-improvement*
having asked in a different,
more therapeutic way.
*Alternative* Tell me what
was going on around that
time.

John

N: Oh,
she's
military?
C: Yeah.

N: leans to side
C: good eye
contact, sits
normally

potentially
missing
vital
informatio
n. It's
better to
ask openended in
these
situations.
(-) Closed
question
(a) Nontherapeutic
asking
closedquestion
(b) I know
closedquestions
give only
limited
informatio
n,
potentially
missing
vital
informatio
n. It's
better to
ask openended in

Dismaye
d

Uh oh, his
mom is
military.
That's a red
flag for
sure.
Oops, I'm
getting offtopic and
that's nontherapeutic.
Better refocus and
bring it
back to the
client.

2. I think I may have strayed

and started addressing
issues external to my client,
but it also did help some to
understand his mom
because that seems to be
one of his main triggers. I
also think I might have
given off some judgmental
vibes here with my verbal
response of Oh, so I want
to *self improvement* be
careful in the future to be
mindful and watch out for
slips like that.
*Alternative* I could have
asked, Tell me about your
mom.

John
these
situations.

N: Ok, so
before you
said you
hit her?
C: Well, I
mean, I
didn't want
to, I try to
walk away
but she
comes after
me. And
not to
sound bad,
but she'll
cuss at me
and scream
at me and I
try to stay
away but
she won't
leave me
alone.

N: leans in
(+) Openclose, finger tips ended &
pressed together (+)
Focusing
C: body tenses,
question
uses hands
making animated
gestures

Determin
ed

Remember T
he said that
he'd hit her.
Let's focus
on that and
remember
to stay nonjudgmental.

3. I think my non-verbal
communication of leaning
in close clearly conveyed
my genuine interest in my
client and that he responded
positively to this gesture.

John
N: You
seem
angry.
C: I'm
more sad
than angry.

Dialogue

N: slightly
leaning back,
looking down
then back up at
client

(+)
Reflection
of Feelings

Curious

Technique

Student
Feelings

Ah ha! I've T
got an
analysis.
Let me see
if I've got it
right.

1. This was a moment where

I recognized CBT,
verbalizing my client's
feelings by turning a mirror
on him using ROF, would
benefit my client.

C: looking down,
bites lower lip

Non Verbal
Communication

Student
Thoughts

T/N

Analysis

John
N: Sad?
C: Yeah,
because
like I don't
want to
fight. My
mom
doesn't
take her
medication
s or see her
therapist. I
take my
medication
s and see
my
therapist!
N: So
what I
hear you
saying is
you feel
like you
are doing
your part
and she's
not.
C: Yeah.

N: leaning in
close, shoulders
hunched, arms
resting over
thighs

(+)
Intrigued
Restatemen
t

Oh, looks
like I was
kinda off.
Better
clarify.

1. This exchange is to
encourage my client to
explore his feelings further.
Asking in an open manner
allows for him to expand
and for me to gather more
data than with a closed
response. I also find out his
medication compliance
status and treatment.

(+)
Paraphrasi
ng

Ah ha,
now I've
got
something.
This is
definitely
putting
together the
big
picture.

1. This exchange helped

shed light on some of my
client's behavior, his reason
for doing what he was
doing.

C: arms crossed
across body

N: nodding,
same as above
C: nods,
uncrosses arms,
looks off to side

Secure,
confident

John
N: Must
N: nodding,
be
lean back
frustrating slightly
.
C: moves legs,
C: She
good eye contact
always
blames me
and says
I'm lying,
even when
I'm not. I
got put
here
because I
was angry
and acted
out.

(+)
Expression
of
Empathy

N: You
were
angry and
acted out.

(+)
Concerne
Restatemen d
t

C: Uh-huh.
And that's
how come
they
brought me
here.

N: nodding,
same as above
C: leans back in
seat, shrugs
shoulders

Sympath
etic,
helpless

Umm, say T
something
to address
his feelings,
show you
understand
and care.

1. Again, keeping the CBT

model in mind, I am
working to connect my
client's feelings and
thoughts with his
behaviors.

Give him
more
validation,
understandi
ng.

1. This is putting together

my client's behavior with
his thoughts and feelings
from the last exchange.

John

N: Ok, so
now what
happens
from here,
moving
forward?

N: leans back
somewhat, good
eye contact, uses
hands to mimic
forward
motion

C: I'm
going to go
from here
to the
residential
side, for
like 2 to 3
months.

C: bouncing
slightly in seat,
points to other
unit

N: And
after that?

N: adjusts body,
rubs hands
together

C: Well, I
want to
live with
my Dad on
the east
coast. The
school's
out there
aren't as

C: good eye
contact, puts feet
on ground

(+) General
lead & (+)
Open
ended
question

Hopeful,
pragmati
c,
determin
ed

(+) Open
ended
question

Determin
ed

Man I
wish I
could help
this kid.
Maybe if I
try to push
this into the
future he'll
come up
with some
solutions.
Better be
careful to
not give
advice
though.
Ok, keep
the
questioning
going. Let
him figure
it out for
himself.
Keep
listening.
Forget
about
everything

1. This question is meant to

help me start determining
my client's discharge and
follow-up care needs, and to
encourage him to selfidentify strategies and
solutions as well as assess
whether or not he is
thinking ahead or not,
whether he's hopeful or not.

1. I wanted to encourage
him to keep going by
looking forward, visualizing
himself in the future thereby
helping us identify his
wants, needs, etc.

John
good, but I
can live
with that.

N: How do
you feel
about
that?
C: It's fine,
like what
else is
there? My
mom
doesn't do
what she's
suppose to
and then I
get in
trouble and
they said if
it happens
again I
have to go
to foster
care. I
don't want
to go to
foster care.
I tell lies so
my mom

else going
on around
in the
room.

N: scooches
(+) Open
forward in chair ended
to edge of seat,
question
fingertips
pressed
together,
leaning in
towards client
C: Brings one leg
back up to body,
holds it. Eyes
well up with
tears. Starts
sniffling then
crying. Body is
open and loose,
slumped back in
chair.

Intrigued, This is
T
concerne going well,
d, sad
I hope I'm
making a
difference
and getting
everything I
need. Uhoh he just
dropped a
bombshell.
This is
getting
heavy.
Should I
keep
going?

4. I interpreted my client's
nonverbal communication
as shaken and upset, very
sad and heavy. I saw this
being the crux of what was
really bothering him deep
down and as a real sensitive
issue for him, something
that was hurting him
emotionally and mentally
and affecting him physically
too. It was also physically
draining for him AEB his
slumped posture, perhaps
also a sign of exhaustion or
defeat?

John
won't get
in trouble.
I don't
want to be
separated
and I don't
want
anything
bad to
happen to
my mom. I
just don't
want any
of my
family to
get into a
bad
situation
that's my
fault and I
want to
stop it from
happening.
Dialogue

Non Verbal
Communication

Technique

Student
Feelings

Student
Thoughts

T/N

Analysis

John
N: .
C: .

N: Silence
(holding same
position, frozen
in place,
nodding then
looking away,
down and back
up to client)
C: silence,
slumped in chair,
eyes looking
down and up
back-and-forth

N: That
must be
hard.
Sounds
like you
care a lot

N: shifting
around, leaning
back a little,
hands moving
around
nervously,

(+) Silence

Uncomfo
rtable,
doubt,
hesitant

Oh shit, I
T
made him
cry. What
the hell do I
do now?
I'm such a
jerk I
shouldn't
have kept
pushing
him. Maybe
it's okay
though, it
wasn't my
fault? It's
just how he
is feeling
and it's ok
to cry. Just
stay quiet
and don't
say
anything
stupid right
now this is
a delicate
moment.
(+)
Nervous, Oh geez
T
Expression awkward, too much
of
torn,
silence is
Empathy & unsure
going on.
(+) Check
Better say
out & (+)
something

2. On one hand I thought it

was good I used silence as a
therapeutic communication
technique, but on the other I
wished I was a little less
uncomfortable and awkward
with it. For *selfimprovement* I want to try
work on being a little more
comfortable around
crying/tears, maybe offer a
statement like It's okay to
cry to reassure my client as
well as myself that this is a
normal and natural human
feeling/response that is okay
to express.

1. I think this was another

CBT moment of figuring
out what my client wanted
for himself.
Putting it all together it
seemed to me that his

John
for your
family and
that you
want to
protect
them and
for
everyone
to get
along. Is
that an
accurate
summary
to make?
C: Yeah.

motioning
nearby staff for
Kleenex
C: wiping eyes
dry, sitting back
up in seat,
looking around,
attempts a small
smile

Summarizi
ng

quick to
help him
out and
break the
awkwardne
ss. Don't
mess this
up. I don't
think this is
helping, uhoh he
knows how
scared and
weird I feel
right now.
Oh no I let
him down I
should've
said
something
else.

hitting/acting out against his

mom (behavior) was r/t his
(thinking) she wasn't doing
her part and always blaming
him for stuff which made
him feel as though he wasn't
worth it (felt worthless).

John
CBT Analysis:
His thoughts: (direct quotes) My mom always blames me and says I'm lying. My mom doesn't do what she's supposed to do and
then I get in trouble. I tell lies so my mom won't get in trouble. I don't want to be separated and I don't want anything bad to
happen to my mom. I just don't want any of my family to get into a bad situation that's my fault and I want to stop it from
happening. I felt bad about what I did. (my assessment) I'm doing my part but you (Mom) aren't doing yours. I don't want to argue
or fight but I have no other choice.
His feelings: Frustrated, angry, upset. Helpless. Despair. Fear. Worry. Concern. Guilt. Shame. Worthlessness. Unfairly treated.
His behaviors: Arguing/fighting, yelling. Physical aggression (hitting). Crying.