JENNIFER KIAHA-RAQUINO

PMH 360 PROCESS RECORDING

Client Dx: Bipolar I disorder, Mania with Psychosis, Hx of PTSD
Age: 41 yrs old
Los: 30 days
Dialogue
Hi, my name is
Jennifer. Im a
nursing student
from KCC. Are
you available to
talk?
Yeah, ok I dont
want to do
exercises anyway.

So, tell me why

youre here at
Kahi Mohala?
I had a trespassing
charge.

Non Verbal
Communication
Smiling and
offering seat next
to me.
Smiles back sits in
chair directly across
from me.

Technique/
Skills
Introductory
statement.

Student
Feelings
Slightly
nervous.

Student Thoughts

T/N

I hope this goes

well.

Maintaining eye
contact.
Maintains eye
contact as well.

Open ended
question.

Slightly
nervous.

I hope this goes

well.

Analysis
1.This introductory statement opens
up for conversation and I used it to
begin conversation as well as start
my MSE so far at this point I could
tell the client was fairy groomed,
cooperative and friendly, speech
with a normal rate and tone.
3. I used nonverbal communication
of smiling to engage the client and
show friendliness.
4. The client smiled back and sat
directly across from me which
shows an interest in conversation.
1. This statement is focusing on the
current hospitalization for this
client her answer was brief and
blunt.
3. Maintaining eye contact at this
point positively contributed to this
interaction it showed my interest in
the client.
4. The client maintained eye contact
as well which continued to show
interest in conversation.

JENNIFER KIAHA-RAQUINO

PMH 360 PROCESS RECORDING

Tell me more
about that?
Yeah, but I dont
want to talk about
that.

Maintaining eye
contact.
Looks away, shakes
head.

Open ended
question.

Increased
nervousness.

What am I going to
say now?

(Use of silence)
So, tell me if you
have any concerns
about being
here?
Yeah, but no, I
dont care Im
leaving here soon.
Tell me about
your concerns?
They treat me like
shit here. Just like
the CIA. Thats
why Im retiring.
But, I will be out in
one month, thats
all Im thinking
about, just one
month.
So you say
youre leaving in
one month, Where
will you be
going?
Home, theyre

Smiling, use of
silence.
Regains eye
contact.

Use of silence,
open ended
question.

Curious.

What do I say next?

Concerned facial
expression.
Maintains eye
contact. Slightly
fidgets with hands.

Open ended
question.

Entranced.

I hope she opens

up.

1. I used open ended questions to

continue assessing my MSE on this
client and to see where I could go
from here to get more insight about
this client.
4. At this interaction the client
became fidgety which made me feel
like I was losing her interest or
possibly agitating her.

Keeping eye
contact.
Fidgets with hair.

Paraphrasing,
error-closed
question.

Slightly
confused.

I hope I can stay on

topic.

1. I began to assess future discharge

plans and follow up care for this
client. Her statement said a lot, she
was homeless and needed to
establish a residence.
4. The client continued to fidget,

1. I continued to focus on what led

to the current hospitalization to get
the client to open up.
4. The client looked away and
shook her head which I interpreted
as a defense mechanism so I did not
continue with that subject.
1. I used a brief moment of silence
hoping the client would say
something else pertaining to her
current hospitalization. Next, I tried
another angle to get the client to
open up about her current
hospitalization.

JENNIFER KIAHA-RAQUINO

PMH 360 PROCESS RECORDING

making me find a
residence. This is
my first time on
Oahu. Im from
Big Island.

Tell me more
about Big Island.
Um, its open
places. Boring.
Lots of drugs, but I
dont do drugs.
They arent giving
me the right
medicine here.
They gave me
tegretol. Tegretol is
bad, it makes me
see blood. Like real
blood. Everywhere.
Youve never taken
a blood bath till
you work for the
CIA. Like a real
blood bath. Thats
why Im retiring.
Oh. (Use of
silence) So lets
talk about your
3

Nodding as client
continues to talk.
Fidgets with hair
and hands. Facial
expressions
exaggerated and
changes with mood
and topic changes.

Open ended
focused
statement.

Confused.

What just
happened?

Maintains eye
contact, use of
silence.

Use of silence,
Open ended
focused

Confused.

How can I keep this

client on track?

her nonverbal communication along

with jumping to different topics
deferred me from my agenda.
5. Error non therapeutic closed
question. I could have said Tell me
about your plans when you leave
here? to focus on the bigger
picture and possible needs for the
client.
1. I started focusing on the clients
history hoping to gain more insight,
her response took me to a whole
other topic which lead me to
believe there may be some not so
good memories about big island for
this client.
2. (Self-improvement) I could have
been able to start exploring the
social relationships and financial
relationships of the client. I will
improve on staying on an
appropriate track with the client by
using a better open ended question
more pertinent to the current
situation.
5. Non therapeutic I should have
said Tell me more about your
plans when you leave here?
1. I tried to focus back onto the
client and her medications to see
how much she knew about them.

JENNIFER KIAHA-RAQUINO

PMH 360 PROCESS RECORDING

medications. Tell
me about your
medications.
They dont have
the correct
medications. They
have Invega not
Concerta. I know
everything about
medication. Ive
been taking it for
20 years. They
usually have one or
the other. I inject
myself. It doesnt
hurt. I can teach
you about
medications.
So you said you
have to inject
yourself with
medication. That
must be hard to
inject yourself.
No its fine. The
state hospital is
better. I got
whatever I wanted
there.
Oh? You were in
the state hospital?
Can you tell me
4

Smiling. Using
hand gestures in
reference to
injections.

statement.

Per report she refuses medications

at times so I wanted to see if I could
possibly give her any needed
education pertaining to medication.
Her statement led me to believe that
she felt a loss of control with her
medications and that she was used
to handling them on her own
2. (Self-improvement) At this point
my use of silence wasnt working
with this particular client. I will
improve on being quicker and more
meaningful with my flow of
therapeutic communication.

Concerned facial
expression.
Smiles, nods head,
body is relaxed.

Clarifying
statement,
expression of
empathy.

Interested.

I hope this question

helps.

1. I continued to focus on
medication compliance and
education. Her statement led me to
try to assess if she was taking
medications at state hospital it
seemed as though she felt more
comfortable at state hospital versus
Kahi Mohala.

Maintains eye
contact. Nodding.
Fidgets with hands.

Minimal
encourager,
open ended

Helpless and
confused.

I hope she feels

better letting all of
this out.

1. I thought I was could focus on

the clients illness by finding out
more about her stay at state

JENNIFER KIAHA-RAQUINO

PMH 360 PROCESS RECORDING

about that?
Yea 5 times. Its
better there
(Began to laugh to
self as if
remembering an
event at state
hospital) (Client
then began to
continue talking
jumping from
subject to subject
which included:
cooking, being a
vegan, working as
a CNA, working as
a dental assistant,
being from Illinois
then moving to Big
Island) Im done
talking now.
(Stands up) I will
talk to you later.

Exaggerated body
movements.
Laughing to self.

question.
Error-multiple
questions.

(Later in the
evening)
Hey ______, Are
you up to talking
again?
Yeah, sure.

Smiling and
maintaining eye
contact, sits in seat
next to client.
Smiles, adjust self
in seat.

Introductory
question.

Focused.

I need to get
somewhere with
this client.

hospital. Her statements went

quickly to other subjects I
interpreted this as part of her mental
illness and the state hospital is a
trigger for her to have some mania.
2. (Self-improvement) As the client
continued to jump from subject to
subject I simply nodded and
continued to listen. I was struggling
to find the correct thing to say. I
need to improve by directing the
conversation better.
3. At this point I was confused and
felt helpless I only responded with
nodding. I wasnt sure where to go
from here and I think the client
could see that and it affected the
conversation negatively and
eventually the client got distracted
and uninterested in talking to me.
5. Error non therapeutic-multiple
questions at once, I should have
asked one question at a time. This
may have helped pace the
conversation better.
1. This statement was to open up
conversation again since the client
abruptly stopped conversation
previously.
3. My thoughts, feelings, and
nonverbal communication affected
this interaction positively because I

JENNIFER KIAHA-RAQUINO

PMH 360 PROCESS RECORDING

Lets talk about

your family. Tell
me about them.
I dont talk to
them. I shut them
out. Its better that
way.
So you are telling
me its better for
you to shut them
out?
Yeah, they were
abusive to me.

Serious facial
expression with
eye contact.
Breaks eye contact.

Open ended
focusing
statement.

Focused.

I can work with

this.

Concerned facial
expression leaning
in towards client.
Nodding head,
regains eye contact.

Paraphrasing

Curious.

I wonder what
happened.

Oh? (use of
silence) Who was
abusive?
My mom. My
dad.

Maintaining eye
contact, use of
silence.
Maintaining eye
contact.

Minimal
encourager,
use of silence,
Error-closed
question.

Sympathetic.

Minimal
encouragement
isnt working with
this client.

Lets talk about

the abuse. Can

Leaning in
towards client.

Focusing,
open ended

Sad.

I hope I dont make

her sad.

had more confidence in what I was

doing at this time. I was goal
oriented and focused.
4. The clients nonverbal
communication suggested that she
was interested in conversation.
1. My focus was on the clients
support system, triggers, mental
illness, and history. Her response
told me that she used defense
mechanisms of avoidance towards
her family and I needed to find out
why.
1. I continued to focus on why she
had avoidance towards her family.
3. My feelings, thoughts and
nonverbal communication affected
this interaction positively. I noticed
when I started leaning in towards
the client she opened up more and
wanted to talk.
1. I started focusing on her abuse
which could be a trigger and
contribute to this client negatively.
Her response was brief and blunt.
5. Error-non therapeutic closed
question. I should have asked Can
you tell me about the abuse? This
may have gotten her to discuss the
abuse more specifically.
1. I wanted the client to open up.
Her response indicated that her

JENNIFER KIAHA-RAQUINO

PMH 360 PROCESS RECORDING

you tell me what
kind of abuse?
Every kind of
abuse there is. All
of it. They divorced
when I was 7. It
was for the best.
Its better not
talking to them.
Thats why I shut
them out.
You sound upset
talking about your
parents?
Yes, but I had my
grandmother. She
was an angel. I
dont know what I
would have done
without her. But,
she died 8 years
ago.
Tell me about
your friends or
any other family
members?
No friends. I have
a husband and a
sister. Shes one
year and five
months older than
me. I shut her out
7

Fidget with hands.

question.

childhood troubled her and that she

had a strong avoidance defense
mechanism.

Concerned facial
expression.
Breaks eye contact.

Reflection of
feeling.

Sad.

I hope shes ok with T

my questions.

1. I wanted her to continue to

express her feelings Her response
showed that her grandmother was
part of her coping mechanism and
made her happy.

Nodding head.
Fidgets with hands.

Focusing,
open ended
question.

Interested.

What do I ask next?

1. I focused on any other possible

coping mechanism or outside
support that she may have.
2. (Self-improvement) Instead of
focusing on friends or family as
support I could have continued to
focus on the clients feelings and
maybe find other coping
mechanisms.

JENNIFER KIAHA-RAQUINO

PMH 360 PROCESS RECORDING

too. I dont talk to
her.
So you said you
have a husband.
Do you have any
children?
No children.

So, you said you

have no children?
Is that correct?
(Nods heads yes)
Tell me more
about your
husband.
Hes from Illinois
where I grew up.
Hes a good person.
Most people are
not good people.
Everywhere you go
people are not
good. Thats just
how it is.
So, you said your
husband is a good
person?
Yes, I only know
3 good people. One
8

Leaning in
towards client.
Looks away.

Focusing,
Error-closed
question

Interested.

I thought her chart

said she has one
child.

Concerned facial
expression.
Looks away.
Adjusts in seat, sits
with knees to chest.
Nodding head.
Fidgets with hands.

Restatement,
Clarifying
question.

Confused.

Did I read the chart

wrong? Maybe
shes avoiding it.

Open ended
focusing
statement.

Interested.

I think shes
changing the
subject on me.

Nodding head,
maintaining eye
contact.
Maintains eye
contact, adjusts self

Restatement

Curious.

I want to find out

more.

1. I wanted the client to talk about

her child to see if there may be a
relationship with her child.
5. Error-non therapeutic closed
question. I should have said I read
in your chart that you have a child,
tell me about your child. This may
have gotten her to open up.
1. Her response indicated to me that
there may be a lot of difficulties in
this area for this client since she did
not even acknowledge having a
child.
1. I continued the focus back to her
husband to see if he may be able to
care for her with her mental illness,
be a support system for her, as well
and assist her in discharge or follow
up care. Her response indicated that
he is a person that she trusts and
may be able to rely on.

1. I continued focus on support,

MSE, and mental illness. Her
response to me indicated that she is
able to trust others. She decided to
be medication compliant at that

JENNIFER KIAHA-RAQUINO

PMH 360 PROCESS RECORDING

is a dentist, the
other is a dentist,
and one is my
husband. (Client
is called to line up
for med pass) I
have to go line up.
(Stands up and
walks away.)

in seat.

time. Per report she refuses

medications.

My client had many things to say at times as well answered briefly and bluntly at other times. This showed me that there are
areas in which the client can be distracted and well as areas in which the client has some avoidance. Throughout our conversations my
client had become distracted and veered off topic while talking about places such as with her concerns about Kahi Mohala, Big Island,
as well as State Hospital. To analyze this I would say that these places trigger thoughts and memories of events that happened with this
client in these particular places. Her behavior of being fidgety and changing the subject shows that she has uncomfortable feelings
about these places. It seems that these places and topics cause her some anxiety.
When speaking to my client about why she was in Kahi Mohala, her parents, and abuse she answered briefly with minimal
words. To analyze this it shows that her thoughts about this are being blocked because they are unwanted thoughts. Her behavior is
avoidance, and her feelings are sad.
Based on the conversations I had with this client she has her mental illness diagnoses as well as life experiences that comprise
her. She also has all her circles which contribute to her as well. There is so much that comes in to play to make a person who they are
as well as contribute to their thoughts, behaviors, and feelings. I feel like I was able to get an idea of a small portion of this person and
what she was going through at that day and time. The cognitive behavior model is a good tool to use in mental health.