Psych Unit Experience - Essay Example

Introduction The interaction that was recorded was with an 81 year old Caucasian female, referred to as X.X. The main diagnosis with this particular individual was a combination of psychotic disorder, severe depression and hallucination. At an Axis 1 level, the patient was defined to have psychotic disorder. Axis II, the developmental disorders, were deferred. Axis III, had no physical conditions that related to the state X X was in. Axis IV, was unspecified, with no psychosocial disorders that could be specified. Axis V, the highest level of functioning for the patient, was 35/45. The psychiatric unit visited was a lock in facility in which X.X. was admitted to. X.X met with me in her room to talk with me as a visitor. There was continuous assistance available to those in the area from nurses, as well as other patients who were more sociable in the area. The goals set before this interaction was to get to know about X.X and the specific disorder she had. This included the ability to interact and understand the psychosis and level of hallucinations. This goal also included the ability to learn to communicate with an individual who had these specific types of disorders and what this meant for the client. Understanding how therapeutic communication could work with someone suffering from psychosis disorder and hallucination was the main concept linked to this. The next goal that was set before meeting with the client was based on the desire to have a clearer understanding of the clients psychosis disorder by gaining information about the client or their past. The thoughts and feelings that I had prior to the interaction that occurred were a combination of being nervous and excited. Interacting with a patient in a psychiatric ward is a new experience to me and caused me to have several questions about what would happen when meeting with the client. This was combined with only a slight understanding on how the client would behave or act, which caused more of a sense of nervousness. Because one of the goals was to understand therapeutic communication at a different level, I was also cautious of how I dealt with X.X and wanted to make sure that I was able to interact correctly when meeting with the patient. Interaction The first interaction with X.X was based on the patient talking to the wall, specifically with stating that she saw her husband having a heart attack. This was known to be caused through hallucination as well as depression. This was combined with the fact that X.X did not receive sleep for the past two days. Because of the hallucinations it was difficult to define communication strategies with the patient. After a brief introduction, empathy and silence were the two main components used. As the client continued to talk of the hallucination that was seen, the interaction became lessened. X.X continued to move into her state of seeing her husband dying of a heart attack. The more this occurred, the more she was tied into interaction with the wall, while all communication between the patient and myself were lessened. If the patient was able to slightly come out of the hallucination, it was only briefly. During this time, the response used was empathy for the patient during the interaction. Therapeutic communication that was a part of the process then became a part of the process. This was a combination of empathy that was used, as well as reflecting that was a part of the process. The communication was not based on specific words said, but was based on body language that was used with interactions with the patient that showed the empathy, leaving the communication method of science as the third interaction. Nodding and sitting back while the patient went through the hallucination was the only interaction that could occur. This left a space for the patient to express their psychosis and hallucination to a full effect, with an understanding through the empathy that X.X was not alone. Nodding and trying to reach out to the patient with the empathy and reflection was further taken account for with moving closer to the patient and trying to get them to stop looking only at the wall so they could begin to come out of the hallucination. However, the patient's response was to continue to look into the wall and become further influenced by the hallucination that was occurring. Because the patient was talking so much about the hallucination, it became difficult to take part in any interactions. This event led to the second interaction with X.X. At this point, X.X went further into the hallucination, but began to recognize the area in which she was at. This led to a realization that was based on the hallucination, but also an understanding that X.X was in a psychiatric ward. X.X stopped talking to the wall and stood up, while pacing around the room. She started calling for help from the nurses by moving in and out of her room so they would call for help. Her main call for hope was to make sure that her husband would receive an ambulance to rescue her husband. The communication strategy used with this was once again to use silence with the patient. Because her draw into the hallucination was so much further into finding her husband, interaction would have caused further problems because of the depth of the psychosis. There was also not an immediate reaction from the nurses and others in the ward to help X.X with the hallucination that she had. The communication at the first level was silence, until there were more options for the patient to understand where she was at, and to begin moving out of the state of hallucination in which she was in. When the interaction between the nurse and client did occur, it showed the same type of empathy with the client. The therapeutic interaction from the client to the nurse was based on trying to calm X.X down. This began with reassurance with the interaction. The body language used was to pat X.X on the back and to hold her hand so she could calm down. This was combined with reassurance from the nurse, stating that X.X would be okay, and to use empathy with her situation. The nurse continued with identifying and clarifying the questions that were asked by X.X. This re-affirmation allowed X.X to stop pacing and caused her to calm down. She slowly began to interact with the nurse and come out of the hallucination that she was faced with. The effect of using the empathy and clarification then led X.X to move into the ability to slowly come out of the state of hallucination that she was in and to bring her back to a realistic view that was within the psychiatric ward. This particular technique showed the process of therapeutic change that is a part of the assistance that X.X needed. The image that X.X was seeing was against the worldly view that was available. The job of the nurse was to use the communication to show the change between these two realities. This particular process showed how the communication moved from the “should” thoughts that X.X saw with the world, versus the reality of the psychiatric ward in which X.X was in. The confrontation and pointing out specific points within the hallucination furthered this by not only helping for this grounding in reality, but also by pinpointing specific images to X.X, which helped her to separate her mind from the two realities with the use of the images (Watzlawick, Paul, 1993). Assessment Within this particular setting, there were three main communication techniques used; empathy, silence and reflection. The therapeutic connection made with this came with the interaction from others, including empathy, identification and clarification of the hallucinations that were occurring from the patient. These were used to help X.X come out of the hallucination and to have an understanding for the specifics that were a part of her psychosis. This was also because the communication techniques on a verbal level were almost impossible to make a part of the conversation because of the description of the hallucination that the patient had. This caused the nonverbal communication to be congruent, but the verbal aspect to not be a part of the interaction with X.X. This was linked to the behavior with X.X moving further into the hallucination as well as the inability to show a level of communication with the patient. The main concept that relates to both the verbal and nonverbal communication, not only shows an element of communication, but links this to the emotions that X.X was feeling while having the vision of her husband dying. The more the communication was used, the more it was able to pull her out of this particular hallucination and ground her in reality. However, the use of empathy and silence combined also created an emotional tie that allowed X.X to come out of her hallucination. The verbal aspect of this with the nurse was seen when empathy was used to relate to X.X. Combining the emotional aspects through empathy and understanding, even with non-verbal communication was a way to help the patient to begin healing from the hallucination she had seen. This helped X.X to come out of the hallucination and feel grounded, not only from the verbal grounding, but also the emotional response (Clyman, Robert, 1991). My feelings behind this interaction were a level of anxiousness. The hallucination and intensity of the particular interaction led to the inability to communicate effectively, with an unawareness of how to reach the patient with the needed responses to remove their psychosis during the particular scene. When X.X began to pace in and out of her room to call for assistance, there was a sense of urgency to try to help the client. However, seeing another individual interact with the client was more of an assurance of how to use therapeutic communication to help the client come back to a sense of reality. Seeing this through another client made the reasoning behind the actions more reasonable. Conclusion During this interaction, the psychosis of X.X was met with non-verbal communication and therapeutic needs by the client. If I had to meet with the client another time, I would try to use more verbal communication, such as clarifying what the patient sees and how this relates to their needs. This would be combined with the ability to help the patient by continuing the verbal communication throughout the hallucinations to help them identify a sense of reality through the psychotic episode. Using clarification, repetitiveness and other phrases, such as asking what happened and why, would be able to help the patient and provide them with a sense of assurance with their hallucination, combined with a grounding in reality that would be available. Even though most of the episode would have been done differently, it was still helpful in understanding the influence of therapeutic communication and what it means. Having this experience provided extra insight into what it means to communicate effectively, both with verbal and non-verbal communication, even if the patient does not seem to be connected to reality in any sense. Understanding how this can work for a patient to ground them and bring them out of psychotic episodes provides an understanding to the effectiveness of communication when working within the psychiatric ward. Summary When relating to the goal, it can be said that the goal was met. Even though the therapeutic communication was not as effective, there was still the ability to understand how the communication can be used with specific interactions. Related to this was the ability to understand more about the psychosis that the patient was dealing with, as well as the depth of the hallucinations. With the communication, was an understanding of how patients can move into an alternative reality and set of concepts, while the communication works as a tool to help them stay grounded in a sense of reality. If I were to re-do this interaction, I would use more communication to help the patient understand the concepts of reality so they wouldn't move into as much depth with the psychotic episode. References 1. Clyman, Robert. (1991). The Procedural Organization of Emotions: A Contribution From Cognitive Science to the Psychoanalytic Theory of Therapeutic Action. Journal of the American Psychoanalytic Association: (39), 349-382. 2. Watzlawick, Paul. (1993). “The Language of Change: Elements of Therapeutic Communication.” W.W. Norton and Company: New York. Read More