course material

1. NSG3MHI Mental Health And Illness
Answers:
Part A: MSE Documentation
Alison has been presented to see a general physician following an episode of low mood that
her sister noticed for a few months. Alison is a 38-year old woman who has been divorced
and is the mother of two children. She currently works at the local supermarket. Alison
appears slightly older than her age. She is of endomorphic build and has short, wavy, brown
hair. She is wearing a peach-pink long-sleeved top and a black pair of tracks, which are
appropriate to the occasion and weather. She is mostly looking down during the
conversation with intermittent eye contact with the GP. She is cooperative throughout the
interview. No presence of abnormal psychomotor movements has been noticed. She uses
controlled hand gestures while explaining something to the GP. She reports that her mood is
‘fed-up’, ‘miserable’, and ‘black’ in the morning (presence of diurnal mood variation – “I get
up in the morning, everything seems very black.”). Her range of affect is labile and she is
tearful (she comes into tears while describing a tearful experience at home). Her quantity of
speech is in the normal range. The rate of her speech is normal, the tone is monotonous and
soft and the fluency and rhythm are clear. No abnormalities have been detected in her
thought-form or thought processes. Her thoughts are goal-directed. Her thoughts content
are worthlessness, uselessness, helplessness, hopelessness (“there’s no point really”) of
guilt (“I should be doing more for them really but I’m not, I’m bit useless at that..”) and
burden (I am just a bit of a burden to everybody really). Her memory and concentration are
slightly impaired. She reports having her attention aroused spontaneously but does not
remain sustained. She is oriented to time, place, and person. She has insight into her
difficulties related to her depression in ways that hampered her relationship with her
children and her current boyfriend named Dave.
She reports that she has lost her appetite and is suffering from disturbed sleep.
Furthermore, she reports that she does not find pleasure in going out with her friends or
engaging in self-care activities. She reports feeling fatigued, exhausted, and having no
energy to spend time with the kids. She also reports walking up early in the morning and
having difficulty getting back to sleep. Alison reported that she has a previous episode of
depression when she separated from her husband. She had a self-harming attempt
(overdose on paracetamol) episode during that period as reported by her. According to her

2. report, it can be concluded that she did not have suicidal ideation. She also had no concrete
suicidal plan. Therefore, it can be concluded that there is no current possibility of self-harm
in Alison’s case. However, through the report, it has been established that there is no
possible harm to her children. Her judgment seems to be intact. She reports feeling hopeful
about the near future stating that she has no plan of harming herself in the near future as
she can now come to the GP for follow-ups.
Part B: Therapeutic Communication
The therapist began the session by greeting Alison as she entered the clinic. She introduced
herself to Alison before beginning the session. It is clearly notable in the video that the
therapist smiled while greeting Alison to create a positive and warm impression on her
(Perrotta, 2020). Studies have noted that greeting the client with a smile and introducing
oneself at the beginning of the session can help develop a foundation for a warm therapist-
client relationship (Perrotta, 2020). The therapist is seen asking Alison how she would be
liked to be addressed in the session. This question demonstrated the provision of client
autonomy and respect (Perrotta, 2020). These are subtle qualities of a positive, respectful,
and mutually collaborative therapeutic relationship (Totton, 2018). The therapist is seen
implementing the SOLER non-verbal communication techniques from the beginning of the
session (Nandini, 2020). She is sitting squarely from the client so that the client does not
feel emotionally and physically invaded and threatened. The therapist has maintained an
open posture of the upper body; however, the therapist is seen sitting cross-legged which
can send conflicting non-verbal messages to the client (Yang, 2018). This might increase the
client’s ability to open up and be comfortable around the therapist. She is slightly leaning
forward and pointing her body towards the client while maintaining eye contact as
appropriate (ErlinaYaumas et al., 2018). The therapist seems relaxed, poised, and confident
about her role as a therapist (Nandini, 2020).
The therapist uses verbal cues like “okay”, “so”, “right”, and “alright” to communicate her
genuine interest and undivided attention towards the client (ErlinaYaumas et al., 2018). The
use of these verbal cues during verbal communication ensures that the client feels heard
and understood. However, the rate of speech of the therapist is too fast, which might make
her incoherent and incomprehensible. A moderate rate of speech should be maintained. To
ensure that empathetic listening is exercised, the therapist should have allowed the client
more time to reflect on and gather her thoughts before speaking (Bas-Sarmiento et al.,
2020).
She used motivational interviewing skills in the session. As the therapist explored further
into the thoughts and feelings of the client, she kept asking the client questions that helped
her re-focus on the protective factors and her internal resources (strengths, hope, optimism,
and resilience) (Ranjan, 2018). She also helped the client identify some people in her
environment that might help her cope with the issues. She adequately used paraphrasing
and summarizing techniques throughout the session. These techniques are used by

3. therapists to ensure that they have properly understood the client and help the client
summarize and reflect on the major discussions of the discussion.
The therapist had used adequate counseling skills like paraphrasing, summarizing,
empathetic listening, verbal communication skills, and motivational interviewing skills in
the session. However, the therapist should have used more emotional reflective skills in the
session to allow Alison to recognize her emotions and thoughts. The therapist could have
used enhanced summarizing skills to help the client better recapitulate the discussion.
References
Bas-Sarmiento, P., Fernández-Gutiérrez, M., Baena-Baños, M., Correro-Bermejo, A., Soler-
Martins, P. S., & de la Torre-Moyano, S. (2020). Empathy training in health sciences: A
systematic review. Nurse education in practice, 44, 102739.
https://doi.org/10.1016/j.nepr.2020.102739
ErlinaYaumas, N., Syafril, S., Noor, N. M., Mahmud, Z., Umar, J., Wekke, I. S., & Rahayu, T.
(2018). The importance of counselling basic skills for the counsellors. International Journal
of Pure and Applied Mathematics, 119(18), 1195-1207. url: https://www.acadpubl.eu/hub/
Nandini, M. (2020). SOLER Way of Communication in Nursing. Asian Journal of Nursing
Education and Research, 10(1), 110-111. DOI : 10.5958/2349-2996.2020.00025.7
Perrotta, G. (2020). Accepting “change” in psychotherapy: from consciousness to awareness.
Journal of Addiction Research and Adolescent Behaviour, 3. DOI: 10.31579/2688-7517/018
Postings, T. (2021). Counselling Skills. SAGE.
Ranjan, S. (2018). Unit-4 Counselling Strategies and Skills. IGNOU.
https://www.egyankosh.ac.in/bitstream/123456789/43393/1/Unit-4.pdf
Totton, N. (2018). Power in the therapeutic relationship. In The Political Self (pp. 29-42).
Routledge.
Yang, L. (2018). Study on the Nonverbal Behavior in Psychological Counseling. In
International Conference on Educational Technology, Training and Learning (ICETTL).
https://www.clausiuspress.com/conferences/AETP/ICETTL%202018/BCW676.pdf