Fred Smith, aged 38 years, is held involuntarily under the provisions of Mental Health Legislation. He had been referred to his GP when he had begun to miss work (as a town planner), was drinking increasing amounts of alcohol and had injured himself when challenging local people of 'spying on him'. He had not sustained a fracture when he fell from the garden wall to a hard surface three meters below but knocked his head and had a brief Loss of Consciousness (LOC). When reviewed by his GP he was suspicious and uncooperative accusing the GP, who was known to him for many years, of being in league with his Neighbours.

You meet him in your role in the tertiary hospital where Mr Smith has been sent involuntarily for observation and assessment.

You are meeting with Mr Smith to explore his current situation and explain his possible up-coming withdrawal from alcohol. The mental health service uses an Alcohol Withdrawal Scale that uses diazepam to support alcohol withdrawal if needed. Mr Smith does not regard his alcohol use as problematic but is keen to use support to improve his life.

1. Provide a brief introduction to your interaction. Include the person's reason for admission, the nature of the facility and a summary of your previous interactions with this person.
2. Analyse this documentation to identify the therapeutic approaches you used and the responses of the person, using the same document format or template provided.
3. Based on this analysis, paper in which you reflect on the strengths of these approaches and consider where alternative therapeutic interactions might have been used for a different response.
4. A concluding statement summarizing alternative approaches to the interactions should be included.

Heron's six categories of interventions
Authoritative	Prescriptive
	Informative
	Confronting
Facilitative	Cathartic
	Catalytic
	Supportive

Authoritative Interventions

Authoritative Interventions are characterized by those interactions where the helper (for example nurse) is using approaches that provide information, challenge assumptions or make suggestions.

Prescriptive Informative Confronting

Intentor purpose This approach attempts to direct client's behavior.It may involve giving advice, being judgmental,critical,or evaluative.

Uses When delegating nursing duties, advising people prior todischarge,or enabling a student to develop new skills.

Example Perhaps youwould like to talk with your family about this?

Facilitative Interventions

Facilitative interventions are those interventions where the helper is drawing out ideas, solutions, confidence and similar to assist the person being helped to reach their own conclusions, solutions or decisions.

CatharticCatalytic Supportive

Intentor purpose Seeksto help client to express painfulemotions.This might be by encouraging laughter or crying.

Uses When counselling relatives or caring for distressed, depressed or seriously ill people.

Example It isall rightif you want to cry.

2. Drafting response to Fred Smith's story

In pairs, draft a script responding to Fred Smith's psychoeducation needs for information about possible experience of alcohol withdrawal, the use of an alcohol withdrawal scale and diazepam use in this context.

Decide on your role - nurse or Mr. Smith. These roles do not have to be swapped. Your interaction can be around 5 minutes long. Try not to be too 'heavily' scripted and to allow the interaction to progress naturally, even if this departs from your original ideas for a script. Stay focused on the purpose of this meeting and interaction with Mr. Smith (as per Mr. Smith's story) and let this guide your interactions. Recording the interaction will allow you to have an accurate recording of your interaction, including verbal, paralinguistic and non-verbal components of your interaction to transcribe.

Record the interaction using smart phone or other device.

3. Transcription of interaction and analysis

• Transcribe a portion of your role-play of your interaction with Fred Smith This need not be longer than 3-5 minutes long. Use the template downloaded from Mylo. Ensure that you comment on all aspects of communication including verbal, paralinguistic and nonverbal elements.
• Categories each of the nurse's interactions according to Heron's 6 CIA.
• Finally, when you are satisfied that these categories capture the intent of the interaction, by considering Mar Smith's response analyze whether another interaction category might have been more useful or resulted in a different response from Mr. Smith.