Social dysfunction is one of the hallmark characteristics of chronic schizophrenia. Social cognition has been identified as having a role in this feature of the disorder. Recent literature and research has focused on facial and vocal affect recognition and social cue perception. Each of these functions influences an individual's ability to respond in a social situation. Despite the growing body of research, little is known about the actual interaction of providers with these clients.
This qualitative descriptive research study focused on the interactions of a clinical nurse specialist (CNS) with three clients with schizophrenia in an urban community mental health center. Three sessions per client were videotaped during medication monitoring sessions. The CNS was interviewed post client contact. The videotapes were analyzed in five steps, beginning with a global analysis of the overall the interaction followed by a microanalysis of the nonverbal communication of the CNS and each client. The third step analyzed nonverbal with the verbal communication. Congruency between the CNS's nonverbal behaviors and client responses was then examined. In the final step, the three videotapes for each client were analyzed for similarities and differences along with a cross case analysis. Data collected from the interviews with the CNS were analyzed for similarities and differences in interactional style across cases.
Several patterns emerged. The interactional style of the CNS conveyed commitment and empathy. She appeared to join with her clients despite their persistent psychotic symptoms and used humor with two of the clients. All three clients responded to her with both verbal and nonverbal communication. The clients showed difficulty with direct eye contact that made reciprocal movement and interchange difficult. Even when making eye contact, clients did not respond until the CNS used exaggerated facial and vocal cues. This finding is consistent with the literature on social cognition describing the difficulty that this population has with facial affect recognition. This study begins the documentation of verbal and nonverbal communication that could be considered in helping clients learn how to enhance interaction with others outside the clinical setting.
