NR 201 – INTERPERSONAL PROCESS ANALYSIS (IPA)

Student’s Name: Date: Setting:

Patient’s Initials:

Client’s Diagnosis Axis I – V

I:
II:
III:
IV:
V:

Goals for Conversation:

1.
2.
3.
Ego Defenses S/S Illness Developmental Level
Student’s Verbal/Non-Verbal Client’s Verbal/Non-Verbal Technique / Rationale Student’s Thoughts, Feelings
Evaluation
Ego Defenses # 1
Ego Defenses # 2
Ego Defenses # 3
S/S Illness # 1
S/S Illness # 2
S/S Illness # 3
Developmental Level (Erikson)
Developmental Level (Freud)
Developmental Level (Maslow)

1
Student’s Verbal/Non-Verbal Client’s Verbal/Non-Verbal Technique / Rationale Student’s Thoughts, Feelings
Evaluation

2
Student’s Verbal/Non-Verbal Client’s Verbal/Non-Verbal Technique / Rationale Student’s Thoughts, Feelings
Evaluation

3
 Student’s Verbal/Non-Verbal Client’s Verbal/Non-Verbal Technique / Rationale Student’s Thoughts, Feelings
Evaluation

Analysis, Evaluation:

4
Observation of Interaction:

Therapeutic or Non-Therapeutic

Evaluation of Goals:

1.
2.
3.