Please provide a brief and detailed response to each comment. Please read the both detachment for further instructions.
This week we will continue looking at how you process feelings with clients as well as looking at documentation and feedback you have received in supervision on how you are doing.
As one noted psychologist would state to his clients, "What's your objection to having all of your feelings?" Did you find that you were censoring your gut-level feelings towards clients upon review of the client progress notes? What types of emotion did you think you might have held back, and why?
Has supervisory time spent in review of your session documentation been helpful, uncomfortable, or a combination of both? Please elaborate.
We processed through having difficult feelings about clients and counter transference. As you reflect on our discussion have you come up with new ideas to deal with these situations? What are some ideas? Do you feel more comfortable with the topic if the situation arrives? What is still your stuck point if any with this situation?
In professional training for the helping professions, students are usually given a format to provide a detailed account or transcript of everything that transpired in a session with a client, together with the trainee's emotional reactions, and other observation and analysis. In social work, for example, the system is known as process recording, which refers both to observation of the counseling process and the ability of the practicum student to digest or process what has transpired.
Detailed session recording serves a wide variety of purposes:
It trains students to recall the details of their interactions with clients-the verbal and nonverbal content that makes up the interaction.
It trains students to be aware of emotional undertones of the interaction, which will provide clues to the motivational state experienced by the client, and to transference phenomena.
It encourages students to develop insight into their own emotional reactions to clients and counseling situations (countertransference) so that they will not act out on their feelings without awareness.
It provides a framework to track the helping process, identify what skills were or were not applied, and clarify the purposes and efficacy of their interventions.
It develops the ability to communicate insights, thoughts, and feelings in written form.
It provides a framework for the instructor and student to collaboratively evaluate the training process individually, as the basis for class discussion, in students' casework, or in practicum classes. Students may also refer to recorded material in their theoretical papers, linking it to their practice.
Session recording is one of many recording activities in which students and counselors engage. Taking a moment to carefully distinguish these activities is worthwhile:
They write biopsychosocial assessments.
They provide diagnostic summaries.
They create treatment plans.
They present cases for addictions trainees, usually following the CPM (cases presentation method) in use among the affiliates of the International Certification Reciprocity Consortium (ICRC).
Structured progress notes, such as the SOAP (acronym for the parts of the notes: Subjective, Objective, Assessment, Plan), resemble mini-treatment plans. A progress note may, of course, describe processes of the client-counselor interaction, but that is not the main purpose of the recording.
Logs: Field instruction or practicum experiences in helping professions usually require students to keep a log of their activities, client interaction, and feelings. Logs may contain process notes (comments on client-counselor interaction and feelings aroused) but not full recordings of sessions.
Discharge summaries: Summaries of discharge.
There are a number of variations in recording what transpires in a counseling session. However, there is a typical format that is common in counseling as identified below.
1. Start out with a brief statement giving some background on the type of facility where the session took place and some background information on the client. Make sure to disguise identifying characteristics or data.
2. The recording incorporates three components:
a. Dialogue (verbatim verbal transcript) and description of nonverbal behaviors and other events or interruptions during the session.
b. Observations of client affect and gut-level feelings of the trainee.
c. Skills utilized and reflection on how skills might be better applied in the future to similar situations.
3. The format can vary from:
a. A narrative which incorporates the above items.
b. Alternating sentences or short paragraphs on each of the above items.
c. A two-column format.
d. A three-column format.
Columnar formats are a sort of prism to draw out or force attention to the different topics of concern, and to allow systematic response and evaluation by the instructor.
Be sure to be clear about what is a thought and what is a feeling. Using the word felt does not necessarily mean an emotion is being communicated. Stating "I felt she diverted the group from her irresponsibility by acting flirtatious" is a thought. It really means "I think she diverts the group from her irresponsibility by acting flirtatious." "I felt annoyed at her attention-getting drama" is a feeling. Describe the feelings you were having during the event. Below are some examples:
Content: Eileen talked about how some people are judgmental and prejudiced against her because of her same-sex partner.
Observation: I could see the intense emotion that Eileen was experiencing. She seemed to be holding back tears.
Feeling: (Inappropriate approach to description of feeling):
Feeling: I hate when people judge me. It is wrong that society allows this.
Appropriate approach to description of feelings:
Feeling: I felt very sad when Eileen was talking. I also felt guilty because I started to think about when I have been judged, and at one point I stopped focusing on Eileen. Do not censor or filter feelings. Elaborate on them.
Finally, in the transcript there should be a section commenting on the choice of counseling theory and approach, and its appropriateness to this client, the client's demographics, and the diagnosis.
Audio recordings have quite a few advantages over written transcripts and commentaries. They demonstrate many of the voice qualities that convey crucial information about affect and attitude: rhythm, tone, modulation, volume. They also illuminate the pace of the interactions, where the session lags or picks up pace, whether there is an abrupt change in the session, and whether turns are taken politely or by interruption.
Video, of course, documents all the rich information from gesture, posture, facial expression, and use of space.
Consider this scenario:
A school referral brought in a rebellious teenage girl and her parents, who sat in a circle along with the counselor, a man in his middle 20s. The girl proceeded to cross her legs, toss her hair, and demonstrate other body language cues that later would be seen as flirtatious. The counselor looked down and adjusted his socks. The father drummed his fingers, and the mother moved her chair closer to the girl, who then assumed a more demure posture. When the counselor and the family later viewed the tape, none of them had been aware of the subtext of the interaction. There was probably more important information about family dynamics from observed body language than from a written transcript of what was actually said.
From audio and video recordings, a written transcript with commentary and feelings in formats suggested above can be created. The audio and video recordings cannot leave the premises, in compliance with HIPAA guidelines. In addition, provision must be made for the storage and destruction of recordings. Finally, agencies usually have a consent form that demonstrates that the client has volunteered to have the session recorded as well as used in supervision. If no such form exists, then the student and the site supervisor must create one and have it approved by higher administration. Most clients do not mind being taped if it is understood that the aim is to provide clients with the best service. Also, remember that parental permission must be obtained if an individual under the age of 18 is recorded.
Recording what happens in a counseling session is a critical element in the treatment process. Counselors often see many clients in any given day. Obviously, they cannot remember all of the fine details about what is discussed in the sessions. Recording even the smallest detail can be beneficial when reviewing previous sessions. For these reasons, audio and video are some of the best methods for recording sessions.
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