Process Recording
Question
Process Recording/Journal Instructions
Description
Process Recordings/Journals are used by mental health professions as a retrospective tool to analyze the process of communication between PMHNP and Client. It is an effective way of learning interviewing skills and reflecting on one’s practice. All PMHNP students in clinical placement are required to become familiar with recording the process of interaction with clients. In PMHNP clinical practicum I, the first process recording and reflective journal will be developed. This exercise will assist in self-reflection on interview skills, which will enhance interview process, analysis, professional reflection and journal entry. Student outcomes will be improvement of psychiatric interview, analytic skills, critical thinking, self-reflection and documentation.
Process Recording Requirements
The following outline covers the 3 major areas to include within a process recording.
Part I: Description of client, tuning in (pre-self-reflection) and interview purpose
Part II: Recording the interview content, analysis and reflection (4 column grid format)
Part III: PMHNP Student’s impressions, goals, questions and next steps.
PART I: All 3 content areas below must be included.
a. Identifying information: Include student’s name, date of interview/contact, and date of submission. Identify the client (Initials to protect confidentiality in submission). Include the number of times this client has been seen (i.e., "Fourth contact with Mrs. S."). If client is seen in location other than the agency, state the general location where client was seen.
b. “Tuning In”: This is the preparation phase of an interview/contact with client. Anticipate the client’s thoughts, feelings, issues, as they enter the interview. Also consider your own thoughts and feelings as you anticipate this interview.
c. Purpose and goal for the interview/contact: Brief statement of the purpose of the interaction and if there are any specific goals to be achieved, the nature of the presenting issues and/or referral.
PART II: The Interview Process Recording (four-column grid-see sample)
Column I: Content: A description of what happened, as close to actual dialogue as the student can recall, should be completed. This section does not have to include a full session of dialogue but should include a portion of dialogue. The student should reflect verbatim dialogue of PMHNP student and client.
Column II: Reflection: The student's feelings and reactions to the client and to the interview. This requires the student to put into writing unspoken thoughts and reactions the student had during the interview e.g. "I was feeling confused/perplexed at what the client was saying, not sure why I was reacting this way…”
Column III: Observation/Analysis: Thoughts about what has happened during the interview (e.g., Why is he acting this way?) and/or identification of skills or theoretical/frameworks used.( e.g. “I used the strengths perspective“; “I used the skill of partializing.”)
Column IV: Professor Feedback. Remarks regarding student reflection, observation and analysis for grading (see process recording rubric).
Process Recording Exemplar
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I |
II |
III |
IV |
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Content Dialogue |
Reflection & Feelings |
Observation/Analysis |
Feedback |
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Record word for word (to the best of your ability) what happened during the selected segment of the interview, including both verbal and nonverbal communication. Be certain to include third-person participants, interruptions, and other occurrences that were not part of the planned session/interview with the client. |
The student’s feelings and reactions to the client and to the interview as it takes place. This requires putting into writing unspoken thoughts and reactions as the interview is going on. Do not use this column to analyze the client’s reactions – use it to identify and look at your own thoughts and feelings. |
This column can be used to analyze one’s own theoretical frameworks, interviewing techniques or therapeutic communication, and to suggest alternate approaches that might have been more effective; or, one’s observations and thoughts regarding what has been happening during the interview. i.e., in the course of carrying out the interview, the student is thinking: “I wonder what he really meant by that statement? That seems to contradict what he told me earlier.” |
In this column, the professor can make remarks right opposite the interaction, feeling level, or observations that have been recorded |
PART III: Process Recording Reflection
a. Summary of the student's impressions: This is a summary of the student's analytical thinking about the entire interview/contact and/or any specific interaction about which the student is unsure. What did you learn from this interview? Are there any patterns in your practice emerging more distinctly?
b. Future plans/next steps: Identify any unfinished business and/or any short/long term goals. Given all of the above, what are you planning to do next time with the client? Are there things that need to be researched, learned, or considered, prior to the next interview? Is your overall purpose still appropriate?
c. Identify questions: Include any client action or non-verbal activity that the student may want to discuss with Preceptor/Professor or Colleagues.
d. Reflection on Interview Process: Discuss what you have learned about your practice and the competencies and/or practice behaviors relevant to your learning.
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Solution
Process Recording
Part I: Identifying Information
J.K is the client who I interviewed on February 18, 2022. The interview is happening at her home, with the participants being only she and I. The interview is about her life experience in living with depression. I am meeting the client because I have been offering her psychological care since she was diagnosed with depression. We have had several sessions, and this is one of the meetings. The goals hoped to achieve in the meeting are to identify the patient progress to recovery, understand the ongoing client’s system, improve the client’s self-awareness and identify their strengths and weaknesses. The contact is a weekly session and, as the client requested, is a home-based therapy. The client’s purpose in the meeting is to observe my impression as a student, define my roles, realize my content, and plan another contact meeting. On ongoing treatment, the contact will enable the student to identify the effectiveness of therapy, needed alteration to treatment methods, and other medication-related factors.
The client’s current state is a 25-year-old female, well-groomed, upright posture, and fluent speech. The patient was referred to the program after inpatient treatment for depression, which complicated self-harm. She is a firstborn in three and broke up with her fiancé recently. She has been living alone since then, and this seems to cause more damage to her already existing condition. Today’s session is oriented to making her go back to her home so that her mother and siblings can care for her as the care provider has broken up with her.
Since we started engaging in the contact in the past five months, there has been an improvement to her status for the last three months until two weeks ago when the fiancé left. She has been feeling lonely, abandoned and her positivity about life has diminished. Additionally, she has been experiencing depressive symptoms that were already getting eliminated. At first, she was not so receptive, could keep quiet the whole session, sleep, or maybe eat the entire time, but as time has moved, she has been more cooperative, engaging, and optimistic about the effect of the contact on her health. She even used to miss some sessions, but she has attended all the contact sessions for the past three months, which is a positive move for her. Despite this, I realize that she has been staying in her house all the time, does not go out to interact, receives no attention from anyone at all. Starting a journal with her to be filled regularly was a positive move to her engaged treatment. I anticipate that this interview will help her recovery, and the client will be cooperative as always despite the different circumstances.
Part II: The Interview Process Recording
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Content dialogue |
Reflection and feelings |
Observation and analysis |
Feedback for instructor’s comments |
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The student sat on a couch in the backyard with the client to avoid distractions. Student: hey, J. K, how are you? J.K: mmmh… Not so good. Student: What has been happening? J.K: (sobbing), my lovely fiancé left me, (crying) that is it, nobody loves me. Student: Dr. Jake has told me about what’s going on. How do you feel about it? J.K: (crying and rubbing hands against each other) I feel so bad. It sucks being alone. I have to stay alone in this whole house do everything for myself. It is lonely and scary. Student: What do you imply by saying that? J.K: it’s just that there is nothing I can do for myself. I can’t be happy alone because I hate myself; I don’t appreciate who I am. I wish I could be someone else, someone happy with myself. Or maybe I could disappear forever, never to be seen. I cannot work because everyone considers me insane, my family does not care about me, I don’t have anyone to show me love. Student: you sound frustrated about this and wish you could change it. J.K, yes, but I am unable to. Student: I didn’t know that you were going through all this; I understand why you feel so. If you had an option, what would you do? J.K: I don’t know. Kill me and get away from this suffering. Student: you don’t have to do so because things can turn around. You can recover through the therapy session, and your life can make a lot of sense again. Remember how productive you have been in your family as the breadwinner. At your work, you have the potential to lead such a life again, just sticking to therapy, remaining positive, and working towards going on. J.K: okay. How can I do this? Student: through positive strategies like doing what makes you happy, focusing on the positive side of everything, ensuring that every moment you are productive, and shunning negative thoughts. J.K: okay, I will cooperate and work together with you to ensure my recovery. I would wish to come and participate in your recovery programs as well. I don’t want to do this alone. Student: thank you. That is positive of you, mainly because it had some from you (J.K laughing). Things will get easier for you, and the team will be glad to welcome you. J.K: I am ready. |
This made me sad hearing it from her, although I already knew.
Frightening as it poses suicidal thoughts.
This is dad and unimaginable. A sense of lack of self-worth and lack of self-esteem is hurting.
It is not your fault but their fault. You don’t have to curse yourself. It is them that have neglected you.
This is frustrating and sad.
This made me about to cry, how she wept bitterly, telling me she had nothing to do for herself.
I freaked out at the sound of this. Had she decided to commit suicide?
I was trying to show positivity.
Encouraging her by her strengths
This made me feel already achieving success. She was starting to understand and embrace therapy.
Happy, she says that she wants to cooperate in therapy. This is relieving. Glad I didn’t say it to her.
What better statement could I have told her? I am showing her that she is welcome and she can do it. I was happy to see her laugh.
This was satisfactory. |
Clients previously did not want to sit in the backyard, so this is a unique move.
Essential to know from herself what she feels about herself instead of assuming.
She blames herself for everything that has been happening to her.
She feels nobody got her, and she is fighting the depression alone. She needs company, support, and physical acceptance.
She thinks her presence is a nuisance to others.
Needs love
The client is interested in change but doesn’t know what to do.
Not so optimistic about her strategies.
The client felt motivated, encouraged, and comfortable reflecting on her strengths.
The client is cheerful and willing to embrace team association in therapy and improvement.
Humor lightened up the atmosphere and shifted the mood to positivity. |
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Part III: Process Recording Reflection
From the contact, my impression is that communication, speaking, and attentive listening are vital factors for a practical therapy session. J.K is improving from the therapies, and from today’s treatment, she seems better that she wants to join the team in the therapy program from which she had dropped out. Contact interaction offers one a better understanding of their situation and a different view of working towards recovery. I learned that most individuals suffer from mental illnesses and their complications because they lack someone to share their feelings, emotions, and attitudes with. On the next session with the client, the goal will be to assess the outcome of the group therapy sessions, changes in lifestyle, personal feelings changes like self-acceptance, and self-love assessment.
Clenching fists and rubbing hands against each other are two client non-verbal activities I would like to discuss with the professor or colleagues. Also, what r is one client’s nonverbal act that happens when I feel like crying as the client cries? Handling mentally ill affected patients requires understanding, empathy, and active listening. Most of these patients get better and heal by having someone listen to them, which is a competency lesson I learned from the contact session.
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