Field 4 - Process Recording

PROCESS RECORDING FORM Submitted by: ___ Case Name: ___J.D._ Location of Interview: ___ __Date of Interview: _ _ Present: _J.D. and Intern______________________________________________________ Purpose of Contact and Goal of Session: __Today’s session is PJ weekly session. The client had homework to do from last session of journaling, attempting to work spot jobs to get some probation fees caught up, see probation officer and change address and getting his ID to move forward looking for employment. He was to check up on his insurance with DHS to see if it has gone through. If PJ has followed through, I have a job interview for him with a local factory. ____________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ Basic Client Demographics: J.D 28-year-old Caucasian single male living in a homeless shelter. PJ originally came into therapy due to feelings of anxiety, depression, and feelings of worthlessness and hopelessness. PJ. has no family support and no friends at the time of intake. He had spent the last several months living from one couch to another with acquaintances. He has been sober from his doc (meth) for a period of 6 days at intake. PJ’s family, his father and brother, reside in Texas and are also involved in drugs. PJ has 2 previous drug charges for drugs and is on probation. PJ presented to the mission after spending a few nights in an abandoned building in below freezing temperatures and starving. He reports almost freezing to death and looked at coming to the shelter as a last resort and views it as the ultimate low. We began with biweekly sessions and have phased down to once weekly after PJ getting his anxiety and depression on the upward climb. Journaling, mindfulness, coping skills have all helped PJ immensely. ________________________ How did you preparing for your interaction with the client: I spoke with HR friend of mine at a local factory about PJ interviewing for a job? I looked over case notes from previous sessions to remind myself where we left off and what PJ was to do this week. I checked the facility records to see if PJ had any problems or strikes since our last meeting. _________________________ ______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Verbatim Dialogue what was said between you and the client? Student Feelings & Reactions – Your internal dialogue Observations and Primarily a Systems and Social Analysis - (What did you learning theory. My therapy is a client in environment type of see happening with the client? Why do you think theory looked at through a trauma focused lens as my clients are it is happening? What did you do because of it? living in perpetual crises in a homeless shelter. Clients want to (Interventions) continue to achieve with positive Intern: Hey PJ come on in, how are you today Verbatim Dialogue – what was said between you and the client I am looking at PJ for any signs of substance abuse signs as well as looking for general mood. He seems to look pleasant and happy. Student Feelings & Reactions – Internal dialogue Client is smiling PJ: Hi Ms. Patty. I am great and how are you Intern: I am fantastic and happy to see you looking so happy and relaxed. That is wonderful. How has your week been? PJ: It has been ok. Lots of people left this week. I worked a few spot jobs and caught up my probation fees, seen my probation officer, and got my ID. PJ comes in with a smile on his face. He seems happy with himself and I think he has completed all he was supposed to and is proud of himself. He is almost strutting in. Observations & Analysis (What did you see happening with the client? Why do you think it is happening? PJ appears happy and relaxed as he sits casually and started talking Client is sitting very relaxed and smiling. No jitters or anxiety type of actions currently I see my client doing well and happy. I want him to do well and feel he will. He is moving forward Smiling, puffed out chest, looking very proud. Sitting up very straight in chair reinforcement many times. It is a bigger reward if clients are helped to identify how they can help themselves. Attentive listening Genuineness, warmth, positive affirmation of client looking happy Intern: Wow what an amazing week. What I am hearing is that you worked enough in one week to pay all your fees up to date and get your id? PJ: Yup in one week I am so ready to go to work and want a life like other people Intern: That is so amazing. I am so proud for you. I can see how proud you are. I do have something for you. I have an address here on this card, if you can go by there, they will interview to begin a job at ARI. The factory you were hoping to work. Do you think you are ready? PJ: Yes, I am ready. I am nervous, but that is ok. Usually means I am doing something right. Wrong is easy, right is harder. I am not sure the mission will take me to the interview. What should I do? Client is working hard, and Direct eye contact, huge obviously proud. He wants smile on his face, sitting to make me proud back again relaxed now, still puffed up with pride Reframing information for clarity, while also reinforcing the positive things my client achieved I feel positive about client and the work he is doing. Some concern putting him in gen public where drugs are available. I can see fear Eye contact, smile left, tears in his eyes Active listening Emotional Intelligence Client is smiling again Appears happy A little fearful Smiling and moving around somewhat in his chair, reaching for card and his hands are shaky Positive reinforcement, open ended questions, warmth, advocacy for client in the work place, intervention for client Client is attempting to have me do his work, to make it easier. He is nervous and fearful Client is teary and shaky but smiling slightly Will apply problem solving techniques to enable client to answer his own questions Active listening, genuineness Emotional Intelligence Setting boundaries Intern: Am I hearing that you are nervous about starting a new job? Open ended question Client: Yes, but I want to do it Happy Intern: Ok so what do you think your choices or what are some ideas about getting a way to go to interview? Are there procedures to follow here to do that? PJ: I can ask the manager, and Jack. I also have a few people that lived here before that would give me a ride. And yes, I must get permission to go and sign the board Intern: Good PJ. SO, do those things and see what you can do to get there. I will be here tomorrow, and you can check in with me to let me know what you have found. I am hopeful you can find a way. Smiling and sitting up again Asking probing questions, using emotional intelligence and boundary setting along with problem solving Listening Listening and responding Client is thinking for himself Problem solving Listening Eye contact and smiling very happy about going to work although nervous Positive reinforcement Interview Assessment: (Reflect on the interaction. Did you accomplish what you set out to do? If not, do you know what happened to get you off your goal? What theory do you think you were using during the interaction? What did you learn?) Primarily a Systems and Social learning theory. My therapy is a client in environment type of theory looked at through a trauma focused lens as my clients are living in perpetual crises in a homeless shelter. Clients want to continue to achieve with positive reinforcement many times. It is a bigger reward if clients are helped to identify how they can help themselves.__________________________________________________ How can you/will you integrate this new learning with this client (or other clients): (Identify unfinished business and your thoughts about interventions you may wish to consider for future encounters. What have you and the client(s) decided to work toward? What are the shortterm goals? What are the longer-term goals?) ___Short term goals are to go for job interview and get a job. Continue with coping skills and journaling as well. Long term goal is to have the financial stability to get an automobile and his own place to live. PJ wants to live alone as he feels he is still weak in sobriety and is afraid others may drag him back down. PJ desired long-term sobriety. _______________________________________________ ____________________________________________________________________________________________________________ Identify questions for your field instructor: (What specific questions do you have for your field instructor, e.g., about how to keep the focus clear, what to do when a client displays anger, sadness, resistance, etc., what to do with silences.) ____________________________________________________________________________________________________________ __I feel my main issue is wanting to do for my client. I know I am supposed to help them do things. I continuously must remind myself do not do things for them teach them to do it for themselves. I have the scripture written in my planner on the front of my client book everywhere as a reminder. The majority attempts to manipulate to get others to do for them as well. I do fail and do for them many times before even thinking about it. _PJ will continue with weekly meeting__________________________________________________________________________