Process Recording: How to Do It and What to Include

Dialogue 

Clinician: Good morning, nice weather we are having today, don’t you think? 

Client: Yes, it is, I especially love the sun and the overall fall feeling 

Clinician: beautiful colors to improve our moods and view of life 

Client: I absolutely agree 

Clinician: welcome to Open Sky Community Services where your optimal health is our desire. I am a qualified healthcare professional with a degree in psychology and three years of experience in working with patients in mental health 

Client: thank you 

Clinician: how are you feeling today 

Client: I am not okay. I have tried to solve my issues by myself but I feel that they are getting worse by the day. My life is not going well and I am at the verge of giving up 

Clinician: (responding with a nod) please share with me what is happening in your life at the moment 

Client: COVID-19 has had a lot of negative impacts on my life. Before the pandemic, I was doing well at my job and despite the responsibility to care for my two children by myself, I was managing well. 

Clinician: Mmhh 

Client: However, things started going south when I was laid off from work and had no meaningful source of income. I worked in a restaurant which had to be closed due to issues of social distancing. I have not managed to get any job since then. I have been surviving through the help of family but I feel like everyone is now viewing me and my children as a burden 

Clinician: Okay 

Client: I feel depressed, I have no hope for the future because work is not forthcoming. My children are looking up to me but I have nothing to offer. I have reached my emotional limit 

Introductory Statement 

The client is a 35-year-old single mother with two sons aged seven and five. She divorced from her partner and decided to raise the children by herself after she acquired custody of them. She has been working at a local hotel for the last one and a half years and managed to takes care of all her needs and those of her children. She has family and friends who are ready to help but she feels she has asked for too much help and has gradually turned into a burden for everyone. 

Presenting issue 

The presenting issue is depression as the client explains that she feels depressed. The condition arises from her lack of employment and the limited resources she has to help cater for the needs of her family. The COVID-19 pandemic has presented a significant challenge for many individuals globally. Businesses have been forced to shut down thus rendering many individuals jobless. The client is one of the pandemic’s victims. Her physical and emotional welfare have been affected adversely because she lost her job. She cannot provide for her children and has no other source of income to help her survive. Therefore, the primary issue of focus would be finding a source of income or how she can cater for her needs and those of her children. Once she is back on her feet, her feelings of depression will be concurrently addressed. 

Relevant history 

The client expresses that she has been doing okay before the pandemic. Even after she divorced from her partner, she made the choice to have full custody of her children because she was in a good place financially and emotionally. She expresses that she dealt with the divorce as expected and does not experience any negative feelings from it. She has been emotionally stable for many years and has enjoyed the support of family and friends. She further expresses that she may have gone through post-partum depression after her second child was born but she dealt with it effectively. 

This piece was particularly interesting as it arises from the current pandemic. Many individuals are going through a similar issue as the client and they many not know how to address it. Focusing on this case will provide the necessary experience for dealing with clients who may come to the center with similar issues. It further presents the opportunity to help the client identify how she can address her issue at a time when unemployment and depression are on the rise. As the client receives the needed help, the clinician also expands the experience of dealing with individuals in the community who may have developed mental health issues due to the effects of the pandemic. 

Process Recording excerpt Discussion 

Case formulation 

The issue of focus for the client is unemployment. She presents with depression when seeking therapy and this mental health condition is cause by the lack of a job. Once she gets a source of income, her feelings of depression and any other negative feelings that may have developed with be gradually resolved. The initial occurrence of depression for the client was after the birth of her second child during which she often felt hopeless, tired, uninterested in her child, family and everything around her. Currently, she is experiencing symptoms that indicate she is depressed. She explains that she feels worthless and has no hope for the future. Operant conditioning is a behaviorist approach that explains the client’s current issue. In operant conditioning, the source of positive reinforcement has been removed from the client’s environment and this is causing her psychological distress. Her job was a significant source of positive reinforcement for her as it allowed her to care for herself and her children. With such a crucial factor in her life missing, she is susceptible to depression. Aaron Beck’s cognitive theory also helps analyze the client’s case. The theory describes the cognitive triad; negative thoughts about the self, the future and the world, negative self-schemas and errors in logic. The client’s cognitive well-being has been affected by her unemployment. She feels worthless and helpless which falls under the cognitive triad. She also expresses that she is a burden to her friends and family and this falls under negative self-schemas. She has further developed logical errors in her thinking where she finds it hard to identify her alternatives for employment but majorly thinks about how she is jobless and has failed. Some of her strengths include hard and resilience. Some ethical issues to consider include beneficence and non-maleficence. 

The intervention plan will focus on helping the client find a stable source of income. Addressing this part of her needs will contribute immensely to the solution of her depression and any other psychological distress she is experiencing. Goals for therapy would be to help her identify a stable source of income, help her deal with her feelings of depression and address her cognitive distortions. The intervention would incorporate aspects of operant conditioning and Beck’s cognitive theory to ensure that the client is helped holistically. When considering operant conditioning, it would be important the client identifies all options she has at her disposal for a stable source of income. Conducting research on these options alongside the client would yield good results. Since she has been employed in a hotel for a significant period, she may not have though of any other options outside this industry. She needs to identify options within or outside the hotel industry to help increase her chances of getting work. the advantage is the client is well experienced in different working environments including administrative positions and commands a good following on social media. She needs to be aware that she can look into administrative options or focus on a career on social media platforms such as social media marketing. Researching on these options does not take as much effort and the client starts giving suggestions on what she feels would work best for her. It is imperative that she gains insight into the varied options to ensure she chooses which will work best for her. Fulfilling the goal for therapy would ensure that she identifies and acts on a prospective option for employment. 

Next would be to address her cognitive distortions using tenets of Beck’s cognitive theory. As identified, she thinks lowly of herself as she believes she is a burden to her friends and family. Cognitive restructuring would help the client learn how to think more positively about herself. It would be important to engage the client in the six steps of cognitive restructuring to ensure that she can transit from harboring negative self-thoughts to hitting the pause button to generating positive thoughts. When these two issues are addressed, the patient would manage to deal with her depression as it arises from her joblessness. She will also manage to deal with the negative thoughts she has developed about herself. 

Keeping track of the client’s progress would be crucial as it would indicate the achievement of goals. Progress would be demonstrated by her effort in identifying the opportunities she has for employment and how best she utilizes these opportunities. She would have to send applications or visit potential working environments in person and record her experiences. She would also share feedback from the organizations until she gets a successful response. The records she keeps of all the efforts she has made will help keep track of the progress she is making. Keeping track will also include her noting down any negative self-thoughts she has and how she reacts to this. She will note down the number of times she successfully advances through the six steps of cognitive restructuring to eventually re-constructing the negative through into a positive one. 

Personal assessment 

I believe that I have done fairly well from my initial interactions with the client, to the development of a treatment plan and assessment of the success of tis plan. Prior knowledge of how to conduct myself when dealing with a client was crucial. It helped in successfully exploring the client’s problem to identify her presenting and underlying issues. This was possible through employment of various therapeutic skills such as active listening and exploration. It also ensured that the client freely shared their story and history to help identify the issue she presented. The choice of excerpt allowed me to address a case that was directly related to the COVID-19 pandemic. Dealing with such a case is crucial for any clinician because many individuals are being affected by the virus. Many have lost their jobs, others their businesses and homes. The case presented the opportunity to identify the effects of the virus first-hand and work alongside the client in identifying possible solutions to her problem. 

I believe that I managed to conceptualize the case as expected. I identified theories that fit best with loosing her job and her depressive condition. The operant conditioning and cognitive theories helped identify how personal and environmental factors were contributing to the problems she was facing. I managed to connect these theories to her problem appropriately and identified theory specific strategies to be used in addressing the issues presented by the client. 

I did well in making the identification of solutions mainly the client’s effort. Even when we researched on potential employers or employment opportunities together, she did most of the work. she identified options that identified which areas where the best as they matched her experience or educational background. I further appreciate the focus on cognitive restructuring as her cognitive processes contribute significantly to her self-image. I further ensured that even when at home, she had an activity to remind her of therapy and that when she came for the next session, she was aware of what she wanted to achieve. 

I understand that I would have included a variety of theories in assessing the client’s problem. I only included 2 theories and they may not have been sufficient for such a situation as there are other theories that could have described the client’s experiences better. more theories would have helped provide a different outlook at the client’s problems. I would have analyzed numerous potential solutions for her problems and would have had the liberty of selecting the best for her. 

Overall, it was a good experience interacting with the client and helping her identify how to deal with her issues. I found operant conditioning and Beck’s cognitive theory as appropriate for the case. These two ensured that I did not only focus on the clients physical and environmental well-being but also on her mental health. Through the experience, I have managed to extend my knowledge on clients with psychological issues arising from the COVID-19 pandemic. I believe these would be crucial I helping patients with similar issues in the future.