Process Recording

Agency Information Bishop Lamar Center (BLC) offers quality mental health services to groups, families, and individuals. BLC is strongly committed to client-driven and person-centered services, which ranks the institution at the top compared to other similar agencies. Established in 2010 to cater to the needs of vulnerable groups, BLC deals with diverse issues such as child abuse, domestic violence, sexual abuse, poverty, and drug addiction, among others. This organization is devoted to helping vulnerable groups overcome their issues and empower them towards a bright future.

Client information (confidentiality of course): Jennifer Brown (Jenn)

Jennifer Brown (Jenn), age 45, African American cis-gendered female, divorced, employed fulltime. Jenn and her adult children reside in a single-family home. She has been employed at her current employer for 18 months; she is a college graduate, no legal history. Jenn was assessed as a low risk for suicidality and no history of abuse.

Session Number 1

Date 06/11/2020

Presenting Issue (reason for referral)

Jenn was referred to BLC by her case manager on June 9, 2020 for to address anxiety symptoms. Jenn reported that her daughter has severe anxiety and she believes that caring for her daughter’s has caused her stress and anxiety.

Relevant Information

Jenn received a confirmed diagnosis of generalized anxiety disorder from a previous therapist.

Jenn has been divorced for 18 years and has a 19-year-old son and a 22-year-old daughter. Jenn is employed full time as a teacher at a local Montessori. Jenn's work history is health care, but as a result of her daughter's mental health challenges, Jenn could no longer work in healthcare as her daughter required homeschooling. Her daughter made arrangements to move to Kentucky and live with her father while attending college.

Jenn has been divorced for 18 years and has a 19-year-old son and a 22-year-old daughter. Jenn is employed full time as a teacher at a local Montessori. Jenn's work history is health care, but as a result of her daughter's mental health challenges, Jenn could no longer work in healthcare as her daughter required homeschooling. Her daughter made arrangements to move to Kentucky and live with her father while attending college.

Goal of Session

1. Client Goal: Client will identify the nature and precipitous of anxiety symptoms by 6/11/2020.

2. Your Goal: Therapist will promote self-awareness and emotional intelligence by teaching Jenn to read her emotions and distinguish healthy from unhealthy feelings.

Dialogue

Please group dialogue together.

Identify (for each section)

1. Theory

2. Practice Model

3. Techniques and

4. Skills

Analysis/assessment of dialogue

What was going on?  What were the patient's reactions to your feedback?  How did the client respond verbally (quality of voice, tone, did the respond better to closed or open-ended questions?) How did the client respond non-verbally (how did you know they were listening? were they distracted? Did they welcome your feedback?)

Personal reactions and self-reflection to the interaction

What were you thinking?  How do you feel the session went?  What could you have done better?  What will you do differently/the same next time?

Me: Hello, Jenn, what’s been going on since we last met?

Client: My daughter has terrible anxiety. When she has an episode, she acts so mean towards me. It hurt my feelings, and I get sad. Then it’s like I’m walking on eggshells because I don’t want to upset her anymore. I want to help her, and the more I try, the more I’m hurt. This past Saturday, we went to her aunt’s birthday parade. She was excited to go, and then when we got into the car, she started to panic. She got in the back seat because she did not want to see anyone. Then as we got closer, she got in the front seat. I asked her if she would give her aunt the gift since she was on the passenger side, and she said that she was afraid and didn’t want to. At the last minute, she changed her mind and decided to give her aunt the gift. When she rolled the window down, she attempted to give her aunt the bag that had a bottle of wine in it, and it fell to the ground. She was so angry with me. I didn’t do anything wrong. She decided to get in the front and give her aunt the gift. She cried on the ride home, and when we got into the house, she went to her room and slammed the door. She avoided me and didn’t come out of her room for 24 hours or more.

Me: I can understand how stressful this situation may be. I can tell that this situation is affecting you right now. Let’s take some deep breaths before moving on.

Client: Thank you, that felt so good. I feel better.

Theory: Cognitive Theory

Model: Cognitive Therapy

Technique: Relaxed Breathing

Skills: Empathy, Active listening

I started the session by asking an open- ended question.

Jenn is sitting up; her hands are folded and she’s giving me direct eye contact. Her tone was soft, and there was no hesitation in responding to the open-ended question. I knew that Jenn was listening because she made eye contact. Jenn was not distracted.

I used active listening by giving eye contact. I also nodded my head. I used empathy by telling her that I understand how the situation may be stressful.

I asked her an open-ended question.

I noticed that Jenn seemed stressed while she was talking. After she finished, we did relaxed breathing exercises. In this exercise, we took a long slow breath through the nose and held it for 3-4 seconds following a slow exhale. The goal was to relax the muscles in her neck, shoulders, and face.

I thought that her response to the open-ended question gave her relief but after the breathing exercise, I realized that she was really relieved.

I think that the open-ended question was a great way to start her session.

I don’t think that I would have done anything differently. The response to the open-ended question gave me what I needed to proceed.

Me: Please, tell me more about why you think that your daughter was mad at you?

Client: Well, I think that she was mad because she didn’t say anything to me on the way home. When we got home, she slammed the door, and I didn’t see her for 24 hours.

Me: Is it possible that your daughter was not mad at you, but disappointed in herself because her attempt to try failed?

Client: Oh, my goodness! I never thought about that. Thank you for pointing that out!

Theory: Cognitive Theory

Model: Cognitive Therapy

Technique: Guided Discovery

Skills: Open ended questions, confrontation

Jenn appeared to be relaxed. Her hands rested in her lap and she continued to make eye contact with me. She answered the questions in a monotone. Jenn was excited and welcomed my feedback. I used guided discovery by asked open- ended questions that challenged her thinking which lead to a breakthrough,

I was thinking about if I was saying the words or asking the right questions. I felt like there was a breakthrough because Jenn never thought that her daughter might be upset for different reasons. The next time, I would conduct the session in the same way.

Me: Jenn, you are amazing! You seem excited and it appeared that you discovered a different viewpoint. In our session today, we have discussed the situation with your daughter, and concluded that she might have been upset for other reasons that had nothing to do with you.

Client: Yes.

Me: Thank you for being open to another perspective. Sometimes we have a negative thought process and don’t realize it.

Client: I know that’s the truth!

Me: I would like for you to complete this thought cascade worksheet. When we are feeling anxious, it is common to have a thoughts that leads to more disturbing thoughts, which then leads to an even more disturbing thought, and so on. Believe it or not, this type of “domino effect” of negative automatic thoughts is common. We use this technique to uncover some of our most troublesome worries. Once you find some that are particularly difficult, or relevant for you, you can use the examining thoughts worksheet to begin working on them.

It will guide you in identifying negative thoughts. We can do it together in this session, but I would like you to use this at home for one week, and then we will discuss it when you come back.

Client: Great, sounds good. Thank you, Tiffany.

Me: Thank you, Jenn! Have a great week.

Theory: Cognitive Theory

Practice Model: Cognitive Therapy

Techniques: Identify negative thinking

Skills: paraphrase and encouragement

 Jenn appears relaxed, and she is smiling. Jenn nodded and said yes to agree with what I was saying. Jenn continued to speak in a monotone. Jenn was not distracted and welcomed my feedback. I explained how to complete the worksheet. For example, I explained to Jenn how to identify negative thoughts. The instructions were as followed: 

1. Sit quietly, and try to imagine going into an anxiety-producing situation: what thoughts come up?

2. Recall an event from the past that was anxiety-producing. What thoughts were going through your mind?

3. Role-play, and anxiety-producing event with a friend family member or friend, write down thoughts that came up during this exercise.

4. When Identifying the thoughts, phrase the thoughts in the form of a statement. Avoid what if’s and questions.

5. Complete the thought cascade daily.

What were you thinking?  How do you feel the session went?  What could you have done better?  What will you do differently/the same next time?

I think the session was effective. Jenn was able to identify negative thinking. She also welcomed the homework that I suggested. I would not have changed anything during the session.