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Transcript of Practicum Course
R. Tyler Wilkinson, Ph.D. NCC
This is the section where you report what is told to the counselor. Client's feelings, concerns, plans, intensity of feelings. Pertinent comments are also recorded-these should be brief and accurate. Use quotations if needed; however, limit use to bits and avoid long sections of quotes. Its difficult to remember long direct quotes. If necessary, verify with your recordings. Because of potential access from others, be very mindful as to what information you include in this section. Use your clinical judgment.
This section is the "factual" section of the note. Generally two types of observable data: counselor's observations and outside written content. Observations include: appearance, behaviors, nature of the relationship, etc. If neccessary use the language "as indicated by" or "as evidenced by". Avoid judgements and report observed behaviors. (i.e., "The client is being dysfunctional" instead "The client had difficulty maintaining eye contact and was fidgeting in his seat."). Here you are writing to allow the reader to draw their own conclusion. Outside written content may be client authored, from other mental health/medical professionals, etc.
This section is the summarization of the counselor's "clinical thinking". You can think of this as a synthesis of the previous two sections. Here you can discuss suspected diagnosis and report clinical impressions that could "rule out" a diagnosis. If reporting a DSM-IV diagnosis be sure to report the appropriate code.
This section is where you detail the action you wish to take going forward. You can include things you want to address next session, date/time of future appointment, interventions used in the previous session, assignments given, treatment progess.
Additional notes: Always date your entries and always sign them at the end.
Avoid using names of client, family members, anyone client mentions
Avoid value laden language
Do not erase or white out mistakes-strike through and initial.
Be brief and concise and descriptive.
Use proper spelling and grammar. Avoid slang unless reporting client's use.
S) Client presents to counseling reporting that she is "frustrated" with her roommate. Indicates that she has yelled at her roommate frequently over the last week and reports a history of increasing anger. She reported a history of verbal abuse from her father throughout her childhood, though the last few years have been "better".
O) Client seemed comfortable throughout the session, though her leg shook much of the session indicating some potential anxiety. Appeared flat when discussing her history of verbal abuse in the session.
A) R/O Adjustment disorder with Anxiety (309.24)/ with Mixed Disturbance of Emotions and Conduct (309.4). Clinical impressions: Length of disturbances may indicate chronic symptoms.
P) Scheduled next appointment for 09/07/12 at 3pm. Plan to continue understand family hx of verbal abuse. Continue with narrative treatment techniques.
K. DEEPLY, COUNSELOR IN TRAINING (SIGNATURE).
Cameron, S., & Turtle-song, I. (2002). Learning to
Goal Setting and
write case notes using the SOAP format. The Journal of Counseling and Development, 80, 286-292.
Before you begin to identify with a theory or collection of theories I encourage to think through these general questions:
Are people inherently good or bad?
Why do people come to counseling?
How do people change? What leads to change?
What is your purpose as a counselor?
What makes for good counseling?
Initial Phone Call
Screening Session/Intake Session
Your first task is to inform the client as to the procedures of counseling.
Your second task is to begin to develop a relationship with the client.
Working to understand life from their perspective..
Your initial task is NOT to solve problems, seek solutions, or answer all of their questions.
The Person of the Counselor
One Word Clarification
tell me more...
Business for Today
Field Experience Meetings
No Class Week of 10/15
Keep doors closed.
Client information by Monday!
Observe, assess, gather data
look for themes and patterns in the clients thoughts, bxs, feelings
Use what you know about the client and the emerging themes to develop explanations, and hypothesis about etiology and sustaining factors
Jackson is a 22 year old, Caucasian male who presents to counseling related to not wanting to feel "down" and to get a control over his "gambling". He is the middle of three children. His brother is 27 and plays minor league baseball with a team in the Southeastern United States. His sister is 20 and is attending a private University in the Northeastern United States. His father owns his own business in which he designs and manufactures various signs. The client reports that he works for his father's business. He states that his father just purchased a yacht and travels with his mother 4 months at a time. Client reports difficulty maintaining relationships with peers both platonic and romantic. Client also indicated "poor" relationships with his family. Client states that his father gave him $12000 recently to help with living expenses. Client reports that he "hates it" when his family gives him gifts because "they don't know me and get them wrong". The client was somewhat defense and resistant to the counselor's initial questioning.
What do you need/want to know more about?
What do you observe from reading this?
Lets add to what we would learn in the session
What themes/patterns could emerge with this client?
Bringing this together, how do you begin to understand what may be factoring into the cause of the client's concerns and what is helping maintain some of the symptoms?
What is treatment planning?
Should treatment be planful or spontaneous? (Zuckerman, 2003).
Treatment plans can help create a plan and vision for counseling.
Most managed-care providers require this in the first two sessions.
Zuckerman, E. L. (2003). The paper office. (3rd
ed.). New york: Guilford.
Models of Comprehensive Treatment Planning
PIC: Problem, Intervention, Change indicators
Dates of evaluation
Treatment Questions to Consider
What would happen if you were to make the changes you say you want?
What positive and negative impacts would this have no you and others in your life?
What has not worked in the past/what have you tried already?
What has been the most helpful so far?
Who are your allies for change?
When have things been different?
What do you think needs to be done to make things different?
Difficulties in Session
"Most children receive feedback about their behavior, but generally adults are on their own. No one tells them, 'You talk with your mouth full,' 'Sit up straight,' 'You need to comb your hair and put on a different shirt,' or 'Stop sulking when you don't get your way.' Clients think, feel, and behave in therapy in the same ways they do in real life. We can be of great service to them if we can figure out what they most need to hear and then tell them in a way that allows them to listen.
That doesn't always happen. I worked with a CEO who considered people interesting objecs designed to serve and entertain him. Donald came in because he had a hard time keepign women in his life. He had an easy time attracting them and even getting them to bed. But as he put it, 'The only ones who stick around have cash registers for hearts.' Once after a therapy session, which at the time cost $45, Donald handed me a hundred dollar bil and said, 'Keep the change.' I shoved his money back and asked, 'What are you trying to do to this relationship?'...I bombed with Donald...There weren't many people in the world who would remember him fondly. I did feel a bit of hope when I asked him about what difference his life would make. He looked at me almost sadly and said, 'None of us matters in the end. We're all worms meat.' That was an answer we could have discussed in therapy...(Pipher, 2003).
Pipher, M. (2003). Letters to a young therapist.
New York: Basic Books.
Write about or draw an image depicting one of your fears regarding counseling.
What is relational depth in counseling?
Studies suggest that creating an environment of safety, being real/congruent, warm, and inviting clients to a deeper relationship were important for creating relational depth ( Knox, 2008).
"It felt as though my counsellor, without breaching boundaries, went beyond a professional level/interest and gave me such a human, compassionate response something I couldn’t put a price on . . . I think I had only ever expected to receive from her professional self. . . . [I]t felt like she was giving from her core."(Participant)
Knox, R. (2008). Clients' experiences of relational depth in
person-centered counselling. Counseling and Psychotherapy Research, 8, 182-188.
Its about to begin!
What are your counseling interests?
What question do you have for me?
What are you most excited about regarding this course?
What are you most anxious about regarding this class?
Is there anything about you I should know that would be helpful?