Process Recording is a Life Skill (really!)

If you ask social workers what they liked least about social work school, most will say "process recordings." These documents have been a cornerstone of social work pedagogy for generations, and the bane of students' field education for just as long.

What are they, and why are they so onerous? Most simply, a process recording is a written account of a clinical interaction, typically structured in columns as follows:

1. A verbatim account of what was said by whom, recounted from memory (rather than from an audio or video recording), with the understanding that it will not be 100% accurate, but should be as accurate as the student can make it.
2. The student's observations about the interaction. Most basically, this includes things like body language, environmental cues, and other non-verbals. The same column may also be used to note the student's impressions, interpretations or assumptions, and reasoning for responding in specific ways.
3. The student's thoughts and emotional reactions, along with any associations s/he is making. 
4. The supervisor's comments and questions

Process recordings can be pretty painful to write, for a number of reasons:

1. Unless they're done immediately after the interaction (rarely possible in a busy field placement), it can be very challenging and time consuming to try to bring back the memory of exactly what was said, by whom, in what order. (My first placement was running groups of 8-12 middle school girls - trust me, trying to remember what 12 girls said throughout a 90 minute group is painful!) 
2. Picking apart one's interpretations, thoughts, assumptions and feelings takes practice, and can be uncomfortable and confusing, especially while also trying to integrate a wide range of theory being learned in classes. 
3. It can also be anxiety-provoking to expose one's clinical interactions, and reactions, to one's supervisor for feedback. 

So, given all these perfectly good reasons for hating process recordings, why have they continued to be a primary social work pedagogy? Well, for one thing, we haven't come up with a better window into what students are really saying, thinking, assuming, and feeling as they interact with clients. An audio or video recording would not include the student's internal process, even if it would be a more accurate representation of what was said. As clinicians, we also rarely have the luxury of taping our interventions - it's important to be able to remember client interactions, and process recordings help train the brain to notice and remember clinically relevant information.

Those are the reasons schools of social work think process recordings are important for students. I'd like to take it a step further, though - I think process recordings not only teach important clinical skills, but also provide life skills that can be taught to clients. Think about it: across the continuum of care, we're working with clients to help them develop insight (awareness of their thoughts, feelings, associations, reactions, and behaviors), and adaptive ways of interacting with the world (i.e., coping). To do so, we need to help them to distinguish between thoughts and feelings, and between assumptions and observations. We also need to teach them to break down challenging events into a sequence of discrete events to identify triggers, choices made, and places where a more adaptive response might have been possible. To teach these things, we have to know how to do them ourselves. Students improve their self-awareness and self-reflection through process recordings, and process recordings make this learning explicit, thereby allowing students to apply it implicitly and teach it explicitly with clients.

So, how do you feel about process recordings, remembering your own student experience? What do you think about their applicability to ongoing clinical practice, especially as a potential life skill to offer clients?

What We Learn From Our Own Feelings

At an orientation for new MSW students this week, a more advanced student shared one of her first-ever process recordings. In it, she had misinterpreted a client's standoffishness as resulting from (rather than causing) her discomfort. The advanced student explained that, at the time, she hadn't understood what was going on with the client well enough to understand her reaction.

One of the new students expressed skepticism: "Didn't you have referral information? And access to a Diagnostic Manual?"

The experienced clinicians in the room smiled and shook our heads - likely the new student won't understand why a manual isn't enough information until she starts her own work with clients. 

The truth is, no book can adequately capture the information we, as clinicians, learn from our own feelings. (Students - this is why your professors, supervisors, and advisors all keep pressing you to reflect on your feelings!) Provided that we've done enough of our own work to separate our "stuff" from the client's, the feelings we experience while sitting with someone provide invaluable data on that client's experience. 

I think there are at least three ways that our feelings can be a source of clinical information:

1. Perhaps most obviously, our reactions to a client may be similar to the reactions he or she receives from others. For example, someone whose dependency makes me feel claustrophobic may be having relationship issues because their significant other feels similarly. 
2. Our feelings while sitting with a client may also mirror what the client is feeling. For example, when I sit with someone who is severely depressed, I always feel like I've entered a black hole - bleak, and slow.
3. Lastly, with enough experience encountering various diagnoses (and reflecting on our reactions), I think we each develop a knack for determining a client's most likely diagnosis based on the feeling they elicit. This may not be true of every diagnosis in the DSM, but I have definitely found it to be true of many. For example, psychosis is tricky to sort out using DSM criteria, but schizophrenia, schizoaffective disorder, and mood disorders with psychotic features all have a different "feel."

How do you use your feelings as a source of information while sitting with a client? Are there times when your reactions seem more or less helpful?