Write a process report on a sequence of a therapy session with case study client Gosia, drawing on theory and research on cognitive behavioural therapy (CBT) to do so.

The task: process report
Write a process report on a sequence of a therapy session with case study client Gosia, drawing on theory and research on cognitive behavioural therapy (CBT) to do so.

Word limit: 2000 words (I’ve already written 200)

Your process report should analyse a short section (around 5 minutes) of Gosia’s CBT session, below.

Transcript:

THERAPIST: So what we then do is we start to think about this next column, and so we’ve started to think about the facts that support the unhelpful thought, and you started to tell me a little bit about how true these thoughts actually are. So as I say, we started doing that a little bit in terms of the communication and feeling that you’re not understood, but I wonder how many times when you do talk to people do you feel that you’re being asked to repeat yourself or you’re being misunderstood? How often does that happen?
GOSIA: Very often. Very often.
THERAPIST: Is that in every conversation that you would have?
GOSIA: I think it happens outside of university a little bit more. I think in class, I’m OK. It usually happens during social events.
THERAPIST: OK, so we’ve gone from it happening all the time to not all the time. So what you said is at university, it doesn’t happen. Maybe it’s more socially. So instead of thinking, well, OK, it’s not as true maybe as we think it is. So we think initially what you said is, this happens all the time. People misunderstand me all the time, but what we’ve just discovered is that isn’t quite true either, because at university, which I imagine is probably a good chunk of your day, is it? And it feels as though you’re being understood? Yep. And so let’s think of those environments. I imagine the university and being in lecture halls is relatively quiet and social events. So where is it that you’ve gone to meet people socially?
GOSIA: Sometimes we go to a bar.
THERAPIST: OK, is the bar loud?
GOSIA: Sometimes.
THERAPIST: So some of the things that you’ve talked about in relation to communication isn’t just about what you’re saying, but it’s also about the environment that you’re in. And so the next part here then is thinking about alternative thoughts to the particular situation that you are in. People don’t understand me, I won’t make friends, I should go home or I want to go home. My communication isn’t as good as I want it to be, and I feel different. Now, we start to think, what would somebody else say about the situation? So if you talk to someone else about being at this party, what would they say about it?
GOSIA: That there is a possibility that it was loud and that somebody just didn’t hear exactly what I said.
THERAPIST: OK, so it was loud and perhaps someone just misheard you because of how loud it was. So then that queries the communication part on your side. So let’s put that down as an alternative thought. It was loud, and because of the volume, people might not have heard me. OK, what else? If we’re thinking about an alternative interpretations of the situation, what else might have happened that’s different to the thoughts that you had?
GOSIA: Maybe that person had too much to drink in that time. I didn’t feel comfortable with a person because she was a stranger, and if I know somebody for a longer time, I think they understand me maybe a little bit more? So maybe that was the problem that it was my first time just talking to her?
THERAPIST: We could write that down. So we could put could have been drunk, which would have impacted on her level of communication. Yeah? OK, so let’s think about any more? Any more other explanations for what happened here in the situation that you were originally in?
GOSIA: Nah, that’s it.
THERAPIST: So do you think if we look at your reaction to the initial event, do you think it’s in proportion to how you reacted?
GOSIA: Mm-mm. I think I feel it wasn’t as bad as I thought it was.
THERAPIST: OK, why do you think that is?
GOSIA: Because I look at it from a different perspective.

The task when producing your process report is to put yourself in the shoes of the therapist, comment on what the therapist may be feeling or intending to do with their interventions and construct the best process report you can, based on the available information and your external view of the therapy process. Your process report is therefore different from the traditional process report often used in counselling and psychotherapy training, as you will take the perspective of the therapist in the video and write the report in a speculative way rather than writing about your own feelings or intentions as a therapist.

When interpreting what you see in the video excerpt (and read in the transcript), you should link theoretical concepts (e.g. regarding the therapeutic relationship and CBT) to the client–therapist interaction you annotate. In your comments, you should aim to critically reflect on the therapeutic relationship and the impact the work of the therapist has on the client. For this, you need to evaluate and interpret both the verbal interaction between client and therapist and the non-verbal signs and body language used. You don’t have to comment on every line/statement in the transcript/video but focus on those interaction sequences that you feel offer interventions and meaningful reactions for interpretation.

This assignment is intended to assess your skills in drawing on your knowledge and understanding of the content of Block 4, and the concepts and ideas of a particular therapeutic approach (CBT), to analyse a brief sequence of a therapy process. For this assignment you have been asked to consider the session video sequence (together with the transcript) in the first section of this TMA and to write a process report by taking the perspective of the therapist working with the fictional case study client.

As you read in Week 17, process reports are widely used in counselling and psychotherapy training. The main purpose of a process report is to analyse the therapy process within a relevant theoretical framework (therapeutic orientation) and evaluate the impact of therapeutic interventions on both client and trainee/therapist. While process reports reflect client–therapist interaction, their focus is usually on the trainee/therapist’s work and their capacity to critically reflect on their practice.

Section 2: Session context (400 words)

This section should provide a brief overview of the context for the annotated session extract in Section 3. It should consist of around 400 words and include brief summaries/discussions of:

a.the therapeutic relationship that has developed between client and therapist (drawing on concepts and frameworks around the therapeutic relationship)
b.any professional and ethical issues that might be relevant for this case and the therapeutic work with the client (drawing on professional/ethical issues as discussed in Week 20)
c.the theoretical orientation used by the therapist (cognitive behavioural therapy), with a brief summary of core ideas about how client difficulties evolve and the core concepts/techniques for working with clients (drawing on Week 13/Block 3).
Section 3: Transcript and commentary (800 words)

In this section you should present the annotated transcripts extract of the counselling session selected for the assignment which should comprise around 800 words. (NB the transcript itself is 679 words which is excluded from the word count.)

The transcript excerpt and related commentary should be presented in a two-column table (one for the transcript and one for your comments). Each piece of commentary should be written immediately next to the part of the dialogue it refers to (in italics to distinguish it from the transcribed dialogue).

The commentary should provide a process analysis and evaluation that focuses on the intention and impact of the therapist’s interventions and responses. When commenting on the therapist’s intentions and interventions, links and references should be made to concepts related to the therapeutic relationship and the therapist’s therapeutic orientation (CBT concepts/techniques). Comments on impact should consider the client’s response to the therapist’s intervention and the extent to which the therapist’s intention was achieved. The commentary may relate to the following aspects:

a.therapist interventions and client reactions (this may also include suggestions for alternative interventions)
b.therapist intervention in relation to formulation/theoretical framework
c.possible difficulties and dilemmas experienced by the therapist
d.observations and evidence relating to the therapeutic relationship
e.verbal language and body language used in the sequence.
Section 4: Alternative format (300 words)

This section should briefly discuss how a systemic approach or group therapy (you only need to cover one) could potentially be useful for Gosia and her problems (e.g. if the GP had referred her to this alternative format). The section should comprise around 300 words and may include a brief and succinct discussion of either:

a.potential benefits and limitations of a systemic perspective and systemic work with Gosia
b.a potential hypothesis for Gosia’s problems from a systemic perspective
c.systemic methods and techniques that could be used, and how they would be beneficial

or

d.potential benefits and limitations of group therapy for Gosia
e.group therapy factors that would be especially relevant in her case.

Marking criteria

More specific marking criteria for this TMA are:

Process analysis/evaluation – should
include references to the therapeutic relationship and the therapist’s therapeutic orientation (e.g. CBT concepts and techniques, the rationale for using them etc.)
demonstrate awareness and understanding of the therapy process
demonstrate critical reflection on the work of the therapist.
Session context – should demonstrate a critical understanding and awareness of relevant professional/ethical issues and concepts related to the therapeutic relationship.
Alternative format – should show sound knowledge/understanding of the systemic or group approach and how it could be applied to this client case, discussing possibilities and limitations of the alternative format with the client.
Reflexivity – should demonstrate reflexivity on the experience of writing the assignment.