NU672 Unit 9 Comparative Process Recording, Grief Example

Six Seconds Then, Fourteen Seconds Now: A Comparative Process Recording of Early and Late Responses to Client Grief

[Student Name]

Purdue University Global

NU672: PMHNP Psychotherapy for Individuals, Groups, and Families Clinical

Unit 9 Comparative Process Recording

[Instructor Name]

[Date]

Both clients are composite; dialogue is reconstructed from recordings and details are bracketed.

Why Compare Two Recordings

A single process recording shows how a student worked in one session. Comparing two recordings, one from the start of the practicum and one from near its end, shows whether a specific skill changed. I chose the skill my supervisor and I agreed I most needed to develop: staying with a client's painful feeling before moving to information or action. Hill's helping skills model places exploration before insight and action and treats premature action as a common error of new helpers (Hill, 2020).

Early Recording: Week Three

Client: Ms. [O.], [51], whose mother had died [six] weeks earlier after a long illness. Context: fifth minute of the session, after she described sorting her mother's clothes.

Exchange 1. Client: "I held her coat and I just couldn't stop crying. I sat on the floor for an hour." She began to cry. Student, after about [six] seconds: "That sounds so hard. There's a grief support group at the library on Tuesdays. Would that be something you'd want to try?" Analysis: I acknowledged her pain in four words and moved to a resource. The recording shows her wiping her eyes and saying, "Maybe." She did not return to the coat for the rest of the session.

Exchange 2. Client: "I don't really do groups." Student: "There's also an online one if that's easier." Analysis: I stayed in action mode, now problem-solving her objection. The feeling she had brought, the hour on the floor, was left behind.

Summary of the early recording: two moves toward action in under a minute, no reflection of feeling beyond a stock phrase, and no exploration of what the coat meant to her.

Late Recording: Week Fourteen

Client: Mr. [N.], [68], a retired union electrician whose wife, [70], has Alzheimer disease. Context: minute [22], after he described helping her dress that morning.

Exchange 1. Client: "Then she looked at me and asked who I was. Forty-four years. She asked who I was." He looked down and was silent. Student: said nothing for about [14] seconds, then: "She asked who you were." Analysis: The silence was deliberate. I noticed my urge to say something comforting, and I waited. The restatement was simple and kept the focus on his experience.

Exchange 2. Client: "Like I was a stranger. Like I was the repairman." His voice broke. Student: "What was that like, to be a stranger to her?" Analysis: A clarifying, open question that invited him further into the feeling. Hill describes open questions and reflections of feeling as core exploration skills (Hill, 2020).

Exchange 3. Client: "Like she died, but she's still standing there. And I can't say that to anyone, because she's right there." Student: "You're grieving someone who's still here, and it feels like you're not allowed to." Analysis: A reflection of feeling that named something he had not quite said. He nodded and cried for about a minute. I did not interrupt.

Exchange 4. Client: "The kids think I'm doing great." Student: "What would you want them to know?" Analysis: This question began to move toward insight and possibly action, but it came after he had expressed the feeling, not instead of it.

What Changed

Three changes are visible. First, the time before my response to his tears rose from about [six] seconds to about [14]. Second, my first response changed from a resource to a restatement of his words. Third, across the first four exchanges I used no advice and no information, compared with two pieces of information in the first two exchanges of the early recording.

The silence mattered. Levitt categorized client pauses in therapy and distinguished productive pauses, in which clients reflect or feel, from obstructive ones, in which they disengage or avoid (Levitt, 2001). Mr. [N.]'s silence after "who I was" appears to have been a productive pause, and my waiting allowed it to continue. Waiting did not mean doing nothing; it meant letting his silence do its work before mine interrupted it.

Empathic responding matters beyond the session: a meta-analysis found that therapist empathy was associated with client outcome, with a mean correlation of about [0.28] (Elliott et al., 2018).

Where the Change Stops

The change is real but limited. Later in the same late session, at minute [38], Mr. [N.] said he sometimes wished his wife would die so he could grieve properly, and then said, "That's a terrible thing to say." I responded within [three] seconds: "It's not terrible, a lot of caregivers feel that." The reassurance was well meant and probably accurate, but it closed a moment that could have been explored. It shows that my new skill holds with sadness but not yet with shame or guilt, where my old pattern of quick reassurance returns.

Caregivers of people with dementia carry a heavy emotional load; a meta-analysis found that caregivers differed from noncaregivers most on depression, and that differences were larger for dementia caregivers (Pinquart & Sörensen, 2003). That makes it more important, not less, that I learn to stay with the difficult feelings caregivers voice, including guilt.

How I Measured the Change

To make the comparison fair, I used the same three measures on both recordings. The first was the time between the client's first tearful moment and my first words, measured from the recording's time stamps. The second was the type of my first response, coded as reflection, question, reassurance, information or advice. The third was the number of my turns in the first four exchanges that moved toward action, such as offering a resource or suggesting a step. My supervisor coded both recordings independently, without seeing my codes, and we agreed on all but one response, which we discussed and settled. Using measures that could be counted kept the comparison from resting on my impression that the later session felt better, which is exactly the kind of judgment a student is likely to make in her own favor.

Next Steps

1. Bring the minute [38] segment to supervision and practice responses to statements of guilt that explore rather than reassure.

2. In the next [four] sessions, count my reassurance responses and the time before them, as I did for sadness.

3. Keep using the waiting that worked, and notice whether it holds across different clients and feelings.

References

Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399-410. https://doi.org/10.1037/pst0000175

Hill, C. E. (2020). Helping skills: Facilitating exploration, insight, and action (5th ed.). American Psychological Association.

Levitt, H. M. (2001). Sounds of silence in psychotherapy: The categorization of clients' pauses. Psychotherapy Research, 11(3), 295-309. https://doi.org/10.1080/713663985

Pinquart, M., & Sörensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis. Psychology and Aging, 18(2), 250-267. https://doi.org/10.1037/0882-7974.18.2.250