Clients Name: MC and His Mom DH Student S Name

Process Recording

Clients name: MC and his mom DH Student’s Name:

Introduction: Family therapy session with MC and his mother DH. This is the third family therapy session. The therapeutic goal for family therapy is to decrease conflict in the home. MC would also like to go home for his brother’s birthday.

Goals for meeting: To provide MC and DH with skills they can utilize in order to decrease conflict in the home and increase communication.

Plan for meeting: The first half of the meeting will be focused on the therapeutic goal. The second half will be focused on MC’s visit home and a safety plan and his consultation meeting scheduled for next week.

Narrative Content Behavioral Student’s Internal Supervisor’s of Meeting Concerns Process Comments

S: Thank you for coming DH, MC is practically This is my first time Seeing someone as I just want to go over the lying in the chair, doing family therapy real/authentic is always agenda for therapy today. The shifting back and without a supervisor with best practice. Continuing first half will be devoted to forth every once in me. I am a bit nervous to work on increasing working on our identified a while. He is not because I want my through experiences, therapeutic goal. The second making eye clients to see me the your self-confidences half will be devoted to contact. He is same as they see my will alleviate some of discussing MC’s visit this constantly moving superiors. I don’t want your anxiety. weekend. We will spend time his feet back and them to see me as developing a safety plan and forth as they hang nervous! we will briefly discuss the case over the edge of Parallel behavioral stuff consultation meeting set up for the chair. I wanted to set the between DH & MC- the second week in April. And groundwork for the interesting. of course we will add anything DH is sitting very session and do my best you would like to discuss. still staring straight to keep MC focused on ahead with flat task as he tends to DH: Yeah, That sounds fine. affect. Her foot is distract during therapy. shaking. S: MC, do you have anything to add?

MC: Nah.

S: Okay, great. In our second therapy session we identified decreasing conflict and increasing communication in the home as your therapeutic goal. Does that sound right to you DH?

DH: Yes that’s it. S: MC, does that sound right to you? As DH speaks to It appears to me that DH MC: What MC, MC rolls his tries to interpret for MC I wonder if MC finds eyes and looks and that he has a low these conversations DH: Less fighting MC, you away and down, tolerance for this. helpful. DH know how sometimes I yell never making eye acknowledges her and scream. contact with his inconsistency, so does mother. I figured I should get to MC see this as an empty MC: I guess. the point before MC gets process? Is DH being MC is losing too frustrated with his authentic? DH: Yeah well what she is patience with his mother to participate. I saying is that she wants us to mother and he wanted to implement a talk about that. sighs and rolls his behavior chain analysis eyes as he gives in as suggested by my MC: Do I have to be here? I to her demands. supervisor, MC is need to go to room time. familiar with a BCA because it is used in the Issue of commitment- DH: You need to be here MC. MC is making eye behavior management willingness vs. contact and system in the milieu, and willfulness. MC: Fine. appears to be the suggestion got his listening and attention, but I am not S: Okay. It is often helpful understanding sure he fully understands when meeting together to them. discuss conflict, to pick on a particular event and do what we call a behavior chain analysis. MC, you and your mom will pick one big fight you’ve had at home and we’ll go back and look at the forks in the road and see what DH interrupts At this point DH different choices could have interrupted me, without been made. allowing me to explain what we were about to DH: Yeah, MC like the cell Rude and do. My first instinct was phones, remember when you disrespectful tone to stop her and finish put that mask on at three and smirk on his explaining, but then I Good starting point- o’clock in the afternoon. face as he jumps chose to allow them to assessing and up from his lying go back and forth experiencing first hand MC: What are you talking down position. because I thought I could the family dynamics. about? gain a deeper understanding of what This in the moment, DH: You said, when you were home looks like if I just behavior would have hanging out with those kids-he let them go and talk been a great BCA has a tendency to hang out MC is moving about issues. conflict resolution. Poor with the wrong kids. more and more communication now. He is almost accusation, invalidation MC: Mom: They’re not the lunging towards no cheerleading. wrong kids, you’re lying… his mother when why are you lying? he responds. MC and DH clearly struggled to stay on topic DH: MC, you have a selective and continue to create memory. more conflict as different topics are presented. MC: A what? Mom! I didn’t They cut each even steal the cell phones, other off and talk even ask RC. You don’t like over each other my friends, they’re fine. throughout this entire It was at this time that I DH: The time at the skating conversation. struggled to follow what rink, when you got in a fight they were talking about with the glasses. but noticed that resolution was important MC: What glasses? What are DH is getting more to neither MC nor his you talking about-that wasn’t and more restless mother. They simply me. her feet are moving jumped from one topic to faster and faster, another no problem. DH: It’s the kids and there shaking and was that family at court when moving back and I struggled with your name came up all the forth. DH wondering when and/or time struggles to make if I should jump in and eye contact and ask questions, but chose MC: No it didn’t. What are often looks down not to. My instinct was The behavior should be saying? I don’t even fight at the floor and to to allow them to time limited enough so anymore. I did good the last the side. continue talking. Also, that you could assess- two weeks in school. this is the first time MC complete the BCA & is talking in family discuss the safety plan. DH: Four days. therapy and I saw it as a DH and MC are good time to gather more MC: What, no two weeks…I raising their voices information and observe don’t even fight-I got in like and not hearing his behavior. MC three fights in school so far each other. They became very engaged this year. are struggling to when he was arguing stay on one topic. with his mother and Good time for a mindful DH: That’s not what the struggled to respect her, exercise-expanding on school is saying MC. something we have not the deep breathing. seen since MC’s arrival. MC: What are you, why do MC is becoming I felt as though neither you lie? increasingly jittery one was hearing the and keeps shifting other, but again, I felt DH: MC, you see this how it his position in his that they weren’t is at home, ___finally starting seat. DH has also interested in hearing to see what it is like…you see become more each other. this is good. This is why he’s jittery, but not as here. much as MC and does not shift in S: Okay. Let’s take some her seat. Neither deep breath’s here and pause. one can make eye contact. It took a MC: Are we done? minute to settle them down and Finally when DH said S: Almost. You’re really eventually they did my name I took that as doing a great job…What I did stop and listen. an opportunity to jump Consistently inconsistent notice while you were talking in. was that-it appears that there is some inconsistency between For MC, things appear to your stories… be very concrete. She lies. That’s it. If she lies MC: Nah. She just forgets once she lies every time. sometimes…She lies DH sees this as an Honesty can be sometimes. opportunity to “show” subjective by experience- me what is wrong with focus on validation/bio DH: I lie? Yeah, see-no their family. social DBT theory consistency.

S: I do see some inconsistency. I also think it is DH continuously important to work towards interrupts and goals in baby steps…so we can struggles to listen. achieve them. I am wondering if we focused more on communicating honestly with each other and finish talking MC is shifting DH appears to be on about one subject before back and forth, his board and agreeable with moving on to the next. feet are shaking, he goals, but struggles to is focusing on the have complete DH: Yeah. Yeah. Yes. That floor, struggling to conversations and listen is perfect that is what we need, make eye contact. to me and her son. They both were right MC… Our stories-we successful in avoiding need to get them right the BCA I felt as though I MC. I don’t even need to be MC appeared a bit somewhat lost control of here, am I going on my visit? more relaxed when the situation by allowing I started to wrap up them to go on and on. It DH: MC we need to finish that part of the is often difficult to this up first. session, he determine when to stop continues to look an argument. S: Okay, so I think we have at his mother with reached a point where we can disdain and talk to I wanted to finish up by set a sort of mini goal for her with disrespect. refocusing them on a therapy with RC (MC’s little goal, something brother) when he comes on reachable for them both. Sunday... we can focus on telling the truth and staying on one topic at a time, how does that sound. As I mentioned the weekend, MC’s DH: Great that’s great, that affect became It appeared that I was will be good for us. Right bright and he was losing MC’s interest so I MC? interested all of a switched towards a sudden in talking subject he would like to MC: Yeah, Fine. again. discuss.

S: Okay, great. Now let’s talk about a safety plan for MC’s For MC being successful trip home this weekend. at home is so concrete, I will do this, this and this. DH: Yes. DH appeared I felt as though he has no engaged and a lot connection as to how S: We previously discussed more relaxed while difficult it can be at what MC’s safety plan would going over the home. look like, MC responds best safety plan. She when he has choices, so if DH, appeared to really you find that MC is not want a concrete following direction. way to control MC’s behavior in MC: What? I follow the home. directions MC appeared confused because he is successful DH: MC. Listen. at New Directions when using these skills. S: Yes you do MC, here. And your mom reports that it’s MC continued to sometimes hard for you to be restless, I don’t It was difficult follow direction at home. So think he was developing this safety here we give you chances and interested in plan because MC does we give you choices- discussing his not engage in unsafe something else to do other than behavior when he behaviors while in the what you’re doing. goes home, but home. What I really wanted to discuss wanted to get across was MC: Like what? going home for the that if MC felt anxious or visit. overwhelmed being at S: Well, let’s say you are play home, DH was fighting with your brother responsible for bringing sometimes, you say you do him back to the program that right? immediately. I also figured if DH had an MC: Sometimes. idea of what his coping skills are, she could offer S: Right. So if you are getting him alternatives to his too rough your mom will say, behavior. “MC you are being too rough, please stop. Why don’t you go outside and shoot hoops with your brother, or why don’t you put on a movie and chill for a MC continues to while.” Does that make sense? shift, and fidget A lot of the anxiety I am around. feeling over this safety The shift from the DH: Yeah, that sounds great, MC’s eye contact plan and visit is my own program to home can that’s what I’m missing. is minimal, he stuff because I advocated often be anxiety never looks at his for this home visit and I producing for us all. S: Does that make sense to mother. The am not confident it was There can sometimes feel you MC? ground is his focus. the best idea. like a loss of control and jeopardizing MC’s MC: Yeah, I get it. We do success. that here, but I’ll be good at DH appears to be home. I will. back to her original I wanted to reiterate the position where she importance of following S: I’m sure you will MC, and is staring straight the safety plan. in order for you to go home ahead, slowly you will need to have this plan shaking her foot I was happy that they with you, Okay? back and forth. both agreed to the plan She appears to be and signed the plan. MC: Okay, Okay. either spacing out Everything appears to be or listening a lot of work with DH S: Great. If you choose not to intently. and MC. Maybe I listen to your mother she will should work on tell you one more time and simplifying my work with you to choose presentation. something else to do, if you choose again not to listen you will return to the program immediately, okay? MC appears to be on edge, becoming DH: Coping skills MC. more and more Typing up the safety restless. He is plan was to assist DH in MC: Yeap. ready to move. maintaining MC’s behavior while at home. S: And MC, if you are feeling I thought of it as a little unsafe at all, or if you are piece of what works for feeling overwhelmed being MC here. She appeared home, all you have to do is tell MC was happy to receptive. your mom and you can come sign the safety plan right back, okay? And, MC, as was DH. It gave the visit is with family only. them both You are to stay at the house for something to do the party only. No outings with themselves. with friends, okay?

MC: Yeah. What I noticed most about DH and S Does that work for you DH? MC’s behavior is that they fed off I wanted to make sure DH: Yes, it’s great. I think each other. The we ended with a he’ll do fine with that. more worked up reminder as to what we MC got, the more will be talking about S: Great. I have typed it up DH moved around next time we meet. I and you and MC and I will and appeared wanted them to realize sign it and you can keep a restless and vice that we are working copy and we’ll keep a copy. versa. towards a goal and taking steps towards that DH: Oh good, I really have a goal is a priority. hard time when things aren’t written down. I need them When MC was written down to remember. lounging in the chair DH appeared MC: Can I visit with my substantially more mom? relaxed and in control. S: Of course. I think we’re done here. So next time, we’ll focus on communication skills and staying on task, right? When MC raised MC has had enough. I MC: Right. his voice, DH thought that it would be raised her voice a good time to transition DH: Great. Thank you so and vice versa. to their visit. At the end much. of the session I felt like it Neither MC nor was putting a tape on fast DH made eye forward and watching. contact and when A lot of energy was they did-they expended on this looked away meeting. I did come to immediately they the conclusion that there did not often look is a strong at each other when communication break they were down in the home and addressing each that it is not often that other and they MC and DH are on the appeared anxious same page. throughout the Or having the same entire meeting. I also struggled with conversation. DH’s tendency to interrupt and I found Nice parallel process to myself becoming MC I bet. aggravated, inside of course, but it was difficult to negotiate my feelings around this. Impressions and plan for your next meeting: I think the session went well because finally MC is becoming vocal. I think I got a taste of what it is like at home for MC and what negotiating conflict looks like in a structured, supervised setting. As I said, I do wonder if I let them go on too long and I didn’t get a chance to discuss the case consultation meeting as I desired, but I had to make a decision and felt as though I was losing them both towards the end. I think that In order for them to be successful in therapy they will need intervention in order to stay on task and communicate honestly. It appears that mom is on board with MC’s treatment thus far and I think we can work with her. Overall, I think it was a positive session and it gives me some good stuff to work with in the next family therapy session. I can choose a story and go through it with DH, MC and his brother, perhaps using the behavioral chain analysis. Questions for supervision: 1. Did I let them go on too long? 2. Should I have addressed specific issues mentioned in their conversations? 3. How do you control someone who constantly interrupts? 4. Should I have stopped her and explained the BCA further?

1. Yes, in that you never completed the BCA see notes

2. No, the process not the content

3. Interrupting can be a therapy interfering behavior-what purpose does it serve-how can we meet the needs in more validating ways

4. Not explained it-done it.