SAGE Journal Articles
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The article examines the activity of writing case-notes. For this purpose, case-notes are broadly defined as textual records of encounters between mental health practitioners and their clients. The primary focus is on psychotherapy notes, written for private use. It suggests that note writing is potentially a lively addition to the dialogue within the therapy room, an essential part of the unique relationship that grows between practitioner and client. In particular, it looks at the possibilities of representing intersubjectivity, the third voice, emerging from the dialogue between two subjectivities, in ways that forward both theoretical understanding and the therapeutic endeavour. It will argue that serious engagement with case-notes must of necessity tackle questions of voice, speaking rights, a variety of deafnesses, power, the inscription or oblation of race and gender in professional discourses, and reclamation of knowledge colonized by patriarchal and colonial structures of authority. It is feminist in its orientation. It speaks from a postcolonial African context, and a psychoanalytic approach, and draws on psychotherapy experience saturated with those foundational identities.
Questions to Consider:
- Your text outlines several formats for case notes and your site may request a specified form for notes, but after reading this article, journal on the “voice” present in your notes. Do your notes sound like you, or your supervisor or someone else? How much room do you leave in your notes for your subjective voice? How does this voice flavor your notes and ultimately, your conceptualization of the case?
- The article suggests that note writing should not be the somewhat tedious but necessary chore that many practitioners experience it to be. But that it is instead, potentially, a lively addition to the dialogue within the therapy room, an essential part of the analytic third. If this is true, how can you use the case note writing process to gain greater insight in reflection than you had in the session itself? As an emerging professional, how much time do you need to write carefully reflective case notes after each session? Does your site allow sufficient time for honing this skill?
- What can we learn from the description of South African note taking styles explained in this article? Open a dialogue with your supervisor about intersubjectivity and about “good enough” notes versus truly reflective notes. What are your supervisor’s expectations for your notes? What are your expectations for yourself?
Hoffman, L., Algus, J., Braun, W., Bucci, W., & Maskit, B. (2013). Treatment notes: Objective measures of language style point to clinical insights. Journal of the American Psychoanalytic Association, 61(3), 535-568.
Application of a computerized text analysis procedure is proposed that has the potential for use by psychoanalytic and psychodynamic clinicians: the systematic examination of linguistic style as reflected by clinicians in their ongoing process and case notes, which are ubiquitous in the mental health field. The studies reported here are, as far as is known, the first attempts to study treatment notes systematically using such procedures. Linguistic measures are used to track the trajectory of the clinical process throughout the treatment in two contrasting cases, one rated successful, the other not. The computerized linguistic analysis used here focuses on two analytically relevant linguistic variables: Mean High Referential Activity (MHW), a measure of the degree to which language is connected to emotional processing, and Reflection (REF), the use of words referring to logical functions. Changes in the relative position of these measures indicate nodal points in the treatment that might be analytically or therapeutically problematic, and that might be overlooked in a solely clinical reading. The analyst’s activity as reported in notes during such nodal periods is clinically examined to see how it may have affected the course of the analysis. This method has the potential for use in ongoing treatments, and may help clinicians refine their interventions.
Questions to Consider:
- After reading this article, do you believe that your linguistic style changes throughout your work with a client? Conduct a little informal analysis…review case notes for the same client from beginning to end. Did anything change about the way you discuss the client? Do these changes correspond to difficult sessions?
- Though the procedures used in this study are complicated, highly structured and carefully controlled for research purposes, how can we informally use these concepts to monitor our linguistic style and better understand its impact on our case notes and reflections?
- Ask you supervisor to review a selection of case notes with you searching for changes in linguistic style. What does it mean when you describe your client with brief phases such as “client reported…”, “client shared…” and factual descriptions of events in clients life, versus times when you describe connections and hypothesize about those connections?