FIELD PROCESS RECORDING FORM

Student’s Name:      

Client’s Name:      

Date of Interview:      

1. CONTENT OF INTERVIEW In a few sentences, describe the content of your conversation (i.e. purpose of meeting, setting, client’s age, etc.)     

2. INTERVIEW CONTENTUsing the format presented below, briefly provide a verbatim account of a small portion of your interview with the client at the beginning, middle and ending of your session. Please refer to the Grading Rubric for details. (This form will expand as you enter information.)

Content ofInterview

Client’sFeelings

Student’sFeelings

Student’sThoughts

Supervisor’sComments

Beginning of Interview:                              Middle of Interview:                              End of Interview:                              

3. ASSESSMENT OF INTERVIEWHow would you assess this interview? Did it go well or were there any problems you encountered? Please describe:      

4. EVALUATIONEvaluate your interactions with the client and the interventions you used.      

5. IMPRESSIONSConsolidate your impressions by providing a summary of the case.     

6. FUTURE PLANSWhat are your plans for further client contact/interactions? Describe a brief treatment plan here.     

Student Signature Date Supervisor Signature Date