bsrmanv35.pdf (recommended for
Experiential Therapy of Depression Project
Copyright, Robert Elliott, 1988, 1989
Brief Structured Recall:
Procedure Manual Version 3.51 (11/89)
Part 1: Client Recall
While the client is completing his or her postsession forms, make sure you
have all the materials needed:
Therapist should have given client and self the
following regular Post-Session Forms:
Client Post-Session Questionnaire
Client Personal Questionnaire (for next
Therapist Post-Session Questionnaire
In addition, make sure that the therapist has
administered the two Luborsky-Penn forms:
Helping Alliance Questionnaire (for client)
Facilitating Behaviors (for therapist)
Client Event Recall Form (Version 3.51)
Therapist Event Recall Form (Version 3.2 or
Event Record Forms for taking notes on
Event (10 or more)
Videotape of session, rewound to beginning
Client and Therapist One-month Review forms
Tape recorder for recording recall (test to
make sure it's working properly)
(Where appropriate:) Client One-Month Review
Questionnaire from previous recall, with description of previous event
and possible changes written in.
Event identification (First part of Recall)
Orient Client to Recall Procedure. If
the client has never done a recall before, give him or her some
orientation to the process. Give a version of this:
In a couple of minutes, I will be playing back
parts of the tape of the session you have just finished. I'll do this to
help you remember what was going on during particular moments in the
session. Clients and therapists often have many unspoken experiences
during sessions, including thoughts, feelings, images, memories, and
evaluations of the helpfulness of things said; we find it extremely
interesting to learn about those unspoken experiences.
After this, ask the client if he or she has
ever seen a videotape him/herself before. Be sensitive to the fact that
some clients may need to be desensitized to seeing themselves.
Read H.A.T. answers to questions 1-5 aloud back
to client to verify the information, to familiarize yourself with it,
and to see if the client wishes to add anything. (If s/he does, write it
If client says event is very long (more than 10
min.), ask client to identify the most helpful (or important) part of
the longer event; then do recall on this most important part.
What to do if the client identifies all or
most of the session as the significant event: First, ask the client
to take a moment to think over the session to see if any part or topic
now stands out as having been most helpful or important. If that does
not produce a specific event, reschedule the recall for a later session
and try again. Do not force the client to "come up" with a
minor event, as this will yield poor data and be frustrating for all
concerned. (The same procedure should be followed if the client says
that there was no helpful event in the session. Note also that clients
will occasionally identify events which they feel are important but
whose helpfulness they do not know at that point.)
Verify the information on questions 6 & 7
on the H.A.T. form (reverse side). If the client has forgotten to put
the helpfulness ratings down for these, ask her/him to do so now.
Wind tape forward by fixed counter units
(e.g., 100, 50, 20; roughly 10-, 5-, or 2-minute intervals),
depending on how far into tape client has said event is and how
close you think you are to it. (On many machines, 60 min. is
900-1000 counter units.) It is very important to be conservative in
how far forward you wind the tape - if you go past the event,
clients often become quite confused. Also, be more conservative for
"smaller" events, as these are harder to find. Remember
also that clients sometimes err with regard to event length and
location; we only ask them about location to get a very rough
When you stop the tape, play 10-20 sec,
long enough to allow the client to remember what was going on at
that point in the session. If the client doesn't volunteer the
information, ask him/her if the event is before or after this.
Repeat this process until (a)
you end up in the middle of the event or (b) the client tells you
the event is coming right up.
Surveying the Event:
Find Beginning of Event.
First, with the client's
help, find the beginning of the event, winding back and/or
playing forward until you find it. Make sure to have the client
tell you exactly (down to the word) where the event
begins. If the client needs encouraging, tell him/her that
he/she is the best judge of when the event started, although you
recognize that it may be somewhat arbitrary.
Write down the counter
number (or video stopwatch time) for the exact beginning of the
event. Mark the beginning of the event on the record sheet (draw
a heavy line, write BEGIN).
Instructions . When the
beginning of the event has been found, hand the client a copy of the
Client Event Recall Form and talk him or her through the
instructions on the first page; be sure to point out the three kinds
of information you are looking for: most important things client
said, most important things therapist said, and the end of the
Play Through Event.
Begin playing the event through. As you do so, you will need to do
Keep an eye on the client,
looking for nonverbal signs that s/he has something to note or
say. When this happens, stop the tape, and ask the client if
s/he wants to say anything or if a peak or the end has been
Take brief notes on the
event: for each speaking turn (more than "Uh-Huh"!),
jot down the speaker (T or C), the first word, and a key word.
Write more detailed notes for first and last speaking turn in
the event and any "peak" responses. Have the client
define the exact end of the event, and mark the boundary of the
event on the record sheet (draw a heavy line and write
For all "peak"
responses, write down the following information on the Event
for any "peak" responses and the end of the event.
(These go at the end of the speaking turn, not the
for any "peak" responses (give client a copy of
the Helpfulness Rating Scale, which can be found on Event
Record Forms or the Client Recall Form).
Mark all peaks with an
asterisk in the * column.
Helpful Hints for Surveying
If you suspect the client
has forgotten to pay attention for peaks or the end of the
event, you can occasionally stop the tape in order to inquire
gently (e.g., "Anything so far?" "Anything
more?" "Are we still in the event?") (but don't
If the client goes through
the entire event without identifying peaks for both
client and helper, ask him or her to describe the most
helpful things the client and/or therapist said and then have
the client review the event in order to locate these.
It is generally useful to
rewind the tape a bit after stopping it, otherwise a few seconds
of tape will be missed.
Event Description (second part of Client Recall)
Open-ended Inquiry. This
part of the recall should run 10 minutes or longer. You should encourage
the client to talk freely, while you take brief notes. Give the client a
copy of the form so s/he can follow along on, but record his/her
responses yourself on your copy. Keep in mind that clients may answer
more than one question at a time. Use Open Questions and not-too deep
Reflections to encourage the client to tell you more; do not
interpret, reassure or reflect deeply, or the recall is guaranteed
to turn into another helping session and the client's answers may be
biased. After the client has given an initial answer to the questions, a
useful strategy is to ask her/him if there are any other
feelings, intentions, etc. (but don't overdo this either, or the client
will feel put upon!).
In Version 3.5, the client is
essentially being asked to focus/free associate to a wide range of
questions which are intended to serve as memory probes. Be careful not
to push the client on this, but allow him or her to not have anything to
say in response to a particular probe.
Structured Inquiry: Next,
continue on to the more structured parts of the recall.
Q1. If the client
distinguishes between helpfulness "then" and
helpfulness "now," record both, writing
"then" and "now" next to the ratings. Be
sure to check these ratings against the rating the client
originally gave the event on the H.A.T. questionnaire; it is
very common for helpfulness to change between filling out the
H.A.T. and recall. If this is the case, ask in an inquiring,
interested manner about the discrepancy, to find out its cause
(usually it reflects the impact of the research procedures on
the client's experience of the event).
Impact ratings: Notes:
Make sure the client
understands that he/she is to make these ratings on the basis of
the descriptor(s) which fit best, and encourage him/her to tell
you this (you can circle any descriptors the client mentions as
particularly appropriate, and cross out any which are explicitly
ruled out). Encourage the client to use the "experiential
matching" procedure described in the instructions for these
Follow- up questions:
When the client gives a "3," "4" or
"5" rating for an impact, ask him/her to describe the
content of the impact, that is, what it about. The
"suggested follow-up probes" sheet is essential for
follow-up probes also act as checks to make sure the client is
using the rating scales properly; if the client's answer to the
probe doesn't seem to fit, ask him/her the probe again or ask
him/her to explain further. Make a note if you think the client
has misunderstood the category, but don't push him/her any
further than this.
Most important impact
(Q18): Hand the client the recall form so s/he can glance
through his/her ratings to pick the most important or helpful
impact (Note: It doesn't have to be the highest rating; but if
it isn't, reflect this back to the client: "So, even though
you didn't give _____ the highest rating, it was still the most
important for you.")
Client Feelings and other
Experiences Ratings: For questions 8-12, ask the client to
describe the specific experience on which the rating is based.
Take notes to record anything
else that comes up (e.g., client remarks about the procedure.)
Administration of Client One-Month
Review Questionnaire: The first One-Month
Review should be done with the client; after that, it can be carried out
with clients either in person or by mailing forms to them. Since we do
recalls every four sessions, it is usually convenient to do the One-Month
Review from the previous recall at the same time as the next recall. The
client review can be done either at the beginning or the end of the recall
Client Recall: Administrative
Prepare Client One-Month
Review Questionnaire. While you have the client recall forms at
hand, take a moment to put the appropriate information on the Client
One-Month Review Questionnaire. (This will save having to hunt through
files later and will decrease the likelihood of the forms being
Look up H.A.T. description
of the event you've just gone over with the client. Copy the
descriptive information regarding event itself from questions 1
and 2 on H.A.T. form; be sure to edit out information on impacts
(to avoid prejudicing review data); write this in the space at the
top of the form.
Look up the "possible
changes" section of Client Event Recall Form from today's
event; copy these onto the lines in question 6, page 4 of the
One-Month Review Questionnaire.
Check over data for
completeness and legibility. Please carefully check over the
information you have recorded on the client event description form to
make sure it is complete and legible; the information is no good if no
one can read it!
Part Two: Therapist Recall
Preparation for Therapist Self-recall
Label all record sheets, forms, and
tapes for case, session and date.
Write the number of any
"peak" therapist responses in the appropriate spaces in
"Sequence" section of the Therapist Event Recall Form. If the
client has not specified a peak for the event, use the first major
therapist speaking turn in the event, and fill in detail on the event
Rewind session video or audio tape
to beginning of event.
If applicable, write note reminding
therapist to do his/her One-Month Review Questionnaire for the previous
Take a blank Therapist One-Month
Review Questionnaire and attach a note to it asking the therapist to
prepare the form after doing his/her recall, then file it in the
"Therapist Event Review Pending" file.
Deliver tape, Therapist Event Recall
Form, blank Therapist One-Month Review Questionnaire, and records of event
Therapist Recall :
It is very helpful for the therapist
to have some familarity with the Comprehensive Process Analysis (CPA)
framework, since parts of the Therapist Event Recall Form are based on it.
In particular, the Context section is derived from the levels of context
part of the CPA framework.
The first time a therapist goes
through recall, he or she should be taken through it as a structured
interview by someone with a good knowledge of the procedure and the CPA
framework. In this way, any misunderstandings or confusions about the
intent of particular questions can be cleared up immediately. After the
first time, however, the therapist can fill out the form on his/her own,
as a questionnaire. (Allow 1-2 hours for this, depending on experience and
complexity of event.)
Suggestions for Doing Therapist
In filling out the Therapist
Event Recall Form, the therapist is allowed (and encouraged) to jump
around from heading to heading, in order to make sure material is in
the right place. (This is particularly true of the Context section.)
Therapists should explicate
"obvious" aspects of the event and should not assume that
"everybody knows X"; it is precisely such "taken for
granted" assumptions or observations which may not be shared by
those working in different theoretical orientations. Being able to
explicate these assumptions is a valuable potential contribution of
It's OK to speculate freely
about "possible changes."
It's OK to be detailed in
describing client general characteristics.
Therapist One-Month Review
Therapist should do this
him/herself. He or she can consult the event notes used in the original
recall of the event, but it is often useful to look at the tape of the
Setting up Therapist One-Month
Review Questionnaire. At the end of your self-recall, look up the
"possible changes" on Therapist Event Description Form and
transfer these to rating scales on review questionnaire. Attach the event
notes to the Questionnaire. If you forgot to do this, or can't find the
form, you'll have to set up a new one by looking up your Event Description
Form in the files.
Recommended Follow-up Probes for
Impact Ratings (7/88)
Whenever the client rates an impact
with a "3" or higher, she or he should be asked an appropriate
follow-up probe regarding the content of the impact. This practice also
serves as a check of whether the client is using an impact item properly.
Realization about self:
What was the new thing that you realized about yourself there?
Realization about someone
else: What was the new thing that you realized about
someone else there?
Awareness--Clarification: What was the
feeling or experience that you became more aware of or clearer