A Comparison of Audio Recordings and Therapist's Process Notes in Child and Adolescent Psychoanalytic Psychotherapy

Therapistsʼ process notes - written descriptions of a session produced
shortly afterwards from memory - hold a significant role in child and
adolescent psychoanalytic psychotherapy. They are central in training, in
supervision, and in developing oneʼs understanding through selfsupervision
and forms of psychotherapy research. This thesis examines
such process notes through a comparison with audio recordings of the
same sessions. In so doing, it aims to generate theory that might illuminate
the causes of significantly patterned discrepancies between the notes and
recordings, in order to understand more about the processes at work in
psychoanalytic psychotherapy and to explore the nature of process notes,
their values and limitations.
The literature searches conducted revealed limited relevant studies. All
identified studies that compare process notes with recordings of sessions
seek to quantify the differences between the two forms of recording. Unlike
these, this thesis explores the meaning of the differences between process
notes and recordings through qualitative data analysis. Using
psychoanalytically informed grounded theory, in total nine sets of process
notes and recordings from three different psychoanalytic psychotherapists
are analysed. The analysis identifies eight core categories of findings.
Initial theories are developed from these categories, most significantly
concerning the role and influence of a ʻcore transference dynamicʼ
between therapist and patient. Further theory is developed on the nature
and function of process notes as a means for the therapistʼs conscious and
unconscious processing of the session, as well as on the nature of the
influence of the relationships – both internal and external – within which
they are written.
In the light of the findings, a proposal is made for a new approach for
learning about the patient and clinical work, ʻthe comparison methodʼ
(supervision involving a comparison of process notes and recordings),
and, in particular, for its inclusion within the training of psychoanalytic
psychotherapists. Further recommendations for research are also made.