Читать книгу The Adult Psychotherapy Progress Notes Planner - Berghuis David J., Arthur E. Jongsma Jr., David J. Berghuis - Страница 11

1 Establish Rapport (1)²Caring was conveyed to the client through support, warmth, and empathy.The client was provided with nonjudgmental support and a level of trust was developed.The client was urged to feel safe in expressing his/her/their anger symptoms.The client began to express feelings more freely as rapport and trust level have increased.The client has continued to experience difficulty being open and direct about his/her/their expression of painful feelings; he/she/they were encouraged to use the safe haven of therapy to express these difficult issues.

2 Focus on Strengthening Therapeutic Relationship (2)The relationship with the client was strengthened using empirically supported factors.The relationship with client was strengthened through the implementation of a collaborative approach, agreement on goals, demonstration of empathy, verbalization of positive regard, and collection of client feedback.The client reacted positively to the relationship-strengthening measures taken.The client verbalized feeling supported and understood during therapy sessions.Despite attempts to strengthen the therapeutic relationship, the client reports feeling distant and misunderstood.The client has indicated that sessions are not helpful and will be terminating therapy.

3 Assess Anger Dynamics (3)The client was assessed for various stimuli that have triggered his/her/their anger.The client was assisted in identifying situations, people, and thoughts that have triggered his/her/their anger.The client was assisted in identifying the thoughts, feelings, and actions that have characterized his/her/their anger responses.

4 Administer Psychological Testing (4)The client was administered psychometric instruments designed to objectively assess anger expression.The client was assessed with the Anger, Irritability, and Assault Questionnaire (AIAQ).The client was assessed with the Buss-Durkee Hostility Inventory (BDHI).The client was assessed with the State-Trait Anger Expression Inventory (STAXI).The client was given feedback about the results of the assessment.

5 Refer for Physical Examination (5)The client was referred for a complete physical examination to rule out organic contributors (e.g. brain damage, tumor, elevated testosterone levels) to his/her/their anger.The client has complied with the physical examination and the results were shared with him/her/them.The physical examination has identified organic contributors to poor anger control and treatment was suggested.The physical examiner has not identified any organic contributors to poor anger control, and this was reflected to the client.The client has not complied with the physical examination to assess organic contributors and was redirected to do so.

6 Assess Level of Insight (6)The client's level of insight toward the presenting problems was assessed.The client was assessed in regard to the syntonic versus dystonic nature of his/her/their insight about the presenting problems.The client was noted to demonstrate good insight into the problematic nature of the behavior and symptoms.The client was noted to be in agreement with others' concerns and is motivated to work on change.The client was noted to be ambivalent regarding the problems described and is reluctant to address the issues as a concern.The client was noted to be resistant regarding acknowledgment of the problem areas, is not concerned about them, and has no motivation to make changes.

7 Assess for Correlated Disorders (7)The client was assessed for evidence of research-based correlated disorders.The client was assessed in regard to his/her/their level of vulnerability to suicide.The client was identified as having a comorbid disorder, and treatment was adjusted to account for these concerns.The client has been assessed for any correlated disorders, but none were found.

8 Assess for Culturally Based Confounding Issues (8)The client was assessed for age-related issues that could help to better understand his/her/their clinical presentation.The client was assessed for gender-related issues that could help to better understand his/her/their clinical presentation.The client was assessed for cultural syndromes, cultural idioms of distress, or culturally based perceived causes that could help to better understand his/her/their clinical presentation.Alternative factors have been identified as contributing to the client's currently defined “problem behavior,” and these were taken into account in regard to his/her/their treatment.Culturally based factors that could help to account for the client's currently defined “problem behavior” were investigated, but no significant factors were identified.

9 Assess Severity of Impairment (9)The severity of the client's impairment was assessed to determine the appropriate level of care.The client was assessed in regard to his/her/their impairment in social, relational, vocational, and occupational endeavors.It was reflected to the client that his/her/their impairment appears to create mild to moderate effects on the client's functioning.It was reflected to the client that his/her/their impairment appears to create severe to very severe effects on the client's functioning.The client was continuously assessed for the severity of impairment, as well as the efficacy and appropriateness of treatment.

10 Identify Positive Consequences of Anger Management (10)The client was asked to identify the positive consequences he/she/they have experienced in managing his/her/their anger.The client was assigned the homework exercise “Alternatives to Destructive Anger” from the Adult Psychotherapy Homework Planner (Jongsma).The client was assisted in identifying positive consequences of managing anger (e.g. respect from others and self, cooperation from others, improved physical health).The client was asked to agree to learn new ways to conceptualize and manage anger.

11 List Negative Anger Impact (11)The client was assisted in listing ways that his/her/their explosive expression of anger has negatively impacted his/her/their life.The client was supported as he/she/they identified many negative consequences that have resulted from his/her/their poor anger management.It was reflected to the client that his/her/their denial about the negative impact of his/her/their anger has decreased and he/she/they have verbalized an increased awareness of the negative impact of his/her/their behavior.The client has been guarded about identifying the negative impact of his/her/their anger and was provided with specific examples of how his/her/their anger has negatively impacted his/her/their life and relationships (e.g. injuring others or self, legal conflicts, loss of respect from self or others, destruction of property).

12 Use Motivational Interviewing (12)Motivational interviewing techniques were used to help the client clarify his/her/their stage of motivation to change.Motivational interviewing techniques were used to help move the client to the action stage in which he/she/they agree to learn new ways to conceptualize and manage anger.The client was assisted in identifying his/her/their dissatisfaction with the status quo and the benefits of making changes.The client was assisted in identifying his/her/their level of optimism for making changes.

13 Refer for Medication Evaluation (13)The client was referred to a prescribing clinician to evaluate him/her/them for psychotropic medication to reduce anger symptoms.The client has completed an evaluation by the prescribing clinician and has begun taking medications.The client has resisted the referral to a prescribing clinician and does not want to take any medication to reduce anger symptoms; his/her/their concerns were processed.

14 Monitor Medication Adherence (14)The client's adherence with the clinician's prescription for psychotropic medication was monitored for the medication's effectiveness and side effects.The client reported that the medication has been beneficial to him/her/them in reducing his/her/their experience of anger symptoms; the benefits of this progress were reviewed.The client reported that the medication does not seem to be helpful in reducing anger symptoms; this was reflected to the prescribing clinician.The therapist conferred with the prescribing clinician to discuss the client's reaction to the psychotropic medication, and adjustments were made to the prescription by the physician.

15 Assign Anger Journal (15)The client was assigned to keep a daily journal in which he/she/they will document persons or situations that cause anger, irritation, or disappointment.The client was assigned “Anger Journal” in the Adult Psychotherapy Homework Planner (Jongsma).The client has kept a journal of anger-producing situations, and this material was processed within the session.The client has become more aware of the causes for and targets of his/her/their anger as a result of journaling these experiences on a daily basis; the benefits of this insight were reflected to him/her/them.The client has not kept an anger journal and was redirected to do so.

16 List Targets of/Causes for Anger (16)The client was assigned to list as many of the causes for and targets of his/her/their anger that he/she/they are aware of.The client's list of targets of and causes for anger was processed in order to increase his/her/their awareness of anger management issues.The client has indicated a greater sensitivity to his/her/their angry feelings and the causes for them as a result of the focus on these issues.The client has not been able to develop a comprehensive list of causes for and targets of anger and was gently offered examples in this area.

17 Reconceptualize Anger (17)The client was assisted in reconceptualizing anger as involving different components that go through predictable phases.The client was taught about the different components of anger, including cognitive, physiological, affective, and behavioral components.The client was taught how to better discriminate between relaxation and tension.The client was taught about the predictable phases of anger, including demanding expectations that are not met, leading to increased arousal and anger, which leads to acting out.The client displayed a clear understanding of the ways to conceptualize anger and was provided with positive reinforcement.The client has struggled to understand the ways to conceptualize anger and was provided with remedial feedback in this area.

18 Process Anger Triggers (18)The client was assisted in processing the list of anger triggers and other relevant journal information.The client was assisted in understanding how cognitive, physiological, and effective factors interplay to produce anger.The client was reinforced for his/her/their insight into anger triggers and the cognitive, physiological, and effective factors.The client struggled to connect his/her/their anger triggers with cognitive, physiological, and effective factors and was provided with remedial information in this area.

19 Discuss Rationale for Treatment (19)The client was engaged in a discussion about the rationale for treatment.Emphasis was placed on how functioning can be improved through change in various dimensions of anger management.The concept of rationale for treatment and how functioning can be improved through change in the various dimensions of anger management was revisited.

20 Assign Reading Material (20)The client was assigned to read material that educates him/her/them about anger and its management.The client was directed to read Overcoming Situational and General Anger: Client Manual (Deffenbacher and McKay).The client was assigned to read Anger Management for Everyone (Kassinove and Tafrate).The client has read the assigned material on anger management and key concepts were reviewed.The client has not read the assigned material on anger management and was redirected to do so.

21 Teach Calming Techniques (21)The client was taught deep-muscle relaxation, rhythmic breathing, and positive imagery as ways to reduce muscle tension when feelings of anger are experienced.The client was assigned “Deep Breathing Exercise” in the Adult Psychotherapy Homework Planner (Jongsma).The client has implemented the relaxation techniques and reported decreased reactivity when experiencing anger; the benefits of these techniques were underscored.The client has not implemented the relaxation techniques and continues to feel quite stressed in the face of anger; he/she/they were encouraged to use the techniques.

22 Explore Self-Talk (22)The client's self-talk that mediates his/her/their angry feelings was explored.The client was assessed for self-talk, such as demanding expectations reflected in “should,” “must,” or “have to” statements.The client was assisted in identifying and challenging his/her/their biases and in generating alternative self-talk that correct for the biases.The client was taught about how to use correcting self-talk to facilitate a more flexible and temperate response to frustration.

23 Assign Self-Talk Homework (23)The client was assigned a homework exercise in which he/she/they identify angry self-talk and generate alternatives that help moderate angry reactions.The client was assigned “Journal and Replace Self-Defeating Thoughts” in the Adult Psychotherapy Homework Planner (Jongsma).The client's use of self-talk alternatives was reviewed within the session.The client was reinforced for his/her/their success in changing angry self-talk to more moderate alternatives.The client was provided with corrective feedback to help improve his/her/their use of alternative self-talk to moderate his/her/their angry reactions.

24 Role-Play Calming and Cognitive Coping (24)The client was assisted in visualizing anger-provoking scenes, then using relaxation and cognitive coping skills.The client engaged in role-plays regarding the use of relaxation and cognitive coping in anger-provoking scenes.The client was gradually moved from low to high anger-inducing scenes.The client was assigned to implement calming techniques in his/her/their daily life and when facing anger-triggering situations.The client's experience of using relaxation and cognitive coping in his/her/their daily life was processed, with reinforcement for success and problem solving for obstacles identified.

25 Assign Thought-Stopping Technique (25)The client was directed to implement a thought-stopping technique on a daily basis between sessions.The client was assigned “Making Use of the Thought-Stopping Technique” in the Adult Psychotherapy Homework Planner (Jongsma).The client's use of the thought-stopping technique was reviewed.The client was provided with positive feedback for his/her/their helpful use of the thought-stopping technique.The client was provided with corrective feedback to help improve his/her/their use of the thought-stopping technique.

26 Teach Assertive Communication (26)The client was taught about assertive communication through instruction, modeling, and role-playing.The client was assigned Your Perfect Right (Alberti and Emmons).The client was referred to an assertiveness training class.The client displayed increased assertiveness and was provided with positive feedback in this area.The client has not increased his/her/their level of assertiveness and was provided with additional feedback in this area.

27 Teach Problem-Solving Skills (27)The client was taught problem-solving skills.The client was taught about defining the problem clearly, brainstorming multiple solutions, listing the pros and cons of each solution, seeking input from others, selecting and implementing a plan of action, and evaluating and readjusting the outcome.The client was assigned “Problem-Solving: An Alternative to Impulsive Action” in the Adult Psychotherapy Homework Planner (Jongsma).The client displayed a clear understanding of the use of the problem-solving skills and displayed this through examples.The client struggled to understand the use of problem-solving skills and was provided with remedial feedback in this area.

28 Teach Conflict Resolution Skills (28)The client was taught conflict resolution skills through modeling, role-playing, and behavioral rehearsal.The client was taught about empathy and active listening.The client was taught about “I messages,” respectful communication, assertiveness without aggression, and compromise.The client was reinforced for his/her/their clear understanding of the conflict resolution skills.The client displayed a poor understanding of the conflict resolution skills and was provided with remedial feedback.

29 Conduct Conjoint Session for Skill Generalizations (29)The client was asked to invite his/her/their significant other for a conjoint session.The client and his/her/their significant other were seen together in order to help implement assertiveness, problem-solving, and conflict resolution skills.The client was assigned “Applying Problem-Solving to Interpersonal Conflict” in the Adult Psychotherapy Homework Planner (Jongsma).The client was reinforced for his/her/their increased use of assertiveness, problem-solving, and conflict resolution skills with his/her/their significant other.The client's significant other was urged to assist the client in his/her/their use of assertiveness, problem-solving, and conflict resolution skills.The client has not regularly used assertiveness, problem-solving, and conflict resolution skills with his/her/their significant other and was assisted in identifying barriers to this success.

30 Construct Strategy for Managing Anger (30)The client was assisted in constructing a client-tailored strategy for managing his/her/their anger.The client was encouraged to combine somatic, cognitive, communication, problem-solving, and conflict resolution skills relevant to his/her/their needs.The client was reinforced for his/her/their comprehensive anger management strategy.The client was redirected to develop a more comprehensive anger management strategy.

31 Select Challenging Situations for Managing Anger (31)The client was provided with situations in which he/she/they may be increasingly challenged to apply his/her/their new strategies for managing anger.The client was asked to identify his/her/their likely upcoming challenging situations for managing anger.The client was urged to use his/her/their strategies for managing anger in successively more difficult situations.

32 Consolidate Anger Management Skills (32)Techniques were used to help the client consolidate his/her/their new anger management skills.Techniques such as relaxation, imagery, behavioral rehearsal, modeling, role-playing, or in vivo exposure/behavioral experiences were used to help the client consolidate the use of his/her/their new anger management skills.The client's use of techniques to consolidate his/her/their anger management skills were reviewed and reinforced.

33 Monitor/Decrease Episodes (33)The client's reports of angry episodes were monitored, toward the goal of decreasing their frequency, intensity, and duration.The client was urged to use his/her/their new anger management skills to decrease the frequency, intensity, and duration of his/her/their anger episodes.The client was assigned “Alternatives to Destructive Anger” in the Adult Psychotherapy Homework Planner (Jongsma).The client's progress in decreasing his/her/their angry episodes was reviewed.The client was reinforced for his/her/their success at decreasing the frequency, intensity, and duration of his/her/their anger episodes.The client has not decreased his/her/their frequency, intensity, or duration of anger episodes, and corrective feedback was provided.

34 Provide Rationale for Relapse Prevention (34)The client was provided with the rationale for relapse prevention.The client was helped to understand that treatment will focus on identifying risks and introducing strategies to prevent the risk situations from continuing on.

35 Differentiate Between Lapse and Relapse (35)A discussion was held with the client regarding the distinction between a lapse and a relapse.A lapse was associated with an initial and reversible return of angry outbursts.A relapse was associated with the decision to return to the old pattern of anger.The client was provided with support and encouragement as he/she/they displayed an understanding of the difference between a lapse and a relapse.The client struggled to understand the difference between a lapse and a relapse and was provided with remedial feedback in this area.

36 Discuss Management of Lapse Risk Situations (36)The client was assisted in identifying future situations or circumstances in which lapses could occur.The session focused on rehearsing the management of future situations or circum- stances in which lapses could occur.The client was reinforced for his/her/their appropriate use of lapse management skills.The client was redirected in regard to his/her/their poor use of lapse management skills.

37 Encourage Routine Use of Strategies (37)The client was instructed to routinely use the strategies that he/she/they have learned in therapy (e.g. calming, adaptive self-talk, assertion, and/or conflict resolution).The client was urged to find ways to build his/her/their new strategies into his/her/their life as much as possible.The client was reinforced as he/she/they reported ways in which he/she/they have incorporated coping strategies into his/her/their life and routine.The client was redirected about ways to incorporate his/her/their new strategies into his/her/their routine and life.

38 Develop a “Coping Card” (38)The client was provided with a “coping card” on which specific coping strategies were listed.The client was assisted in developing his/her/their “coping card” in order to list his/her/their helpful coping strategies.The client was encouraged to use his/her/their “coping card” when struggling with anger-producing situations.

39 Schedule “Maintenance” Sessions (39)The client was assisted in scheduling “maintenance” sessions to help maintain therapeutic gains and adjust to life without anger outbursts.Positive feedback was provided to the client for his/her/their maintenance of therapeutic gains.The client has displayed an increase in anger symptoms and was provided with additional relapse prevention strategies.

40 Teach Forgiveness (40)The client was taught about the process of forgiveness and encouraged to begin to implement this process as a means of letting go of his/her/their feelings of strong anger.The client focused on the perpetrators of pain from the past, and he/she/they were encouraged to target them for forgiveness.The advantages of implementing forgiveness versus holding on to vengeful anger were processed with the client.Positive feedback was provided as the client has committed self to attempting to begin the process of forgiveness with the perpetrators of pain.The client has not been able to begin the process of forgiveness of the perpetrators of his/her/their pain and was urged to start this process as he/she/they feel able to.

41 Assign Books on Forgiveness (41)The client was assigned to read books on forgiveness.The client was assigned to read the book Forgive and Forget (Smedes) to increase his/her/their sensitivity to the process of forgiveness.The client has read the book Forgive and Forget and key concepts were processed within the session.The client acknowledged that holding on to angry feelings has distinct disadvantages over his/her/their beginning the process of forgiveness; he/she/they were urged to start this process.The client has not followed through with completing the reading assignment of Forgive and Forget and was encouraged to do so.

42 Assign Forgiveness Letter (42)The client was asked to write a letter of forgiveness to the target of his/her/their anger as a step toward letting go of that anger.The client has followed through with writing a letter of forgiveness of the perpetrator of pain from his/her/their past, and this was processed within the session.The client has not followed through with writing the forgiveness letter and was noted to be very resistive to letting go of his/her/their feelings of angry revenge.Writing and processing the letter of forgiveness have reduced the client's feelings of anger and increased his/her/their capacity to control its expression.

43 Use ACT Approach (43)The use of acceptance and commitment therapy (ACT) was applied.The client was assisted in accepting and openly experiencing angry thoughts and feelings, without being overly impacted by them.The client was assisted in committing his/her/their time and efforts to activities that are consistent with identified personally meaningful values.The client has engaged well in the ACT approach and applied these concepts to his/her/their symptoms and lifestyle.The client has not engaged well in the ACT approach, and remedial efforts were applied.

44 Assign ACT Homework (44)The client was assigned homework situations in which he/she/they practice lessons from mindfulness meditation and ACT.The client was assisted in consolidating his/her/their mindfulness meditation and ACT approaches into his/her/their everyday life.

45 Assign Reading on Mindfulness and ACT (45)The client was assigned reading material consistent with mindfulness and the ACT approach to supplement work done in session.The client was assigned Get out of Your Mind and into Your Life (Hayes).The client has read assigned material and key concepts were processed.The client has not read assigned material and was redirected to do so.

46 Teach Mindfulness Meditation (46)The client was taught mindfulness meditation techniques to help recognize negative thought processes associated with anger.The client was taught to focus on changing his/her relationship with the anger-related thoughts by accepting the thoughts, images, and impulses that are reality-based while noticing, but not reacting to, non-reality-based mental phenomenon.The client was assisted in differentiating between reality-based thoughts and non-reality-based thoughts.The client has used mindfulness meditation to help overcome negative thought processes that trigger anger and was reinforced for this.The client has struggled to apply mindfulness meditation and was provided with remedial assistance in this area.

47 Identify Anger Expression Models (47)The client was assisted in identifying key figures in his/her/their life who have provided examples to him/her/them of how to positively or negatively express anger.The client was reinforced as he/she/they identified several key figures who have been negative role models in expressing anger explosively and destructively.The client was supported and reinforced as he/she/they acknowledged that he/she/they manage his/her/their anger in the same way that an explosive parent figure had done when he/she/they were growing up.The client was encouraged to identify positive role models throughout his/her/their life whom he/she/they could respect for their management of angry feelings.The client was supported as he/she/they acknowledged that others have been influential in teaching him/her/them destructive patterns of anger management.The client failed to identify key figures in his/her/their life who have provided examples to him/her/them as to how to positively express his/her/their anger and was questioned more specifically in this area.

48 Encourage Disclosure (48)The client was encouraged to discuss his/her/their anger management goals with trusted persons who are likely to support his/her/their change.The client was assisted in identifying individuals who are likely to support his/her/their change.The client has reviewed his/her/their anger management goals with trusted persons and their responses were processed.The client has not discussed his/her/their anger management goals and was redirected to do so.