Читать книгу The Addiction Progress Notes Planner - Группа авторов - Страница 19

1 Build Trust and Establish Rapport (1)*Caring 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 anxiety 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 the expression of painful feelings; the client was 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 Nature of Anxiety Symptoms (3)The client was asked to describe past experiences of anxiety and their impact on functioning, including the focus, excessiveness, uncontrollability, type, frequency intensity, and duration of symptoms.The Anxiety and Related Disorders Interview Schedule for the DSM-5 was used to assess the client's anxiety symptoms.The assessment of the client's anxiety symptoms indicated that their symptoms are extreme and severely interfere with their life.The assessment of the client's anxiety symptoms indicated that these symptoms are moderate and occasionally interfere with daily functioning.The assessment of the client's anxiety symptoms indicated that these symptoms are mild and rarely interfere with daily functioning.The results of the assessment of the client's anxiety symptoms were reviewed with the client.

4 Administer Assessments for Anxiety Symptoms (4)The client was administered psychological instruments designed to objectively assess their level of anxiety.The client was administered the Penn State Worry Questionnaire.The client was administered the Outcome Questionnaire 45.2 (OQ-45.2).The client was administered the Symptom Checklist-90-R.The client was provided with feedback regarding the results of the assessment of their level of anxiety.The client declined to participate in the objective assessment of their level of anxiety, and this resistance was processed.

5 Refer for Assessment Regarding Etiology (5)The client was referred for an assessment to rule out nonpsychiatric medical etiologies for their anxiety.The client was referred for an assessment to rule out substance-induced etiologies for their level of anxiety.The client has complied with the referral and the results of this evaluation were reviewed.The client has not complied with the referral for a medical evaluation 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 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 the 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 their clinical presentation.The client was assessed for gender-related issues that could help to better understand 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 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 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 their impairment in social, relational, vocational, and occupational endeavors.It was reflected to the client that their impairment appears to create mild to moderate effects on the client's functioning.It was reflected to the client that 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 Refer to a Physician (10)The client was referred to a prescribing clinician for an evaluation for a prescription of psychotropic medications.The client was reinforced for following through on a referral to a prescribing clinician for an assessment for a prescription of psychotropic medications, but none were prescribed.The client has been prescribed psychotropic medications.The client declined evaluation by a physician for a prescription of psychotropic medications and was redirected to cooperate with this referral.

11 Monitor Medications (11)The client was monitored for compliance with the psychotropic medication regimen.The client was provided with positive feedback about regular use of psychotropic medications.The client was monitored for the effectiveness and side effects of the prescribed medications.Concerns about the client's medication effectiveness and side effects were communicated to the prescribing clinician.Although the client was monitored for medication side effects, they reported no concerns in this area.

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

13 Explore Anxiety/Addiction Making Life Unmanageable (13)The client was presented with the concept that powerlessness over anxiety and addiction makes their life unmanageable.The client was assisted in identifying specific instances wherein they have been powerless over addiction and have experienced anxiety, causing life to be unmanageable.As the client's anxiety has decreased, their life has been noted to be somewhat more manageable.The client denied any concerns in regard to anxiety/addiction making life unmanageable and was provided with feedback about how the clinician sees this occurring.

14 Teach Anxiety/Addiction Relationship (14)The client was taught the relationship between anxiety and addiction, including how substances can be used to treat the anxious symptoms.The client was taught about how more substance abuse becomes necessary to cope with the ongoing anxiety symptoms.The client was assigned “Coping With Stress” from the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).The client accepted the relationship between anxiety and addiction and was assisted in identifying specific examples from experience that support this pattern.The client reported decreased substance use during anxious situations, and this success was celebrated.It was noted that despite learning about the connection between anxiety and addiction, the client has not decreased substance use during anxious situations.The client has not completed the “Coping With Stress” homework and was redirected to do so.

15 Discuss Anxiety Components (15)The client was taught how anxiety typically involves excessive worry about unrealistically appraised threats, various bodily expressions of overarousal, hypervigilance, and avoidance of what is threatening that interact to maintain the problem.The client was taught how treatment breaks the anxiety cycle by encouraging positive, corrective experiences.The client was taught information from Mastery of Your Anxiety and Worry: Therapist Guide (Zinbarg, Craske, & Barlow) or Treating Generalized Anxiety Disorder (Rygh & Sanderson) regarding the anxiety pattern.The client was reinforced as they displayed a better understanding of the anxiety cycle of unwarranted fear and avoidance and how treatment breaks the cycle.The client displayed a poor understanding of the anxiety and was provided with remedial feedback in this area.

16 Discuss Target of Treatment (16)A discussion was held about how treatment targets worry, anxiety symptoms, and avoidance to help the client manage worry effectively.The reduction of overarousal and unnecessary avoidance and a reengagement in rewarding activities were emphasized as treatment targets.The client displayed a clear understanding of the target of treatment and was provided with positive feedback in this area.The client struggled to understand the target of treatment and was provided with specific examples in this area.

17 Assign Reading on Anxiety (17)The client was assigned to read psychoeducational chapters of books or treatment manuals on anxiety.The client was assigned information from Mastery of Your Anxiety and Worry: Workbook (Barlow & Craske) or The Anxiety and Worry Workbook (Clark & Beck).The client has read the assigned information on anxiety, and key points were reviewed.The client has not read the assigned information on anxiety and was redirected to do so.

18 Teach Relaxation Skills (18)The client was taught calming/relaxation/mindfulness skills.The client was taught skills such as applied relaxation, progressive muscle relaxation, cue-controlled relaxation, mindful breathing, and biofeedback.The client was taught how to discriminate better between relaxation and tension.The client was assigned “Progressive Muscle Relaxation” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, McInnis, & Bruce).The client was taught how to apply relaxation skills to daily life.The client was taught relaxation skills as described in New Directions in Progressive Muscle Relaxation (Bernstein, Borkovec, & Hazlett-Stevens) or The Relaxation and Stress Reduction Workbook (Davis et al.).The client was provided with feedback about use of relaxation skills.

19 Assign Relaxation Homework (19)The client was assigned to do homework exercises in which they practice calming/relaxation/mindfulness skills on a daily basis.The client was assigned “Deep Breathing Exercise” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client has regularly used relaxation exercises, and the helpful benefits of these exercises were reviewed.The client has not regularly used relaxation exercises and was provided with corrective feedback in this area.The client has used some relaxation exercises but does not find these to be helpful; the client was assisted in brainstorming how to modify these exercises to be more helpful.

20 Implement Worry Time (20)The client was taught to implement “worry time”—delaying the worry about various environmental settings until a designated “worry time.”The rationale for using a “worry time” was explained, focusing on trying to limit the association between various environmental settings and the experience of worry.The client was assigned the “Worry Time” exercise in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client and therapist agreed upon a specific “worry time” and the client was urged to implement this process.

21 Teach Techniques to Postpone Until Worry Time (21)The client was taught how to recognize, stop, and postpone worry until the agreed-upon worry time.Skills were taught to the client, including thought-stopping, relaxation, and redirection of attention.The “Making Use of the Thought-Stopping Technique” exercise from the Adult Psychotherapy Homework Planner (Jongsma & Bruce) was assigned.The client was encouraged to use the techniques in daily life.The client's use of recognizing, stopping, and postponing worry techniques was reviewed within the session, with reinforcement for success and corrective feedback toward improvement.

22 Discuss Estimation Errors (22)In today's session, examples were discussed about how unrealistic worry typically overestimates a probability of threats.The client was assigned “Past Successful Anxiety Coping” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).It was noted that unrealistic worry often underestimates the client's ability to manage realistic demands.The client was assisted in identifying specific examples of how unrealistic worry involves estimation errors.The client was reinforced for their insightful identification of unrealistic worry and inappropriate estimation.The client has struggled to identify estimation errors in regard to their unrealistic worry and was gently offered examples in this area.

23 Analyze Fears Logically (23)The client's fears were analyzed by examining the probability of their negative expectation becoming a reality, the consequences of the expectation if it occurred, their ability to control the outcome, the worst possible result if the expectation occurred, and their ability to cope if the expectation occurred.The client was assigned “Analyze the Probability of a Feared Event” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was assigned material from Cognitive Therapy of Anxiety Disorders (Clark & Beck).The client's ability to control the outcome of circumstances was examined and the effectiveness of worry on that outcome was also examined.Cognitive therapy techniques have been effective at helping the client understand beliefs and distorted messages that produce worry and anxiety.As the client has increased understanding of distorted, anxiety-producing cognitions, their anxiety level has been noted to be decreasing.Despite the client's increased understanding of distorted messages that produce worry and anxiety, their anxiety level has not diminished.

24 Develop Insight Into Worry as Avoidance (24)The client was assisted in gaining insight into how worry creates acute and/or chronic anxious apprehension, leading to avoidance that precludes finding solutions to problems and maintains a worry-avoidance cycle.The client was reinforced for their insightful understanding about how worry creates an avoidance cycle.The client struggled to understand the nature of worry as a form of avoidance and was provided with remedial information in this area.

25 Identify Distorted Thoughts (25)Through the use of cognitive behavioral therapy techniques, the client was assisted in exploring self-talk, underlying assumptions, schemas, or metacognition that mediate anxiety.The client was assisted in challenging and changing biases and conducting behavioral experiments to test predictions toward dispelling unproductive worry and increasing self-confidence in addressing the subject of worry.The client was reinforced as they verbalized an understanding of the cognitive beliefs and messages that mediate anxiety responses.The client was assisted in replacing distorted messages with positive, realistic cognitions.The client failed to identify distorted thoughts and cognitions and was provided with tentative examples in this area.

26 Assign Exercises on Self-Talk (26)The client was assigned homework exercises in which they identify fearful self-talk creates reality-based alternatives and tests through behavioral experiments.The client was assigned “Negative Thoughts Trigger Negative Feelings” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client's replacement of fearful self-talk with reality-based alternatives was reviewed.The client was reinforced for successes at replacing fearful self-talk with reality-based alternatives.The client was provided with corrective feedback for failures to replace fearful self-talk with reality-based alternatives.The client has not completed their assigned homework regarding fearful self-talk and was redirected to do so.

27 Construct Anxiety Stimulus Hierarchy (27)The client was assisted in constructing a hierarchy of feared and avoided activities, procedures, and conditions or social events.The client was assigned the “Gradually Reducing Your Phobic Fear” exercise in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).It was difficult for the client to develop a hierarchy of stimulus situations, as the causes of their anxiety remain quite vague; they were assisted in completing the hierarchy.The client was successful at creating a focused hierarchy of specific stimulus situations that provoke anxiety in a gradually increasing manner; this hierarchy was reviewed.

28 Select Initial Exposures (28)Initial exposures were selected from the hierarchy of anxiety-producing situations, with a bias toward the likelihood of being successful.A plan was developed with the client for managing the symptoms that may occur during the initial exposure.The client was assisted in rehearsing the plan for managing the exposure-related symptoms within their imagination.Positive feedback was provided for the client's helpful use of symptom management techniques.The client was redirected for ways to improve symptom management techniques.

29 Conduct Worry Exposure (29)The client was asked to vividly imagine worst-case consequences of worries, holding them in mind until the anxiety associated with them decreases.The client was asked to imagine consequences of worries as described in Mastery of Your Anxiety and Worry: Therapist Guide (Zinbarg, Craske, & Barlow).The client was supported as they maintained a focus on the worst-case consequences of worry until the anxiety weakened.The client was assisted in generating reality-based alternatives to the worst-case scenarios, and these were processed within the session.

30 Conduct Exposure in Vivo (30)The client was assisted in engaging in activities usually avoided because of unrealistic worry.The client was assisted in removing any unnecessary, anxiety-drive safety behaviors as described in Mastery of Your Anxiety and Worry: Therapist Guide (Zinbarg, Craske, & Barlow).The client was supported while engaging in difficulty activities until anxiety weakened.

31 Assign Homework on Situational Exposures (31)The client was assigned homework exercises to perform worry exposures and record their experience.The client was assigned situational exposure homework from Mastery of Your Anxiety and Worry: Workbook (Craske & Barlow).The client's use of worry exposure techniques was reviewed and reinforced.The client has struggled in implementation of worry exposure techniques and was provided with corrective feedback.The client has not attempted to use the worry exposure techniques and was redirected to do so.

32 Teach Problem-Solving Strategies (32)The client was taught a specific problem-solving strategy to reduce unproductive worry or avoidance.The client was taught problem-solving strategies including specifically defining a problem, generating options for addressing it, evaluating the pros and cons of each option, selecting and implementing an action plan, and reevaluating and refining the plan.The client was provided feedback on the use of the problem-solving strategies.The client was unable to make use of problem-solving strategies and remedial feedback was given.

33 Assign Problem-Solving Exercise (33)The client was assigned a homework exercise in which they solve a current problem about which they worry.The client was assigned a problem to solve as described in Mastery of Your Anxiety and Worry: Workbook (Craske & Barlow).The client was assigned “Applying Problem-Solving to Interpersonal Conflict” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was provided with feedback about ther use of the problem-solving assignment.

34 Engage in Behavioral Activation (34)The client was engaged in “behavioral activation” by scheduling activities that have a high likelihood for pleasure and mastery.The client was directed to complete tasks from the “Identify and Schedule Pleasant Activities” assignment from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).Instruction, rehearsal, role-playing, role reversal, and other techniques were used to engage the client in behavioral activation.The client was reinforced for success in scheduling activities that have a high likelihood for pleasure and mastery.The client has not engaged in pleasurable activities and was redirected to do so.

35 Develop Interpersonal Skills and Relationships (35)As interpersonal deficits were identified as a primary factor in the client's anxiety, they were assisted in developing new interpersonal skills and relationships.The client displayed a clear understanding of the new interpersonal skills and relationships and was reinforced for this success.The client has struggled in regard to developing new interpersonal skills and relationships and was redirected in this area.

36 Assign Homework on Social Skills (36)The client was assigned a homework exercise in which they implement social skills in everyday life.The client was assigned the homework exercise “Restoring Socialization Comfort” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client's use of homework exercises in daily life was reviewed, with reinforcement for success and corrective feedback toward improvement.The client did not complete homework exercises and was redirected to do so.

37 Use Acceptance-Based Therapies (37)Techniques from acceptance-based therapies were used to help the client accept worries and overcome avoidance.The client was assisted in identifying and expanding acceptance rather than judgment and avoidance or internal experiences.The client was assisted in promoting action in areas of importance.The client was asked to read The Mindful Way Through Anxiety (Orsillo & Roemer) and key concepts were reviewed.

38 Differentiate Between Lapse and Relapse (38)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 symptoms, fears, or urges to avoid.A relapse was associated with the decision to return to fearful and avoidant patterns.The client was provided with support and encouragement while displaying 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.

39 Discuss Management of Lapse Risk Situations (39)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 circumstances in which lapses could occur.The client was reinforced for appropriate use of lapse management skills.The client was redirected in regard to poor use of lapse management skills.

40 Encourage Continued Use of Strategies (40)The client was instructed to continue using new and effective therapeutic skills (e.g., relaxation, cognitive restructuring, exposure and problem-solving).The client was urged to find ways to build new strategies into their life as much as possible.The client was reinforced as they reported ways in which they have incorporated coping strategies into their life and routine.The client was redirected about ways to incorporate new strategies into their routine and life.

41 Develop a “Coping Card” (41)The client was given a “coping card” or other reminder on which new and effective worry management skills and other important information are available to the client for later use.The client was assisted in developing the “coping card” in order to list helpful coping strategies.The client was encouraged to use the “coping card” when struggling with anxiety-producing situations.

42 Schedule a “Maintenance” Session (42)The client was scheduled for a “maintenance” session between 1 and 3 months after therapy ends.The client was advised to contact the therapist if they need to be seen prior to the “maintenance” session.The client's “maintenance” session was held and the client was reinforced for successful implementation of therapy techniques.The client's “maintenance” session was held and the client was coordinated for further treatment, as progress has not been sustained.

43 Process Family-of-Origin Experiences (43)Today's therapy session explored family-of-origin experiences for learning to be fearful and anxious.The client was asked to explore how childhood experiences relate to current anxious thoughts, feelings, and behavior.The client was encouraged to honestly and openly share regarding past rejection experiences, harsh criticism, abandonment, or trauma.The client was given support and affirmation regarding the uncomfortable feelings related to fear-producing situations from their family of origin.As the client has progressed in treatment, verbally expressing and clarifying feelings from the past have become easier.The client has continued to struggle with openly and honestly sharing feelings associated with past rejection experiences, harsh criticism, abandonment, or trauma and was urged to do so as they feel safer.

44 Assign Books on Shame (44)The client was assigned to read excerpts from books related to shame.The client was assigned to read Healing the Shame That Binds You (Bradshaw) and Facing Shame (Fossum & Mason).The client has followed through with learning about shame through books (e.g., Healing the Shame That Binds You [Bradshaw], Facing Shame [Fossum & Mason]), and the key concepts were processed.The client has not followed through on reading books related to shame (e.g., Healing the Shame That Binds You [Bradshaw], Facing Shame [Fossum & Mason]) and was redirected to do so.

45 Develop Positive Self-Descriptive Statements (45)The client was asked to make a list of 10 positive self-descriptive statements.The client was assigned “Positive Self-Talk” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client has followed through on making a list of positive self-descriptive statements, and these were reviewed.It was reflected to the client that they have developed a pattern of describing self more positively and have been feeling an increased level of self-esteem.The client has not followed through on developing a list of positive self-descriptive statements and was encouraged to do so.

46 Use Step 3 (46)The client was taught a 12-step program's third step, focusing on how to turn problems, worries, and anxieties over to a higher power.The client was taught about trusting that a higher power is going to help resolve the situation.The client has begun turning problems, worries, and anxieties over to a higher power and is trusting that the higher power is going to help resolve the situation; this progress was reinforced.The client rejected the idea of turning problems, worries, and anxieties over to a higher power and does not feel that this concept will be helpful in resolving anxiety; the client was urged to remain open to these concepts.

47 Develop Alternative Actions (47)The client was assisted in developing a list of situations in which they feel anxious and crave substances.The client was assigned “Coping With Stress” and “Benefits of Helping Others” in the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).The client was assisted in developing an alternative constructive plan of action for when they feel anxious and crave substances (e.g., relaxation exercises, physical exercise, call a sponsor, go to a meeting, call the counselor, talk to someone).The client was reinforced in implementing positive coping strategies to deal with situations that trigger anxiety and craving substance use.The client has resisted identifying anxiety-producing situations and times when they crave substances and is noted to be vulnerable to relapse because of this resistance.

48 Probe Family-of-Origin Experiences (48)Today's therapy session explored family-of-origin experiences for learning to be fearful and anxious.The client was asked to explore how childhood experiences relate to current anxious thoughts, feelings, and behavior.The client was given support and affirmation regarding the uncomfortable feelings related to fear-producing situations from their family of origin.The client continued to exhibit anxiety related to family-of-origin experiences and was provided with remedial information in this area.

49 Assign Step 4 Exercise (49)The client was taught about a 12-step program's Step 4, focusing on detailing the exact nature of their wrongs and forgiveness.The client was directed to write an autobiography detailing the exact nature of their wrongs.The client was assigned the Step 4 exercise from The Alcoholism and Drug Abuse Client Workbook (Perkinson).Active listening skills were provided as the client has completed an autobiography and has detailed the exact nature of their wrongs.The client endorsed the need to forgive self and others and has begun to process this; this insight was reinforced.The client described struggles regarding how to forgive self and others; these barriers were processed.The client has not completed the Step 4 exercise and was redirected to do so.

50 Develop Recovery Group Involvement (50)The client was taught about how active involvement in a recovery group is a way to build trust in others and confidence in self.The client was assigned “Aftercare Plan Components” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was referred to an appropriate recovery group.The client described involvement in an active recovery group, and the benefits they have experienced were reviewed.The client acknowledged that they have not followed through with involvement in a recovery group, and the client was redirected to do so.

51 Educate the Family About Anxiety Disorders (51)A family session was held to educate the client's family and significant others regarding anxiety disorder, treatment, and prognosis. Active listening was modeled.Family members expressed their positive support of the client and a more accurate understanding of anxiety and substance-abuse concerns.Family members were neither understanding nor willing to provide support to the client, in spite of diagnosis of an anxiety disorder; they were urged to reconsider this refusal.

52 Direct Family Members to List Support for Recovery (52)Family members were assisted in identifying ways in which they could be supportive of the client's sobriety.A family session was held to facilitate communication of techniques that the family can use to assist in the client's recovery.The client reported family members assisting significantly in encouragement and other techniques to help them recover from anxious behavior and addiction; the client was urged to express gratitude.The client's significant others were strongly encouraged to attend Al-Anon meetings on a regular basis to help support the client's recovery.

53 Assess Satisfaction (53)A treatment satisfaction survey was administered to the client.The client's survey responses indicated a high level of satisfaction with treatment services; these results were processed.The client's survey responses indicated a medium level of satisfaction with treatment services; these results were processed.The client's survey responses indicated a low level of satisfaction with treatment services; these results were processed.Although the client was encouraged to complete a treatment satisfaction survey, it was refused.