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
