agreed to stop the pattern of self-mutilating behavior.There have been no recent reports of occurrences of suicidal gestures, threats, or self-mutilating behavior.8 Affective Instability (8)The client described a history of affective instability owing to marked mood reactivity when stress occurs.The client's mood reactivity is usually quite short lived, as the client returns to a calm state after demonstrating strong feelings of anger, anxiety, or depression.The client's emotional lability has been reduced and the client reports less-frequent incidents of mood reactivity.
9 Feelings of Emptiness (9)The client reported a chronic history of feeling empty and bored with life.The client's frequent complaints of feeling bored and that life had no meaning had alienated them from others.The client has not complained recently about feeling empty or bored but appears to be more challenged and at peace with life.
10 Intense Anger Eruptions (10)The client frequently has eruptions of intense and inappropriate anger triggered by seemingly insignificant stressors.The client seems to live in a state of chronic anger and displeasure with others.The client's eruptions of intense and inappropriate anger have diminished in their frequency and intensity.The client reported that there have been no incidents of recent eruptions of anger.
11 Transient Paranoia or Dissociation (11)The client reports transient stress-related paranoid ideation.The client has a history of dissociative symptoms when experiencing transient stress.The client has made progress in stabilizing the pattern of paranoid ideation and dissociative symptoms in reaction to transient stress.The client copes well with transient stress.
12 Feels Others Are Unfair (12)The client made frequent complaints about the unfair treatment the client believes that others have given them.The client frequently verbalized distrust of others and questioned their motives.The client has demonstrated increased trust of others and has not complained about unfair treatment from them recently.
13 Black-or-White Thinking (13)The client demonstrated a pattern of analyzing issues in simple terms of right or wrong, black or white, trustworthy versus deceitful, without regard for extenuating circumstances or considering the complexity of the situations.The client's black-or-white thinking has caused the client to be quite judgmental of others.The client finds it difficult to consider the complexity of situations but prefers to think in simple terms of right versus wrong.The client has shown some progress in allowing for the complexity of some situations and extenuating circumstances, which might contribute to some other people's actions.
INTERVENTIONS IMPLEMENTED
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 borderline 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 Behaviors, Emotional Dysregulation, and Cognitions (3)The client's experience of distress and disability was assessed to identify targets of therapy.The client's pattern of behaviors (e.g., self-harm, anger outbursts, apparent competence, active passivity) was assessed to help identify targets for therapy.The client's emotional dysregulation, including mood swings, sensitivity, and painful emptiness, was assessed in regard to targets for therapy.The client's cognitions were assessed, including biases such as dichotomous thinking, overgeneralization, and catastrophizing, to assist in identifying targets for therapy.Specific targets for therapy were identified.
4 Explore Childhood Abuse/Abandonment (4)Experiences of childhood physical or emotional abuse, neglect, or abandonment were explored.As the client identified instances of abuse and neglect, the feelings surrounding these experiences were processed.The client's experiences with perceived abandonment were highlighted and related to current fears of this experience occurring in the present.As the client's experience of abuse and abandonment in childhood was processed, the client denied any emotional impact of these experiences.The client denied any experience of abuse and abandonment in childhood and was urged to talk about these types of concerns as they deem it necessary in the future.
5 Assess Substance Use History (5)The client's use of alcohol and other mood-altering substances was assessed.The client's use of alcohol and other mood-altering substances can be treated as a self-harm behavior.The client's use of alcohol and other mood-altering substances can be treated as an impulsive behavior.The client was referred for a more in-depth substance use assessment.
6 Arrange Substance Abuse Evaluation (6)The client's use of alcohol and other mood-altering substances was assessed.The client was assessed to have a pattern of mild substance use.The client was assessed to have a pattern of moderate substance use.The client was assessed to have a pattern of severe substance use.The client was referred for a substance use treatment.The client was found to not have any substance use concerns.
7 Assess Level of Insight (7)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.
8 Assess for Correlated Disorders (8)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.
9 Assess for Culturally Based Confounding Issues (9)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 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.
10 Assess Severity of Impairment (10)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
