for Medication Evaluation (11)The client was assessed in regard to the need for psychotropic medication.The client was referred to a prescribing clinician to be evaluated for psychotropic medications to stabilize mood.The client has cooperated with a referral to a prescribing clinician and has attended the evaluation for psychotropic medications.The client has refused to attend a medication evaluation for psychotropic medications and was redirected to do so.12 Monitor Medication Adherence (12)The client's adherence with prescribed medications was monitored, and effectiveness of the medication on their level of functioning was noted.The client reported that the medication has been beneficial in stabilizing mood and was encouraged to continue its use.The client reported that the medication has not been beneficial in stabilizing mood; this was reflected to the prescribing clinician.The client reported side effects of the medication that they found intolerable; these side effects were relayed to the prescribing clinician.
13 Monitor Misuse (13)The client was informed of the risks of misusing medications.The client reported appropriate use of medication and was encouraged to continue its use.The client reported misusing medication and was redirected; this was reflected to the prescribing clinician.
14 Orient to Dialectical Behavioral Therapy (DBT) (14)The client was oriented to DBT.The multiple facets of DBT were highlighted, including support, collaboration, mindfulness, distress tolerance, coping, and interpersonal skill building.The use of exchange and negotiation, balancing of the rational and emotional mind, and acceptance and change strategies were emphasized.
15 Teach Biosocial View (15)The biosocial view related to borderline personality disorder was emphasized with the client.Biological and environmental vulnerabilities were explored with the client.
16 Assign Reading on Borderline Personality Disorder (16)The client was asked to read selected materials that reinforce therapeutic interventions.Portions of DBT Skills Training Handouts and Worksheets (Linehan) or The Dialectical Behavioral Therapy Skills Workbook (McKay, Wood, & Brantley) were assigned to the client.The client has read assigned materials and key concepts were reinforced.The client has not read assigned materials that reinforce therapeutic interventions and was redirected to do so.
17 Solicit Agreement for DBT (17)Using commitment strategies and motivational interviewing, an agreement was solicited from the client to work collaboratively within the parameters of the DBT approach.The client was assigned “Addressing Readiness and Motivation” in the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).A written agreement was developed with the client to work collaboratively within the parameters of the DBT approach.The client has agreed to work within the DBT approach, including staying in therapy for the specified time period, attending scheduled therapy sessions, reducing self-harm and suicidal behaviors, staying sober, and participating in skills training to address the behavioral, emotional, and cognitive vulnerabilities targeted in treatment.The client was reinforced for commitment to working within the DBT program.The client has not agreed to work within the DBT program and was referred back to “treatment as usual.”
18 Explore Self-Harm Behavior (18)The client's history and nature of self-harm and suicidal behaviors were explored thoroughly.The client recalled a pattern of self-harm and suicidal behaviors that has dated back several years.The client's self-harm and suicidal behaviors were identified as being associated with feelings of depression, fear, and anger, as well as a lack of self-identity.
19 Assess Suicidal Behavior (19)The client's history and current status regarding suicidal gestures were assessed.The onset, frequency, triggers, seriousness/risks, means, access to means, intent and immediate consequences that may reward or maintain the self-harm behaviors were identified.Alternative responses to these thoughts and actions were proposed.
20 Arrange Hospitalization (20)As the client was judged to be harmful of self, arrangements were made for voluntary psychiatric hospitalization.As the client refused a necessary psychiatric hospitalization, the proper steps to involuntarily hospitalize the client were initiated.The client has been psychiatrically hospitalized.Ongoing contact with the psychiatric hospital has been maintained in order to coordinate the most helpful treatment while in the hospital.
21 Assign Self-Monitoring Forms (21)The client was informed of the usefulness of self-monitoring forms, such as DBT Diary Cards.The client was assigned self-monitoring forms to assess self-harm risk.The client completed assigned self-monitoring forms and these were reviewed at the start of each session.The client did not complete assigned self-monitoring forms and was redirected to do so.
22 Refer to Emergency Helpline (22)The client was provided with an emergency helpline telephone number that is available 24 hours a day.Positive feedback was provided as the client promised to use the emergency helpline telephone number rather than engaging in any self-harm behaviors.The client has not used the emergency helpline telephone system in place of engaging in self-harm behaviors and was reminded about this useful resource.
23 Provide Therapist Contact Information (23)The client was provided with the therapist's telephone number for phone coaching of skills learned in therapy.The client was provided with clear instructions for proper use of phone contact, including establishing limits.The client used the provided telephone number and was appropriate in its use.The client used the provided telephone number but was inappropriate in its use and was redirected in this area.The client has not used the provided telephone number and was reminded of its usefulness.
24 Elicit Contact Contract (24)An agreement was elicited from the client that they will initiate contact with the therapist or an emergency helpline if the suicidal urge becomes strong and before any self-injurious behavior is enacted.The client completed “No Self-Harm Contract” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was reinforced in promising to terminate self-mutilation behavior and to contact emergency personnel if urges for such behavior arise.The client has followed through on the non-self-harm contract by contacting emergency service personnel rather than enacting any suicidal gestures or self-mutilating behavior; the client was reinforced for this healthy use of support.The client's potential for suicide was consistently assessed despite the suicide prevention contract.
25 Teach Distress Tolerance Skills (25)The client was taught about how to apply DBT distress tolerance skills and chain analysis.The client was reinforced for using distress tolerance skills and chain analysis to identify and intervene to reduce self-harm and suicidal behaviors.The client struggled to understand distress tolerance skills and chain analysis and was provided with remedial information.
26 Assign Self-Monitoring Homework (26)The client was assigned self-monitoring homework (e.g., DBT Diary Card) to help guide in-session chain analysis and problem-solving.The client completed self-monitoring homework, and this was reviewed.The client did not complete self-monitoring homework and was redirected to do so.
27 Resolve Therapy-Interfering Behaviors (27)The client's pattern of therapy-interfering behavior (e.g., missing appointments, noncompliance, abruptly leaving therapy) was consistently monitored.The client was confronted for therapy-interfering behaviors.The clinician took appropriate responsibility for the clinician's own therapy-interfering behaviors.Therapy-interfering behaviors were resolved.
28 Use Strategies to Manage Maladaptive Behaviors, Thoughts, and Feelings (28)Validation, dialectical strategies, and cognitive-behavioral strategies were used to help the client manage, reduce, or stabilize maladaptive behaviors, thoughts, and feelings.Therapeutic techniques as described in Dialectical Behavior Therapy in Clinical Practice (Dimeff & Koerner) were used to help the client manage symptoms.The client was assigned “Plan Before Acting” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).Validation was consistently used to help the client manage, reduce, and stabilize maladaptive behaviors, thoughts, and feelings.Dialectical strategies, such as metaphor or devil's advocacy, were used to help the client manage, reduce, or stabilize maladaptive behaviors, thoughts, and feelings.Cognitive-behavioral
