analysis, and problem-solving were used to help the client manage, reduce, or stabilize maladaptive behaviors, thoughts, and feelings.It was noted that the client has decreased maladaptive behaviors, thought patterns, and feelings.29 Conduct Skills Training (29)Group skills training was used to teach responses to identified problem behaviors.Individual skills training was used to teach the client responses to personal vulnerabilities and skill deficits.The client was taught to analyze own behavior, mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance skills.The client has participated in skills training for specific behavioral problems, and the benefit of this treatment was reviewed.The client has not participated in group skills training and was redirected to do so.
30 Teach Skills for Regular Use (30)Behavioral strategies were taught to the client via instruction, modeling, and advising.Role-playing and exposure exercises were used to strengthen the client's use of behavioral strategies.The client was provided with regular homework assignments to help incorporate the behavioral strategies into everyday life.The client was reinforced for regular use and understanding of behavioral strategies.The client has struggled to understand the behavioral strategies and was provided with remedial information in this area.
31 Conduct Trauma Work (31)As the client's adaptive behavior patterns have been evident, work on posttraumatic sequelae was initiated.The client was assisted in using new adaptive behavior patterns and emotional regulation skills to reduce denial and increase insight into the effects of previous trauma.The client was helped to reduce maladaptive emotional and/or behavioral responses to trauma-related stimuli through the regular use of adaptive behavioral patterns and emotional skills.The client was assisted in reducing self-blame and increasing acceptance and tolerance.The client has been noted to be successful in using adaptive behavioral patterns and emotional regulation skills in managing the effects of previous trauma.The client has become more emotionally dysregulated because of the trauma work and was redirected to use behavioral and emotional regulation skills.
32 Explore Schema and Self-Talk (32)The client was assisted in exploring how their schema, underlying assumptions, and self-talk mediate trauma-related and other fears.The client's distorted schema, assumptions, and self-talk were reviewed.The client was reinforced for insight into self-talk, assumptions, and schema that support trauma-related and other fears.The client struggled to develop insight into self-talk, assumptions, and schema and was provided with tentative examples of these concepts.
33 Assign Exercises on Self-Talk (33)The client was assigned homework exercises in which they identify fearful self-talk and create reality-based alternatives.The client was assigned the homework exercise “Journal and Replace Self-Defeating Thoughts” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was directed to complete the “Daily Record of Dysfunctional Thoughts” from Cognitive Therapy of Depression (Beck, Rush, Shaw, & Emery).The client's replacement of fearful self-talk with reality-based alternatives was critiqued.The client was reinforced for successes at replacing fearful self-talk with reality-based alternatives.The client has not completed assignments for identifying and replacing dysfunctional self-talk and was redirected to do so.
34 Reinforce Positive Self-Talk (34)The client was reinforced for implementing positive, realistic self-talk that enhances self-confidence and increases adaptive action.The client noted several instances from daily life that reflected the implementation of positive self-talk, and these successful experiences were reinforced.
35 Develop Hierarchy of Triggers (35)The client was directed to develop a hierarchy of feared and avoided trauma-related stimuli.The client was helped to list many of the feared and avoided trauma-related stimuli.The client was assisted in developing a hierarchy of feared and avoided trauma-related stimuli.The client's journaling was used to assist in developing a hierarchy of feared and avoided trauma-related stimuli.
36 Direct Imaginal Exposure (36)Imaginal exposure was directed by having the client describe a chosen traumatic experience at an increasing, but client-chosen, level of detail.Cognitive restructuring techniques were integrated and repeated until the associated anxiety regarding childhood trauma was reduced and stabilized.The session was recorded and provided to the client to listen to between sessions.“Share the Painful Memory” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce) was assigned to help direct the client's imaginal exposure.The client's progress was reviewed and reinforced and problems solved.
37 Assign Homework on Exposure (37)The client was assigned homework exercises to perform exposure to feared stimuli and record experience.The client was directed to listen to the taped exposure session to consolidate skills for exposure to feared stimuli.The client was assigned “Gradually Reducing Your Phobic Fear” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client's use of exposure techniques was reviewed and reinforced.The client has struggled in implementation of exposure techniques and was provided with corrective feedback.The client has not attempted to use the exposure techniques and was redirected to do so.
38 Treat Posttraumatic Stress Disorder (PTSD) (38)The client was identified as having a comorbid PTSD diagnosis.The client was treated with prolonged exposure therapy.The client was treated with cognitive processing therapy.The client was treated with eye movement desensitization and reprocessing (EMDR).The client's PTSD symptoms have significantly decreased and positive reinforcement was provided for this.The client's PTSD symptoms have not significantly decreased, and additional treatment in this area was coordinated.
39 Encourage Trust in Own Evaluations (39)The client was encouraged to value, believe, and trust in their evaluations of self, others, and situations.The client was encouraged to examine situations in a nondefensive manner, independent of others' opinions.The client was encouraged to build self-reliance through trusting their own evaluations.The client was assigned “Forming Stable Relationships” in the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).The client was reinforced for value, belief, and trust in their own evaluations of self, others, and situations.The client was redirected when tending to devalue, disbelieve, and distrust their own evaluations.
40 Encourage Positive Experiences (40)The client was encouraged to facilitate personal growth and “capacity for sustained joy” by choosing experiences that strengthen self-awareness, personal values, and appreciation of life.The client was encouraged to use spiritual practices and other relative life experiences to help increase positive experiences.
41 Teach Problem-Solving Skills (41)The client was taught problem-solving skills.The client was taught to define the problem specifically, brainstorm options, list pros and cons of each option, choose and implement an option, and evaluate the outcome.The client was assigned the homework exercise “Plan Before Acting” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).Modeling, role-playing, and behavioral rehearsal were used to apply this skill to several current conflicts.
42 Conduct Transference-Focused Therapy (42)Transference-Focused Therapy was conducted using client-therapist communications.The client was assisted in understanding split representations of self and difficulties with self-control.The client was taught about how to integrate split representations of self and develop more effective means to self-control.
43 Conduct Schema-Focused Therapy (43)Schema-Focused Therapy was conducted with the client.The client was assisted in learning and changing entrenched, self-defeating patterns.The client was focused on the relationship with the therapist and daily life outside of therapy.The client was assisted in exploring early developmental experience that included trauma.
44 Conduct Mentalization Therapy (44)Mentalization Therapy was conducted with the client.The client was assisted in learning to interpret the actions of self and others through meaningful and understanding examination of mental states such as desires, needs, feelings, beliefs, and reasons.
45 Relate Borderline Traits to Addictive Behavior (45)The client was presented with information about how poor impulse control, poor anger management,
