or images that recall the childhood traumas and their associated intensive emotional response.The client reported a sense of control over the intrusive, distressing thoughts of the traumatic event.The client reported no longer experiencing intrusive, distressing thoughts of the traumatic event.10 Guilt (6)The client described a pattern of guilty feelings related to a history of childhood trauma.The client reported that as they have worked through the childhood traumas, their sense of guilt has diminished.The client reported no longer experiencing feelings of guilt related to childhood trauma.
11 Emotional Numbing (6)The client reported an inability to experience a full range of emotions.The client reported beginning to be in touch with feelings again.The client is able to experience a full range of emotions.
12 Unresolved Emotions (7)The client described a pattern of unresolved emotional conflict because of a history of childhood trauma.The client described a gradual decrease in unresolved emotional conflict.As the client has worked through the childhood trauma, they described a decreased pattern of unresolved emotional conflict.
13 Maladaptive Behaviors (7)The client described a pattern of maladaptive behaviors to deal with the emotional and psychological conflicts related to the childhood trauma.The client has gained insight into how their maladaptive behaviors are a result of the childhood trauma.The client reported a decreased pattern of maladaptive or unsuccessful behaviors that have resulted from the childhood trauma.
14 Inability to Trust Others (8)The client reported a pattern of difficulty trusting others, poor bonding in relationships, and problematic communication in interpersonal relationships because of the early childhood neglect or abuse.As the client has worked through their reaction to the childhood traumas, there has been less conflict within personal relationships as well as an increased pattern of trusting others.The client's partner reported that the client is irritable, withdrawn, and preoccupied with childhood trauma.The client and partner reported increased communication and satisfaction with the interpersonal relationship.
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 experiences of childhood trauma.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 the 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 Assign Step 1 Exercise for Addiction and Childhood Trauma (3)A 12-step recovery program's Step 1 was used to help the client see the powerlessness and unmanageability that have resulted from using addiction to deal with the negative feelings associated with childhood traumas.The client was assigned the Step 1 exercise from The Alcoholism and Drug Abuse Client Workbook (Perkinson).The client displayed an understanding of the concept presented regarding powerlessness and unmanageability regarding addiction and the negative feelings associated with childhood trauma.The client was able to endorse the concept of powerlessness and unmanageability that have resulted from using addiction to deal with negative feelings associated with childhood trauma; this progress was reinforced.The client denied any sense of powerlessness or unmanageability in regard to the use of addiction to deal with negative feelings associated with childhood traumas; the client was provided with tentative examples of this concern.
4 Explore Painful Childhood Experiences (4)The client's painful childhood experiences were explored.Active listening was provided as the client explained what it was like to grow up in their home environment, focusing on the abusive, neglectful experiences that they endured.The client was assisted in identifying the unhealthy emotional and behavioral patterns that have evolved from the painful family-of-origin experiences.The client was helped to identify a variety of emotional effects from the painful situations they endured in the family of origin.The client helped to identify a variety of behavioral patterns that have occurred owing to the painful experiences from the family of origin.The client was assigned “Share the Painful Memory” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client denied any pattern of unhealthy emotional or behavioral patterns that have occurred owing to painful experiences from the family of origin; this was accepted.The client has refused to discuss any details or feelings related to childhood emotional traumas; the client was urged to do so as they feel safe.
5 Administer Psychological Instruments (5)Psychological instruments designed to objectively assess childhood trauma effects on substance abuse were administered to the client.The Childhood Trauma Questionnaire (CTQ) was administered to the client.The Davidson Trauma Scale (DTS) was administered to the client.The Beck Depression Inventory–II (BDI-II) was administered to the client.The Beck Anxiety Inventory (BAI) was administered to the client.The Substance Abuse Subtle Screening Inventory–4 (SASSI-4) was administered to the client.The client was provided with feedback regarding the results of the psychological instruments administered.
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 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
