Feelings Expression (10)The client was supported and encouraged when they began to express feelings of rage, fear, and rejection relating to family abuse or neglect.The client was supported as they have continued to clarify their understanding of feelings associated with major traumatic incidents in childhood.As the client has clarified feelings and shared them within the session, feelings of emotional turmoil have diminished.The client continues to be very guarded about feelings of rage, fear, and rejection related to the family abuse or neglect and was encouraged to get in touch with these feelings as the client is capable of doing so.11 Assign Feelings Journal (11)The client was assigned to record feelings in a journal that describes memories, behavior, and emotions tied to traumatic childhood experiences.The client was assigned “How the Trauma Affects Me” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client has followed through on the journaling assignment and has developed an increased awareness of the impact that childhood experiences have had on present feelings and behaviors; this progress was reviewed.The client was assisted in identifying how childhood experiences have influenced how the client parents their own children today.The client has not completed the assigned feelings journal and was redirected to do so.
12 Assign Books on Childhood Trauma (12)Reading materials relating to traumatic childhood experiences were recommended to the client to assist in developing insight.The client was advised to read It Will Never Happen to Me (Black), Outgrowing the Pain (Gil), or Healing the Child Within (Whitfield).The client has followed through on reading the recommended childhood trauma material, and insights related to that reading were processed.The client has not followed through on reading the recommended material and was redirected to do so.
13 Teach About Unhealthy Rules and Roles (13)The client was presented with information about the unhealthy rules and roles that develop in dysfunctional families.The client was assigned “Changing From Victim to Survivor” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was assisted in identifying the pattern of unhealthy rules and roles that occurred in the family of origin.The client was able to identify the role that they played within the family dynamics.The client struggled to identify or admit to an unhealthy pattern of rules and roles in the family of origin; tentative examples were provided.The client has not completed the assigned homework and was redirected to do so.
14 Connect Childhood Trauma With Trust Issues (14)The client was presented with the concept that childhood trauma experiences have precipitated problems with trust, anger, self-esteem, and depression.The client accepted the concept presented regarding problems with trust, anger, self-esteem, and depression because of childhood experiences.The client rejected the concept that childhood trauma experiences relate to their problems with trust, anger, self-esteem, or depression; tentative examples were provided.
15 Identify Addictive Behavior as an Unhealthy Coping Skill (15)The client was asked about addiction behavior as a means of coping with emotional pain.The client's addictive behavior was confronted as an inappropriate way to cope with emotional pain.The client was assisted in identifying the self-defeating, negative consequences of addictive behavior.Verbal reinforcement was provided as the client identified the self-defeating, negative consequences of the negative behavior.The client denied any pattern of addictive behavior as a way to cope with emotional pain and was provided with specific examples of how this can occur.
16 Teach Healthy Ways to Cope With Pain (16)The client was asked to identify healthier, more constructive means of coping with emotional pain.The client was assigned “Setting and Maintaining Boundaries” from the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma) or “Deep Breathing Exercise” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was assisted in identifying healthier, more constructive means of coping with emotional pain (e.g., sharing pain with others, attending 12-step recovery program meetings, confronting and then forgiving the perpetrator, turning issues over to a higher power).The client was reinforced in endorsing a variety of healthier, more constructive means of coping with emotional pain.The client was reinforced while reporting a pattern of using healthier means for coping.The client has struggled to implement healthier coping mechanisms and continues to rely on addictive behavior; brainstorming techniques were used.The client denied any significant negative consequences from addictive behavior; additional examples were reviewed.
17 Refer for Medication Evaluation (17)The client was referred for a medication evaluation to help stabilize moods and decrease the intensity of angry feelings.The client agreed to follow through with the medication evaluation.The client was strongly opposed to being placed on medication to help stabilize moods and reduce emotional distress.
18 Monitor Effects of Medication (18)The client's response to the medication was discussed in today's therapy session.It was noted that the medication has helped the client to stabilize moods and decrease the intensity of angry feelings.It was noted that the client has had little or no improvement in moods or anger control since being placed on the medication.The client was reinforced as they have consistently taken the medication as prescribed.The client has failed to comply with taking the medication as prescribed and was redirected to do so.
19 Conduct Treatment for Borderline Traits (19)The client was oriented to dialectical behavioral therapy (DBT).The multiple facets of DBT were highlighted, including support, collaboration, challenge, problem-solving, and skill building.The biosocial view related to borderline personality disorder was emphasized, including the constitutional and social influences.The concept of dialectics was reviewed with the client.The client was provided with treatment specific for borderline traits.
20 Refer for PTSD Treatment (20)The client was identified as manifesting posttraumatic stress disorder (PTSD) symptoms.The client was provided with therapy for posttraumatic stress disorder.The client was coordinated for prolonged exposure therapy.The client was coordinated for cognitive processing therapy.The client was coordinated for eye movement desensitization and reprocessing therapy.The client has followed through on treatment for PTSD and was reinforced for this.The client has not followed through on treatment for PTSD and was reminded to do so.
21 Assign Feelings Letter (21)The client was assigned the task of writing a letter to their parents regarding feelings associated with the experience of childhood neglect or abuse.The client has followed through with writing a feelings letter to parents regarding childhood abuse/neglect and this letter was processed.It was reflected to the client that writing the letter regarding childhood abuse experiences has helped decrease feelings of shame and affirm the client as not being responsible for the abuse.The client has not followed through with writing the letter to parents regarding the childhood abuse or neglect experiences and was redirected to do so.
22 Support Confrontation of Perpetrator (22)A conjoint session was held where the client confronted the perpetrator of childhood abusive experiences.The client was supported in confrontation of the perpetrator of abuse and neglect while responsibility for that neglect was placed clearly on the perpetrator.The client found it very difficult to be direct in confrontation of the perpetrator of childhood abuse/neglect; the client was urged to be more direct.The perpetrator responded with defensive statements and denial in reaction to the client's confrontation regarding childhood abuse and neglect; the client was supported in rejecting this blame and denial.Since the confrontation of the perpetrator, the client has reported decreased feelings of shame and more clarity regarding not being responsible for the abuse that occurred; the benefits of this progress were reviewed.The client has declined confrontation of the perpetrator; the client was accepted for this decision and urged to consider confrontation at a later date.
23 Use Empty-Chair Exercise (23)The client was guided in an empty-chair exercise with the perpetrator of the abuse as the imagined person in the empty chair.The client was guided in an empty-chair exercise in which the nonperpetrating parent was imagined to be in the empty chair.The client was assisted in expressing feelings and clarifying the impact that the childhood experiences of abuse had.The client was assigned “It Wasn't My Fault” from the Addiction Treatment Homework Planner (Lenz, Finley,
