The Addiction Progress Notes Planner - Arthur E. Jongsma - E-Book

The Addiction Progress Notes Planner E-Book

Arthur E. Jongsma

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Save hours of time-consuming paperwork The Addiction Progress Notes Planner, Fifth Editionprovides prewritten session and patient presentation descriptionsfor each behavioral problem in the Addiction Treatment Planner,Fifth Edition. The prewritten progress notes can be easily andquickly adapted to fit a particular client need or treatmentsituation. * Saves you hours of time-consuming paperwork, yet offers thefreedom to develop customized progress notes * Organized around 44 behaviorally based presenting problemsincluding depression, gambling, nicotine abuse/dependence, chronicpain, and eating disorders * Features over 1,000 prewritten progress notes summarizingpatient presentation, themes of session, and treatmentdelivered * Provides an array of treatment approaches that correspond withthe behavioral problems and DSM-5 diagnostic categories in TheAddiction Treatment Planner, Fifth Edition * Offers sample progress notes that conform to the latest ASAMguidelines and meet the requirements of most third-party payors andaccrediting agencies, including CARF, TJC, COA, and the NCQA * Incorporates new progress notes language consistent withEvidence-Based Treatment Interventions

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Table of Contents

TITLE PAGE

COPYRIGHT

DEDICATION

PRACTICEPLANNERS® SERIES PREFACE

PROGRESS NOTES INTRODUCTION

ABOUT PRACTICE

PLANNERS

®

PROGRESS NOTES

HOW TO USE THIS

PROGRESS NOTES PLANNER

A FINAL NOTE ABOUT PROGRESS NOTES AND HIPAA

ADULT-CHILD-OF-AN-ALCOHOLIC (ACA) TRAITS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

ANGER

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

ANTISOCIAL BEHAVIOR

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

ANXIETY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)—ADOLESCENT

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)—ADULT

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

BIPOLAR DISORDER

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

BORDERLINE TRAITS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

CHILDHOOD TRAUMA

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

CHRONIC PAIN

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

CONDUCT DISORDER/DELINQUENCY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

DANGEROUSNESS/LETHALITY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

DEPENDENT TRAITS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

EATING DISORDERS AND OBESITY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

FAMILY CONFLICTS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

GAMBLING

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

IMPULSIVITY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

LEGAL PROBLEMS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

LIVING ENVIRONMENT DEFICIENCY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

MEDICAL ISSUES

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

NARCISSISTIC TRAITS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

NICOTINE ABUSE/DEPENDENCE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

OBSESSIVE COMPULSIVE DISORDER (OCD)

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

OCCUPATIONAL PROBLEMS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

OPPOSITIONAL DEFIANT BEHAVIOR

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

PARENT-CHILD RELATIONAL PROBLEM

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

PARTNER RELATIONAL CONFLICTS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

PEER GROUP NEGATIVITY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

POST-TRAUMATIC STRESS DISORDER (PTSD)

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

PSYCHOSIS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

RELAPSE PRONENESS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SELF-CARE DEFICITS—PRIMARY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SELF-CARE DEFICITS—SECONDARY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SELF-HARM

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SEXUAL ABUSE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SEXUAL PROMISCUITY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SLEEP DISTURBANCE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SOCIAL ANXIETY/SKILLS DEFICIT

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SPIRITUAL CONFUSION

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SUBSTANCE-INDUCED DISORDERS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SUBSTANCE INTOXICATION/WITHDRAWAL

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SUBSTANCE USE DISORDERS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SUICIDAL IDEATION

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

TREATMENT RESISTANCE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

UNIPOLAR DEPRESSION

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

END USER LICENSE AGREEMENT

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PracticePlanners®

The Addiction Progress Notes Planner

Fifth Edition

David J. Berghuis

Arthur E. Jongsma, Jr.

 

Cover design: Wiley

To my good friend, Ronn Koehler. Thanks for your friendship and support through the years.

—David J. Berghuis

To John Westra for his many years of prison ministry with those struggling with addictions.

—Arthur E. Jongsma, Jr.

PRACTICEPLANNERS® SERIES PREFACE

Accountability is an important dimension of the practice of psychotherapy. Treatment programs, public agencies, clinics, and practitioners must justify and document their treatment plans to outside review entities in order to be reimbursed for services. The books in the PracticePlanners® series are designed to help practitioners fulfill these documentation requirements efficiently and professionally.

The PracticePlanners® series includes a wide array of treatment planning books, including not only the original Complete Adult Psychotherapy Treatment Planner, Child Psychotherapy Treatment Planner, and Adolescent Psychotherapy Treatment Planner, all now in their fifth editions, but also Treatment Planners targeted to specialty areas of practice, including:

Addictions

Co-occurring disorders

Behavioral medicine

College students

Couples therapy

Crisis counseling

Early childhood education

Employee assistance

Family therapy

Gays and lesbians

Group therapy

Juvenile justice and residential care

Mental retardation and developmental disability

Neuropsychology

Older adults

Parenting skills

Pastoral counseling

Personality disorders

Probation and parole

Psychopharmacology

Rehabilitation psychology

School counseling and school social work

Severe and persistent mental illness

Sexual abuse victims and offenders

Social work and human services

Special education

Speech-language pathology

Suicide and homicide risk assessment

Veterans and active duty military

Women's issues

In addition, there are three branches of companion books, which can be used in conjunction with the Treatment Planners, or on their own:

Progress Notes Planners

provide a menu of progress statements that elaborate on the client's symptom presentation and the provider's therapeutic intervention. Each

Progress Notes Planner

statement is directly integrated with the behavioral definitions and therapeutic interventions from its companion

Treatment Planner

.

Homework Planners

include homework assignments designed around each presenting problem (such as anxiety, depression, chemical dependence, anger management, eating disorders, or panic disorder) that is the focus of a chapter in its corresponding

Treatment Planner

.

Client Education Handout Planners

provide brochures and handouts to help educate and inform clients on presenting problems and mental health issues, as well as life skills techniques. The handouts are included on CD-ROMs for easy printing from your computer and are ideal for use in waiting rooms, at presentations, as newsletters, or as information for clients struggling with mental illness issues. The topics covered by these handouts correspond to the presenting problems in the

Treatment Planners

.

Adjunctive books, such as The Psychotherapy Documentation Primer and The Clinical Documentation Sourcebook, contain forms and resources to aid the clinician in mental health practice management.

The goal of our series is to provide practitioners with the resources they need in order to provide high-quality care in the era of accountability. To put it simply, we seek to help you spend more time on patients and less time on paperwork.

ARTHUR E. JONGSMA, JR.Grand Rapids, Michigan

PROGRESS NOTES INTRODUCTION

ADULT-CHILD-OF-AN-ALCOHOLIC (ACA) TRAITS

CLIENT PRESENTATION

Raised in an Alcoholic Home (1)

*

The client described a history of being raised in an alcoholic home but denied any effects of such an upbringing.

The client described a history of being raised in an alcoholic home but was uncertain about how this affected his/her emotions.

The client described a history of being raised in an alcoholic home, and identified effects, including emotional abandonment, role confusion, abuse, and a chaotic, unpredictable environment.

The client processed issues related to being raised in an alcoholic home, including emotional abandonment, role confusion, abuse, and a chaotic, unpredictable environment.

Inability to Trust and Share Feelings (2)

The client revealed a pattern of extreme difficulty in trusting others, sharing feelings, or talking openly about self.

When the client shares openly with others, he/she experiences feelings of anxiety and uncertainty.

ANGER

CLIENT PRESENTATION

Episodic Excessive Anger (1)

*

The client described a history of loss of temper in response to specific situations.

The client described a history of loss of temper that dates back many years, including verbal outbursts and property destruction, typically related to specific emotional themes.

As treatment has progressed, the client has reported increased control of his/her situational episodic excessive anger.

The client has had no recent incidents of episodic excessive anger.

General Excessive Anger (2)

The client shows a pattern of general, excessive anger across many situations.

The client does not appear to be experiencing anger in response to specific issues, but as a general pattern.

As treatment has progressed, the client has verbalized insight into his/her pattern of excessive anger.

The client has made progress in controlling his/her pattern of excessive anger.

Explosive, Destructive Outbursts (3)

The client described a history of loss of temper in which he/she has destroyed property in fits of rage, often when intoxicated.

The client described a history of loss of temper, involving substance use that dates back to adolescence, including verbal outbursts and property destruction.

The client has reported increased control over his/her temper and a significant reduction in the incidence of poor anger management.

The client has reported no recent incidents of explosive outbursts that have resulted in destruction of any property, or intimidating verbal assaults.

Substance Abuse to Cope With Anger (4)

The client acknowledged that he/she has used substances in an attempt to cope with angry feelings.

The client described situations in which he/she has used substances to cope with angry feelings, but had difficulty identifying the relationship between the substance abuse and anger.

The client identified that his/her substance abuse had a direct connection to anger problems.

The client has maintained total abstinence, which is confirmed by his/her family.

Cognitive Biases Toward Anger (5)

The client shows a pattern of cognitive biases commonly associated with anger.

The client makes demanding expectations of others.

The client tends to generalize labeling the targets of his/her anger.

The client tends to have anger in reaction to perceived slights.

As treatment has progressed, the subject displays decreased patterns of cognitive biases associated with anger.

Evidence of Physiological Arousal (6)

The client displayed direct evidence of physiological arousal in relation to his/her feelings of anger.

The client displays indirect evidence of physiological arousal related to his/her feelings of anger.

As treatment has progressed, the client's level of physiological arousal has decreased as anger has become more managed.

Explosive, Destructive Outbursts (7)

The client described a history of loss of temper in which he/she has destroyed property during fits of rage.

The client described a history of loss of temper that dates back to childhood, involving verbal outbursts as well as property destruction.

As therapy has progressed, the client has reported increased control over his/her temper and a significant reduction in incidents of poor anger management.

The client has had no recent incidents of explosive outbursts that have resulted in destruction of property or intimidating verbal assaults.

Explosive, Assaultive Outbursts (7)

The client described a history of loss of anger control to the point of physical assault on others who were the target of his/her anger.

The client has been arrested for assaultive attacks on others when he/she has lost control of his/her temper.

The client has used assaultive acts as well as threats and intimidation to control others.

The client has made a commitment to control his/her temper and terminate all assaultive behavior.

There have been no recent incidents of assaultive attacks on anyone, in spite of the client having experienced periods of anger.

Overreactive Irritability (8)

The client described a history of reacting too angrily to rather insignificant irritants in his/her daily life.

The client indicated that he/she recognizes that he/she becomes too angry in the face of rather minor frustrations and irritants.

Minor irritants have resulted in explosive, angry outbursts that have led to destruction of property and/or striking out physically at others.

The client has made significant progress at increasing frustration tolerance and reducing explosive overreactivity to minor irritants.

Physical/Emotional Abuse (9)

The client reported physical encounters that have injured others or have threatened serious injury to others.

The client showed little or no remorse for causing pain to others.

The client projected blame for his/her aggressive encounters onto others.

The client has a violent history and continues to interact with others in a very intimidating, aggressive style.

The client has shown progress in controlling his/her aggressive patterns and seems to be trying to interact with more assertiveness rather than aggression.

Harsh Judgment Statements (10)

The client exhibited frequent incidents of being harshly critical of others.

The client's family members reported that he/she reacts very quickly with angry, critical, and demeaning language toward them.

The client reported that he/she has been more successful at controlling critical and intimidating statements made to or about others.

The client reported that there have been no recent incidents of harsh, critical, and intimidating statements made to or about others.

Angry/Tense Body Language (11)

The client presented with verbalizations of anger, as well as tense, rigid muscles and glaring facial expressions.

The client expressed his/her anger with bodily signs of muscle tension, clenched fists, and refusal to make eye contact.

The client appeared more relaxed and less angry, and did not exhibit physical signs of aggression.

The client's family reported that he/she has been more relaxed within the home setting and has not shown glaring looks or pounded his/her fists on the table.

Passive-Aggressive Behavior (12)

The client described a history of passive-aggressive behavior in which he/she would not comply with directions, would complain about authority figures behind their backs, and would not meet expected behavioral norms.

The client's family confirmed a pattern of the client's passive-aggressive behavior in which he/she would make promises of doing something, but not follow through.

The client acknowledged that he/she tends to express anger indirectly through social withdrawal or uncooperative behavior, rather than using assertiveness to express feelings directly.

The client has reported an increase in assertively expressing thoughts and feelings and terminating passive-aggressive behavior patterns.

Violent Rages (13)

The client described several incidents of suppressing angry feelings, then exploding in a violent rage.

The client described several episodes of loss of control over angry feelings that he/she had previously guarded closely.

The client reported gaining greater control over aggressive impulses, although verbal aggression is still present.

The client reported successful control over aggressive impulses, with no recent incidents noted.

The client identified situations in which assertively expressing feelings has helped to gain successful control over aggressive impulses.

Overreaction to Disapproval (14)

The client described a history of reacting too angrily to situations in which he/she perceives disapproval, rejection, or criticism.

The client indicated that he/she recognizes that he/she becomes too angry in the face of perceived disapproval, rejection, or criticism.

The client's perception of disapproval, rejection, or criticism has led to explosive, angry outbursts, destruction of property, and/or striking out at others.

The client has made significant progress at increasing his/her frustration tolerance and reducing explosive overreactivity to perceived disapproval, rejection, or criticism.

Verbal Abuse (15)

The client reported verbal threats of aggression toward others, name-calling, and other verbally abusive speech.

The client showed little or no remorse for harming or intimidating others.

The client projected blame for his/her verbal outbursts onto others.

The client continues to act in an aggressive, intimidating style.

The client has shown progress in controlling his/her aggressive patterns, and seems to be trying to interact with more assertiveness than aggression.

Blaming Others (16)

The client described several incidents during which he/she believes that others were to blame for his/her behaviors.

The client identified that he/she has a pattern of blaming others for his/her own problems.

The client has begun to accept responsibility for his/her own behavior and problems.

Aggression to Achieve Power and Control (17)

The client described an inclination to try to dominate social, family, and other situations by using aggressive means.

The client has alienated himself/herself from others because of his/her dominating and controlling manner.

The client has become more considerate of others' opinions and feelings, and has reduced his/her degree of aggression.

The client has yielded control to others and has decreased his/her need to maintain power and control.

INTERVENTIONS IMPLEMENTED

Build Trust (1)

*

Consistent eye contact, active listening, unconditional positive regard, and warm acceptance were used to help build trust with the client.

The client was urged to feel safe in expressing his/her anger 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 his/her expression of painful feelings; he/she was encouraged to use the safe haven of therapy to express these difficult issues.

Assess Anger Dynamics (2)

The client was assessed for various stimuli that have triggered his/her anger.

The client was assisted in identifying situations, people, and thoughts that have triggered his/her anger.

The client was assisted in identifying the thoughts, feelings, and actions that have characterized his/her anger responses.

Administer Anger Expression Assessment Instruments (3)

The client was administered psychological instruments designed to objectively assess anger traits.

The client was assessed with the Anger, Irritability, and Assault Questionnaire (AIAQ).

The Buss-Durkee Hostility Inventory (BDHI) was used to assess the client's anger expression.

The State-Trait Anger Expression Inventory (STAXI) was used to assess the client's anger expression.

Feedback was provided to the client regarding the results of the anger expression assessment.

The client declined to complete the psychological instruments designed to objectively assess anger expression, and the focus of treatment was changed to this resistance.

Educate About Addictive Behavior to Relieve Uncomfortable Feelings (4)

The client was educated about the tendency to engage in addictive behavior as a means of relieving uncomfortable feelings.

The client was able to develop a list of several incidences of how addictive behavior has been used as a means of relieving uncomfortable feelings.

The client reported a decrease in the use of addictive behaviors as a means of relieving uncomfortable feelings; this success was highlighted.

The client reported that he/she has not decreased his/her use of addictive behaviors as a means of relieving uncomfortable feelings, and was provided with additional feedback in this area.

Teach About High-Risk Situations (5)

The client was taught about high-risk situations (e.g., negative emotions, social pressure, interpersonal conflict, strong positive emotions, testing personal control).

The client was taught about how anger, as a negative emotion, places him/her at a higher risk for addiction.

Active listening skills were used as the client acknowledged the higher risk of addictive behaviors related to negative emotions, social pressure, interpersonal conflict, positive emotions, and testing personal control.

The client was supported as he/she acknowledged how anger places him/her at a higher risk for addiction.

The client rejected the connections between anger and higher risk of substance abuse, and was provided with additional feedback.

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 vs. dystonic nature of his/her 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.

Assess for Correlated Disorders (7)

The client was assessed for evidence of research-based correlated disorders.

The client was assessed in regard to his/her 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.

Assess for Culturally Based Confounding Issues (8)

The client was assessed for age-related issues that could help to better understand his/her clinical presentation.

The client was assessed for gender-related issues that could help to better understand his/her clinical presentation.

The client was assessed for cultural syndromes, cultural idioms of distress, or culturally based perceived causes that could help to better understand his/her 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 his/her 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.

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 his/her impairment in social, relational, vocational, and occupational endeavors.

It was reflected to the client that his/her impairment appears to create mild to moderate effects on the client's functioning.

It was reflected to the client that his/her 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 treatment.

Refer for Psychopharmacological Intervention (10)

The client was referred to a physician for the purpose of evaluation for a prescription for psychotropic medication to aid in reducing tension and improving anger control.

The client has followed through on the referral to a physician and has been assessed for a prescription of psychotropic medication, but none were prescribed.

The client has been prescribed psychotropic medications.

The client has refused a prescription of psychotropic medication provided by the physician.

Monitor Medication Effectiveness and Side Effects (11)

As the client has taken psychotropic medication prescribed by his/her physician, the effectiveness and side effects of the medication have been monitored.

The client reported that the psychotropic medication has been beneficial, and this was relayed to the prescribing clinician.

The client reported that the psychotropic medication has not been beneficial, and this was relayed to the prescribing clinician.

The client has not consistently taken the prescribed psychotropic medication and has been redirected to do so.

The client identified side effects of the psychotropic medications and was directed to consult with a physician if the side effects persist or worsen.

Assign an Anger Journal (12)

The client was assigned to keep a daily journal in which he/she would document persons or situations that cause anger, irritation, and disappointment, and to record the depth of anger, rating on a scale of 1 to 100.

The client was assigned “Anger Journal” from the

Adult Psychotherapy Homework Planner

(Jongsma).

The client was assigned “Is My Anger Due to Feeling Threatened?” from the

Addiction Treatment Homework Planner

(Finley and Lenz).

The client was assigned “Is My Anger Due to Unmet Expectations?” from the

Addiction Treatment Homework Planner

(Finley and Lenz).

The client has kept a journal of anger-producing situations and this material was processed within the session.

It was noted that the client has become more aware of the causes for targets of his/her anger, as a result of journaling these experiences on a daily basis.

The client has not kept an anger journal and was redirected to do so.

Reconceptualize Anger (13)

The client was assisted in reconceptualizing anger as involving different components that go through predictable phases.

The client was taught about the different components of anger, including cognitive, physiological, affective, and behavioral components.

The client was taught how to better discriminate between relaxation and tension.

The client was taught about the predictable phases of anger, including demanding expectations that are not met, leading to increased arousal and anger, which lead to acting out.

The client displayed a clear understanding of the ways to conceptualize anger and was provided with positive reinforcement.

The client has struggled to understand the ways to conceptualize anger and was provided with remedial feedback in this area.

List Targets of/Causes for Anger (14)

The client was assisted in listing as many of the causes for and targets of his/her anger that he/she is aware of.

The client's list of targets of and causes for anger was processed in order to increase his/her awareness of anger management issues.

The client has indicated a greater sensitivity to his/her angry feelings and the causes for them as a result of the focus on these issues.

The client has not been able to develop a comprehensive list of causes for and targets of anger and was provided with tentative examples in this area.

List Negative Anger Impact (15)

The client was assisted in listing ways that his/her explosive expression of anger has negatively impacted his/her life.

The client was supported as he/she identified many negative consequences that have resulted from his/her poor anger management.

It was reflected to the client that his/her denial about the negative impact of his/her anger has decreased and he/she has verbalized an increased awareness of the negative impact of his/her behavior.

The client has been guarded about identifying the negative impact of his/her anger and was provided with specific examples of how his/her anger has negatively impacted his/her life and relationships (e.g., injuring others or self, legal conflicts, loss of respect from self or others, destruction of property).

Identify Positive Consequences of Anger Management (16)

The client was asked to identify the positive consequences he/she has experienced in managing his/her anger.

The client was assigned the homework exercise “Alternatives to Destructive Anger” from the

Adult Psychotherapy Homework Planner

(Jongsma).

The client was assisted in identifying positive consequences of managing anger (e.g., respect from others and self, cooperation from others, improved physical health).

The client was asked to agree to learn new ways to conceptualize and manage anger.

Use Motivational Interviewing (17)

Motivational interviewing techniques were used to help the client clarify his/her stage of motivation to change.

Motivational interviewing techniques were used to help move the client to the action stage in which he/she agrees to learn new ways to conceptualize and manage anger.

The client was assisted in identifying his/her dissatisfaction with the status quo and the benefits of making changes.

The client was assisted in identifying his/her level of optimism for making changes.

Discuss Rationale for Treatment (18)

The client was engaged in a discussion about the rationale for treatment.

Emphasis was placed on how functioning can be improved through change in various dimensions of anger management.

The concept of rationale for treatment and how functioning can be improved through change in the various dimensions of anger management was revisited.

Engage in New Ways to Recognize and Manage Anger (19)

The client was asked to learn new ways to recognize and manage his/her anger.

The client was reinforced for his/her agreement to learn new ways to recognize and manage anger.

The client was uncertain about committing to any change about his/her anger pattern, and was provided with additional feedback in this area.

Assign Reading Material (20)

The client was assigned to read material that educates him/her about anger and its management.

The client was directed to read

Overcoming Situational and General Anger: Client Manual

(Deffenbacher and McKay).

The client was directed to read

Of Course You're Angry

(Rosselini and Worden).

The client was directed to read

The Anger Control Workbook

(McKay).

The client was assigned to read

Anger Management for Everyone

(Kassinove and Tafrate).

The client has read the assigned material on anger management and key concepts were reviewed.

The client has not read the assigned material on anger management and was redirected to do so.

Teach Calming Techniques (21)

The client was taught deep-muscle relaxation, rhythmic breathing, and positive imagery as ways to reduce muscle tension when feelings of anger are experienced.

The client has implemented the relaxation techniques and reported decreased reactivity when experiencing anger; the benefits of these techniques were underscored.

The client has not implemented the relaxation techniques and continues to feel quite stressed in the face of anger; he/she was encouraged to use the techniques.

Explore Self-Talk (22)

The client's self-talk that mediates his/her angry feelings was explored.

The client was assessed for self-talk, such as demanding expectations reflected in “should,” “must,” or “have to” statements.

The client was assisted in identifying and challenging his/her biases and in generating alternative self-talk that corrects for the biases.

The client was taught about how to use correcting self-talk to facilitate a more flexible and temperate response to frustration.

Assign Self-Talk Homework (23)

The client was assigned a homework exercise in which he/she identifies angry self-talk and generates alternatives that help moderate angry reactions.

The client was assigned the exercise “Correcting Distorted Thinking” from the

Addiction Treatment Homework Planner

(Finley and Lenz).

The client's use of self-talk alternatives was reviewed within the session.

The client was reinforced for his/her success in changing angry self-talk to more moderate alternatives.

The client was provided with corrective feedback to help improve his/her use of alternative self-talk to moderate his/her angry reactions.

Role-Play Relaxation and Cognitive Coping (24)

The client was assisted in visualizing anger-provoking scenes, and then using relaxation and cognitive coping skills.

The client engaged in role-plays regarding the use of relaxation and cognitive coping in anger-provoking scenes.

The client was gradually moved from low to high anger-inducing scenes.

The client was assigned to implement calming techniques in his/her daily life and when facing anger-triggering situations.

The client's experience of using relaxation and cognitive coping in his/her daily life was processed, with reinforcement for success and problem solving for obstacles identified.

Assign Thought-Stopping Technique (25)

The client was directed to implement a thought-stopping technique on a daily basis between sessions.

The client was assigned “Making Use of the Thought-Stopping Technique” in the

Adult Psychotherapy Homework Planner

(Jongsma).

The client's use of the thought-stopping technique was reviewed.

The client was provided with positive feedback for his/her helpful use of the thought-stopping technique.

The client was provided with corrective feedback to help improve his/her use of the thought-stopping technique.

Teach Assertive Communication (26)

The client was taught about assertive communication through instruction, modeling, and role-playing.

The client was referred to an assertiveness training class.

The client displayed increased assertiveness and was provided with positive feedback in this area.

The client has not increased his/her level of assertiveness and was provided with additional feedback in this area.

Teach Problem-Solving Skills (27)

The client was taught problem-solving skills.

The client was taught about defining the problem clearly, brainstorming multiple solutions, listing the pros and cons of each solution, seeking input from others, selecting and implementing a plan of action, and evaluating and readjusting the outcome.

The client displayed a clear understanding of the use of the problem-solving skills, and displayed this through examples.

The client struggled to understand the use of problem-solving skills and was provided with remedial feedback in this area.

Teach Conflict Resolution Skills (28)

The client was taught conflict resolution skills through modeling, role-playing, and behavioral rehearsal.

The client was taught about empathy and active listening.

The client was taught about “I messages,” respectful communication, assertiveness without aggression, and compromise.

The client was reinforced for his/her clear understanding of the conflict resolution skills.

The client displayed a poor understanding of the conflict resolution skills and was provided with remedial feedback.

Conduct Conjoint Session for Skill Generalizations (29)

The client was asked to invite his/her significant other for a conjoint session.

The client and his/her significant other were seen together in order to help implement assertiveness, problem-solving, and conflict resolution skills.

The client was reinforced for his/her increased use of assertiveness, problem-solving, and conflict resolution skills with his/her significant other.

The client's significant other was urged to assist the client in his/her use of assertiveness, problem-solving, and conflict resolution skills.

The client has not regularly used assertiveness, problem-solving, and conflict resolution skills with his/her significant other and was assisted in identifying barriers to this success.

Construct Strategy for Managing Anger (30)

The client was assisted in constructing a client-tailored strategy for managing his/her anger.

The client was encouraged to combine somatic, cognitive, communication, problem-solving, and conflict resolution skills relevant to his/her needs.

The client was reinforced for his/her comprehensive anger management strategy.

The client was redirected to develop a more comprehensive anger management strategy.

Select Challenging Situations for Managing Anger (31)

The client was provided with situations in which he/she may be increasingly challenged to apply his/her new strategies for managing anger.

The client was asked to identify his/her likely upcoming challenging situations for managing anger.

The client was urged to use his/her strategies for managing anger in successively more difficult situations.

Consolidate Anger Management Skills (32)

Techniques were used to help the client consolidate his/her new anger management skills.

Techniques such as relaxation, imagery, behavioral rehearsal, modeling, role-playing, or

in vivo

exposure/behavioral experiences were used to help the client consolidate the use of his/her new anger management skills.

The client's use of techniques to consolidate his/her anger management skills was reviewed and reinforced.

Monitor/Decrease Outbursts (33)

The client's reports of angry outbursts were monitored, toward the goal of decreasing their frequency, intensity, and duration.

The client was urged to use his/her new anger management skills to decrease the frequency, intensity, and duration of his/her anger outbursts.

The client was assigned “Alternatives to Destructive Anger” in the

Adult Psychotherapy Homework Planner

(Jongsma).

The client's progress in decreasing his/her angry outbursts was reviewed.

The client was reinforced for his/her success at decreasing the frequency, intensity, and duration of his/her anger outbursts.

The client has not decreased his/her frequency, intensity, or duration of anger outbursts and corrective feedback was provided.

Differentiate Between Lapse and Relapse (34)

A discussion was held with the client regarding the distinction between a lapse and a relapse.

A lapse was associated with an initial and reversible return of angry outbursts.

A relapse was associated with the decision to return to the old pattern of anger.

The client was provided with support and encouragement as he/she displayed an understanding of the difference between a lapse and a relapse.

The client struggled to understand the difference between a lapse and a relapse and was provided with remedial feedback in this area.

Discuss Management of Lapse Risk Situations (35)

The client was assisted in identifying future situations or circumstances in which lapses could occur.

The session focused on rehearsing the management of future situations or circumstances in which lapses could occur.

The client was reinforced for his/her appropriate use of lapse management skills.

The client was redirected in regard to his/her poor use of lapse management skills.

Encourage Routine Use of Strategies (36)

The client was instructed to routinely use the strategies that he/she has learned in therapy (e.g., calming adaptive self-talk, assertion, and/or conflict resolution).

The client was urged to find ways to build his/her new strategies into his/her life as much as possible.

The client was reinforced as he/she reported ways in which he/she has incorporated coping strategies into his/her life and routine.

The client was redirected about ways to incorporate his/her new strategies into his/her routine and life.

Develop a “Coping Card” (37)

The client was provided with a “coping card” on which specific coping strategies were listed.

The client was assisted in developing his/her “coping card” in order to list his/her helpful coping strategies.

The client was encouraged to use his/her “coping card” when struggling with anger-producing situations.

Schedule “Maintenance” Sessions (38)

The client was assisted in scheduling “maintenance” sessions to help maintain therapeutic gains and adjust to life without angry outbursts.

Positive feedback was provided to the client for his/her maintenance of therapeutic gains.

The client has displayed an increase in anger symptoms and was provided with additional relapse prevention strategies.

Encourage Disclosure (39)

The client was encouraged to discuss his/her anger management goals with trusted persons who are likely to support his/her change.

The client was assisted in identifying individuals who are likely to support his/her change.

The client has reviewed his/her anger management goals with trusted persons and their responses were processed.

The client has not discussed his/her anger management goals and was redirected to do so.

Use the ACT Approach (40)

The use of acceptance and commitment therapy was applied.

The client was assisted in accepting and openly experiencing angry thoughts and feelings, without being overly impacted by them.

The client was assisted in committing his/her time and efforts to activities that are consistent with identified personally meaningful values.

The client has engaged well with the ACT approach and applied these concepts to his/her symptoms and lifestyle.

The client has not engaged well with the ACT approach and remedial efforts were applied.

Teach Mindfulness Meditation (41)

The client was taught mindfulness meditation techniques to help recognize negative thought processes associated with anger.

The client was taught to focus on changing his/her relationship with the anger-related thoughts by accepting the thoughts, images, and impulses that are reality-based while noticing, but not reacting to, nonreality-based mental phenomenon.

The client was assisted in differentiating between reality-based thoughts and nonreality-based thoughts.

The client has used mindfulness meditation to help overcome negative thought processes that trigger anger, and was reinforced for this.

The client has struggled to apply mindfulness meditation and was provided with remedial assistance in this area.

Assign ACT Homework (42)

The client was assigned homework situations in which he/she practices lessons from mindfulness meditation and ACT.

The client was assisted in consolidating his/her mindfulness meditation and ACT approaches into his/her everyday life.

Assign Reading on Mindfulness and ACT (43)

The client was assigned reading material consistent with mindfulness and the ACT approach to supplement work done in session.

The client has read assigned material and key concepts were processed.

The client has not read assigned material and was redirected to do so.

Connect Family of Origin as Model for Threat Sensitivity (44)

The client's family of origin experiences were reviewed.

The client was assisted in identifying how his/her family of origin experiences contribute to his/her tendency to see people and situations as threatening.

Identify Anger Expression Models (45)

The client was assisted in identifying key figures in his/her life who have provided examples to him/her of how to positively or negatively express anger.

The client was reinforced as he/she identified several key figures who have been negative role models in expressing anger explosively and destructively.

The client was supported and reinforced as he/she acknowledged that he/she manages his/her anger in the same way that an explosive parent figure had done when he/she was growing up.

The client was encouraged to identify positive role models throughout his/her life whom he/she could respect for their management of angry feelings.

The client was supported as he/she acknowledged that others have been influential in teaching him/her destructive patterns of anger management.

The client failed to identify key figures in his/her life who have provided examples to him/her as to how to positively express his/her anger and was questioned more specifically in this area.

Teach Anger Effects (46)

The client was educated regarding the ways in which anger blocks the awareness of pain, discharges uncomfortable feelings, erases guilt, and places the blame for problems on others.

The client verbalized an understanding of how anger blocks the awareness of pain, discharges uncomfortable feelings, erases guilt, and places the blame for problems on others; this insight was reinforced.

The client's understanding of the effects of anger has resulted in him/her demonstrating improved anger management; this progress was highlighted.

The client did not accept the relationship between how anger blocks the awareness of pain, discharges uncomfortable feelings, erases guilt, and places the blame for problems on others; he/she was urged to continue to consider this relationship.

Develop Forgiveness (47)

The client was assisted in identifying whom he/she needs to forgive.

The client was educated as to the long-term process that is involved in forgiveness, versus it being a magical, single event.

The client was encouraged to read

Forgive and Forget

(Smedes) to learn more about the process of forgiveness.

The client identified a list of individuals whom he/she needs to forgive.

The client was reluctant to emphasize forgiveness, and was provided with additional support in this area.

Turn Perpetrators Over to the Higher Power (48)

The client was taught about the 12-step recovery program concept of a higher power.

The client was taught about the choice to turn the perpetrators of pain over to his/her higher power for judgment.

The client indicated that he/she understands the concept of a higher power and using the higher power for judgment of perpetrators of pain; this insight was processed.

The client rejected the idea of a higher power as a way to provide judgment for perpetrators of pain, and was urged to consider this further.

Focus on Exercise Program (49)

The client was taught the importance of regular exercise in improving anger control and reducing addictive behavior.

The client was referred for assistance in developing an individually tailored exercise program that is approved by his/her personal physician.

The client was reinforced as he/she has accepted the need for regular exercise and has developed a program of implementation.

The client reported implementing an exercise program and his/her level of relaxation was reviewed.

The client has resisted implementation of an exercise regimen, and was redirected to do so.

Teach the Importance of a 12-Step Recovery Program (50)

The client was taught the importance of actively attending a 12-step recovery program, getting a sponsor, reinforcing people around him/her, and sharing feelings.

The client has verbalized an acceptance of his/her need for a 12-step recovery program, getting a sponsor, reinforcing people around him/her, and sharing feelings; this progress was reinforced.

The client was resistive to acceptance of a 12-step recovery program, and additional examples of how helpful this can be were provided.

Develop 5-Year Plan (51)

The client was taught about the concept of a 5-year recovery plan.

The client was assisted in developing a realistic 5-year personal recovery plan.

The client was reinforced for a reasonable 5-year recovery plan.

The client was provided with redirection in areas where his/her recovery plan seemed unrealistic.

Assess Satisfaction (52)

A treatment satisfaction survey was administered to the client.

The client's survey responses indicated a high level of satisfaction with treatment services; these results were processed.

The client's survey responses indicated a medium level of satisfaction with treatment services; these results were processed.

The client's survey responses indicated a low level of satisfaction with treatment services; these results were processed.

Although the client was encouraged to complete a treatment satisfaction survey, it was refused.

*

 The numbers in parentheses correlate to the number of the Behavioral Definition statement in the companion chapter with the same title in

The Addiction Treatment Planner

, Fifth Edition, by Perkinson, Jongsma, and Bruce (Hoboken, NJ: Wiley, 2014).

*

 The numbers in parentheses correlate to the number of the Therapeutic Intervention statement in the companion chapter with the same title in

The Addiction Treatment Planner

, Fifth Edition, by Perkinson, Jongsma, and Bruce (Hoboken, NJ: Wiley, 2014).

ANTISOCIAL BEHAVIOR

CLIENT PRESENTATION

Rule-Breaking History (1)

*

The client confirmed that his/her history of rule breaking, lying, physical aggression, and/or disrespect for others and the law is associated with the use of drugs and/or alcohol.

The client reported frequent incarcerations due to illegal activities and drug/alcohol violations.

The client acknowledged that his/her substance abuse has paralleled his/her antisocial behavior.

The client has demonstrated and verbalized more respect for the rules of society and the needs of others.

Disregard for Others' Rights (2)

The client displayed little concern for the rights of others in his/her pattern of behavior.

The client has often demonstrated a pattern of violating the rights of others in order to meet his/her own needs.

The client verbalized an understanding of how his/her actions have negatively impacted others.

The client has demonstrated increased empathy and sensitivity to the rights of others.

Blaming Others (3)

The client refused to take responsibility for his/her own behavior and decisions; instead, he/she pointed to the behavior of others or to substance abuse as the cause for his/her actions.

The client's interpersonal conflicts were blamed on others or on substance abuse, without him/her taking any responsibility for the problems.

The client is beginning to accept personal responsibility for his/her own behavior, and makes fewer statements projecting responsibility for his/her actions onto others.

Aggressive Behavior to Control Others (4)

The client described a series of incidents in which he/she has become aggressive in order to manipulate, intimidate, or control others.

The client blamed his/her substance abuse for his/her aggressive/destructive behaviors.

The client has acknowledged his/her need to control his/her aggressive, manipulative, and intimidating behaviors.

The client has recently demonstrated good self-control and has not engaged in any aggressive, intimidating, or controlling behaviors.

Dishonesty (5)

The client reported a pattern of lying to cover up his/her responsibility for action or substance abuse, with little shame or anxiety attached to this pattern of lying.

The client seemed to be lying during the session.

The client acknowledged that his/her dishonesty produced conflicts within relationships and distrust from others.

The client has committed himself/herself to being more honest in interpersonal relationships.

Hedonistic Lifestyle (6)

The client described a pattern of hedonistic, self-centered behaviors that reflect little regard by him/her for their negative effects on others.

The client was able to identify how his/her lifestyle is hedonistic and self-centered.

The client was able to identify how his/her lifestyle has displayed little regard by him/her for any values beyond seeking to feel good.

The client has displayed a pattern of acting with greater regard for the needs and welfare of others.

Lack of Empathy (7)

The client described patterns of aggression and disrespect for others, and displayed no remorse or empathy for how this behavior affects others.

The client projected blame for his/her hurtful behavior onto others or onto substance abuse, saying that he/she had no alternative.

The client has begun to develop some empathy for the feelings of others, but only for those who are close to him/her (i.e., friends and family).

The client has reported feelings of empathy both for those who are close to him/her and to others.

Adolescent Criminal Activity (8)

The client confirmed that his/her history of criminal activity and addiction began when he/she was a teenager.

The client reported that he/she was often involved with juvenile justice officials or incarcerated within the juvenile justice system for illegal activities and substance abuse.

The client acknowledged that his/her substance abuse paralleled his/her antisocial behavior and dates back to adolescence.

Recklessness/Thrill Seeking (9)

The client reported having engaged in reckless, adventure-seeking behavior and substance abuse, reflecting a high need for excitement, having fun, and living “on the edge.”

The client described a series of reckless actions, often while under the influence of substances, which showed little consideration for the consequences of such actions.

The client has begun to control his/her reckless impulses and substance abuse, and has reported that he/she is trying to think of the consequences before acting recklessly.

Impulsivity (10)

The client's pattern of impulsive behavior and substance use is demonstrated in his/her frequent geographical moves, traveling with few or no goals, and quitting one job after another.

The client's impulsivity has resulted in a life of instability and negative consequences for self and others.

The client has acknowledged that his/her life of impulsive reactivity and substance abuse has had many negative consequences and that he/she is now committed to making an effort to control these impulses.

The client has shown progress in controlling impulsive reactivity and substance misuse, and now considers the possible consequences of his/her actions before reacting.

INTERVENTIONS IMPLEMENTED

Identify Antisocial and Addictive Behavior as Self-Defeating (1)

*

The client was asked to list the negative consequences that have accrued to him/her due to his/her antisocial behavior.

The client was assigned the Step One exercise from the

Alcoholism & Drug Abuse Patient Workbook

(Perkinson).

The client was asked to identify others who have been negatively impacted by his/her antisocial behavior, and to list the specific pain that these individuals have suffered.

The client was asked to verbalize an acceptance of the powerlessness and unmanageability he/she has over antisocial behavior and addiction.

The client was confronted with the fear, disappointment, loss of trust, and loss of respect that others experience as a consequence of his/her self-centered behavior and lack of sensitivity.

The client denied any negative or self-defeating consequences due to his/her antisocial/addictive behavior, and was provided with tentative examples of how this occurs.

The client has not completed the assigned Step One homework, and was redirected to do so.

Recognize Reciprocity of Antisocial and Addictive Behavior (2)

The client was presented with the concept of a reciprocal relationship between his/her antisocial behavior and addiction.

The client was asked to identify how substances have played a part in his/her choices regarding antisocial behavior.

The client was asked to verbalize how his/her antisocial behavior has encouraged his/her addiction.

The client denied any connection between his/her antisocial and addictive behaviors, and was urged to remain open to this concept.

Administer Antisocial Behavior Rating Scales (3)

The client was administered psychological instruments designed to objectively assess baseline levels of antisocial behavior, impulsivity, and/or aggression.

The client was administered the Psychopathy Checklist–Revised (PCL-R).

The client was administered the Aggressive Acts Questionnaire (AAQ).

The client was administered the Barratt Impulsiveness Scale–11 (BIS-11).

The client was provided feedback regarding the results of the assessment of antisocial behavior, impulsivity, and/or aggression.

The client declined to participate in taking the instruments used to assess antisocial behavior, impulsivity, and/or aggression, and was redirected to do so.

Recognize

Insanity

(4)

The client was presented with the concept of how doing the same things over and over again but expecting different results is irrational.

The client was presented with the concept that irrational behavior (e.g., doing the same thing over and over and expecting different results) is what 12-step recovery programs call

insanity

.

The client was asked to identify his/her experience of

insane

and

irrational

behavior and how this concept applies to him/her.

The client rejected the concept of his/her behavior being

insane

or

irrational,

and was provided with remedial feedback in this area.

Assess Level of Insight (5)

The client's level of insight toward the presenting problems was assessed.

The client was assessed in regard to the syntonic vs. dystonic nature of his/her 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.

Assess for Correlated Disorders (6)

The client was assessed for evidence of research-based correlated disorders.

The client was assessed in regard to his/her 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.

Assess for Culturally Based Confounding Issues (7)

The client was assessed for age-related issues that could help to better understand his/her clinical presentation.

The client was assessed for gender-related issues that could help to better understand his/her clinical presentation.

The client was assessed for cultural syndromes, cultural idioms of distress, or culturally based perceived causes that could help to better understand his/her 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 his/her 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.

Assess Severity of Impairment (8)

The severity of the client's impairment was assessed to determine the appropriate level of care.

The client was assessed in regard to his/her impairment in social, relational, vocational, and occupational endeavors.

It was reflected to the client that his/her impairment appears to create mild to moderate effects on the client's functioning.

It was reflected to the client that his/her 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 treatment.

Review the Rules and Consequences for Failure to Comply (9)

The client was presented with a list of rules that must be kept by participants in the treatment program.

The client was presented with a list of general societal rules/expectations.

The client was presented with appropriate consequences for failing to follow the rules.

The client was praised as he/she has been able to maintain the rules of the program.

The client has failed to follow the presented rules, and appropriate consequences have been implemented.

Review Rule Breaking and Natural Consequences (10)

The client was presented with several examples of his/her rule/limit breaking that have led to negative consequences for self and others.

The client was asked to identify several examples of his/her rule/limit breaking that have led to negative consequences for self and others.

The client was consistently reminded of the pain that others suffer as a result of his/her antisocial behavior.

Teach About Empathy (11)

Role-playing and role reversal techniques were used to teach the client the value of being empathetic to the needs, rights, and feelings of others.

The client was assigned “How I Have Hurt Others” from the

Adult Psychotherapy Homework Planner

(Jongsma).

The client was asked to commit himself/herself to acting more sensitively to the rights and feelings of others.

The client has not completed the assigned “How I Have Hurt Others” homework, and was redirected to do so.

Teach About Criminal Thinking (12)

The client was taught that actions do not spontaneously occur, but rather are preceded by a variety of decisions.

The client was asked to review how his/her decisions are sometimes based in criminal thinking.

The client was asked to list five times that antisocial behavior led to negative consequences, and to also list the many decisions that were made along the way.

The client was helped to see how many negative consequences are preceded by decisions based in criminal thinking.

It was pointed out to the client that he/she justifies his/her antisocial attitude as the way that he/she learned to live because of childhood or other socialization processes.

Teach About the Effects of Dishonesty (13)

The client was asked to list the positive effects for others when he/she is honest and reliable.

The client was taught that pain and disappointment result when honesty and reliability are not given the highest priority in one's life.

The client was asked to identify situations in which he/she could be more honest and reliable.

The client identified ways in which he/she is being more honest and reliable, and these were processed.

The client was confronted for continuing to be dishonest and unreliable.

Connect Criminal Activity and Low Self-Esteem (14)

The client was taught about how the emotional dynamics of criminal activity lead to feelings of low self-esteem.

The client was asked to identify personal examples of how criminal activity has led to feelings of low self-esteem.

The client displayed a clearer understanding of the connection between criminal activity and feelings of low self-esteem, and this insight was reinforced.

The client had difficulty displaying an understanding of the connection between criminal activity and low self-esteem, and was provided with additional information in this area.

Link Criminal Thinking to Antisocial Behavior and Addiction (15)

The client was taught how criminal thinking (e.g., super-optimism, little empathy for others, power orientation, a sense of entitlement, self-centeredness) leads to antisocial behavior and addiction.

Personal examples of how criminal thinking has led to antisocial behavior and addiction in the client's life were processed.

The client denied that he/she has engaged in criminal thinking leading to antisocial behavior and addiction, and was provided with remedial feedback.

Identify How Blaming Results in Continued Mistakes (16)

The client was asked to identify how blaming others results in a failure to learn from his/her mistakes.

The client was confronted with a pattern of his/her behavior that demonstrates a failure to learn from mistakes.

The client was asked to list incidents from his/her past that are examples of blaming others, resulting in a failure to learn from mistakes.

Active listening was provided as the client displayed an understanding of how blaming others results in a failure to learn from mistakes, and described situations in which he/she was changing that pattern.

The client was confronted for continuing to blame others for his/her own mistakes.

Explore Reasons for Blaming (17)

The client's history was explored, with a focus on causes for the avoidance of accepting responsibility for his/her own behavior.

The client's history of physical and emotional abuse was explored, and an association with denying responsibility for his/her behavior was made.

The client's early history of lying was explored as to causes and consequences.

Parental modeling of projection of responsibility for their behavior was examined.

Confront Projection (18)

The client was consistently confronted for failing to take responsibility for his/her own actions and for placing the blame for them onto others.

As the client's pattern of projecting blame onto others began to weaken, he/she was reinforced for taking personal responsibility for his/her actions.

The importance of taking responsibility for one's own behavior and the positive implications for this as a way to motivate change were reviewed.

Teach the Difference Between Antisocial and Prosocial Behaviors (19)

The specific criteria for identifying antisocial behaviors and the opposite prosocial behaviors were brainstormed with the client.

A commitment to practicing prosocial behaviors was developed.

The client was assisted in developing a list of prosocial behaviors (e.g., helping others) to practice each day.

The client was helped to identify several instances in which he/she has been practicing prosocial behaviors.

The client was confronted for persisting in antisocial behaviors.

Confront Disrespect (20)

The client was confronted consistently and firmly when he/she exhibited an attitude of disrespect for the rights and feelings of others.

It was firmly and consistently emphasized to the client that others have a right to boundaries, privacy, and respect for their feelings and property.

Thoughtful attitudes and beliefs about the welfare of others, as well as respect for others, were modeled for the client.

List Typical Antisocial Thoughts and Alternative Thoughts (21)