The Complete Adult Psychotherapy Treatment Planner E-Book

Arthur E. Jongsma

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Practice Planners
• Sprache: Englisch
• Veröffentlichungsjahr: 2021

Seitenzahl: 754

Beschreibung

The revised edition of the clinicians' time-saving Psychotherapy Treatment Planner Revised and updated, the sixth edition of The Complete Adult Psychotherapy Treatment Planner offers clinicians a timesaving, evidence-based guide that helps to clarify, simplify and accelerate the treatment planning process so they can spend less time on paperwork and more time with clients. The authors provide all the elements necessary to quickly and easily develop formal, customizable treatment plans that satisfy the demands of HMOs, managed-care companies, third-party payers and state and federal agencies. This revised edition includes new client Short-Term Objectives and clinician Therapeutic Interventions that are grounded in evidence-based treatment wherever research data provides support to an intervention approach. If no research support is available a best practice standard is provided. This new edition also offers two new presenting problem chapters (Loneliness and Opioid Use Disorder) and the authors have updated the content throughout the book to improve clarity, conciseness and accuracy. This important book: * Offers a completely updated resource that helps clinicians quickly develop effective, evidence-based treatment plans * Includes an easy-to-use format locating treatment plan components by Presenting Problem or DSM-5 diagnosis * Contains over 3,000 prewritten treatment Symptoms, Goals, Objectives and Interventions to select from * Presents evidence-based treatment plan components for 45 behaviorally defined Presenting Problems * Suggests homework exercises specifically created for each Presenting Problem Written for psychologists, therapists, counselors, social workers, addiction counselors, psychiatrists, and other mental health professionals, The Complete Adult Psychotherapy Treatment Planner, Sixth Edition has been updated to contain the most recent interventions that are evidence-based.

Leseprobe

Table of Contents

COVER

TITLE PAGE

COPYRIGHT

PRACTICE

PLANNERS

®

SERIES PREFACE

ACKNOWLEDGMENTS

ABOUT THE COMPANION WEBSITE

INTRODUCTION

ABOUT PRACTICE

PLANNERS

®

TREATMENT PLANNERS

ABOUT THIS SIXTH EDITION COMPLETE

ADULT PSYCHOTHERAPY TREATMENT PLANNER

HOW TO USE THIS TREATMENT PLANNER

A FINAL NOTE ON TAILORING THE TREATMENT PLAN TO THE CLIENT

REFERENCES AND FURTHER READING

SAMPLE TREATMENT PLAN

ANXIETY

DIAGNOSIS

ANGER CONTROL PROBLEMS

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

ANTISOCIAL BEHAVIOR

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

ANXIETY

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)—ADULT

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

BIPOLAR DISORDER—DEPRESSION

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

BIPOLAR DISORDER—MANIA

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

BORDERLINE PERSONALITY DISORDER

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

Notes

CHILDHOOD TRAUMA

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

CHRONIC PAIN

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

COGNITIVE DEFICITS

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTES

DEPENDENCY

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

DEPRESSION—UNIPOLAR

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

DISSOCIATION

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

EATING DISORDERS AND OBESITY

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

EDUCATIONAL DEFICITS

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

FAMILY CONFLICT

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

FEMALE SEXUAL DYSFUNCTION

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

FINANCIAL STRESS

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

GRIEF/LOSS UNRESOLVED

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

IMPULSE CONTROL DISORDER

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

INTIMATE RELATIONSHIP CONFLICTS

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

LEGAL CONFLICTS

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

LONELINESS

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

LOW SELF‐ESTEEM

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

MALE SEXUAL DYSFUNCTION

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

MEDICAL ISSUES

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

OBSESSIVE‐COMPULSIVE AND RELATED DISORDERS

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

OPIOID USE DISORDER

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTES

PANIC/AGORAPHOBIA

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

PARANOID IDEATION

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

PARENTING

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

PHASE OF LIFE PROBLEMS

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

PHOBIA

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

POSTTRAUMATIC STRESS DISORDER (PTSD)

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

PSYCHOTICISM

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

SEXUAL ABUSE VICTIM

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

SEXUAL ORIENTATION CONFUSION

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTES

SLEEP DISTURBANCE

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

SOCIAL ANXIETY

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

SOMATIC SYMPTOM/ILLNESS ANXIETY

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

SPIRITUAL CONFUSION

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

SUBSTANCE USE

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

SUICIDAL IDEATION

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

TYPE A BEHAVIOR

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

VOCATIONAL STRESS

BEHAVIORAL DEFINITIONS

LONG‐TERM GOALS

DIAGNOSTIC SUGGESTIONS

NOTE

APPENDIX A: BIBLIOTHERAPY SUGGESTIONS

General

Anger Control Problems

Antisocial Behavior

Attention Deficit Hyperactivity Disorder (ADHD)—Adult

Bipolar Disorder—Depression

Bipolar Disorder—Mania

Borderline Personality Disorder

Childhood Trauma

Chronic Pain

Cognitive Deficits

Dependency

Depression–Unipolar

Dissociation

Eating Disorders and Obesity

Educational Deficits

Family Conflict

Female Sexual Dysfunction

Financial Stress

Grief/Loss Unresolved

Impulse Control Disorder

Intimate Relationship Conflicts

Legal Conflicts

Loneliness

Low Self‐Esteem

Male Sexual Dysfunction

Medical Issues

Obsessive‐Compulsive and Related Disorders (OCD)

Opioid Use Disorder

Panic/Agoraphobia

Paranoid Ideation

Parenting

Phase of Life Problems

Phobia

Posttraumatic Stress Disorder (PTSD)

Psychoticism

Sexual Abuse Victim

Sexual Orientation Confusion

Sleep Disturbance

Social Anxiety

Somatic Symptom/Illness Anxiety

Spiritual Confusion

Substance Use

Suicidal Ideation

Type A Behavior

Vocational Stress

APPENDIX B: REFERENCES TO CLINICAL RESOURCES FOR EVIDENCE‐BASED CHAPTERS

Anger Control Problems

Anxiety

Attention Deficit Hyperactivity Disorder—Adult

Bipolar Disorder—Depression

Bipolar Disorder—Mania

Borderline Personality Disorder

Chronic Pain

Cognitive Deficits

Depression—Unipolar

Eating Disorders and Obesity

Grief/Loss Unresolved

Family Conflict

Female Sexual Dysfunction

Intimate Relationship Conflicts

Male Sexual Dysfunction

Medical Issues

Obsessive‐Compulsive and Related Disorders

Opioid Use Disorder

Panic/Agoraphobia

Parenting

Phobia

Posttraumatic Stress Disorder (PTSD)

Psychoticism

Sleep Disturbance

Social Anxiety

Somatic Symptom/Illness Anxiety

Substance Use

Suicidal Ideation

Type A Behavior

Vocational Stress

APPENDIX C: RECOVERY MODEL OBJECTIVES AND INTERVENTIONS

LONG‐TERM GOALS

NOTE

APPENDIX D: ALPHABETICAL INDEX OF SOURCES FOR ASSESSMENT INSTRUMENTS AND CLINICAL INTERVIEW FORMS CITED IN INTERVENTIONS

Additional Sources of Commonly Used Scales and Measures

END USER LICENSE AGREEMENT

Guide

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PracticePlanners® Series

Treatment Planners

The Complete Adult Psychotherapy Treatment Planner, Fifth Edition

The Child Psychotherapy Treatment Planner, Fifth Edition

The Adolescent Psychotherapy Treatment Planner, Fifth Edition

The Addiction Treatment Planner, Fifth Edition

The Continuum of Care Treatment Planner

The Couples Psychotherapy Treatment Planner, Second Edition

The Employee Assistance Treatment Planner

The Pastoral Counseling Treatment Planner

The Older Adult Psychotherapy Treatment Planner, Second Edition

The Behavioral Medicine Treatment Planner

The Group Therapy Treatment Planner

The Gay and Lesbian Psychotherapy Treatment Planner

The Family Therapy Treatment Planner, Second Edition

The Severe and Persistent Mental Illness Treatment Planner, Second Edition

The Mental Retardation and Developmental Disability Treatment Planner

The Social Work and Human Services Treatment Planner

The Crisis Counseling and Traumatic Events Treatment Planner, Second Edition

The Personality Disorders Treatment Planner

The Rehabilitation Psychology Treatment Planner

The Special Education Treatment Planner

The Juvenile Justice and Residential Care Treatment Planner

The School Counseling and School Social Work Treatment Planner, Second Edition

The Sexual Abuse Victim and Sexual Offender Treatment Planner

The Probation and Parole Treatment Planner

The Psychopharmacology Treatment Planner

The Speech‐Language Pathology Treatment Planner

The Suicide and Homicide Treatment Planner

The College Student Counseling Treatment Planner

The Parenting Skills Treatment Planner

The Early Childhood Intervention Treatment Planner

The Co‐Occurring Disorders Treatment Planner

The Complete Women's Psychotherapy Treatment Planner

The Veterans and Active Duty Military Psychotherapy Treatment Planner

Progress Notes Planners

The Child Psychotherapy Progress Notes Planner, Fifth Edition

The Adolescent Psychotherapy Progress Notes Planner, Fifth Edition

The Adult Psychotherapy Progress Notes Planner, Fifth Edition

The Addiction Progress Notes Planner, Fifth Edition

The Severe and Persistent Mental Illness Progress Notes Planner, Second Edition

The Couples Psychotherapy Progress Notes Planner, Second Edition

The Family Therapy Progress Notes Planner, Second Edition

The Veterans and Active Duty Military Psychotherapy Progress Notes Planner

Homework Planners

Couples Therapy Homework Planner, Second Edition

Family Therapy Homework Planner, Second Edition

Grief Counseling Homework Planner

Group Therapy Homework Planner

Divorce Counseling Homework Planner

School Counseling and School Social Work Homework Planner, Second Edition

Child Therapy Activity and Homework Planner

Addiction Treatment Homework Planner, Fifth Edition

Adolescent Psychotherapy Homework Planner, Fifth Edition

Adult Psychotherapy Homework Planner, Fifth Edition

Child Psychotherapy Homework Planner, Fifth Edition

Parenting Skills Homework Planner

Veterans and Active Duty Military Psychotherapy Homework Planner

Client Education Handout Planners

Adult Client Education Handout Planner

Child and Adolescent Client Education Handout Planner

Couples and Family Client Education Handout Planner

Complete Planners

The Complete Depression Treatment and Homework Planner

The Complete Anxiety Treatment and Homework Planner

The Complete Adult Psychotherapy Treatment Planner

Sixth Edition

Arthur E. Jongsma, Jr.

L. Mark Peterson

Timothy J. Bruce

This edition first published 2021.Copyright © 2021 by John Wiley & Sons, Inc.

Edition History

John Wiley & Sons, Inc. (5e, 2014); John Wiley & Sons, Inc. (4e, 2006); John Wiley & Sons, Inc. (3e, 2003); John Wiley & Sons, Inc. (2e, 1999); John Wiley & Sons, Inc. (1e, 1995)

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.

The right of Arthur E. Jongsma, Jr., L. Mark Peterson, and Timothy J. Bruce to be identified as the authors of this work has been asserted in accordance with law.

Registered OfficeJohn Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA

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While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Library of Congress Cataloging‐in‐Publication Data

Names: Jongsma, Arthur E., Jr., 1943- author. | Peterson, L. Mark, author. | Bruce, Timothy J., author.

Title: The complete adult psychotherapy treatment planner / Arthur E. Jongsma, L. Mark Peterson, Timothy J. Bruce.

Description: Sixth edition. | Hoboken : Wiley, [2021] | Series: Practiceplanners. | Includes bibliographical references.

Identifiers: LCCN 2020025450 (print) | LCCN 2020025451 (ebook) | ISBN 9781119629931 (paperback) | ISBN 9781119629986 (adobe pdf) | ISBN 9781119629924 (epub)

Subjects: LCSH: Psychotherapy—Handbooks, manuals, etc. | Medical records—Handbooks, manuals, etc. | Adulthood--Psychological aspects—Handbooks, manuals, etc. | Mental illness—Treatment—Handbooks, manuals, etc.

Classification: LCC RC480.5 .J663 2021 (print) | LCC RC480.5 (ebook) | DDC 616.89/14—dc23

LC record available at https://lccn.loc.gov/2020025450LC ebook record available at https://lccn.loc.gov/2020025451

Cover Design: WileyCover Images: © Ryan McVay/Getty Images

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 Practice

Planners

®

series includes a wide array of treatment planning books including not only the original

Complete Adult Psychotherapy Treatment Planner

,

Child Psychotherapy Treatment Planner

,

Adolescent Psychotherapy Treatment Planner

, and

Addictions Treatment Planner

all now in their sixth editions, but also Treatment Planners targeted to specialty areas of practice, including:

Co‐occurring disorders

Integrated 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

Intellectual and developmental disability

Neuro rehabilitation

Older adults

Parenting skills

Pastoral counseling

Personality disorders

Probation and parole

Psychopharmacology

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 military duty

Women's issues

In addition, there are three branches of companion books that 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

.

The Series also includes:

Evidence‐Based Psychotherapy Treatment Planning Video Series

offers 12 sixty‐minute programs that provide step‐by‐step guidance on how to use empirically supported treatments to inform the entire treatment planning process. In a viewer friendly manner, Drs. Art Jongsma and Tim Bruce discuss the steps involved in integrating evidence‐based treatment (EBT) Objectives and Interventions into a treatment plan. The research support for the EBTs is summarized, and selected aspects of the EBTs are demonstrated in role‐played counseling scenarios.

A companion Treatment Planning software product is also available:

TheraScribe

®

,

the #1 selling treatment planning and clinical record‐keeping software system for mental health professionals. TheraScribe

®

allows the user to import the data from any of the Treatment Planner, Progress Notes Planner, or Homework Planner books into the software's expandable database to simply point and click to create a detailed, organized, individualized, and customizable treatment plan along with optional integrated progress notes and homework assignments. TheraScribe is available by calling 616‐776‐1745. Also, see

TheraScribe.com

for more information.

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

ACKNOWLEDGMENTS

Since 2005 we have turned to research evidence to inform the treatment Objectives and Interventions in our latest editions of the Psychotherapy Treatment Planner books. Although much of the content of our Planners was “best practice” and also from the mainstream of sound psychological procedure, we have benefited significantly from a thorough review that looked through the lens of evidence‐based practice. The later editions of the Planners now stand as content not based just on “best practice” but on reliable research results. Although several of my coauthors have contributed to this recertification of our content, Timothy J. Bruce has been the main guiding force behind this effort. Dr. Bruce has used his depth of knowledge regarding evidence‐supported treatment to shape and inform the content of the last three editions of Adult, Adolescent, Child, and Addiction Psychotherapy Treatment Planners.

I am pleased to announce that after the current revisions of these planners, Dr. Bruce will be assuming the role of Series Editor as I move toward retirement. I make this move with the utmost confidence that the PracticePlanners series will be in very capable hands. Tim is the consummate psychologist who knows the research literature on psychotherapy, is a compassionate and effective therapist, and whose integrity and ethics are of the highest caliber. I am always thankful for Tim Bruce and his many gifts.

It has now been 25 years since my first Treatment Planner book was published by Wiley. The series has grown to 53 books and my relationship with the highly regarded John Wiley & Sons publishing house continues to be strong. In a day of pervasive quickly fading loyalties I count it a blessing for us to be trusted partners for all these years. Thank you to my current editor Darren along with Veronika and Monica for your great professionalism.

I also tip my hat to my coauthor, Mark Peterson, who launched this Complete Adult Psychotherapy Treatment Planner with me by adding his original content contributions many years ago and has supported all the efforts to keep it fresh and evidence based.

Finally, every ship needs a strong rudder to stay on course. My rudder for all the vagaries of life is my wife, Judy, and we both keep seeking God's will as our ultimate map.

AEJ

I am more than fortunate to have been invited some 15 years ago by Dr. Art Jongsma to work with him on his well‐known and highly regarded PracticePlanners series and to have been welcomed by his coauthors with whom I have had the pleasure of working, including our coauthor on this volume, Mark Peterson. As a reader of this book, you probably appreciate that Dr. Jongsma's treatment planners are works of enormous value to practicing clinicians as well as terrific educational tools for “students” of our profession. I remember reading my first treatment planner and thinking, “Wow! Art has done something here, and done it very well!” Since then, I have come to know Art, his family, his friends, his thoughts, his values, his love of my paella, the way he lives his life, and I can tell you that my first impression was correct. As a psychologist, husband, father, colleague, you name it, Art Jongsma has done something here and done it very well. I am more than fortunate to have him as a colleague and friend. As Art noted in his acknowledgment, he recently told me of his plans to “move toward” retirement and asked me if I would take stewardship of, take care of, his brainchild and invaluable contribution to our field. To say the least, I was honored, but also simultaneously humbled. By this, I mean that I am no Art Jongsma, but I will do my best to keep this series of the quality and value that he has. Thank you again, Art, for everything.

I would also like to thank the team at John Wiley & Sons. Executive Editor Darren Lalonde, Senior Project Editor Daniel Finch, Senior Manager Veronika Yefremenko, and their staff who were expert, kind, supportive, and professional in managing what I think we should call a highly effective international coordination of the writing and publishing process. It was a pleasure.

Lastly, I would like to thank my wife of 39 years, Lori, our son Logan, daughter‐in‐law Cassy, and daughter Madeline, for all they do. I am more than fortunate. Thank you.

TJB

ABOUT THE COMPANION WEBSITE

This book is accompanied by a companion website.

www.wiley.com\go\jongsma\adulttp6e

This website includes:

Appendix E: References to Empirical Support for Evidence‐Based Chapters in the Complete Adult Psychotherapy Treatment Planner, 6

th

Edition

Please note that corresponding homework assignments can be digitally downloaded through purchase of The Adult Psychotherapy Homework Planner, 6th Edition.

INTRODUCTION

ABOUT PRACTICEPLANNERS® TREATMENT PLANNERS

Pressure from third‐party payers, accrediting agencies, and other outside parties has increased the need for clinicians to quickly produce effective, high‐quality treatment plans. Treatment Planners provide all the elements necessary to quickly and easily develop formal treatment plans that satisfy the needs of most third‐party payers and state and federal review agencies.

Each Treatment Planner:

Saves you hours of time‐consuming paperwork.

Offers the freedom to develop customized treatment plans.

Includes over 1,000 clear statements describing the behavioral manifestations of each relational problem and provides long‐term goals, short‐term objectives, and clinically tested treatment options.

Has an easy‐to‐use reference format that helps locate treatment plan components by behavioral problem or

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition

(

DSM‐5™

) diagnosis.

As with the rest of the books in the PracticePlanners® series, our aim is to clarify, simplify, and accelerate the treatment planning process, so you spend less time on paperwork and more time with your clients.

ABOUT THIS SIXTH EDITION COMPLETE ADULT PSYCHOTHERAPY TREATMENT PLANNER

This Sixth Edition of the Complete Adult Psychotherapy Treatment Planner has been improved in many ways:

Updated with new and revised evidence‐based Objectives and Interventions from the research literature

Revised, expanded, and updated References to Clinical Resources for Evidence‐Based Chapters appendix

Moved a Revised Appendix for References to Empirical Support online as found at:

www.wiley.com/go/jongsma/adulttp6e

More suggested homework assignments integrated into the Interventions

Expanded and updated self‐help book list in the Bibliotherapy appendix

Addition of new chapters on Loneliness and on Opioid Use Disorder

Unipolar Depression chapter has been renamed Depression—Unipolar and Sexual Identity Confusion chapter has been renamed Sexual Orientation Confusion

Suicidal Ideation has been added to the list of evidence‐based chapters with new research content inserted

Integrated

DSM‐5

diagnostic labels and codes into the Diagnostic Suggestions section of each chapter and all transition references to

DSM‐IV

have been removed

Evidence‐based practice (EBP) is steadily becoming the standard of care in mental health care as it has in medical health care. Professional organizations such as the American Psychological Association, National Association of Social Workers, and the American Psychiatric Association, as well as consumer organizations such the National Alliance for the Mentally Ill (NAMI) have all endorsed the use of EBP. In some practice settings, EBP is becoming mandated. Some third‐party payers are requiring use of EBP for reimbursement. It is clear that the call for evidence and accountability is being increasingly sounded. So, what is EBP and how is its use facilitated by this Planner?

Borrowing from the Institute of Medicine's definition (Institute of Medicine, 2001), the American Psychological Association (APA) has defined EBP as “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (APA Presidential Task Force on Evidence‐Based Practice, 2006). Consistent with this definition, we have identified those psychological treatments with the best available supporting evidence, added Objectives and Interventions consistent with them in the pertinent chapters, and identified these with this symbol: . As most practitioners know, research has shown that although these treatment methods may have demonstrated efficacy, factors such as the individual psychologist (e.g., Wampold, 2001), the treatment relationship (e.g., Norcross, 2019), and the client (e.g., Bohart & Tallman, 1999) are also vital contributors to optimizing a client's response to psychotherapy. As noted by the APA, “Comprehensive evidence‐based practice will consider all of these determinants and their optimal combinations.” (APA, 2006, p. 275). For more information and instruction on constructing evidence‐based psychotherapy treatment plans, see our 12 DVD‐based training videos titled Evidence‐Based Psychotherapy Treatment Planning (Jongsma & Bruce, 2010–2012).

The sources we used to identify the evidence‐based treatments integrated into this Planner are multiple and, we believe, high quality. They include rigorous meta‐analyses, current critical, expert reviews, as well as evidence‐based practice guideline recommendations. Examples of specific sources include the Cochrane Collaboration reviews; the work of the Society of Clinical Psychology identifying research‐supported psychological treatments; evidence‐based treatment reviews (e.g., David, Lynn, & Montgomery, 2018; Nathan & Gorman, 2015), as well as critical analyses of the process through which evidence‐based practice is defined (e.g., Dimidjian, 2019; Norcross, Hogan, Koocher, & Maggio, 2017). Evidence‐based practice guidelines informing the selection process include those from the American Psychological Association, American Psychiatric Association, the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom, and the National Institute on Drug Abuse (NIDA) to name a few.

Although sources may vary slightly in the criteria they use for judging levels of empirical support, we favored those that use more rigorous criteria, typically requiring demonstration of efficacy through randomized controlled trials or clinical replication series, good experimental methodology, and independent replication. Our approach was to evaluate these various sources and include those treatments supported by the highest level of evidence and for which there was consensus across most of these sources. For any chapter in which EBP is indicated, references to the sources used to identify them can be found online at www.wiley.com/go/jongsma/adulttp6e. In addition to these references to empirical support, we have also included a References to Clinical Resources appendix. Clinical resources are books, manuals, and other resources for clinicians that describe the details of the application, or the “how to,” of the treatment approaches described in a chapter.

We recognize that there is debate regarding evidence‐based practice among mental health professionals, who are not always in agreement regarding the best treatment, what factors contribute to good outcomes, or even what constitutes “evidence.” We also recognize that some practitioners are skeptical about changing their practice based on psychotherapy research. Our intent in this book is to accommodate these differences by providing a range of treatment plan options, including those consistent with the “best available research” (APA, 2006), those reflecting common clinical practices of experienced clinicians (that may not have been subjected to study), and some that reflect promising emerging approaches. Our intent is to allow users of this planner an array of options so they can construct what they believe to be the best plan for their particular client.

More recently, psychotherapy research is moving toward trying to identify evidence‐based principles of psychotherapeutic change that cut across the various individual psychotherapies that have largely been the focus of outcome research. An example of this call is seen in Goldfried (2019), in which he advances the following principles:

Promoting client expectation and motivation that therapy can help

Establishing an optimal therapeutic alliance

Facilitating client awareness of the factors associated with his or her difficulties

Encouraging the client to engage in corrective experiences

Emphasizing ongoing reality testing in the client's life

Although many endorse this effort, at the time of this writing it is still in progress. Consequently, our approach to identifying objectives and interventions consistent with evidence‐based practices reflects what has been done from the “principles” approach as well as the research demonstrating the efficacy and effectiveness of individual models. Perhaps the field will advance enough by the next edition of this planner to include only evidence‐based principles of psychotherapeutic change. Until then, we believe that the approach we have taken reflects the current state of the science.

Each of the chapters in this edition provides options to integrate homework exercises into the Interventions. Many (but not all) of the client homework exercise suggestions were taken from and can be found in the Adult Psychotherapy Homework Planner (Jongsma, 2013). You will find more homework assignments suggested in this sixth edition of the Adult Psychotherapy Treatment Planner than in previous editions.

The Bibliotherapy Suggestions appendix of this Planner has been expanded and updated from previous editions. It includes classics, recently published offerings, as well as more recent editions of books cited in our earlier editions. All the self‐help books and client workbooks cited in the chapter Interventions are listed in this appendix. There are also many additional books listed that are supportive of the treatment approaches described in the respective chapters. Each chapter has a list of self‐help books consistent with the chapter's content listed in this appendix.

In its final report titled Achieving the Promise: Transforming Mental Health Care in America, The President's New Freedom Commission on Mental Health called for recovery to be the “common, recognized outcome of mental health services” (New Freedom Commission on Mental Health, 2003). To define recovery, the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services and the Interagency Committee on Disability Research in partnership with six other Federal agencies convened the National Consensus Conference on Mental Health Recovery and Mental Health Systems Transformation (SAMHSA, 2004). Over 110 expert panelists participated including mental health consumers, family members, providers, advocates, researchers, academicians, managed care representatives, accreditation bodies, state and local public officials, and others. From these deliberations, the following consensus statement was derived:

Mental health recovery is a journey of healing and transformation for a person with a mental health problem to be able to live a meaningful life in a community of his or her choice while striving to achieve maximum human potential. Recovery is a multi‐faceted concept based on the following 10 fundamental elements and guiding principles:

Self‐direction

Individualized and person‐centered

Empowerment

Holistic

Nonlinear

Strengths‐based

Peer support

Respect

Responsibility

Hope (SAMHSA,

2004

, p. 13)

These principles are defined in Appendix C. We have also created a set of Goal, Objective, and Intervention statements that reflect these 10 principles. The clinician who desires to insert into the client treatment plan specific statements reflecting a Recovery Model orientation may choose from this list.

In addition to this list, we believe that many of the Goal, Objective, and Intervention statements found in the chapters reflect a recovery orientation. For example, our assessment interventions are meant to identify how the problem affects this unique client and the strengths that the client brings to the treatment. Additionally, an intervention statement such as, “Assist the client in finding positive, hopeful things in his/hertheir life at the present time” from the Suicidal Ideation chapter is evidence that recovery model content permeates items listed throughout our chapters. However, if the clinician desires a more focused set of statements directly related to each principle guiding the recovery model, they can be found in Appendix C.

We have done a bit of reorganizing of chapter content for this edition. We have renamed the Unipolar Depression chapter as Depression—Unipolar. This chapter continues to be distinct from the chapter written for Bipolar Disorder—Depression. Bipolar Disorder—Mania continues to be a companion to the Bipolar Disorder—Depression chapter. You will note that some of the content from the Bipolar Disorder—Depression chapter is repeated in the Bipolar Disorder—Mania chapter, but that the evidence‐based treatment (EBT) symbol may or may not be present for the same content. This is done to indicate that the particular EBT currently has support for its efficacy on that particular chapter's problem (e.g., symptoms of mania) but not necessarily on other aspects of the disorder (e.g., symptoms of bipolar depression). If more information is desired regarding the specific effects of any evidence‐based treatment, one can find them by consulting the references to empirical support for that chapter online at www.wiley.com/go/jongsma/adulttp6e.

In regard to new presenting problems to add to this Planner, we debated whether we should add a chapter on Opioid Use Disorder because it is a continuing national addiction problem of major proportions. We decided that, although the chapter on Substance Use contains content that is directly applicable to opioid use treatment, there is enough content unique to Opioid Use treatment to call for the addition of this new chapter. We borrowed some content from the Opioid Dependence chapter found in The Veterans and Active Duty Military Psychotherapy Treatment Planner by Moore and Jongsma (2015) and updated it with more recent treatment research results. The other new chapter for this edition focuses on Loneliness as a primary presenting problem. Interventions deal with social anxiety, depression, low self‐esteem, grief, developmental communication issues, and personality disorder factors. Despite our current culture's preoccupation with “social media,” hosts of people feel isolated and afraid to or do not know how to “reach out and touch someone.” We hope this chapter will help clinicians effectively treat clients with this problem.

Lastly, some clinicians have asked that the Objective statements in this Planner be written such that the client's attainment of the Objective can be measured. We have written our objectives in behavioral terms and many are measurable as written. For example, this Objective from the Anxiety chapter is one that is measurable as written because it either can be done or it cannot: “Verbalize an understanding of the role that cognitive biases play in excessive irrational worry and persistent anxiety symptoms.” But at times the statements are too broad to be considered measurable. Consider, for example, this Objective from the Anxiety chapter: “Identify, challenge, and replace biased, fearful self‐talk with positive, realistic, and empowering self‐talk.” To make it quantifiable a clinician might modify it to read, “Give two examples of identifying, challenging, and replacing biased, fearful self‐talk with positive, realistic, and empowering self‐talk.” Clearly, the use of two examples is arbitrary, but it does allow for a quantifiable measurement of the attainment of the Objective. Similarly, consider this example from the Anxiety chapter: “Identify and engage in pleasant activities on a daily basis.” To make it more measurable the clinician might simply add a desired target number of pleasant activities, thus: “Identify and report engagement in two pleasant activities on a daily basis.” The exact target number that the client is to attain is subjective and should be selected by the individual clinician in consultation with the client. Once the exact target number is determined, then our content can be very easily modified to fit the specific treatment situation. For more information on psychotherapy treatment plan writing, see Jongsma (2005).

We hope you find these improvements to this sixth edition of the Adult Treatment Planner useful to your treatment planning needs.

HOW TO USE THIS TREATMENT PLANNER

Use this Treatment Planner to write treatment plans according to the following progression of six steps:

Problem Selection.

Although the client may discuss a variety of issues during the assessment, the clinician must determine the most significant problems on which to focus the treatment process. Usually a primary problem will surface, and secondary problems may also be evident. Some other problems may have to be set aside as not urgent enough to require treatment at this time. An effective treatment plan can deal with only a few selected problems or treatment will lose its direction. Choose the problem within this

Planner

that most accurately represents your client's presenting issues.

Problem Definition.

Each client presents with unique nuances as to how a problem behaviorally reveals itself in his or her life. Therefore, each problem that is selected for treatment focus requires a specific definition about how it is evidenced in the particular client. The symptom pattern should be associated with diagnostic criteria and codes such as those found in the

DSM‐5

or the International Classification of Diseases. This

Planner

offers such behaviorally specific definition statements to choose from or to serve as a model for your own personally crafted statements.

Goal Development.

The next step in developing your treatment plan is to set broad goals for the resolution of the target problem. These statements need not be crafted in measurable terms but can be global, long‐term goals that indicate a desired positive outcome to the treatment procedures. This

Planner

provides several possible goal statements for each problem, but one statement is all that is required in a treatment plan.

Objective Construction.

In contrast to long‐term goals, objectives must be stated in behaviorally measurable language so that it is clear to review agencies, health maintenance organizations, and managed care organizations when the client has achieved the established objectives. The objectives presented in this

Planner

are designed to meet this demand for accountability. Numerous alternatives are presented to allow construction of a variety of treatment plan possibilities for the same presenting problem.

Intervention Creation.

Interventions are the actions of the clinician designed to help the client complete the objectives. There should be at least one intervention for every objective. If the client does not accomplish the objective after the initial intervention, new interventions should be added to the plan. Interventions should be selected on the basis of the client's needs and strengths and the treatment provider's full therapeutic repertoire. This

Planner

contains interventions from a broad range of therapeutic approaches, and we encourage providers to write other interventions reflecting their own training and experience.

Some suggested interventions listed in the Planner refer to specific books that can be assigned to the client for adjunctive bibliotherapy. Appendix A contains a full bibliographic reference list of these materials, including these two popular choices: Read Two Books and Let's Talk Next Week: Using Bibliotherapy in Clinical Practice by Joshua and DiMenna and Rent Two Films and Let's Talk in the Morning: Using Popular Movies in Psychotherapy, Second Edition by Hesley and Hesley (both books are published by Wiley). For further information about self‐help books, mental health professionals may wish to consult Authoritative Guide to Self‐Help Resources in Mental Health, Revised Edition (Norcross et al., 2003).

Diagnosis Determination.

The determination of an appropriate diagnosis is based on an evaluation of the client's complete clinical presentation. The clinician must compare the behavioral, cognitive, emotional, and interpersonal symptoms that the client presents with the criteria for diagnosis of a mental illness condition as described in

DSM‐5

. Despite arguments made against diagnosing clients in this manner, diagnosis is a reality that exists in the world of mental health care, and it is a necessity for third‐party reimbursement. It is the clinician's thorough knowledge of

DSM‐5

criteria and a complete understanding of the client assessment data that contribute to the most reliable, valid diagnosis.

Congratulations! After completing these six steps, you should have a comprehensive and individualized treatment plan ready for immediate implementation and presentation to the client. A sample treatment plan for Anxiety is provided at the end of this introduction.

A FINAL NOTE ON TAILORING THE TREATMENT PLAN TO THE CLIENT

One important aspect of effective treatment planning is that each plan should be tailored to the individual client's problems and needs. Treatment plans should not be mass‐produced, even if clients have similar problems. The individual's strengths and weaknesses, unique stressors, social network, family circumstances, and symptom patterns must be considered in developing a treatment strategy. Drawing upon our own years of clinical experience and the best available research, we have put together a variety of treatment choices. These statements can be combined in thousands of permutations to develop detailed treatment plans. Relying on their own good judgment, clinicians can easily select the statements that are appropriate for the individuals whom they are treating. In addition, we encourage readers to add their own definitions, goals, objectives, and interventions to the existing samples. As with all of the books in the Treatment Planner series, it is our hope that this book will help promote effective, creative treatment planning—a process that will ultimately benefit the client, clinician, and mental health community.

REFERENCES AND FURTHER READING

American Psychiatric Association.

American Psychiatric Association practice guidelines

. American Psychiatric Association.

http://psychiatryonline.org/guidelines.aspx

.

American Psychiatric Association. (2013).

Diagnostic and statistical manual of mental disorders

(5th ed.). American Psychiatric Association.

American Psychological Association.

APA clinical practice guidelines

. American Psychological Association.

https://www.apa.org/about/offices/directorates/guidelines/clinical-practice

.

American Psychological Association Division 12: Society of Clinical Psychology.

American Psychological Association division 12 website on research‐supported psychological treatments

.

https://www.div12.org/treatments

.

APA Presidential Task Force on Evidence‐Based Practice. (2006). Evidence‐based practice in psychology.

American Psychologist

,

61

,

271–285.

Bohart, A., & Tallman, K. (1999).

How clients make therapy work: The process of active self‐healing

. American Psychological Association.

Cochrane Collaboration Reviews.

http://www.cochrane.org/

.

David, D., Lynn, S. J., & Montgomery, G. H. (Eds.). (2018).

Evidence‐based psychotherapy: The state of the science and practice

. Wiley.

Dimidjian, S. (Ed.) (2019).

Evidence‐based practice in action

. Guilford Press.

Goldfried, M. R. (2019). Obtaining consensus in psychotherapy: What holds us back?

American Psychologist

,

74

(4), 484–496.

Institute of Medicine. (2001).

Crossing the quality chasm: A new health system for the 21st century

. National Academy Press.

https://www.nap.edu/catalog/10027/crossing-the-quality-chasm-a-new-health-system-for-the

.

Jongsma, A. E. (2013).

Adult psychotherapy homework planner

(3rd ed.). John Wiley and Sons.

Jongsma, A. (2005). Psychotherapy treatment plan writing. In G. P. Koocher, J. C. Norcross, & S. S. Hill (Eds.),

Psychologists' desk reference

(2nd ed., pp. 232–236). Oxford University Press.

Jongsma, A. E., & Bruce, T. J. (2010–2012).

The evidence‐based psychotherapy treatment planning

[DVD‐based series]. John Wiley & Sons.

http://www.Wiley.com/go/ebtdvds

.

Moore, B. A., & Jongsma, A. E. (2015).

The veterans and active duty military psychotherapy treatment planner

. John Wiley and Sons.

Nathan, P. E., & Gorman, J. M. (Eds.). (2015).

A guide to treatments that work

(4th ed.). Oxford University Press.

National Institute on Drug Abuse.

https://www.drugabuse.gov

.

National Institute for Health and Clinical Excellence (NICE).

http://www.nice.org.uk

.

New Freedom Commission on Mental Health. (2003).

Achieving the promise: Transforming mental health care in America

(Final report. DHHS Publication No. SMA‐03‐3832). New Freedom Commission on Mental Health.

https://govinfo.library.unt.edu/mentalhealthcommission/reports/FinalReport/downloads/downloads.html

.

Norcross, J. C. (Ed.). (2019).

Psychotherapy relationships that work

(3rd ed.). Oxford University Press.

Norcross, J. C., Hogan, T. P., & Koocher, G. P., & Maggio, L. A. (2017).

Clinician's guide to evidence‐based practices: Behavioral health and the addictions

. Oxford University Press.

Norcross, J. C., Santrock, J. W., Campbell, L. F., Smith, T. P., Sommer, R., & Zuckerman, E. L. (2003).

Authoritative guide to self‐help resources in mental health

,

revised edition

. Guilford Press.

Substance Abuse and Mental Health Services Administration's (SAMHSA) National Mental Health Information Center, Center for Mental Health Services (2004).

National consensus statement on mental health recovery

. SAMHSA.

Wampold, B. E. (2001).

The great psychotherapy debate: Models, methods, and findings

. Lawrence Erlbaum.

SAMPLE TREATMENT PLAN

ANXIETY

Behavioral Definitions

Excessive and/or unrealistic worry that is difficult to control occurring more days than not for at least 6 months about two or more events or activities.

Motor tension (e.g., restlessness, tiredness, shakiness, muscle tension).

Autonomic hyperactivity (e.g., palpitations, shortness of breath, dry mouth, trouble swallowing, nausea, diarrhea).

Hypervigilance (e.g., feeling constantly on edge, experiencing concentration difficulties, having trouble falling or staying asleep, exhibiting a general state of irritability).

Long‐Term Goals:

Reduce overall frequency, intensity, and duration of the anxiety so that daily functioning is not impaired.

Learn and implement coping skills that result in a reduction of anxiety and worry, and improved daily functioning.

OBJECTIVES

INTERVENTIONS

 Work cooperatively with the therapist toward agreed‐upon therapeutic goals while being as open and honest as comfort and trust allows.

Establish rapport with the client toward building a strong therapeutic alliance; convey caring, support, warmth, and empathy; provide nonjudgmental support and develop a level of trust with the client toward feeling safe to discuss generalized anxiety and its impact on his/her/their life.

Strengthen powerful relationship factors within the therapy process and foster the therapy alliance through paying special attention to these empirically supported factors: work collaboratively with the client in the treatment process; reach agreement on the goals and expectations of therapy; demonstrate consistent empathy toward the client's feelings and struggles; verbalize positive regard toward and affirmation of the client; and collect and deliver client feedback as to the client's perception of his/her/their progress in therapy (see

Psychotherapy Relationships That Work: Vol. 1

by Norcross and Lambert and Vol. 2 by Norcross and Wampold).

Describe situations, thoughts, feelings, and actions associated with anxieties and worries; their impact on functioning; and attempts to resolve them.

Ask the client to describe past experiences of anxiety and their impact on functioning; assess the focus, excessiveness, and uncontrollability of the worry and the type, frequency, intensity, and duration of anxiety symptoms (consider using a structured interview such as the

Anxiety and Related Disorders Interview Schedule for the DSM‐5

by Brown and Barlow.)

 Verbalize an understanding of the cognitive, physiological, and behavioral components of anxiety and its treatment.

Discuss how anxiety typically involves excessive worry about unrealistically appraised threats, various bodily expressions of overarousal, hypervigilance, and avoidance of what is threatening that interact to maintain the problem (see

Mastery of Your Anxiety and Worry: Therapist Guide

by Zinbarg, Craske, and Barlow;

Treating Generalized Anxiety Disorder

by Rygh and Sanderson).

Discuss how treatment targets worry, anxiety symptoms, and avoidance to help the client manage worry effectively, reduce overarousal, eliminate unnecessary avoidance, and reengage in rewarding activities.

Assign the client to read psychoeducational materials as a bibliotherapy adjunct to in‐session work (e.g.,

Mastery of Your Anxiety and Worry: Workbook

by Craske and Barlow;

The Anxiety and Worry Workbook

by Clark and Beck.

 Learn and implement calming skills to reduce overall anxiety and manage anxiety symptoms.

Teach the client calming/relaxation/mindfulness skills (e.g., applied relaxation, progressive muscle relaxation, cue controlled relaxation; mindful breathing; biofeedback) and how to discriminate better between relaxation and tension; teach the client how to apply these skills to daily life (see

New Directions in Progressive Muscle Relaxation

by Bernstein, Borkovec, and Hazlett‐Stevens; or supplement with

The Relaxation and Stress Reduction Workbook

by Davis, et al.).

Assign the client homework in which they practice calming/relaxation/mindfulness skills daily, gradually applying them progressively from non‐anxiety‐provoking to anxiety‐provoking situations; review and reinforce success; find solutions for obstacles toward sustained implementation (or supplement with “Deep Breathing Exercise” in the

Adult Psychotherapy Homework Planner

by Jongsma).

Learn and implement a strategy to limit the association between various environmental settings and worry, delaying the worry until a designated “worry time.”

Explain the rationale and teach a worry time intervention in which the client postpones interacting with worries until a designated time and place; use worry time for exposure (repeating worry toward extinction) and/or the application of problem‐solving skills to address worries; agree upon and implement a worry time with the client.

Teach the client how to recognize, stop, and postpone worry to the agreed upon worry time using skills such as thought stopping, relaxation, and redirecting attention (or supplement with “Making Use of the Thought‐Stopping Technique” and/or “Worry Time” in the

Adult Psychotherapy Homework Planner

by Jongsma to assist skill development); encourage use in daily life; review and reinforce success; find solutions for obstacles toward sustained implementation.

 Verbalize an understanding of the role that thinking plays in worry, anxiety, and avoidance.

Assist the client in analyzing worries by examining potential biases such as the probability of the negative expectation occurring, the real consequences of it occurring, ability to control the outcome, the worst possible outcome, and ability to accept it (or supplement with “Analyze the Probability of a Feared Event” in the

Adult Psychotherapy Homework Planner

by Jongsma;

Cognitive Therapy of Anxiety Disorders

by Clark and Beck).

 Identify, challenge, and replace biased, fearful self‐talk with positive, realistic, and empowering self‐talk.

Using techniques from cognitive behavioral therapies including intolerance of uncertainty and metacognitive therapies explore the client's self‐talk, underlying assumptions, schema, or metacognition that mediate anxiety; assist the client in challenging and changing biases; conduct behavioral experiments to test biased versus unbiased predictions toward dispelling unproductive worry and increasing self‐confidence in addressing the subject of worry (see

Cognitive Therapy of Anxiety Disorders

by Clark and Beck;

Metacognitive Therapy for Anxiety and Depression

by Wells).

Assign the client a homework exercise to identify fearful self‐talk, identify biases in the self‐talk, generate alternatives, and test them through behavioral experiments (or supplement with “Negative Thoughts Trigger Negative Feelings” in the

Adult Psychotherapy Homework Planner

by Jongsma); review and reinforce success, providing corrective feedback toward improvement.

DIAGNOSIS

F41.1

Generalized Anxiety Disorder

ANGER CONTROL PROBLEMS

BEHAVIORAL DEFINITIONS

Shows a pattern of episodic excessive anger in response to specific situations or situational themes.

Shows a pattern of general excessive anger across many situations.

Shows cognitive biases associated with anger (e.g., demanding expectations of others, overly generalized labeling of the targets of anger, anger in response to perceived “slights”).

Shows direct or indirect evidence of physiological arousal related to anger.

Reports a history of explosive, aggressive outbursts out of proportion with any precipitating stressors, leading to verbal attacks, assaultive acts, or destruction of property.

Displays overreactive verbal hostility to insignificant irritants.

Engages in physical and/or emotional abuse against significant other.

Makes swift and harsh judgmental statements to or about others.

Displays body language suggesting anger, including tense muscles (e.g., clenched fist or jaw), glaring looks, or refusal to make eye contact.

Shows passive‐aggressive patterns (e.g., social withdrawal, lack of complete or timely adherence in following directions or rules, complaining about authority figures behind their backs, uncooperative in meeting expected behavioral norms) due to anger.

Passively withholds feelings and then explodes in a rage.

Demonstrates an angry overreaction to perceived disapproval, rejection, or criticism.

Uses abusive language meant to intimidate others.

Rationalizes and blames others for aggressive and abusive behavior.

Uses aggression as a means of achieving power and control.

—.

—.

—.

LONG‐TERM GOALS

Learn and implement anger management skills to reduce the level of anger and irritability that accompanies it.

Increase honest, appropriate, respectful, and direct communication using assertiveness and conflict resolution skills.

Develop an awareness of angry thoughts, feelings, and actions, clarifying origins of, and learning alternatives to aggressive anger.

Decrease the frequency, intensity, and duration of angry thoughts, feelings, and actions and increase the ability to recognize and assertively express frustration and resolve conflict.

Implement cognitive behavioral skills necessary to solve problems in a more constructive manner.

Come to an awareness and acceptance of angry feelings while developing better control and more serenity.

Become capable of handling angry feelings in constructive ways that enhance daily functioning.

Demonstrate respect for the rights of others to have their own thoughts and feelings.

—.

—.

—.

SHORT‐TERM OBJECTIVES

THERAPEUTIC INTERVENTIONS

 Work cooperatively with the therapist toward agreed‐upon therapeutic goals while being as open and honest as comfort and trust allow (1, 2).

Establish rapport with the client toward building a strong therapeutic alliance; convey caring, support, warmth, and empathy; provide nonjudgmental support and develop a level of trust with the client toward feeling safe to discuss anger control issues and their impact on the client's life.

Strengthen powerful relationship factors within the therapy process and foster the therapy alliance through paying special attention to these empirically supported factors: work

collaboratively

with the client in the treatment process; reach agreement on the

goals and expectations

of therapy; demonstrate

consistent empathy

toward the client's feelings and struggles; verbalize

positive regard

toward and

affirmation

of the client; and collect and deliver

client feedback

as to the client's perception of his/her/their progress in therapy (see

Psychotherapy Relationships That Work: Vol. 1

by Norcross and Lambert and

Vol. 2

by Norcross and Wampold).

Identify situations, thoughts, and feelings associated with anger, angry verbal and/or behavioral actions, and the targets of those actions. (3)

Thoroughly assess the various stimuli (e.g., situations, people, thoughts) that have triggered the client's anger and the thoughts, feelings, and actions that have characterized anger responses.

Complete psychological testing or objective questionnaires for assessing anger expression. (4)

Administer to the client psychometric instruments designed to objectively assess anger expression (e.g.,

Anger, Irritability, and Assault Questionnaire

;

Buss‐Durkee Hostility Inventory

;

State‐Trait Anger Expression Inventory

); give the client feedback regarding the results of the assessment; readminister as indicated to assess treatment response.

Cooperate with a complete medical evaluation. (5)

Arrange for a medical evaluation to rule out nonpsychiatric medical and substance‐induced etiologies for poorly controlled anger (e.g., brain injury, tumor, elevated testosterone levels, stimulant use).

Provide behavioral, emotional, and attitudinal information toward an assessment of specifiers relevant to a

DSM

diagnosis, the efficacy of treatment, and the nature of the therapy relationship. (6, 7, 8, 9)