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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: PracticePlanners
- Sprache: Englisch
Create customized formal treatment plans with over 1,000 professional goal and intervention statements
The Continuum of Care Treatment Planner offers clinicians a timesaving, evidence-based guide that helps to clarify, simplify, and accelerate the process of planning treatments for adults and adolescents. The authors provide a thorough introduction to treatment planning, along with the elements necessary to quickly and easily develop formal, customizable treatment plans. Treatment planning statements satisfy the demands of HMOs, managed-care companies, third-party payers, and state and federal agencies.This planner provides treatment planning components foranxiety, bipolar disorder, depression, eating disorders, posttraumatic stress disorder, substance use disorders, and beyond. Following the user-friendly format that has made the Treatment Planners series so popular, this book smooths the planning process so you can spend less time on paperwork and more time with clients.
- Get definitions, treatment goals and objectives, therapeutic interventions, and DSM-5 diagnoses for mental disorders in adults and adolescents
- Employover 1,000 polished goals and intervention statements as components of provider-approved treatment plans
- Use workbook space to record customized goals, objectives, and interventions
- Access a sample plan that meets all requirements of third-party payers and accrediting agencies,including the JCAHO
This updated edition of The Continuum of Care Treatment Planner is a valuable resource for psychologists, therapists, counselors, social workers, psychiatrists, and other mental health professionals who work with adult and adolescent clients.
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Veröffentlichungsjahr: 2025
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Table of Contents
Cover
Table of Contents
Series Page
Title Page
Copyright Page
Dedication Page
PREFACE
ABOUT THE COMPANION WEBSITE
INTRODUCTION
ABOUT PRACTICE
PLANNERS
®
TREATMENT PLANNERS
ABOUT THIS SECOND EDITION OF
THE CONTINUUM OF CARE 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
Part 1 ADULTS
ANGER CONTROL PROBLEMS
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
ANXIETY
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) – ADULT
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
BIPOLAR DISORDER – DEPRESSION
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
BIPOLAR DISORDER – MANIA
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
DEPRESSION – UNIPOLAR
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
DISSOCIATION
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
EATING DISORDERS AND OBESITY
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
IMPULSE CONTROL DISORDER
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
OPIOID USE DISORDER
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
PARANOID IDEATION
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
POSTTRAUMATIC STRESS DISORDER (PTSD)
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
SCHIZOPHRENIA SPECTRUM
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
SUBSTANCE USE
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
SUICIDAL IDEATION
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTION
Part 2 ADOLESCENTS
ANXIETY
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
BIPOLAR DISORDER
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
CONDUCT DISORDER/DELINQUENCY
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
DEPRESSION – UNIPOLAR
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
EATING DISORDER
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
OPIOID USE
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
POSTTRAUMATIC STRESS DISORDER (PTSD)
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
SCHIZOPHRENIA SPECTRUM
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
SUBSTANCE USE
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
SUICIDAL IDEATION
BEHAVIORAL DEFINITIONS
LONG‐TERM GOALS
DIAGNOSTIC SUGGESTIONS
Appendix A BIBLIOTHERAPY SUGGESTIONS
Appendix B PROFESSIONAL RESOURCES
Appendix C RECOVERY MODEL OBJECTIVES AND INTERVENTIONS
Appendix D CITED ASSESSMENT INSTRUMENTS AND THEIR SOURCES
End User License Agreement
Guide
Cover Page
Table of Contents
Series Page
Title Page
Copyright Page
Dedication Page
PREFACE
ABOUT THE COMPANION WEBSITE
Begin Reading
Appendix A BIBLIOTHERAPY SUGGESTIONS
Appendix B Appendix BPROFESSIONAL RESOURCES
Appendix C RECOVERY MODEL OBJECTIVES AND INTERVENTIONS
Appendix D CITED ASSESSMENT INSTRUMENTS AND THEIR SOURCES
WILEY END USER LICENSE AGREEMENT
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Wiley PracticePlanners® Series
Treatment Planners
The Complete Adult Psychotherapy Treatment Planner, Sixth Edition
The Child Psychotherapy Treatment Planner, Sixth Edition
The Adolescent Psychotherapy Treatment Planner, Sixth Edition
The Addiction Treatment Planner, Sixth Edition
The Continuum of Care Treatment Planner, Second Edition
The Couples Psychotherapy Treatment Planner, with DSM‐5 Updates, Second Edition
The Employee Assistance Treatment Planner
The Pastoral Counseling Treatment Planner, Second Edition
The Older Adult Psychotherapy Treatment Planner with DSM‐5 Updates, Second Edition
The Behavioral Medicine Treatment Planner
The Group Therapy Treatment Planner
The Gay and Lesbian Psychotherapy Treatment Planner
The Family Therapy Treatment Planner, with DSM‐5 Updates, Second Edition
The Severe and Persistent Mental Illness Treatment Planner, with DSM‐5 Updates, Second Edition
The Mental Retardation and Developmental Disability Treatment Planner
The Social Work and Human Services Treatment Planner
The Crisis Counseling and Traumatic Events Treatments Planner, with DSM‐5 Updates, Second Edition
The Personality Disorders Treatments 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, with DSM‐5 Updates, 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, with DSM‐5 Updates
Progress Notes Planners
The Child Psychotherapy Progress Notes Planner, Sixth Edition
The Adolescent Psychotherapy Progress Notes Planner, Sixth Edition
The Adult Psychotherapy Progress Notes Planner, Sixth Edition
The Addiction Progress Notes Planner, Sixth 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, Sixth Edition
Adolescent Psychotherapy Homework Planner, Sixth Edition
Adult Psychotherapy Homework Planner, Sixth Edition
Child Psychotherapy Homework Planner, Sixth 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
Wiley PracticePlanners®
The Continuum of Care Treatment Planner
Second Edition
Chris E. Stout
Timothy J. Bruce
Arthur E. Jongsma, Jr.
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Library of Congress Cataloging‐in‐Publication Data Applied forPaperback ISBN: 9781394273461
Cover Design: WileyCover Image: © Ryan McVay/Getty Images
To my Uncle Noble, who has inspiredmy innovation, and my Uncle Ralph,who has inspired my humanity.
—C.E.S.
To all of the residents I have worked withfor your years of dedicated serviceacross the continuum of care.
—T.J.B.
PREFACE
This second edition of the Continuum of Care Treatment Planner updates and expands its first edition, including new chapters, appendices, and the inclusion of objectives and interventions consistent with identified evidence‐based practices, details of which can be read in the Introduction of this Planner. We hope you find this new edition informative, up to date, and, above all, useful.
It is increasingly common for clinicians and practices to provide care in multiple treatment venues – ranging from inpatient to partial hospitalization, residential, intensive outpatient, day treatment, and outpatient settings. This book is intended for such practitioners. Each chapter is also organized to move sequentially through objectives and interventions most likely to be used in the different levels of care and settings starting with inpatient, through transitional care, to outpatient. Chapters can also be used to construct treatment plans at any point along this continuum.
Although the components of this book have been tailored to suit needs across the broader continuum of care, the goals of this second edition remain the same as its predecessor: to stimulate clinical thought, to improve the quality and comprehensiveness of treatment plans, and to reduce the time involved in recordkeeping.
Working on this book required taking time and energy away from our professional responsibilities and our personal lives. So we would like to express immense gratitude to our coworkers – and particularly, to our spouses and children – for managing without us and providing unflagging encouragement and support.
CHRIS E. STOUT, PSYD., MBA
TIMOTHY J. BRUCE, PHD
ARTHUR E. JONGSMA, JR., PHD
ABOUT THE COMPANION WEBSITE
This book is accompanied by a companion website.
www.wiley.com/go/stout/continuumTP2e
This website includes:
Appendix E: References to Empirical Support for Indicated Evidence‐Based Content in the Continuum of Care Treatment Planner, Second 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 SECOND EDITION OF THE CONTINUUM OF CARE TREATMENT PLANNER
This second edition of the Continuum of Care Treatment Planner has been improved in many ways:
Updated with new Objectives and Interventions consistent with identified evidence‐based practices
An expanded and updated list of self‐help books in the Bibliotherapy Suggestions (
Appendix A
)
A new appendix of Professional Resources including recommended books, chapters, manuals, and other “how‐to” clinical resources (
Appendix B
)
A new appendix with Objectives and Interventions reflecting principles of the Recovery Model of mental health care (
Appendix C
)
A new alphabetical appendix of sources for assessment instruments, measures, and inventories used in mental health care (
Appendix D
)
An online appendix of references to empirical work supporting the evidence‐based content found in this
Planner
More suggested homework assignments integrated into the Interventions
Addition of new chapters on Attention‐Deficit/Hyperactivity Disorder in adults, Bipolar Disorder, Opioid Use Disorder, Posttraumatic Stress Disorder (PTSD), Schizophrenia Spectrum Disorders, Substance Use, and chapters for adolescent clients including Bipolar Disorder, Conduct Disorder, Eating Disorder, Opioid Use Disorder, PTSD, Schizophrenia Spectrum, and Substance Use Disorders
Integrated
DSM‐5
diagnostic labels and codes into the Diagnostic Suggestions section of each chapter
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 on Mental Illness have all endorsed the use of EBP. In some practice settings, EBP is becoming mandated. Some third‐party payers require the use of EBP for reimbursement. 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 indicated 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 Presidential Task Force on Evidence‐Based Practice, 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 et al., 2018; Nathan & Gorman, 2015), as well as critical analyses of the process through which evidence‐based practice is defined (e.g., Dimidjian, 2019; Norcross et al., 2017). EBP guidelines informing the selection process include those from the American Psychological Association, American Psychiatric Association, the National Institute for Health and Clinical Excellence in the United Kingdom, and the National Institute on Drug Abuse, 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/stout/continuumTP2e. In addition to these references to empirical support, we have also included a Professional 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. To maintain the consistency and integrity of the evidence‐based content in the PracticePlanners Series, some of the evidence‐based content in this Planner is adapted from other Planners in the series, including the sixth editions of the Adult and Adolescent Treatment Planners. Although this does build some redundancy across treatment planners in the series that provide this content, we felt that the convenience of having it readily available in each planner supersedes other, more resource‐consuming, options for accessing it.
We recognize that there is debate regarding EBP 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 Presidential Task Force on Evidence‐Based Practice, 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 to identify these principles 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 their 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 previous and continuing research examining and 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 & Bruce, 2022) and the Adolescent Psychotherapy Homework Planner (Jongsma et al., 2024). You will find more homework assignments suggested in this second edition of the Continuum of CareTreatment Planner than in its first edition.
The Bibliotherapy Suggestions (Appendix A of this Planner) have 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 their choice while striving to achieve maximum human potential. Recovery is a multifaceted 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 their 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 organized chapters on mood disorders in a way that may benefit from explanation. We have titled the chapter on unipolar depression as “Depression – Unipolar.” This chapter is distinct from the chapter written for Bipolar Disorder – Depression. Bipolar Disorder – Mania is the 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 indicated 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/stout/continuumTP2e.
Because chapters in this Planner cover the continuum of care from inpatient through outpatient, each chapter has been divided to indicate objectives and interventions commonly associated with the level of care indicated by the subtitles “Inpatient/Partial Hospitalization” and “Outpatient.” Although the content under each of the subtitles is common to the indicated level of care, it is not intended to be exclusive to these settings and could be used at other levels of care.
We want to make a few points about this Planner to avoid misunderstandings about its intended use, especially in relation to seeking third‐party reimbursement. First, some interventions contain citations to books, manuals, and the like intended to provide therapists more information on the “how‐to” of applying the intervention described. References to these citations are found in Appendix B, Professional Resources. These citations are intended as examples of how the intervention could be done. They are not intended to be a requirement for the proper application of the intervention. Accordingly, we begin each of these citations with “e.g.,” to indicate that the suggested reading is an example of how the intervention could be done but not the only way. Second, some interventions are longer than what is typically required in a treatment plan submitted for reimbursement. When this is the case, it is often because we have added additional information on the major steps of an intervention or provided examples of intervention options intended to be helpful. We do this occasionally because in addition to reducing the time it takes to document a treatment plan, another aim of this series is educational. As with all our interventions, we advise users of these Planners to edit them as needed to fit your needs. In the case of these longer interventions, the user could simply delete the additional educational content and keep only the primary description of the intervention.
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 thinking plays in worry, anxiety, and avoidance.” 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 commonly used objective when the intervention is behavioral activation: “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 second edition of the Continuum of Care 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 descriptive statements 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. Factors such as the individual's demographic and sociocultural considerations, strengths and weaknesses, insight, unique stressors, social network, family circumstances, symptom patterns, and severity of impairment 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 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. (n.d.).
American Psychiatric Association practice guidelines
. American Psychiatric Association.
http://psychiatryonline.org/guidelines.aspx
.
American Psychiatric Association. (2013).
Diagnostic and Statistical Manual of Mental Disorders
5. American Psychiatric Association.
American Psychological Association. (n.d.). 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. (n.d.). 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. (n.d.).
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. (2005). Psychotherapy treatment plan writing. In G. P. Koocher, J. C. Norcross, & S. S. Hill (Eds.),
Psychologists' Desk Reference
2, pp. 232–236. Oxford University Press.
Jongsma, A. E. (2013).
Adult Psychotherapy Homework Planner
3. John Wiley and Sons.
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
.
Jongsma, A. E., & Bruce, T. J. (2022).
Adult Psychotherapy Homework Planner
6. John Wiley & Sons.
Jongsma, A. E., Peterson, L. M., McInnis, W. P., & Bruce, T. J. (2024).
Adolescent Psychotherapy Homework Planner
6. John Wiley & Sons.
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
4. Oxford University Press.
National Institute on Drug Abuse. (n.d.).
https://www.drugabuse.gov
.
National Institute for Health and Clinical Excellence (NICE). (n.d.).
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
3. Oxford University Press.
Norcross, J. C., Hogan, T. P., & Koocher, G. P., & Maggio, L. A. (2017).
Clinicians 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
1. Work cooperatively with the therapist toward agreed‐upon therapeutic goals while being as open and honest as comfort and trust allows. (1, 2)
1. 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 their life.
2. 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 their progress in therapy (see, e.g.,
Psychotherapy Relationships That Work: Vol. 1
by Norcross & Lambert and Vol. 2 by Norcross & Wampold).
2. Describe situations, thoughts, feelings, and actions associated with anxieties and worries; their impact on functioning; and attempts to resolve them. (3)
3. 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 & Barlow).
3. Verbalize an understanding of the cognitive, physiological, and behavioral components of anxiety and its treatment. (4, 5, 6)
4. 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, e.g.,
Mastery of Your Anxiety and Worry: Therapist Guide
by Zinbarg et al.;
Treating Generalized Anxiety Disorder
by Rygh & Sanderson).
5. 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.
6. Assign the client to read psychoeducational materials as a bibliotherapy adjunct to in‐session work (see, e.g.,
Mastery of Your Anxiety and Worry: Workbook
by Craske & Barlow;
The Anxiety and Worry Workbook
by Clark & Beck).
4. Learn and implement calming skills to reduce overall anxiety and manage anxiety symptoms. (7, 8)
7. 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, e.g.,
New Directions in Progressive Muscle Relaxation
by Bernstein, Borkovec, & Hazlett‐Stevens; or supplement with
The Relaxation and Stress Reduction Workbook
by Davis et al.).
8. 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; resolve obstacles toward sustained implementation (or supplement with “Deep Breathing Exercise” in the
Adult Psychotherapy Homework Planner
by Jongsma & Bruce).
5. Learn and implement a strategy to limit the association between various environmental settings and worry, delaying the worry until a designated “worry time.” (9, 10)
9. 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.
10. 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 & Bruce to assist skill development); encourage use in daily life; review and reinforce success; resolve obstacles toward sustained implementation.
6. Verbalize an understanding of the role that thinking plays in worry, anxiety, and avoidance. (11)
11. 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 (see, e.g.,
Cognitive Therapy of Anxiety Disorders
by Clark & Beck).
7. Identify, challenge, and replace biased, fearful self‐talk with positive, realistic, and empowering self‐talk. (12, 13)
12. 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, e.g.,
Cognitive Therapy of Anxiety Disorders
by Clark & Beck;
Metacognitive Therapy for Anxiety and Depression
by Wells).
13. 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 & Bruce); review and reinforce success, providing corrective feedback toward improvement.
DIAGNOSIS
F41.1 Generalized Anxiety Disorder
Part 1ADULTS
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.
Demonstrate respect for the rights of others to have their own thoughts and feelings.
__. _____________________________________________________________
_____________________________________________________________
__. _____________________________________________________________
_____________________________________________________________
__. _____________________________________________________________
_____________________________________________________________
SHORT‐TERM OBJECTIVES
THERAPEUTIC INTERVENTIONS
1. Work cooperatively with the therapist toward agreed‐upon therapeutic goals while being as open and honest as comfort and trust allow. (1, 2)
1. 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.
2. 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 their progress in therapy (see, e.g.,
Psychotherapy Relationships That Work: Vol. 1
by Norcross & Lambert and
Vol. 2
by Norcross & Wampold).
2. Identify situations, thoughts, and feelings associated with anger, angry verbal and/or behavioral actions, and the targets of those actions. (3)
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.
3. Complete psychological testing or objective questionnaires for assessing anger expression. (4)
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.
4. Cooperate with a complete medical evaluation. (5)
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).
5. Provide behavioral, emotional, and attitudinal information toward an assessment of specifiers relevant to a
DSM
diagnosis, motivation for change, sociocultural considerations, the efficacy of treatment, and the suicide risk. (6, 7)
6. Assess the client's cognitive, behavioral, and emotional status related to insight, motivation, and comorbid disorders: (1) level of insight toward the presenting problems (e.g., from demonstrating good insight into the problem to demonstrating resistance to acknowledging the problem); (2) level or stage of motivation to change (e.g., from voicing strong motivation and demonstrating action toward change to voicing and/or demonstrating resistance to change); and (3) evidence of relevant comorbidities (e.g., depression secondary to an anxiety disorder) including vulnerability to suicide, if appropriate (e.g., increased suicide risk when comorbid depression is evident).
7. Assess relevant sociocultural factors and degree of impairment: (1) issues of age, gender, culture, resources, and preferences that could help explain the presenting problem(s), affect treatment selection and outcome, and provide a better understanding of the client's behavior; and (2) severity of distress and disability to determine appropriate level of care as well as the efficacy of treatment (e.g., no longer demonstrates severe impairment but the problem now is causing mild or moderate distress/disability).
6. Cooperate with explorations as to the appropriate level of care currently needed. (8)
8. Evaluate an appropriate level of care based on the severity of the client's functional impairment and/or symptom severity. Consider outpatient, inpatient, residential, intensive outpatient (IOP), or partial hospitalization (PHP) programs that have recognized expertise in treating anger control problems.
7. Agree to an evaluation for admission to an inpatient psychiatric care provider. (9)
9. Refer client for an inpatient admission evaluation to an appropriate psychiatric hospital or psychiatric unit in a general hospital setting.
Inpatient/Partial Hospitalization
8. Cooperate with admission process to inpatient psychiatric care. (10)
10. Facilitate the client's admission to inpatient care, either voluntary or involuntary/judicial, if the client is a threat to self or others and/or is unable to provide for their own basic needs.
9. Comply with unit rules following program guidelines and cooperate with the staff in their therapeutic interactions. (11, 12, 13, 14)
11. Have staff supportively provide the client with unit rules regarding behavioral expectations (e.g., no disrupting groups/milieu) and consequences of nonadherence (e.g., decrease in privileges, group restrictions, transfer to less stimulating/more structured environment); request consistent follow‐through.
12. Support staff in maintaining a milieu that demonstrates a safe, calm, and therapeutic environment in which the client is treated with respect and support as an individual.
13. Support staff in providing a supportive milieu (e.g., staff availability to discuss any topic client wishes; empathic responsiveness; encouragement; modeling) to enhance and expand trust with others.
14. Support staff in demonstrating a calm, tolerant demeanor to decrease the client's fears about communicating their needs.
10. Talk to staff when sensing the onset of fearfulness, anger, confusion, and/or agitation. (15, 16, 17)
15. Have staff ensure the client is monitored and supervised every 15 minutes for hostile and aggressive behavior.
16. Administer medication in as‐needed situations, as ordered by prescriber.
17. Collaborate with staff to determine if a more restrictive level of care is needed within the inpatient environment, such as an intensive care unit.
11. Attend group therapy to discuss feelings of anger and impulses produced by those feelings; calmly and openly receive feedback from the group members. (18)
18. Facilitate or request the group therapist to facilitate group therapy toward developing emotion regulation skills and appropriate, assertive peer interactions without aggressive reactivity.
12. Learn to express feelings in a nonaggressive manner through artistic expression. (19)
19. Instruct the art therapist to conduct art therapy group to teach the client how to express angry feelings and impulses via artistic expression; process with therapist, peers, or both.
13. Establish postdischarge needs and outpatient treatment goals. (20)
20. Meet with the client and family/support system to educate them about the signs of symptom escalation. Instruct family/support members in ways to seek clinical assistance.
14. Develop an understanding of postdischarge living situation. (21)
21. Arrange for an appropriate level of post‐discharge care for the client. Consider residential, IOP, PHP, or back to home with outpatient follow‐up care.
15. Identify changes needed to maintain benefits and to prevent rehospitalization. (22, 23)
22. Collaborate with the client on identifying outpatient treatment needs and developing therapy goals along with ways to identify triggers early on and appropriately respond.
23. Reinforce with the client the importance of maintaining changes and managing stress.
16. Discuss issues related to proper anger management and postdischarge return to work. (24)
24. Secure appropriate, signed information releases to share information and dispositional planning with relevant personnel.
17. Specify the postdischarge community leisure options that will be pursued. (25)
25. Provide the client with community leisure resource information and encourage its use. Help the client develop a social support system or utilize community resources (e.g., YMCA, YWCA, service organizations, etc.).
Outpatient
18. Explore the consequences of anger, motivation, and willingness to participate in treatment, and agree to participate to learn new ways to think about and manage anger. (26, 27, 28)
26. Assist the client in identifying the positive consequences of managing anger (e.g., respect from others and self, cooperation from others, improved physical health, etc.); assign “Alternatives to Destructive Anger” in the
Adult Psychotherapy Homework Planner
by Jongsma & Bruce.
27. Ask the client to list and discuss ways anger has negatively affected daily life (e.g., hurting others or self, legal conflicts, loss of respect from self and others, destruction of property); process this list.
28. Use motivational interviewing techniques toward clarifying the client's stage of change, moving the client toward the action stage in which the client agrees to take specific actions to conceptualize and manage anger more effectively (see, e.g.,
Motivational Interviewing
by Miller & Rollnick).
19. Cooperate with a medication evaluation for possible treatment with psychotropic medications to assist in anger control; take medications consistently, if prescribed. (29, 30)
29. Assess the client for the need and willingness to take psychotropic medication to assist in control of anger; refer them to a qualified prescriber for a medication evaluation, if needed.
30. Monitor the client's psychotropic medication adherence, side effects, and effectiveness; confer as indicated with the prescriber.
20. Keep a daily journal of persons, situations, and other triggers of anger; record thoughts, feelings, and actions taken or not. (31, 32)
31. Ask the client to self‐monitor, keeping a daily journal in which the client documents persons, situations, thoughts, feelings, and actions associated with moments of anger, irritation, or disappointment (or supplement with “Anger Journal” in the
Adult Psychotherapy Homework Planner
by Jongsma & Bruce); routinely process the journal toward helping the client understand their own contributions to generating anger.
32. Assist the client in generating a list of anger triggers; process the list toward helping the client understand the causes and expressions of anger.
21. Verbalize increased awareness of anger expression patterns, their causes, and their consequences. (33, 34)
33. Convey a model of anger that involves different dimensions (cognitive, physiological, affective, and behavioral) that interact predictably (e.g., demanding expectations not being met leading to increased arousal and anger leading to aggression), and that can be understood and changed (see, e.g.,
Anger Management
by Kassinove & Tafrate;
Overcoming Situational and General Anger
by Deffenbacher & McKay).
34. Process the client's list of anger triggers and other relevant journal information toward helping the client understand how cognitive, physiological, and affective factors interplay to produce anger.
22. Verbalize an understanding of how the treatment is designed to help regulate anger, effectively manage it, and improve quality of life. (35)
35. Discuss the rationale for treatment, emphasizing how functioning can be improved through change in the various dimensions of anger; revisit relevant themes throughout therapy to help the client consolidate understanding.
23. Read material that supplements the therapy by improving understanding of anger, anger control problems, and their management. (36)
36. Assign the client reading material that educates them about anger and its management (see, e.g.,
Overcoming Situational and General Anger: Client Manual
by Deffenbacher & McKay;
Anger Management for Everyone
by Tafrate & Kassinove); process and revisit relevant themes throughout therapy to help the client consolidate understanding of relevant concepts.
24. Learn and implement calming and coping strategies as part of an overall approach to managing anger. (37)
37. As part of a larger personal and interpersonal skill set, teach the client tailored calming techniques (e.g., progressive muscle relaxation, breathing induced relaxation, calming imagery, cue‐controlled relaxation, applied relaxation, mindful breathing) for reducing chronic and acute arousal that accompanies anger expression (or supplement with “Deep Breathing Exercise” in the
Adult Psychotherapy Homework Planner
by Jongsma & Bruce).
25. Identify, challenge, and replace anger‐inducing self‐talk with self‐talk that facilitates a more measured response. (38, 39, 40)
38. Use cognitive therapy techniques to explore the client's self‐talk that mediates angry feelings and actions (e.g., demanding expectations reflected in should, must, or have‐to statements); identify, challenge, and change biased self‐talk, assist them in generating appraisals that correct for the biases and facilitate a more flexible and temperate response to frustration; explore underlying assumptions and schema if needed. Combine new self‐talk with calming skills as part of a coping skills set for managing anger.
39. Assign the client a homework exercise to identify angry self‐talk and generate alternatives that help regulate angry reactions; review; reinforce success, resolve obstacles toward sustained and effective implementation (or supplement with “Journal and Replace Self‐Defeating Thoughts” in the
Adult Psychotherapy Homework Planner
by Jongsma & Bruce).
