The Family Therapy Progress Notes Planner E-Book

Arthur E. Jongsma

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Practice Planners
• Sprache: Englisch
• Veröffentlichungsjahr: 2010

Seitenzahl: 618

Beschreibung

The Bestselling treatment planning system for mental health professionals The Family Therapy Progress Notes Planner, Second Edition contains complete prewritten session and patient presentation descriptions for each behavioral problem in The Family Therapy Treatment Planner, Second Edition. The prewritten progress notes can be easily and quickly adapted to fit a particular client need or treatment situation. * Saves you hours of time-consuming paperwork, yet offers the freedom to develop customized progress notes * Organized around 40 behaviorally based presenting problems, including family-of-origin interference, depression in family members, divorce, financial conflict, adolescent and parent hostility, friction within blended families, traumatic life events, and dependency issues * Features over 1,000 prewritten progress notes (summarizing patient presentation, themes of session, and treatment delivered) * Provides an array of treatment approaches that correspond with the behavioral problems and DSM-IV-TR¯TM diagnostic categories in The Family Therapy Treatment Planner, Second Edition * Offers sample progress notes that conform to the requirements of most third-party payors and accrediting agencies, including CARF, The Joint Commission (TJC), COA, and the NCQA * Presents new and updated information on the role of evidence-based practice in progress notes writing and the special status of progress notes under HIPAA

Leseprobe

Table of Contents

PracticePlanners® Series

Treatment Planners

Progress Notes Planners

Homework Planners

Client Education Handout Planners

Complete Planners

Title Page

Copyright Page

Dedication

PRACTICEPLANNERS® SERIES PREFACE

Acknowledgments

Introduction

ABOUT PRACTICEPLANNERS PROGRESS NOTES

HOW TO USE THIS PROGRESS NOTES PLANNER

A FINAL NOTE ABOUT PROGRESS NOTES AND HIPAA

ACTIVITY/FAMILY IMBALANCE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

ADOLESCENT/PARENT CONFLICTS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

ADOPTION ISSUES

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

ALCOHOL ABUSE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

ANGER MANAGEMENT

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

ANXIETY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

BLAME

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

BLENDED FAMILY PROBLEMS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

CHILD/PARENT CONFLICTS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

COMMUNICATION

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

COMPULSIVE BEHAVIORS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

DEATH OF A CHILD

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

DEATH OF A PARENT

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

DEPENDENCY ISSUES

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

DEPRESSION IN FAMILY MEMBERS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

DISENGAGEMENT/LOSS OF FAMILY COHESION

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

EATING DISORDERS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

EXTRAFAMILIAL SEXUAL ABUSE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

FAMILY ACTIVITY DISPUTES

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

FAMILY BUSINESS CONFLICTS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

FAMILY MEMBER SEPARATION

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

FAMILY-OF-ORIGIN INTERFERENCE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

FINANCIAL CHANGES

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

GEOGRAPHIC RELOCATION

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

INCEST SURVIVOR

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

INFIDELITY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

INHERITANCE DISPUTES BETWEEN SIBLINGS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

INTERFAMILIAL DISPUTES OVER WILLS AND INHERITANCE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

INTERRACIAL FAMILY PROBLEMS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

INTOLERANCE/DEFENSIVENESS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

JEALOUSY/INSECURITY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

LIFE-THREATENING/CHRONIC ILLNESS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

MULTIPLE BIRTH DILEMMAS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

PHYSICAL/VERBAL/PSYCHOLOGICAL ABUSE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

RELIGIOUS/SPIRITUAL CONFLICTS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

REUNITING ESTRANGED FAMILY MEMBERS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SEPARATION/DIVORCE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

SEXUAL ORIENTATION CONFLICTS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

TRAUMATIC LIFE EVENTS

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

UNWANTED/UNPLANNED PREGNANCY

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

PracticePlanners® Series

Treatment Planners

The Complete Adult Psychotherapy Treatment Planner, Fourth Edition

The Child Psychotherapy Treatment Planner, Fourth Edition

The Adolescent Psychotherapy Treatment Planner, Fourth Edition

The Addiction Treatment Planner, Fourth 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

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

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

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, Third Edition

The Adolescent Psychotherapy Progress Notes Planner, Third Edition

The Adult Psychotherapy Progress Notes Planner, Third Edition

The Addiction Progress Notes Planner, Third Edition

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

The Couples Psychotherapy Progress Notes Planner

The Family Therapy Progress Notes Planner, Second Edition

The Veterans and Active Duty Military Psychotherapy Progress Notes Planner

Homework Planners

Employee Assistance 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

Child Therapy Activity and Homework Planner

Addiction Treatment Homework Planner, Fourth Edition

Adolescent Psychotherapy Homework Planner II

Adolescent Psychotherapy Homework Planner, Second Edition

Adult Psychotherapy Homework Planner, Second Edition

Child Psychotherapy Homework Planner, Second Edition

Parenting Skills 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

This book is printed on acid-free paper.

Copyright © 2010 by David J. Berghuis and Arthur E. Jongsma, Jr. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.

Published simultaneously in Canada.

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ISBN 978-0-470-44884-7(paper) ISBN 978-0-470-63837-8 (ebk) ISBN 978-0-470-63838-5 (ebk) ISBN 978-0-470-36839-2 (ebk)

To Lucy Berghuis and Tom Ranney, who have helped to complete our family.

—David J. Berghuis

To Justin, Carter, Kaleigh, and Tyler—grandchildren who enrich our family circle with their energy and love.

—Arthur E. Jongsma, Jr.

PRACTICEPLANNERS®SERIES PREFACE

Accountability is an important dimension of the practice of psychotherapy. Treatment programs, public agencies, clinics, and practitioners must justify and document their treatment plans to outside review entities in order to be reimbursed for services. The books and software in the PracticePlanners® series are designed to help practitioners fulfill these documentation requirements efficiently and professionally. The PracticePlanners® series includes a wide array of treatment planning books including not only the original Complete Adult Psychotherapy Treatment Planner, Child Psychotherapy Treatment Planner, and Adolescent Psychotherapy Treatment Planner, all now in their fourth editions, but also Treatment Planners targeted to specialty areas of practice, including:

• Addictions

• Co-occurring disorders

• Behavioral medicine

• College students

• Couples therapy

• Crisis counseling

• Early childhood education

• Employee assistance

• Family therapy

• Gays and lesbians

• Group therapy

• Juvenile justice and residential care

• Mental retardation and developmental disability

• Neuropsychology

• Older adults

• Parenting skills

• Pastoral counseling

• Personality disorders

• Probation and parole

• Psychopharmacology

• Rehabilitation psychology

• School counseling

• 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

• Women’s issues

• Veteran’s and active duty military

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

• Progress Notes Planners provide a menu of progress statements that elaborate on the client’s symptom presentation and the provider’s therapeutic intervention. Each Progress Notes Planner statement is directly integrated with the behavioral definitions and therapeutic interventions from its companion Treatment Planner.

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

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

The series also includes:

• 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 customized treatment plan along with optional integrated progress notes and homework assignments.

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

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

ARTHUR E. JONGSMA, JR.Grand Rapids, Michigan

ACKNOWLEDGMENTS

This book builds on the revised work done on the new edition of the Family Therapy Treatment Planner (2010) by Sean Davis, Frank Dattilio, and Art Jongsma. They highlighted evidence-based interventions that already existed in the previous edition and added new research supported content where needed. Two new chapters were also added to the new edition of the Treatment Planner: Reuniting Estranged Family Members and Interfamilial Disputes over Wills and Inheritance. Since this Progress Notes Planner follows the Treatment Planner, those new chapter titles are also found in this volume. We thank those authors of the Treatment Planner for their work on the new edition.

We also thank the production staff at John Wiley & Sons for their help in revising this new edition of the Family Therapy Progress Notes Planner. Digging out old files and integrating new material can be a challenge in manuscript management.

Finally, we thank the editorial staff at John Wiley & Sons for their ongoing support for this PracticePlanner project. Special thanks to Marquita Flemming, Judi Knott, and Margaret Alexander, who have guided us for many years.

ARTHUR E. JONGSMA, JR. DAVID J. BERGHUIS

INTRODUCTION

ABOUT PRACTICEPLANNERS®PROGRESS NOTES

Progress notes are not only the primary source for documenting the therapeutic process, but also one of the main factors in determining the client’s eligibility for reimbursable treatment. The purpose of the Progress Notes Planner series is to assist the practitioner in easily and quickly constructing progress notes that are thoroughly unified with the client’s treatment plan.

EachProgress Notes Planner:

• Saves you hours of time-consuming paperwork.

• Offers the freedom to develop customized progress notes.

• Features over 1,000 prewritten progress notes summarizing patient presentation and treatment delivered.

• Provides an array of treatment approaches that correspond with the behavioral problems and DSM-IV diagnostic categories in the corresponding companion Treatment Planner.

• Offers sample progress notes that conform to the requirements of most third-party payors and accrediting agencies, including The Joint Commission, COA, CARF, and NCQA.

HOW TO USE THISPROGRESS NOTES PLANNER

This Progress Notes Planner provides a menu of sentences that can be selected for constructing progress notes based on the behavioral definitions (or client’s symptom presentation) and therapeutic interventions from its companion Treatment Planner. All progress notes must be tied to the patient’s treatment plan-session notes should elaborate on the problems, symptoms, and interventions contained in the plan.

Each chapter title is a reflection of the client’s potential presenting problem. The first section of the chapter, “Client Presentation,” provides a detailed menu of statements that may describe how that presenting problem manifested itself in behavioral signs and symptoms. The numbers in parentheses within the Client Presentation section correspond to the numbers of the Behavioral Definitions from the Treatment Planner.

The second section of each chapter, “Interventions Implemented,” provides a menu of statements related to the action that was taken within the session to assist the client in making progress. The numbering of the items in the Interventions Implemented section follows exactly the numbering of Therapeutic Intervention items in the corresponding Treatment Planner.

All item lists begin with a few keywords. These words are meant to convey the theme or content of the sentences that are contained in that listing. The clinician may peruse the list of keywords to find content which matches the client’s presentation and the clinician’s intervention.

It is expected that the clinician may modify the prewritten statements contained in this book to fit the exact circumstances of the client’s presentation and treatment. To maintain complete client records, in addition to progress note statements that may be selected and individualized from this book, the date, time, and length of a session; those present within the session; the provider; provider’s credentials’ and a signature must be entered in the client’s record.

A FINAL NOTE ABOUT PROGRESS NOTES AND HIPAA

Federal regulations under the Health Insurance Portability and Accountability Act (HIPAA) govern the privacy of a client’s psychotherapy notes, as well as other protected health information (PHI). PHI and psychotherapy notes must be kept secure and the client must sign a specific authorization to release this confidential information to anyone beyond the client’s therapist or treatment team. Further, psychotherapy notes receive other special treatment under HIPAA; for example, they may not be altered after they are initially drafted. Instead, the clinician must create and file formal amendments to the notes if he or she wishes to expand, delete, or otherwise change them. Our TheraScribeTM software provides functionality to help clinicians maintain the proper rules concerning handling PHI, by giving the ability to lock progress notes once they are created, to acknowledge patient consent for the release of PHI, and to track amendments to psychotherapy notes over time.

Does the information contained in this book, when entered into a client’s record as a progress note, qualify as a “psychotherapy note” and therefore merit confidential protection under HIPAA regulations? If the progress note that is created by selecting sentences from the database contained in this book is kept in a location separate from the client’s PHI data, then the note could qualify as psychotherapy note data that is more protected than general PHI. However, because the sentences contained in this book convey generic information regarding the client’s progress, the clinician may decide to keep the notes mixed in with the client’s PHI and not consider it psychotherapy note data. In short, how you treat the information (separated from or integrated with PHI) can determine if this progress note planner data is psychotherapy note information. If you modify or edit these generic sentences to reflect more personal information about the client or you add sentences that contain confidential information, the argument for keeping these notes separate from PHI and treating them as psychotherapy notes becomes stronger. For some therapists, our sentences alone reflect enough personal information to qualify as psychotherapy notes and they will keep these notes separate from the client’s PHI and require specific authorization from the client to share them with a clearly identified recipient for a clearly identified purpose.

ACTIVITY/FAMILY IMBALANCE

CLIENT PRESENTATION

1. Tension Due to Outside Activities (1)1

a. The family has experienced tension due to a family member’s excessive time given to outside activities.

b. A parent spends an excessive amount of time at work away from home, resulting in arguments and tension within the family.

c. A family member spends a great deal of time involved in sports activities, resulting in tension about the lack of time spent with other family members.

d. A family member spends a great deal of time involved in activities away from the family, resulting in tension about lack of time with other family members.

e. Family members often experience arguments and conflicts when they try to resolve the activity/family imbalance.

f. Family tension has decreased as family members have developed a greater balance regarding activities outside of the home.

2. Priorities Questioned (2)

a. Family members often question other family members’ priorities because of the unusual amount of time that is dedicated to outside activities.

b. Family members are uncertain about how important they are to other family members due to the unusual amount of time that is dedicated to outside activities.

c. Family members have become more at ease with the level of importance of the family within all family members’ lifestyles.

3. Shift of Duties (3)

a. Some family duties and responsibilities have been unfairly shifted to other family members due to the time absorbed by the external activities.

b. Family members experience conflicts and tension due to the unfair shifting of responsibilities.

c. Family members have become more understanding about how their outside activities affect others and have become more responsible for their own duties around the home.

d. The family has prioritized responsibilities in a different manner, which has reduced the conflict and tension within the family.

4. Jealousy and Envy (4)

a. Family members often experience feelings of jealousy and envy due to the increased amount of time dedicated to external activities.

b. Accusations of favoritism have arisen among family members.

c. Feelings of jealousy and envy often lead to arguments and conflict between family members.

d. As family members have begun to resolve concerns related to jealousy and envy, conflict has decreased.

e. Family members report no further feelings of envy or jealousy.

5. Competition for Absent Family Member’s Time (5)

a. Family members often feel as though they are in competition with each other for the absent family member’s available time.

b. Family members display attention-seeking behaviors to obtain time with the frequently absent family member.

c. Family members often disagree about how they can use the absent family member’s available time.

d. As activity/family imbalance issues have been worked out, family members are able to obtain adequate time with the previously unavailable family member.

6. Mental Illness (6)

a. A family member’s excessive involvement with activities away from the family appears to be related to mental illness.

b. Bipolar disease appears to be the precipitating cause of the activity/family imbalance issues.

c. As the family member’s mental illness has been treated, the activity/family imbalance issues have been resolved.

INTERVENTIONS IMPLEMENTED

1. Obtain All Family Members’ Opinions (1)2

a. Each family member was allowed to express opinions about who is absent too often from the family.

b. Family members were encouraged to provide open, honest opinions about family members being overly committed to outside activities.

c. Family members were redirected when they tried to argue or deny other family members’ opinions.

d. It was reflected to the family that they have very similar opinions about the activity/family imbalance issues.

e. Family members were noted to have quite varied opinions about the activity/family imbalance issues, and these differences in perception were summarized.

2. Facilitate Ventilation of Feelings (2)

a. Family members were asked to express their feelings regarding the activity/family imbalance pattern.

b. Family members were provided with support and encouragement when they openly expressed their feelings regarding the activity/family imbalance issues.

c. Family members were redirected when they attempted to deny or invalidate the family members’ emotions about the activity/family imbalance.

d. Family members were guarded about their feelings related to the activity/family imbalance and were encouraged to open up about these emotions when they felt safe to do so.

3. Encourage Ownership of Feelings and Behavior (3)

a. All family members were encouraged to take ownership of their own feelings and behavior.

b. All family members were encouraged to identify and express their feelings.

c. Each family member was directed to identify the behaviors they have that contribute to the conflicts over activity/family imbalance.

d. Family members were supported as they took ownership of their feelings and behavior.

e. Family members tended to blame others for their feelings and behavior and were provided with feedback about this pattern.

4. Define Problem Clearly (4)

a. The family was asked to clearly define the problem of activity/family imbalance.

b. The family was assisted in developing specific information about the problem of activity/ family imbalance.

c. When family members fell into vague generalizations, they were redirected to be more specific.

d. Family members’ descriptions of the problem areas of activity/family imbalance were redefined in behavioral terms.

5. Review Evolution of the Problem (5)

a. The family was assisted in identifying how the activity/family imbalance problems evolved.

b. It was noted that the activity/family imbalance appeared to start because of emotional concerns.

c. It was noted that the activity/family imbalance seemed to begin due to logistical considerations.

d. It was noted that the activity/family imbalance appeared to begin with financial problems.

e. It was noted that the activity/family imbalance started with family-of-origin pressures.

f. The family was uncertain about why the activity/family imbalance started and was provided with tentative examples of how these patterns begin.

6. Use Assessment Techniques (6)

a. Objective assessment techniques were used to help define the activity/family imbalance problem and its historical roots.

b. The Family-of-Origin Scale (Hovestadt et al.) was used to help define the activity/family imbalance problem and its historical roots.

c. The Family-of-Origin Inventory (Stewart) was used to help define the problem and its historical roots.

d. The results of the objective assessment techniques were reflected to the family.

7. Solicit Opinions about Energy Directed Outside the Family (7)

a. Each family member was asked to provide an opinion about why excessive energy is directed to activities outside of the family.

b. Each family member’s opinion was validated and honored in regard to perceptions about why excessive energy is directed to activities outside of the family.

c. The family’s opinions regarding the excessive energy that is directed to activities outside of the family were summarized and reflected to the family.

8. Identify Each Family Member’s Priorities (8)

a. Each family member was asked to express personal priorities regarding how time is spent.

b. Each family member was requested to rank his/her activities as to how much time is spent with them.

c. Family members’ priorities were reflected to them, including similarities and differences.

9. Explore Differences in Priorities (9)

a. Family members were asked to compare their list of priorities.

b. Family members were asked to discuss how their priorities differ from each other.

c. Family members were asked to identify the reasons why their priorities have become divergent.

d. It was reflected to the family members that they have come to a greater understanding of each other’s priorities as a result of discussing the differences in their priorities and the etiologies of those differences.

e. Family members were provided with feedback about how and why their priorities are different.

10. Develop Family Priorities (10)

a. The family was assisted in developing a list of priorities endorsed by all members.

b. Family members were urged to compromise in order to develop a list of priorities suitable to all family members.

c. Family members were reinforced for developing a set of priorities that are acceptable to all family members.

d. Family members failed to develop a set of priorities for the family as a whole and were provided with redirection in this area.

11. Explore Barriers to Cohesive Priorities (11)

a. The family was questioned about issues that may interfere with the cohesive, rank-ordered list of priorities endorsed by all members.

b. Family members were assisted in identifying worries or fears that may affect the cohesiveness of the list of family priorities.

c. Family members were helped to identify logistical concerns that will affect the family’s list of priorities.

d. Family members were helped to identify how avoidance of conflict affects family priorities.

e. Family members were unable to identify possible barriers to the cohesive set of priorities for the family and were provided with tentative examples of possible barriers.

12. Develop Healthy Intervention Technique (12)

a. Family members were assisted in finding healthy ways to address issues that interfered with the rank-ordered list of priorities.

b. Family members were encouraged to use assertive communication techniques.

c. Family members were taught about how to replace aggressive and passive-aggressive communication with healthy communication.

d. Family members were reinforced for their healthy pattern of communication; specific examples were highlighted.

e. Family members were redirected when they used unhealthy communication.

13. Explore Perceived Expectations (13)

a. Family members were asked to verbalize their perceptions of what other family members expect of them.

b. Perceived expectations were compared to family members’ actual expectations of one another.

c. It was reflected to the family members that they often perceive others to expect much more of them than what is actually expected.

d. It was reflected to the family members that their perceptions of what others expect of them are quite accurate.

14. Suggest Helpful Communication Techniques (14)

a. Family members were taught helpful communication techniques to more effectively express their disagreement over the activity issue.

b. Family members were taught the use of “I” statements.

c. Family members were urged to stay calm and respectful in tone when discussing the activity issue.

d. Family members were reinforced for their use of calm, respectful, and direct communication techniques.

e. Family members have not used respectful communication techniques and were reminded to do so.

15. Objectively Assess Relationships (15)

a. An assessment inventory was used to objectively define the nature of the relationships within the family.

b. The Index of Family Relations (Hudson) was used to assess the nature of the relationships within the family.

c. The results of the objective assessment of the relationships within the family were presented to the family members.

16. Discuss Inventory Results (16)

a. The results of the assessment inventory were discussed with the family.

b. The assessment inventory results indicated that family members do not feel close to one another.

c. The assessment inventory results indicated that family members do feel close to one another.

d. The family was helped to process the results of the objective assessment of family relationships, and the implication of this information was reviewed.

17. Discuss Home-Based Duties (17)

a. Family members were asked to discuss how home-based duties have been assigned to individual family members.

b. Each family member was asked to provide feedback on what would be the fairest distribution of duties and responsibilities, and why duties should be distributed in this manner.

c. Family members were assisted in synthesizing how home-based duties and responsibilities should be assigned.

d. It was reflected to the family members that they have very divergent beliefs about how home-based duties should be assigned.

18. Delineate Underlying Beliefs (18)

a. The family was asked to identify their beliefs about the basis for delegation of household chores.

b. Family members were asked about how chores should be delegated in regard to income earners versus non-income earners.

c. Family members were asked their opinion about how chores should be delegated based on age levels.

d. The family was assisted in clearly defining the underlying beliefs that form the basis for the delegation of household chores.

19. Develop a Fair Method for Assigning Chores (19)

a. The family was assisted in developing a fair method for assigning chores for various family members.

b. It was suggested to the family to use a lottery drawing to randomize the assignment of chores.

c. Family members were assisted in fine-tuning the selected method of assigning chores.

20. Confront Laziness (20)

a. Family members who were attempting to shirk their household chore responsibilities were directly confronted.

b. An emphasis was placed on the need for all family members to take responsibility for their own behavior.

c. Working for the good of the family was prioritized above working for the good of one’s self.

d. The family was assisted in respectfully confronting those who have shirked news based responsibilities.

e. Family members who have increased their level of responsibility within the family were reinforced.

f. Family members continued to tend to shirk their responsibilities and require other family members to take over for them; treatment focus was changed to address this issue.

21. Explore Jealousy/Envy (21)

a. Family members were asked about their level of jealousy and envy in regard to the activity/family imbalance.

b. Family members were supported as they expressed their feelings regarding the activity/ family imbalance.

c. Family members were provided with examples of situations in which they might experience jealousy or envy.

d. Family members denied any pattern of jealousy or envy and were urged to be aware of this dynamic.

22. Focus on Time-Allocation Arguments (22)

a. The family was asked to identify the specific arguments that they have over time allocation.

b. The family was assisted in identifying how time-allocation disagreements have developed.

23. Facilitate Emotional Ventilation (23)

a. Family members were asked to express their feelings regarding the lack of time that they are able to have with each other.

b. Family members were asked to express their feelings regarding the great amount of time spent with a specific family member.

c. Family members were encouraged to openly express their feelings; when other family members attempted to suppress the healthy expression of emotion, they were redirected to allow this necessary ventilation.

d. Family members were very guarded about expressing their feelings and were urged to be more open as they felt safe to do so.

24. Probe for Avoidance (24)

a. Family members were questioned about whether they may be using external activities as a way to avoid contact or closeness with the family.

b. Family members were noted to be avoidant of closeness with other family members by remaining overly involved in external activities.

c. The avoidant family member was provided with support as the pattern of avoidance was processed and reviewed.

25. List Pros and Cons of Closeness (25)

a. Each family member was asked to list the pros and cons of being a close-knit family unit.

b. Family members were assisted in clarifying the positive aspects of being a close family unit.

c. Family members were assisted in clarifying the negative side of being a close family unit.

d. It was reflected to the family that all family members seem to be seeking a close-knit family unit.

e. It was reflected to the family members that they are not unified in their desire to obtain a more close-knit family unit.

26. Suggest Intimacy Builders (26)

a. Ways to increase family intimacy were suggested to the family.

b. The family was encouraged to engage in social and recreational activities together.

c. The family was encouraged to play The UnGame (Zakich) as a way to build mutual understanding.

d. The family was reinforced for using specific activities to build family intimacy.

e. The family has not used activities to build family intimacy and was redirected in this area.

27. Assess Family Mental Health History (27)

a. The often-absent family member’s extended family was assessed for the presence of mental health concerns.

b. It was noted that there are mental health problems within the family-of-origin of the too-often-absent family member.

c. It was reflected that there is no history of mental health illness within the too-often-absent family member’s history.

28. Assess for Mental Health Issues (28)

a. The family member who is often spending excessive time outside of the home was assessed for a mental health issue.

b. The too-often-absent family member was assessed for any obsessive or compulsive symptoms.

c. The too-often-absent family member was assessed for addiction concerns.

d. The too-often-absent family member was assessed for severe and persistent mental illness concerns, such as bipolar disorder.

e. Mental health problems were identified for the too-often-absent family member, and an appropriate referral was initiated.

f. Upon assessment, no significant mental health concerns were identified for the too-often-absent family member, and this was reflected to the family.

29. Suggest Further Evaluation (29)

a. The too-often-absent family member was referred to another mental health professional (e.g., clinical psychologist or psychiatrist) for an in-depth assessment of mental health needs.

b. The too-often-absent family member has followed through on the referral for further evaluation, and the results of this assessment were reviewed.

c. The too-often-absent family member has not followed up on a referral for a more in-depth evaluation, and the reasons for this resistance were processed and resolved.

30. Discuss Treatment Options (30)

a. The various treatment options available for the mentally ill family member were discussed.

b. The family was provided with specific information regarding treatment available for the mentally ill family member.

c. A specific referral was made for treatment for the mentally ill family member’s needs.

d. The family has followed up on treatment for the mentally ill family member, and the benefits of this treatment were reviewed.

e. The family has not followed up on treatment for the mentally ill family member and was redirected to do so.

31. Develop Support for Mentally Ill Family Member (31)

a. Ways in which the family can support the mentally ill family member were identified.

b. Family members were asked to commit to helpful ways in which they can assist the mentally ill family member in recovery.

c. Family members were reinforced for the support provided to the mentally ill family member.

d. Family members have not been supportive of the mentally ill family member and were reminded about how helpful this can be.

32. Use Buddy System (32)

a. The buddy system was suggested as a way for family members to obtain peer support.

b. Family members were encouraged to use a peer support model in the family, attending treatment or support groups together, or holding each other accountable.

c. Family members were encouraged to seek out others outside of the family who can provide support regarding the family member’s mental illness concerns.

d. Family members’ use of peer support/buddy system concepts was reviewed.

e. The family has not used peer support or the buddy system to gain support in coping with the mental illness in the family and was reminded about these helpful resources.

33. Confront Denial (33)

a. The family was confronted for their denial of the mental illness concerns.

b. The mentally-ill family member was confronted for denying the mental illness concerns.

c. The nonmentally-ill family members were confronted about their pattern of denial of mental illness within the family.

34. Uncover Enabling (34)

a. Family members were taught about how enabling can exacerbate mental illness concerns.

b. Family members were confronted for their pattern of enabling the mentally ill family member.

c. Positive reinforcement was provided to the family members for decreasing their enabling behaviors.

ADOLESCENT/PARENT CONFLICTS

CLIENT PRESENTATION

1. Conflicts with Adolescent Child (1)3

a. The parents reported experiencing conflicts with their adolescent child.

b. The conflicts with the adolescent child have been so severe and persistent as to interfere with the family’s overall functioning.

c. The parents and their adolescent child experience frequent arguments that affect the day-today functioning of the family.

d. As treatment has progressed, the conflicts between the parents and their adolescent child have decreased, and the family is functioning better.