001

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

001

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.
Each Progress 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 THIS PROGRESS 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.
2. Disagreements Regarding Parenting Strategies (2)
a. The parents described a lack of agreement regarding strategies for dealing with various types of negative adolescent behaviors.
b. One partner advocates for stricter parental controls, while the other partner endorses a more permissive approach.
c. The parents’ variable pattern of disciplinary response is ineffective in managing their adolescent’s behavior.
d. As communication has increased, the parents have gained an agreement regarding strategies for dealing with various types of negative adolescent behaviors.
3. Resentment about Conflict (3)
a. Family members complain about the time and attention that the adolescent-centered conflict takes from other family members and responsibilities around the home.
b. There is increased tension in the home due to the adolescent-centered conflict.
c. As the adolescent-centered conflict has been decreased, the resentment and tension in the home have also decreased.
4. Parents Feel Loss of Control (4)
a. The parents feel a loss of control over their adolescent.
b. The adolescent seems to be empowered by the parent’s dilemma and loss of control.
c. The adolescent resists parental intervention.
d. As treatment has progressed, the parents feel more in control and the adolescent is more compliant to the parents’ interventions.
5. Substance Abuse (5)
a. The adolescent has acted out in the area of substance abuse.
b. The adolescent has dabbled in drugs and alcohol.
c. The adolescent has regularly been abusing drugs and alcohol.
d. As treatment has progressed, the adolescent has discontinued substance abuse.
6. Sexual Acting Out (5)
a. The adolescent has acted out in a sexual manner.
b. The adolescent is involved in age-inappropriate sexual activity.
c. The adolescent’s sexual activity is against general family norms or expectations.
d. As treatment has progressed, the adolescent’s sexual acting out has diminished.
7. Poor School Performance (5)
a. The adolescent has displayed poor school performance.
b. The adolescent’s school performance has decreased significantly.
c. As treatment has progressed, the adolescent’s school performance has improved.
8. Delinquency (5)
a. The adolescent has acted out with delinquent behavior.
b. The adolescent has experienced legal problems due to his/her delinquent behavior.
c. As treatment has progressed, the adolescent’s delinquent behavior has ended.

INTERVENTIONS IMPLEMENTED

1. Share Perceptions/Feelings about Adolescent’s Behavior (1)4
a. Time was provided for each of the family members to share their perceptions about the adolescent’s behavior and to discuss their feelings.
b. Family members were supported as they openly and honestly discussed their perceptions and feelings about the adolescent’s behavior.
c. Family members appeared to be quite guarded about discussing the adolescent’s behavior and were urged to be more open in this area.
2. Assess Stability of Acting-Out Behavior (2)
a. An assessment was made regarding the adolescent’s acting-out behavior in regard to transience versus a more stable pattern.
b. The adolescent’s acting-out behavior was judged to be transient.
c. The adolescent’s acting-out behavior was judged to be a stable pattern of behavior.
3. Direct Parents to Share Philosophy and Expectations (3)
a. The parents were asked to share their philosophy on parenting.
b. The parents were asked about the expectations that they have for their child.
c. Active listening skills were used as the parents described their philosophy on parenting and the expectations that they have for their child.
d. The parents were uncertain about how to describe their parenting style and expectations and were provided with assistance in clarifying their views.
4. Administer Questionnaire/Inventories (4)
a. Questionnaires and inventories were used to assess the specific areas of conflict and how the family may be contributing to the problems.
b. The Adolescent Coping Orientation for Problem Experiences (A-COPE) by McCubbin and Thompson was used to assess specific areas of conflict and how the family may be contributing to the problems.
c. The results of the adolescent conflict assessment were discussed with the family.
5. Assess Belief Systems about Behavior (5)
a. Family members’ belief systems about appropriate versus inappropriate behavior were assessed.
b. Interviews and questionnaires were used to assess what behaviors the family members see as appropriate versus inappropriate.
c. The Family Beliefs Inventory (Roehling and Robin) was administered.
d. The Parent-Adolescent Questionnaire (Robin, Koepk, and Moye) was administered.
e. The results of the assessment regarding the family members’ belief systems were shared with the family.
6. Explore for Exacerbating Dynamics (6)
a. The family interactional patterns were explored for dynamics that may be exacerbating the conflict between the adolescent and the parents.
b. Family members were assessed regarding underlying conflicts, family-of-origin issues, unrealistic expectations, marital problems, and other dynamics that may be exacerbating the conflicts between the adolescent and the parents.
c. The familial interactional patterns and dynamics that are exacerbating conflict between the adolescent and parents were pointed out to the family members.
d. Family members were supported as they accepted interpretations regarding dynamics that exacerbate the conflict between the adolescent and the parents.
e. The family was quite reluctant to accept the dynamics that may be exacerbating the conflict between the adolescent and the parents and were urged to watch for evidence that may support or disprove these patterns.
7. Explore for Environmental Stressors (7)
a. Family members were assessed regarding any environmental stressors that may be exacerbating the conflicts between the adolescent and the parents.
b. The environmental stressors that are exacerbating conflict between the adolescent and parents were pointed out to the family members.
c. Family members were supported as they accepted interpretations regarding environmental dynamics that exacerbate the conflict between the adolescent and parents.
d. The family was quite reluctant to accept that environmental dynamics may be exacerbating the conflict between the adolescent and the parents and were urged to watch for evidence that may support or disprove these interpretations.
8. Role-Play Problem (8)
a. The parent and adolescent were asked to role-play a problem to assess how the parents solve the problem.
b. A role-play was conducted with the parents to assess their ability to solve problems.
c. Feedback was provided to the parents regarding the strengths and weaknesses of their approach to problem solving with their adolescent.
d. Modify strengths and weaknesses
e. The parents were taught how the adolescent’s strengths can be augmented.
f. The parents were taught ways in which the adolescent’s weakness can be diminished.
9. Recommend Reading on Parenting Techniques (9)
a. The parents were encouraged to read books on parenting techniques.
b. The parents were directed to read The Five Love Languages of Teenagers (Chapman).
c. The parents were directed to read Parents, Teens and Boundaries: How to Draw the Line (Bluestein).
d. The parents were directed to read Parents and Adolescents: Living Together (Patterson and Forgatch).
e. The parents were directed to read Raising an Emotionally Intelligent Child (Gottman and Declaire).
f. The parents were directed to read Parenting Teens with Love and Logic (Cline and Fay).
g. The parents have read the assigned material on parenting and key points were processed.
h. The parents have not read the assigned material on parenting and were redirected to do so.
10. Assign Monitoring of Adolescent’s Activities (10)
a. The parents were assigned to coordinate monitoring of their adolescent’s activities, keeping track of where the adolescent is, who the adolescent is with, what the adolescent is doing, and when the adolescent will be home.
b. The parents have coordinated monitoring of their adolescent’s activities on a regular basis.
c. The parents have not monitored their adolescent’s activities and deficiencies in this area were reviewed.
11. Review Monitoring Efforts (11)
a. The parents were assigned to record their joint monitoring efforts.
b. The parents have regularly recorded joint monitoring efforts of the adolescent, and this record was reviewed.
c. The parents were asked to discuss the successes that they have had at monitoring the adolescent’s whereabouts.
d. The partners were asked to identify times and situations where their monitoring of the adolescent’s whereabouts needs to be improved.
e. The parents were unable to identify any ways in which their monitoring of the adolescent needs to be improved, and their thorough record of monitoring the adolescent was noted to be consistent with this assessment.
f. The parents were unable to identify any areas in which they needed to improve their monitoring of the adolescent, but were confronted with examples of where they have not been able to successfully monitor the adolescent, as indicated in the record that they have kept.
g. The parents have not regularly recorded their monitoring activities of the adolescent and were redirected to do so.
12. Investigate Behavior Pattern to Increase (12)
a. The parents were asked to identify one of their adolescent’s positive behaviors that they would like to increase.
b. The parents were assigned to record the occurrence of their adolescent’s positive behavior every day for a week.
c. The couple was asked to note the situations that precede the identified positive behavior (i.e., antecedents) and follow the behavior (i.e., consequences).
d. The parents have regularly identified the occurrence of the adolescent’s positive behavior, antecedents, and consequences and were encouraged to continue this.
e. The parents have not regularly recorded the occurrence, antecedents, and consequences of the identified positive behavior pattern and were redirected to do so.
13. Identify and Practice Rewards (13)
a. The parents were directed to identify an appropriate reward (e.g., praise, use of the car, increase of allowance) to reinforce the adolescent’s positive behavior.
b. The parents were provided with assistance in identifying an appropriate reward to reinforce the adolescent’s positive behavior.
c. The parents were asked to rehearse praising a positive behavior pattern in the session.
d. The couple was provided with feedback about their practice of praising positive behavior.
e. The parents were directed to seek input and agreement from the adolescent for the rewards for positive behavior.
14. Review Behavioral Contract Implementation (14)
a. The implementation of the behavioral contract was reviewed.
b. The family was supported as they gave examples of successes and failures in the implementation of the behavioral contract.
c. The successes in the family’s implementation of the behavioral contract were reinforced.
d. Redirection was provided for situations in which the family did not succeed with the use of the behavioral contract.