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was helped to list many of the feared and avoided trauma-related stimuli.The client was assisted in developing a hierarchy of feared and avoided trauma-related stimuli.The client's journaling was used to assist in developing a hierarchy of feared and avoided trauma-related stimuli.

      36 Direct Imaginal Exposure (36)Imaginal exposure was directed by having the client describe a chosen traumatic experience at an increasing, but client-chosen, level of detail.Cognitive restructuring techniques were integrated and repeated until the associated anxiety regarding childhood trauma was reduced and stabilized.The session was recorded and provided to the client to listen to between sessions.“Share the Painful Memory” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce) was assigned to help direct the client's imaginal exposure.The client's progress was reviewed and reinforced and problems solved.

      37 Assign Homework on Exposure (37)The client was assigned homework exercises to perform exposure to feared stimuli and record experience.The client was directed to listen to the taped exposure session to consolidate skills for exposure to feared stimuli.The client was assigned “Gradually Reducing Your Phobic Fear” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client's use of exposure techniques was reviewed and reinforced.The client has struggled in implementation of exposure techniques and was provided with corrective feedback.The client has not attempted to use the exposure techniques and was redirected to do so.

      38 Treat Posttraumatic Stress Disorder (PTSD) (38)The client was identified as having a comorbid PTSD diagnosis.The client was treated with prolonged exposure therapy.The client was treated with cognitive processing therapy.The client was treated with eye movement desensitization and reprocessing (EMDR).The client's PTSD symptoms have significantly decreased and positive reinforcement was provided for this.The client's PTSD symptoms have not significantly decreased, and additional treatment in this area was coordinated.

      39 Encourage Trust in Own Evaluations (39)The client was encouraged to value, believe, and trust in their evaluations of self, others, and situations.The client was encouraged to examine situations in a nondefensive manner, independent of others' opinions.The client was encouraged to build self-reliance through trusting their own evaluations.The client was assigned “Forming Stable Relationships” in the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).The client was reinforced for value, belief, and trust in their own evaluations of self, others, and situations.The client was redirected when tending to devalue, disbelieve, and distrust their own evaluations.

      40 Encourage Positive Experiences (40)The client was encouraged to facilitate personal growth and “capacity for sustained joy” by choosing experiences that strengthen self-awareness, personal values, and appreciation of life.The client was encouraged to use spiritual practices and other relative life experiences to help increase positive experiences.

      41 Teach Problem-Solving Skills (41)The client was taught problem-solving skills.The client was taught to define the problem specifically, brainstorm options, list pros and cons of each option, choose and implement an option, and evaluate the outcome.The client was assigned the homework exercise “Plan Before Acting” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).Modeling, role-playing, and behavioral rehearsal were used to apply this skill to several current conflicts.

      42 Conduct Transference-Focused Therapy (42)Transference-Focused Therapy was conducted using client-therapist communications.The client was assisted in understanding split representations of self and difficulties with self-control.The client was taught about how to integrate split representations of self and develop more effective means to self-control.

      43 Conduct Schema-Focused Therapy (43)Schema-Focused Therapy was conducted with the client.The client was assisted in learning and changing entrenched, self-defeating patterns.The client was focused on the relationship with the therapist and daily life outside of therapy.The client was assisted in exploring early developmental experience that included trauma.

      44 Conduct Mentalization Therapy (44)Mentalization Therapy was conducted with the client.The client was assisted in learning to interpret the actions of self and others through meaningful and understanding examination of mental states such as desires, needs, feelings, beliefs, and reasons.

      45 Relate Borderline Traits to Addictive Behavior (45)The client was presented with information about how poor impulse control, poor anger management, fear of abandonment, and intense mood swings increase the probability of addictive behavior.The client was assigned “Analyzing Acting-Out Behavior” from the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).Active listening was used as the client identified specific incidences from their own life when their borderline traits have led to addictive behavior.The client has reported, as therapy has progressed, decreased incidences of borderline behaviors, with a commensurate decrease in addictive behavior.The client has struggled to identify how poor impulse control, poor anger management, fears of abandonment, and intense mood swings have led to an increase in addictive behavior; the client was provided with specific feedback in this area.

      46 Teach About a Higher Power (46)The client was presented with information about how faith in a higher power can aid in recovery from borderline traits and addiction.The client was assisted in processing and clarifying their own ideas and feelings regarding their higher power.The client was encouraged to describe beliefs about the idea of a higher power.The client rejected the concept of a higher power; the client was urged to consider this concept at a later time.

      47 Develop an Aftercare Plan (47)The client was assisted in developing an aftercare plan that will support recovery when feeling angry, anxious, abandoned, or depressed.The client was assigned “Personal Recovery Planning” in the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).The client has listed several components of an aftercare plan that will support sobriety (e.g., self-help groups and sponsors, family activities, counseling); feedback was provided about the completeness of this plan.The client was reinforced in describing active pursuit of the elements of the aftercare plan.The client has not followed through on an aftercare plan and was redirected to do so.

      48 Assist Family Members in Listing Support for Recovery (48)Family members were assisted in identifying ways in which they could be supportive of the client's sobriety.The client reported family members assisting significantly in encouragement and other techniques to help recover from borderline traits and addiction; this validation was emphasized.The client's significant others were strongly encouraged to attend Al-Anon meetings on a regular basis to support recovery.The client reported that family members have not been supportive of recovery; this rejection was processed.

      49 Educate the Family About Borderline Syndrome (49)Family members were taught about the client's borderline syndrome and the steps that the client must take to recover successfully.Family members were reinforced as they have displayed an understanding of the client's borderline syndrome and the steps that the client must take to recover successfully.Family members refused to accept the information about the client's borderline syndrome, and they did not display an understanding of the steps that the client must take to recover successfully; remedial feedback was provided.

      50 Develop a 5-Year Plan (50)The client was taught about the concept of a 5-year recovery plan.The client was assisted in developing a realistic 5-year personal recovery plan.The client was reinforced for a reasonable 5-year recovery plan.The client was provided with redirection in areas where the recovery plan seemed unrealistic.

      51 Assess Satisfaction (51)A treatment satisfaction survey was administered to the client.The client's survey responses indicated a high level of satisfaction with treatment services; these results were processed.The client's survey responses indicated a medium level of satisfaction with treatment services; these results were processed.The client's survey responses indicated a low level of satisfaction with treatment services; these results were processed.Although the client was encouraged to complete a treatment satisfaction survey, it was refused.

NOTES

      1 * The numbers in parentheses correlate to the number of the Behavioral Definition statement in the companion chapter with the same title in The Addiction Treatment Planner, Sixth Edition, by Perkinson, Jongsma,

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