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on medication to help stabilize moods and reduce emotional distress.

      18 Monitor Effects of Medication (18)The client's response to the medication was discussed in today's therapy session.It was noted that the medication has helped the client to stabilize moods and decrease the intensity of angry feelings.It was noted that the client has had little or no improvement in moods or anger control since being placed on the medication.The client was reinforced as they have consistently taken the medication as prescribed.The client has failed to comply with taking the medication as prescribed and was redirected to do so.

      19 Conduct Treatment for Borderline Traits (19)The client was oriented to dialectical behavioral therapy (DBT).The multiple facets of DBT were highlighted, including support, collaboration, challenge, problem-solving, and skill building.The biosocial view related to borderline personality disorder was emphasized, including the constitutional and social influences.The concept of dialectics was reviewed with the client.The client was provided with treatment specific for borderline traits.

      20 Refer for PTSD Treatment (20)The client was identified as manifesting posttraumatic stress disorder (PTSD) symptoms.The client was provided with therapy for posttraumatic stress disorder.The client was coordinated for prolonged exposure therapy.The client was coordinated for cognitive processing therapy.The client was coordinated for eye movement desensitization and reprocessing therapy.The client has followed through on treatment for PTSD and was reinforced for this.The client has not followed through on treatment for PTSD and was reminded to do so.

      21 Assign Feelings Letter (21)The client was assigned the task of writing a letter to their parents regarding feelings associated with the experience of childhood neglect or abuse.The client has followed through with writing a feelings letter to parents regarding childhood abuse/neglect and this letter was processed.It was reflected to the client that writing the letter regarding childhood abuse experiences has helped decrease feelings of shame and affirm the client as not being responsible for the abuse.The client has not followed through with writing the letter to parents regarding the childhood abuse or neglect experiences and was redirected to do so.

      22 Support Confrontation of Perpetrator (22)A conjoint session was held where the client confronted the perpetrator of childhood abusive experiences.The client was supported in confrontation of the perpetrator of abuse and neglect while responsibility for that neglect was placed clearly on the perpetrator.The client found it very difficult to be direct in confrontation of the perpetrator of childhood abuse/neglect; the client was urged to be more direct.The perpetrator responded with defensive statements and denial in reaction to the client's confrontation regarding childhood abuse and neglect; the client was supported in rejecting this blame and denial.Since the confrontation of the perpetrator, the client has reported decreased feelings of shame and more clarity regarding not being responsible for the abuse that occurred; the benefits of this progress were reviewed.The client has declined confrontation of the perpetrator; the client was accepted for this decision and urged to consider confrontation at a later date.

      23 Use Empty-Chair Exercise (23)The client was guided in an empty-chair exercise with the perpetrator of the abuse as the imagined person in the empty chair.The client was guided in an empty-chair exercise in which the nonperpetrating parent was imagined to be in the empty chair.The client was assisted in expressing feelings and clarifying the impact that the childhood experiences of abuse had.The client was assigned “It Wasn't My Fault” from the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).The client was reinforced as they affirmed self as not being responsible for the abuse and placed responsibility clearly on the perpetrator.The client was supported in confronting the nonperpetrating parent for not protecting the client from the abusive experiences in childhood.

      24 Reinforce Holding Perpetrator Responsible (24)Any and all statements that the client made that reflected placing blame on the perpetrators and nonprotective, nonnurturing adults for painful childhood experiences were reinforced.The client was consistently reminded that they were not responsible for the abuse and neglect that occurred in childhood but that it was the responsibility of childhood parents or caretakers.The client continues to struggle with self-blame for the abusive experiences of childhood; statements indicating self-blame were confronted and reframed.

      25 Explore Victim Versus Survivor (25)The client was asked to consider the positive and negative consequences of considering self as a victim versus being a survivor of childhood trauma.The client's understanding of the advantages of self-perception as a survivor of abuse and neglect rather than a victim was processed.The client has continued to view self as a victim of painful childhood experiences and has not moved forward toward feeling empowered as a survivor; this stagnation was reflected to the client.

      26 Reinforce Survivor Self-Perception (26)The client was encouraged and reinforced to perceive self as a survivor rather than a victim of childhood abuse or neglect.The client was assigned “Changing from Victim to Survivor” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).As the client increased statements that reflected a self-perception of survivorship rather than victimization, strong reinforcement was given.The client has continued to make statements of being a victim rather than statements of personal empowerment that reflect survivorship; the client was helped to reframe these statements into survivor statements.

      27 Teach Share-Check Technique (27)The client was taught to build trust in relationships through the use of the share-check technique.The client reported beginning to share personal thoughts and feelings with others on a minimal basis in order to see if those feelings are dealt with respectfully and supportively; the results of this sharing were reviewed.The client expressed difficulty with building trust and intimacy with others; the client was reminded to do this in small steps.The client was reinforced in expressing insight into difficulty with building trust as related to childhood experiences of abuse and neglect.

      28 Teach Trust in Others (28)The client was encouraged and taught the advantages of treating others as trustworthy while continuing to assess their character.Positive feedback was provided as the client reported beginning to increase trust and interaction with others.The client continues to struggle with issues of trust and to be withdrawn in social relationships; the client was reminded to increase trust in small steps.

      29 Teach Healthy Problem-Solving and Communication (29)The client was taught healthy conflict resolution skills (e.g., active listening, using “I” messages, cooperation, compromise, mutual respect).The client reported an increase in using the healthy conflict resolution skills they have been taught.The client identified that they have regularly been using healthy conflict resolution skills (e.g., active listening, using “I” messages, cooperation, compromise, mutual respect); this experience was reviewed.The client has struggled to implement the use of healthy conflict resolution skills; barriers to this progress were brainstormed.

      30 Teach Honest Communication Skills (30)The client was taught about healthy communication skills, including being honest, asking for wants, and sharing feelings.The client was provided with modeling, role-playing, and behavior rehearsal to teach more honest communication skills.The client was reinforced for more honest communication.The client continues to struggle in being straightforward with honesty, asking for wants, and sharing feelings; additional techniques were provided.

      31 Teach Assertiveness Skills (31)The client was taught assertiveness skills through the use of modeling, behavior rehearsal, and role-playing.The client displayed an understanding of the assigned components of assertiveness.The client was assigned “Becoming Assertive” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, McInnis, & Bruce).The client used a journal to list assertive experiences; the journal was processed.The client listed several situations in which they have been able to be assertive; these were processed.The client reported finding it very difficult to implement assertiveness skills; small successes were encouraged.

      32 Identify Unresolved Needs, Wishes, and Wants (32)The client was assisted in identifying, understanding, and verbalizing unresolved needs, wishes, and wants from childhood.The client was assigned “Corresponding With My Childhood Self” from the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma) to help a variety of needs, wishes, and wants from childhood.As the client has progressed in therapy, they have been helped to identify techniques for resolving childhood needs, wishes, and wants.The client was unable to consistently identify

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