The Adult Psychotherapy Progress Notes Planner. David J. Berghuis

detachment and any childhood abuse and was urged to consider this connection as he/she/they felt able to do so.

      41 Assess Anger-Producing Stimuli (41)The client was asked to describe his/her/their history and nature of anger feelings and expression.A focus was placed on assessing the stimuli that have triggered the client's anger and thoughts, feelings, and aggressive actions.The client's responses to various stimuli (e.g. situations, people, and thoughts) were reviewed.The client was assigned the homework exercise “Anger Journal” from the Adult Psychotherapy Homework Planner (Jongsma).

      42 Administer Psychological Testing (42)Psychological testing instruments were administered with a focus on objectively assessing anger expression.The client was assessed with the Anger, Irritability, and Assault Questionnaire (AIAQ).The client was assessed with the Buss-Durkee Hostility Inventory (BDHI).The client was assessed with the State-Trait Anger Expression Inventory (STAXI).The client was provided with feedback regarding the results of the assessment.

      43 Teach Calming Techniques (43)The client was taught calming relaxation skills.The client was taught progressive muscle relaxation, breathing-induced relaxation, calming imagery, cue-controlled relaxation, and applied relaxation.The client was taught how to discriminate better between relaxation and chronic or acute physiological activation that accompanies his/her/their angry feelings.The client was taught relaxation skills and was provided with feedback about his/her/their use of relaxation skills.

      44 Role-Play Relaxation and Cognitive Coping Skills (44)Role-play techniques were used to help the client use relaxation and cognitive coping skills in visualized anger-provoking scenes.The client was assisted in applying relaxation and cognitive coping skills to lower and then higher anger-inducing scenes.The client was assigned to implement calming techniques in his/her/their daily life when facing trigger situations.The client was assisted in processing his/her/their application of calming techniques in his/her/their daily life.

      45 Explore Self-Talk (45)The client was assisted in identifying distorted schemas and related automatic thoughts that mediate his/her/their angry feelings and actions.The client was taught the role of distorted thinking in precipitating emotional responses.The client was provided with examples of distorted or automatic thoughts, typically relating to should, must, or have-to statements.The client was challenged on his/her/their negative biases and assisted with healthier self-talk.The client was assisted in relating his/her/their self-talk and calming skills as a package of coping skills for managing anger.

      46 Assign Exercises on Self-Talk (46)The client was assigned homework exercises in which he/she/they identify anger-inducing self-talk and create reality-based alternatives, such as “Alternatives to Destructive Anger” from the Adult Psychotherapy Treatment Planner (Jongsma).The client's replacement of anxiety of anger-producing self-talk with reality-based alternatives was critiqued.The client was reinforced for his/her/their successes at replacing anger-based self-talk with reality-based alternatives.The client was provided with corrective feedback for his/her/their failure to replace anger-producing self-talk with reality-based alternatives.The client has not completed his/her/their assigned homework regarding replacing angry self-talk and was redirected to do so.

      47 Review Alternatives (47)The client was assisted in reviewing alternatives to destructive anger in response to trigger situations.The client was taught about assertiveness, relaxation, diversion, and calming self-talk.

      48 Teach Forgiveness (48)The client was taught the value of forgiveness as a means of overcoming pain and hurt, rather than holding on to it and acting out the anger that results from it.The client was asked to list those parental figures from his/her/their childhood that have caused him/her/them pain and suffering.The client was assisted in developing a list of benefits of beginning a process of forgiveness toward those perpetrators of pain in his/her/their childhood.

      49 Process Distrust (49)The client was asked to verbalize what he/she/they could be afraid of in placing trust in others.The client's fear of being taken advantage of, being disappointed, being abandoned, or being abused when trust is placed in another person was processed.Positive feedback was provided to the client as he/she/they displayed insight into his/her/their pattern of distrust.

      50 Encourage Trust (50)The client was assisted in identifying some personal thoughts and feelings that he/she/they could disclose to another person as a means of beginning the process of showing trust in others.The client was assisted in identifying one or two other people within his/her/their life that he/she/they could trust with personal information.The client was asked to commit to making a disclosure to a significant other that would demonstrate trust.Positive feedback was provided as the client identified that he/she/they have made trusting disclosures to others.The client did not make trusting disclosures to others, and the reasons behind this failure were processed.

      51 Process Trust Exercise (51)The client's feelings of anxiety regarding trusting someone were explored.The client's experience with placing trust in another person was reviewed and the success was reinforced.

NOTES

      1 1 The numbers in parentheses correlate to the number of the Behavioral Definition statement in the companion chapter with the same title in The Complete Adult Psychotherapy Treatment Planner, Sixth Edition, by Jongsma, Peterson, and Bruce (Hoboken, NJ: Wiley, 2020).

      2 2 The numbers in parentheses correlate to the number of the Therapeutic Intervention statement in the companion chapter with the same title in The Complete Adult Psychotherapy Treatment Planner, Sixth Edition, by Jongsma, Peterson, and Bruce (Hoboken, NJ: Wiley, 2020).

ANXIETY

      CLIENT PRESENTATION

      1 Excessive Worry (1)¹The client described symptoms of preoccupation with worry that something dire will happen.The client showed some recognition that his/her/their excessive worry is beyond the scope of rationality, but he/she/they feel unable to control it.The client described that he/she/they worry about issues related to family, personal safety, health, and employment, among other things.The client reported that his/her/their worry about life circumstances has diminished and he/she/they are living with more of a sense of peace and confidence.

      2 Excessive Worry Response to Recent Stressor (2)The client described symptoms of preoccupation with worry that something dire will happen in response to a recent stressor.The client showed some recognition that his/her/their excessive worry is due to a recent stressor.The client reported that his/her worry about a certain stressor has diminished and he/she/they are living with more of a sense of peace and confidence.

      3 Excessive or Unrealistic Worry (3)The client has described symptoms of excessive and/or unrealistic worry.The client's excessive and/or unrealistic worry has decreased.The client reported an average amount of worry that is realistic in nature.

      4 Motor Tension (4)The client described a history of restlessness, tiredness, muscle tension, and shaking.The client moved about in his/her/their chair frequently and sat stiffly.The client said that he/she/they are unable to relax and are always restless and stressed.The client reported that he/she/they have been successful at reducing levels of tension and increasing levels of relaxation.

      5 Autonomic Hyperactivity (5)The client reported the presence of symptoms such as heart palpitations, dry mouth, tightness in the throat, and some shortness of breath.The client reported periods of nausea and some diarrhea when anxiety levels escalate.The client stated that occasional tension headaches are also occurring along with other anxiety-related symptoms.Anxiety-related symptoms have diminished as the client has learned new coping mechanisms.

      6 Hypervigilance (6)The client related that he/she/they are constantly feeling on edge, that sleep is interrupted, and that concentration is difficult.The client reported being irritable and snappy in interaction with others as his/her/their patience is thin and he/she/they are worrying about everything.The client's family members report that he/she/they are difficult to get