The Adult Psychotherapy Progress Notes Planner. David J. Berghuis

Problem-Solving Strategies (29)The client was taught a specific problem-solving strategy.The client was taught problem-solving strategies including specifically defining a problem, generating options for addressing it, implementing a plan, evaluating options, and reevaluating and refining the plan.The client was assigned the homework exercise “Applying Problem Solving to Inter- personal Conflict” from the Adult Psychotherapy Homework Planner (Jongsma).The client was provided feedback on his/her/their use of the problem-solving strategies.

      30 Assign Problem-Solving Exercise (30)The client was assigned a homework exercise in which he/she/they problem-solve a current problem.The client was assigned to solve a problem as described in Mastery of Your Anxiety and Worry: Workbook (Craske and Barlow).The client was provided with feedback about his/her/their use of the problem-solving assignment.

      31 Engage in Behavioral Activation (31)The client was engaged in “behavioral activation” by scheduling activities that have a high likelihood for pleasure and mastery.The client was directed to complete tasks from the “Identify and Schedule Pleasant Events” assignment from the Adult Psychotherapy Homework Planner (Jongsma).Rehearsal, role-playing, role-reversal, and other techniques were used to engage the client in behavioral activation.The client was reinforced for his/her/their success in scheduling activities that have a high likelihood for pleasure and mastery.The client has not engaged in pleasurable activities and was redirected to do so.

      32 Develop Interpersonal Skills and Relationships (32)As interpersonal deficits were identified as a primary factor in the client's anxiety, he/she/they were assisted in developing new interpersonal skills and relationships.The client displayed a clear understanding of the new interpersonal skills and relationships and was reinforced for this success.The client has struggled in regard to developing new interpersonal skills and relation- ships and was redirected in this area.

      33 Assign Homework on Communication Skills (33)The client was assigned a homework exercise in which he/she/they implement communication skills and training into his/her/their everyday life.The client was assigned the homework exercise “Restoring Socialization Comfort” from the Adult Psychotherapy Homework Planner (Jongsma).The client's use of homework exercises in his/her/their daily life was reviewed, with reinforcement for success and corrective feedback toward improvement.

      34 Provide Psychoeducation About Acceptance Approach (34)The client was taught about acceptance of worry.The client was taught about approaches such as mindfulness, cue detection, monitoring, and decentering.The client was assigned reading from An Acceptance-based Behavioral Therapy for Generalized Anxiety Disorder (Roemer and Orsillo).The client was given supplemental material from The Mindful Way Through Anxiety (Orsillo and Roemer).The client has read the assigned information on acceptance and key points were reviewed.The client has not read the assigned information and was redirected to do so.

      35 Differentiate Between Lapse and Relapse (35)A discussion was held with the client regarding the distinction between a lapse and a relapse.A lapse was associated with an initial and reversible return of symptoms, fear, or urges to avoid.A relapse was associated with the decision to return to fearful and avoidant patterns.The client was provided with support and encouragement as he/she/they displayed an understanding of the difference between a lapse and a relapse.The client struggled to understand the difference between a lapse and a relapse and was provided with remedial feedback in this area.

      36 Discuss Management of Lapse Risk Situations (36)The client was assisted in identifying future situations or circumstances in which lapses could occur.The session focused on rehearsing the management of future situations or circum- stances in which lapses could occur.The client was reinforced for his/her/their appropriate use of lapse management skills.The client was redirected in regard to his/her/their poor use of lapse management skills.

      37 Encourage Routine Use of Strategies (37)The client was instructed to routinely use the strategies that he/she/they have learned in therapy (e.g. cognitive restructuring, exposure).The client was urged to find ways to build his/her/their new strategies into his/her/their life as much as possible.The client was reinforced as he/she/they reported ways in which he/she/they have incorporated coping strategies into his/her/their life and routine.The client was redirected about ways to incorporate his/her/their new strategies into his/her/their routine and life.

      38 Develop a “Coping Card” (38)The client was provided with a “coping card” on which specific coping strategies were listed.The client was assisted in developing his/her/their “coping card” in order to list his/her/their helpful coping strategies.The client was encouraged to use his/her/their “coping card” when struggling with anxiety-producing situations.

      39 Schedule a “Maintenance” Session (39)The client was scheduled for a “maintenance” session between 1 and 3 months after therapy ends.The client was advised to contact the therapist if he/she/they need to be seen prior to the “maintenance” session.The client's “maintenance” session was held and he/she/they were reinforced for his/her/their successful implementation of therapy techniques.The client's “maintenance” session was held and he/she/they were coordinated for further treatment, as his/her/their progress has not been sustained.

      40 Use Motivational Interviewing (40)Techniques from motivational interviewing were used to help the client discuss ambivalence about changing current worry patterns.The client was assisted in deciding on whether to make changes.The client was assisted in identifying willingness to take action steps toward change.

      41 Utilize Paradoxical Intervention (41)A paradoxical intervention was developed with the client in which he/she/they were encouraged to experience the anxiety at specific intervals each day for a defined length of time.The client has implemented the assigned paradoxical intervention and reported that it was difficult for him/her/them to maintain the anxiety as he/she/they were eager to get on with other activities.The client has experienced, in general, a reduction of his/her/their anxiety as he/she/they have developed an insight into his/her/their ability to control it; this insight was processed.The client has not used the paradoxical intervention and was redirected to do so.

      42 Assign Cost-Benefit Analysis (42)The client was asked to complete a cost-benefit analysis as found in Ten Days to Self-Esteem! (Burns) in which he/she/they were asked to list the advantages and disadvantages of maintaining the anxiety.Completing the cost-benefit analysis exercise has been noted to be beneficial to the client as he/she/they developed more insight into the impact of anxiety on his/her/their daily life.The client has not followed through on completing the cost-benefit analysis of his/her/their anxiety and was encouraged to do so.

      43 Identify Unresolved Conflicts (43)The client was assisted in becoming aware of unresolved life conflicts that contribute to his/her/their persistent fears.The client was assisted in clarifying his/her/their feelings of anxiety as they relate to unresolved life conflicts.The client was assisted in identifying steps that could be taken to begin resolving issues in his/her/their life that contribute to persistent fear and worry.As the client has been helped to resolve life conflicts, his/her/their feelings of anxiety have diminished.The client did not display insight into unresolved conflicts and how they contribute to his/her/their persistent fears and was gently offered examples in this area.

      44 Develop Insight into Past Traumas (44)The client's past traumatic experiences that have become triggers for anxiety were examined.The client has been assisted in developing insight into how past traumatic experiences have led to anxiety in present unrelated circumstances.The client's insights into the role of past emotional pain and present anxiety were reinforced.The development of insight regarding past traumas has resulted in a reduction in the experience of anxiety.

      45 List Life Conflicts (45)The client was asked to list his/her/their important past and present life conflicts that may contribute to his/her/their feelings of worry.The client's list of life conflicts that trigger anxiety was processed.The client was assisted in clarifying the causes for his/her/their worry and to put them into better perspective.The client was unable to make a connection between life conflicts and his/her/their anxiety/worry and was gently offered examples in this area, as well as ways to put them in better perspective.

      46 Reinforce Responsibility Acceptance (46)The client was supported and reinforced for following through with the work, family, and social responsibilities rather than using escape and avoidance to focus on anxiety symptoms.The