The Adult Psychotherapy Progress Notes Planner. David J. Berghuis

client was quite guarded and unrealistic about his/her/their pattern of losses and was provided with feedback in this area.

      46 Probe Losses (46)Real or perceived losses in the client's life were explored.Active listening was used as the client confirmed that he/she/they have unresolved feelings regarding losses that have been experienced.It was interpreted to the client that his/her/their experience of loss has precipitated fears of abandonment in other relationships.The client denied any significant losses in his/her/their life, and this was accepted.

      47 Process Losses (47)The client's experiences of loss were processed in an attempt to help him/her/them put them into proper perspective.The client was helped to identify adaptive ways to replace the losses that were experienced.The client failed to process and develops adaptive ways to replace losses that have been experienced and was gently offered examples of how to do this.

      48 Explore Family-of-Origin History (48)The client was supported as he/she/they shared experiences from his/her/their family-of-origin history that have caused feelings of low self-esteem and fear of abandonment.The client was supported as he/she/they revealed experiences with critical and rejecting parents that led to feelings of low self-esteem.The client disclosed experiences of childhood abandonment by parent figures; these have been noted to lead to the fear of abandonment in current relationships.The client was quite guarded about his/her/their family-of-origin history and was urged to be more open in this area, as he/she/they feel capable of doing so.

      49 Use ACT Approach (49)Acceptance and commitment therapy (ACT) was applied.The client was assisted in accepting and openly experiencing depressive thoughts and feelings, without being overly impacted by them.The client was assisted in committing his/her/their time and efforts to activities that are consistent with identified personally meaningful values.The client has engaged well in the ACT approach and applied these concepts to his/her/their symptoms and lifestyle.The client has not engaged well in the ACT approach and remedial efforts were applied.

      50 Assign Positive Affirmations (50)The client was assigned to write at least one positive affirmation statement on a daily basis regarding oneself and the future.The client was assigned “Positive Self-Talk” exercise from the Adult Psychotherapy Homework Planner (Jongsma).The client has followed through on the assignment of writing positive affirmation statements and reported that he/she/they are feeling more positive about the future.The client was reinforced for making positive statements regarding oneself and his/her/their ability to cope with the stresses of life.The client has not followed through on the assignment of writing positive affirmation statements and was encouraged to do so.

      51 Teach Normalization of Sadness (51)The client was taught about the variation in mood that is within the normal sphere.The client reported that he/she/they are developing an increased tolerance to mood swings and is not attributing them to significant depression; this progress was reinforced.The client is verbalizing more hopeful and positive statements regarding the future and accepting some sadness as a normal variation and feeling; the benefits of this progress were highlighted.

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).

BIPOLAR DISORDER—MANIA

      CLIENT PRESENTATION

      1 Mood Dysfunction (1)¹The client exhibits an abnormally and persistently elevated, expansive, or irritable mood.The client displays multiple symptoms of mania.The client displays inflated self-esteem or grandiosity.The client displays decreased need for sleep.The client displays pressured speech, flight of ideas, and distractibility.The client displays excessive goal-directed activity or psychomotor agitation, and excessive involvement in pleasurable, high-risk behavior.The client's mood has returned to normal limits.

      2 Marked Impairment in Functioning (2)The client's elevated mood and irritability caused marked impairment in his/her/their functioning.The client's occupational functioning has been affected by his/her/their mania.The client's social activities have been affected by his/her/their mania.The client's relationships with others have been affected by his/her/their mania.As treatment has progressed, the client's mood and irritability have decreased, with less effect on functioning.

      3 Pressured Speech (3)The client gave evidence of pressured speech within the session.The client reported that his/her/their speech rate increases as he/she/they feel stressed.The client's pressured speech has shown evidence of a decrease in intensity.The client showed no evidence of pressured speech in today's session.

      4 Flight of Ideas/Racing Thoughts (4)The client demonstrated an inability to stay focused on one subject and moved quickly from one topic to another.The client reported that he/she/they have difficulty concentrating on one thought because other thoughts interfere.The client reported that at times of quiet reflection, he/she/they are disturbed by thoughts racing through his/her/their mind.The client's thoughts are not racing as they had been and he/she/they are able to stay focused on one topic in a conversation.

      5 Grandiosity (5)The client gave evidence of grandiose ideas regarding his/her/their abilities, plans, and accomplishments.In spite of attempts to try to get the client to be more realistic, his/her/their grandiosity continued.The client's grandiosity has diminished and he/she/they have become more reality-based.There has been no recent evidence of grandiosity in the client's description of self or plans for the future.

      6 Persecutory Beliefs (5)The client described feeling misunderstood and persecuted by others who do not acknowledge his/her/their grandiose ideas.The client described feelings of anger and persecution directed at those who discount his/her/their grandiosity.As the client's grandiosity has diminished, his/her/their feelings of persecution and low frustration threshold with others have also diminished.

      7 Lack of Sleep (6)The client described a pattern of attaining far less sleep than would normally be needed.The client has gone through periods of time when he/she/they did not sleep for 24 consecutive hours because his/her/their energy level was so high.As the client's mania has begun to diminish, he/she/they have begun to return to a more normal sleeping pattern.The client is getting 6 to 8 hours of sleep per night.

      8 Diminished Appetite (7)The client described a pattern of eating far less than normal amounts of food.The client has gone through periods of time when he/she/they have had very little to eat for an entire day.As the client's mania has begun to diminish, he/she/they have begun to return to a more normal eating pattern.The client is eating at least two meals per day.

      9 Motor Agitation (8)The client was restless and agitated within the session and reports an inability to sit quietly and relax.The client's high energy level is reflected in increased motor activity, restlessness, and agitation.The client's motor activity has decreased and the level of agitation has diminished.The client demonstrated normal motor activity and reports being able to stay calm and relaxed.

      10 Easily Distracted (9)The client gave evidence of a short attention span and a high level of distractibility.The client reported that he/she/they are unable to focus his/her/their thoughts on one topic.The client's attention shifted quickly from one stimulus to the next.The client has shown increased ability to focus attention and has reduced distractibility.

      11 Disinhibition/Impulsivity (10)The client reported a behavior pattern that reflects a lack of normal inhibition and an increase in impulsivity without regard to potentially painful consequences.The client's impulsivity has been reflected in sexual acting out, poor financial decisions, and committing of social