The Adult Psychotherapy Progress Notes Planner. David J. Berghuis

in touch with these feelings as he/she/they are capable of doing so.

      15 Assign Feelings Journal (15)The client was assigned to record his/her/their feelings in a journal that describes memories, behavior, and emotions tied to traumatic childhood experiences.The client was assigned “How the Trauma Affects Me” from the Adult Psychotherapy Homework Planner (Jongsma).The client has followed through on the journaling assignment and has developed an increased awareness of the impact that his/her/their childhood experiences have had on present feelings and behaviors; this progress was reviewed.The client was assisted in identifying how his/her/their childhood experiences have influenced how he/she/they parent his/her/their own children today.The client has not completed the assigned feelings journal and was redirected to do so.

      16 Assign Books on Childhood Trauma (16)Reading materials relating to traumatic childhood experiences were recommended to the client to assist him/her/them in developing insight.The client was advised to read It Will Never Happen to Me (Black), Outgrowing the Pain (Gil), or Healing the Child Within (Whitfield).The client has followed through on reading the recommended childhood trauma material, and insights related to that reading were processed.The client has not followed through on reading the recommended material and was redirected to do so.

      17 Explore Client's Parenting (17)The client was assisted in comparing his/her/their own parenting behavior to that of parental figures of his/her/their childhood.The client's understanding of how his/her/their own parenting patterns have been influenced by the negative patterns of his/her/their own parents was processed.The client was resistive to drawing any parallels between his/her/their own parenting style and that of his/her/their abusive and neglectful parents; these parallels were offered in a tentative manner.

      18 Refer for Dialectical Behavioral Therapy (DBT) (18)The client was identified as experiencing distress or disability due to borderline personality disorder concerns.The client was provided with DBT.The client was referred to a therapist specializing in DBT.The client was reinforced for his/her/their involvement in DBT.The client has not utilized DBT and was redirected to do so.

      19 Refer for Posttraumatic Stress Disorder (PTSD) Treatment (19)The client was identified as manifesting PTSD symptoms.The client was provided with therapy for PTSD.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.

      20 Train Relaxation Techniques (20)The client was trained in the use of deep muscle relaxation to offset tension associated with recalling trauma.The client was trained with deep breathing techniques to offset tension associated with recalling trauma.The client was assigned “Deep Breathing Exercise” from the Adult Psychotherapy Homework Planner (Jongsma).The client used relaxation techniques and was reinforced for doing so.The client struggled to use relaxation techniques and was given remedial feedback.

      21 Assign Feelings Letter (21)The client was assigned the task of writing a letter to his/her/their parents regarding his/her/their feelings associated with the experience of childhood neglect or abuse.The client has followed through with writing a feelings letter to his/her/their parents regarding his/her/their childhood abuse/neglect and this letter was processed.It was reflected to the client that writing the letter regarding his/her/their childhood abuse experiences has helped him/her/them decrease feelings of shame and self-affirm as not being responsible for the abuse.The client has not followed through with writing the letter to his/her/their 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 his/her/their childhood abusive experiences.The client was supported in his/her/their 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 his/her/their confrontation of the perpetrator of childhood abuse/neglect; he/she/they were urged to be more direct.The perpetrator responded with defensive statements and denial in reaction to the client's confrontation of him/her/them 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 to him/her/them; the benefits of this progress were reviewed.The client has declined confrontation of the perpetrator; he/she/they were accepted for this decision and urged to consider confrontation at a later date.

      23 Utilize 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 his/her/their feelings and clarifying the impact that the childhood experiences of abuse had on him/her/them.The client was supported in confronting the nonperpetrating parent for not protecting him/her/them from the abusive experiences in childhood.The client was reinforced as he/she/they self-affirmed as not being responsible for the abuse and placed responsibility clearly on the perpetrator.

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

      25 Assign Forgiveness Letter (25)The client was assigned to write a letter of forgiveness to the perpetrator of the childhood hurt.The client was assigned “Feelings and Forgiveness Letter” from the Adult Psychotherapy Homework Planner (Jongsma).The client has followed through with writing his/her/their forgiveness letter to the perpetrator of the childhood hurt; as this letter was processed, he/she/they reported experiencing a sense of putting the issue in the past.The client reported that he/she/they have begun the process of forgiving the perpetrator of his/her/their childhood pain and others who may have been passive collaborators; the benefits of this progress were highlighted.The client has not followed through on writing the forgiveness letter to the perpetrator of his/her/their childhood pain and was redirected to do so.

      26 Teach Forgiveness Benefits (26)The client was taught the benefits of beginning the process of forgiving those adults who perpetrated abuse and neglect on him/her/them during childhood.The client was supported as he/she/they have begun the process of forgiving the perpetrators of his/her/their childhood abuse and neglect.As the client has begun to forgive the perpetrators of his/her/their painful childhood experiences, it was noted that he/she/they have also begun to release feelings of hurt and anger and put the issue in the past.It was reflected that as the client has begun forgiveness, he/she/they have been able to experience feelings of trust in others.

      27 Recommend Forgiveness Books (27)Reading books on forgiveness was recommended to the client to increase his/her/their understanding of the process and benefits of forgiveness.The client was advised to read Forgive and Forget (Smedes) or When Bad Things Happen to Good People (Kushner).The client has followed through with reading the recommended material on forgive- ness and key concepts were reviewed and processed.Since the client has read the forgiveness material, he/she/they have been able to identify the positive aspects for oneself of being able to forgive all those involved with the abuse; this insight was processed.The client has not followed through on reading the recommended material on forgiveness and was redirected to do so.

      28 Explore Victim Versus Survivor (28)The client was asked to consider the positive and negative consequences of considering oneself as a victim versus being a survivor of childhood trauma.The client's understanding of the advantages of perceiving oneself 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 him/her/them.

      29 Reinforce