39 Assign Homework on Procrastination (39)The client was assigned homework to accomplish identified tasks without procrastination.The client was assigned “Self-Monitoring Self-Reward Program” in the Adult Psychotherapy Homework Planner (Jongsma) to assist in reducing procrastination.The client was urged to use techniques learned in therapy to address procrastination.The client's use of new techniques was reviewed, with encouragement for successes and corrective feedback toward improving the skill and decreasing procrastination.
40 Teach Self-Control Strategies (40)The client was taught the self-control strategy of “stop, listen, think, and act” to assist him/her/them in curbing impulsive behavior.The client was taught problem-solving self-talk as a means of reducing impulsivity.Role-playing was used to help the client apply self-control strategies to daily life situations that are affected by his/her/their ADHD symptoms.The client reported success at applying self-control strategies and indicated that his/her/their impulsivity has been diminished; this progress was reinforced.The client has not learned the self-control strategies and was provided with remedial feedback in this area.
41 Select Situations to Apply Skills (41)The client was directed to identify situations in which he/she/they will be challenged to apply his/her/their new strategies for managing ADHD.The client was urged to start the application of new strategies with a situation that was highly likely to be successful.The client was assisted in identifying a hierarchy of gradually more challenging situations to apply his/her/their new techniques.
42 Consolidate New Skills (42)The client was assisted in consolidating the use of his/her/their new ADHD management skills.Techniques such as imagery were used to help the client consolidate his/her/their new ADHD management skills.Techniques such as behavioral rehearsal, modeling, role-playing, and in vivo expo- sure/behavioral experiments were introduced to help the client consolidate the use of his/her/their new ADHD management skills.
43 Teach Relaxation Techniques (43)The client was taught various relaxation techniques including deep muscle relaxation, rhythmic breathing, meditation, and guided imagery to be used when stress levels increase.The client was advised to use techniques from The Relaxation and Stress Reduction Workbook (Davis et al.).The client was advised to use techniques from “Deep Breathing Exercise” in the Adult Psychotherapy Homework Planner (Jongsma).It was noted that the client has implemented relaxation procedures to reduce tension and physical restlessness and reported that this technique is beneficial.The client has not followed through on implementation of relaxation techniques to reduce restlessness and tension and was encouraged to do so.
44 Review Symptoms and Fixes (44)The client was assisted in reviewing the symptoms that have been problematic and the newly learned coping skills that he/she/they will use to manage the symptoms.The client was assigned “Symptoms and Fixes for ADHD” in the Adult Psychotherapy Homework Planner (Jongsma).
45 Teach Mindful Meditation (45)The client was explained the rational for mindful meditation to enhance attention regulation.The client was taught the skills of mindful meditation.The client was asked to apply mindful meditation to tasks that require attentional focus.Positive feedback was provided as the client reported that he/she was able to use mindful meditation during tasks.The client reported difficulties with applying mindful meditation with appropriate tasks and was provided with remedial feedback in this area.
46 Refer to ADHD Group (46)The client was referred to group therapy for adults with ADHD to help increase his/her/their understanding of ADHD, boost self-esteem, and to receive feedback from others.It was noted that the client has followed through on attendance at the ADHD group therapy sessions and reported that they have been beneficial.The client has not followed through on consistent attendance at the ADHD group therapy sessions and was encouraged to do so.
47 Teach Listening Skills (47)Role-playing and modeling were used to teach the client how to listen to others and to accept their feedback regarding his/her/their behavior.Positive feedback was provided as the client reported that, on several occasions, he/she/they were able to use the new listening skills to accept direction and feedback from others.The client continued to report difficulties with listening as he/she/they become defensive whenever feedback or direction is given to him/her/them and he/she/they were provided with remedial feedback in this area.
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—DEPRESSION
CLIENT PRESENTATION
1 Depressed Affect (1)1The client reported that he/she/they feel deeply sad and have periods of tearfulness on an almost daily basis.The client's depressed affect was clearly evident within the session as tears were shed on more than one occasion.The client reports an irritable mood.The client reported that he/she/they have begun to feel less sad and can experience periods of joy.The client appeared to be happier within the session and there is no evidence of tearfulness.
2 Loss of Appetite (2)The client reported that he/she/they have not had a normal and consistent appetite.The client's loss of appetite has resulted in a significant weight loss associated with the depression.As the depression has begun to lift, the client's appetite has increased.The client reported that his/her/their appetite is at normal levels.
3 Lack of Activity Enjoyment (3)The client reported a diminished interest in or enjoyment of activities that were previously found pleasurable.The client has begun to involve oneself with activities that he/she/they previously found pleasurable.The client has returned to an active interest in and enjoyment of activities.
4 Psychomotor Agitation (4)The client demonstrated psychomotor agitation within the session.The client reported that with the onset of the depression, he/she/they have felt unable to relax or sit quietly.The client reported a significant decrease in psychomotor agitation and the ability to sit more quietly.It was evident within the session that the client has become more relaxed and less agitated.
5 Psychomotor Retardation (4)The client demonstrated evidence of psychomotor retardation within the session.The client moved and responded very slowly, showing a lack of energy and motivation.As the depression has lifted, the client has responded more quickly and psychomotor retardation has diminished.
6 Sleeplessness/Hypersomnia (5)The client reported periods of inability to sleep and other periods of sleeping for many hours without the desire to get out of bed.The client's problem with sleep interference has diminished as the depression has lifted.Medication has improved the client's problems with sleep disturbance.
7 Lack of Energy (6)The client reported that he/she/they feel a very low level of energy compared to normal times in his/her/their life.It was evident within the session that the client has low levels of energy, as demonstrated by slowness of walking, minimal movement, lack of animation, and slow responses.The client's energy level has increased as the depression has lifted.It was evident within the session that the client is demonstrating normal levels of energy.
8 Lack of Concentration (7)The client reported that he/she/they are unable to maintain concentration and are easily distracted.The client reported that he/she/they are unable to read material