33 Develop Relapse Drill (33)The client and family were assisted in drawing up a “relapse drill,” detailing roles and responsibilities.Family members were asked to take responsibility for specific roles (e.g. who will call a meeting of the family to problem-solve potential relapse; who will call the physician, schedule a serum level, or contact emergency services, if needed).Obstacles to providing family support to the client's potential relapse were reviewed and problem-solved.The family was asked to make a commitment to adherence to the plan.The family was reinforced for their commitment to adherence to the plan.The family has not developed a clear commitment to the relapse prevention plan and was redirected in this area.
34 Conduct Interpersonal and Social Rhythm Therapy (34)An assessment was conducted of the client's daily activities using an interview and the social rhythm metric.Information from the interview and social rhythm metric helped to conduct interpersonal and social rhythm therapy.
35 Establish Routine Daily Activities (35)The client was assisted in establishing a more routine pattern of daily activities.The client was assigned “Keeping a Daily Rhythm” in the Adult Psychotherapy Homework Planner (Jongsma).The client was assisted in identifying a routine pattern of sleeping, eating, solitary and social activities, and exercise.A form was developed to help review and schedule activities.An emphasis was placed on creating a predictable rhythm for each day.
36 Teach About Sleep Hygiene Practices (36)The client was taught about the importance of good sleep hygiene.The client was assigned the “Sleep Pattern Record” from the Adult Psychotherapy Homework Planner (Jongsma).The client's sleep pattern was routinely assessed.Interventions for the client's sleep pattern were provided, as he/she/they have been noted to have a dysfunctional sleep pattern.
37 Promote Behavioral Activation (37)The client was assisted in listing activities that he/she/they have previously enjoyed but not engaged in since experiencing the loss.The client was encouraged to re-engage in enjoyable activities.The client was assigned “Identify and Schedule Pleasant Activities” from the Adult Psychotherapy Homework Planner (Jongsma).The client's experience of reactivating previously enjoyed activities was processed.Care was taken to be certain not to overstimulate the client.The client was reinforced for initiating and maintaining a balanced level of activity and rest.
38 Conduct Interpersonal Portion of Therapy (38)The interpersonal component of the interpersonal and social rhythm therapy techniques was initiated.An assessment was completed of the client's current past significant relationships, including themes related to grief, interpersonal role disputes, role transitions, and skill deficits.The client was supported as he/she/they reviewed concerns related to interpersonal relationships.
39 Use Interpersonal Therapy Techniques to Resolve Interpersonal Problems (39)Interpersonal therapy techniques were used to explore and resolve issues surrounding grief, role disputes, and role transitions.The client was provided with direction and training in regard to skill deficits.Support and strategies for resolving identified interpersonal issues were provided.Encouragement and reinforcement were provided to the client for successful resolution of interpersonal problems.
40 Establish a Rescue Protocol (40)A rescue protocol was developed, in order to identify and manage clinical deterioration.Specific factors that would trigger the rescue protocol were identified.Specific factors of the rescue protocol were developed, including medication use, sleep pattern restoration, daily routine, and conflict-free social support.The client and significant others were reinforced for their use of the rescue protocol.The client and significant others were redirected in regard to the use of the rescue protocol.
41 Schedule “Maintenance” Sessions (41)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.
42 Assign Reading on Bipolar Disorder (42)The client was assigned to read or view material on bipolar disorder.The client was assigned to read The Bipolar Disorder Survival Guide (Miklowitz).The client was assigned to read The Bipolar Disorder Workbook (Forester and Gregory).The client was assigned to read Bipolar 101 (White and Preston).The client has read the assigned information on bipolar disorder and key concepts were reviewed.The client has not read the assigned information on bipolar disorder and was redirected to do so.
43 Pledge Support (43)The client was reassured on a regular basis that the therapist would be available to consistently listen to and support him/her/them.The client reacted favorably to the therapist's pledge of support and has begun to show trust in the relationship by sharing thoughts and feelings.
44 Explore Abandonment Fears (44)The client's fear of abandonment by sources of love and nurturance was explored.Active-listening skills were used as the client confirmed that he/she/they struggle with the fear that those who have provided love and nurturance to him/her/them will eventually abandon him/her/them.The client denied any fear of abandonment by sources of love and nurturance; he/she/they were urged to monitor this on an as-needed basis.
45 Differentiate Losses (45)The client was helped to differentiate between real and imagined, as well as actual and exaggerated, losses.The client was supported as he/she/they verbalized grief, fear, and anger regarding real or imagined losses in life.The client was helped to make a differentiation between his/her/their real and imagined losses, rejections, and abandonment.The 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 place losses in perspective.The client was helped to identify adaptive ways to replace the losses that were experienced.The client failed to process and develop 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 Confront Grandiosity (49)The client's grandiosity and demandingness were gradually, but firmly, confronted.The client was assigned “What Are My Good Qualities?” from the Adult Psychotherapy Homework Planner (Jongsma).The client was assigned “Acknowledging My Strengths” from the Adult Psychotherapy Homework Planner (Jongsma).The client has become less expansive and more socially appropriate with the consistent confrontation of his/her/their grandiosity and demandingness.The client has reacted with anger and irritability when his/her/their grandiosity was confronted.
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