confirmed that their history of rule breaking, lying, physical aggression, and/or disrespect for others and the law is associated with the use of drugs and/or alcohol.The client reported frequent incarcerations due to illegal activities and drug/alcohol violations.The client acknowledged that substance abuse has paralleled their antisocial behavior.The client has demonstrated and verbalized more respect for the rules of society and the needs of others.
2 Disregard for Others' Rights (2)The client displayed little concern for the rights of others in their pattern of behavior.The client has often demonstrated a pattern of violating the rights of others in order to meet needs.The client verbalized an understanding of how their actions have negatively affected others.The client has demonstrated increased empathy and sensitivity to the rights of others.
3 Substance Use (3)The client's use of substances exacerbates antisocial behavior patterns such as criminal activity, aggression and intimidation, thrill seeking, impulsivity, and self-centeredness.The client has no interest in reducing the substance use that exacerbates antisocial behavior patterns.The client identified an interest in reducing substance use to help reduce antisocial behavior patterns.The client has significantly reduced or eliminated substance use.
4 Blaming Others (4)The client refused to take responsibility for their own behavior and decisions; instead, the client pointed to the behavior of others or to substance abuse as the cause for their actions.The client's interpersonal conflicts were blamed on others or on substance abuse, without the client taking any responsibility for the problems.The client is beginning to accept personal responsibility for their own behavior and makes fewer statements projecting responsibility onto others for their actions.
5 Aggressive Behavior to Control Others (5)The client described a series of incidents in which they have become aggressive in order to manipulate, intimidate, or control others.The client blamed substance abuse for aggressive/destructive behaviors.The client has acknowledged the need to control aggressive, manipulative, and intimidating behaviors.The client has recently demonstrated good self-control and has not engaged in any aggressive, intimidating, or controlling behaviors.
6 Dishonesty (6)The client reported a pattern of lying to cover up responsibility for actions or substance abuse, with little shame or anxiety attached to this pattern of lying.The client seemed to be lying during the session.The client acknowledged that their dishonesty produced conflicts within relationships and distrust from others.The client has committed to being more honest in interpersonal relationships.
7 Hedonistic Lifestyle (7)The client described a pattern of hedonistic, self-centered behaviors that reflect little regard for their negative effects on others.The client was able to identify how their lifestyle is hedonistic and self-centered.The client was able to identify how their lifestyle has displayed little regard for any values beyond seeking to feel good.The client has displayed a pattern of acting with greater regard for the needs and welfare of others.
8 Lack of Empathy (8)The client described patterns of aggression and disrespect for others and displayed no remorse or empathy for how this behavior affects others.The client projected blame for hurtful behavior onto others or onto substance abuse, saying that they had no alternative.The client has begun to develop some empathy for the feelings of others but only for those who are close to them (i.e., friends and family).The client has reported feelings of empathy both for those who are close to them and to others.
9 Adolescent Criminal Activity (9)The client confirmed that their history of criminal activity and addiction began in adolescence.The client reported that they were often involved with juvenile justice officials or incarcerated within the juvenile justice system for illegal activities and substance abuse.The client acknowledged that substance abuse paralleled their antisocial behavior and dates back to adolescence.
10 Recklessness/Thrill Seeking (10)The client reported having engaged in reckless, adventure-seeking behavior and substance abuse, reflecting a high need for excitement, having fun, and living “on the edge.”The client described a series of reckless actions, often while under the influence of substances, which showed little consideration for the consequences of such actions.The client has begun to control reckless impulses and substance abuse and has reported trying to think of the consequences before acting recklessly.
11 Impulsivity (11)The client's pattern of impulsive behavior and substance use is demonstrated in frequent geographical moves, traveling with few or no goals, and quitting one job after another.The client's impulsivity has resulted in a life of instability and negative consequences for self and others.The client has acknowledged that their life of impulsive reactivity and substance abuse has had many negative consequences and that they are now committed to making an effort to control these impulses.The client has shown progress in controlling impulsive reactivity and substance misuse and now considers the possible consequences of actions before reacting.
INTERVENTIONS IMPLEMENTED*
1 Build Trust and Establish Rapport (1)Caring was conveyed to the client through support, warmth, and empathy.The client was provided with nonjudgmental support and a level of trust was developed.The client was urged to feel safe in expressing antisocial behavior symptoms.The client began to express feelings more freely as rapport and trust level have increased.The client has continued to experience difficulty being open and direct about the expression of painful feelings; the client was encouraged to use the safe haven of therapy to express these difficult issues.
2 Focus on Strengthening Therapeutic Relationship (2)The relationship with the client was strengthened using empirically supported factors.The relationship with client was strengthened through the implementation of a collaborative approach, agreement on goals, demonstration of empathy, verbalization of positive regard, and collection of client feedback.The client reacted positively to the relationship-strengthening measures taken.The client verbalized feeling supported and understood during therapy sessions.Despite attempts to strengthen the therapeutic relationship the client reports feeling distant and misunderstood.The client has indicated that sessions are not helpful and will be terminating therapy.
3 Identify Antisocial and Addictive Behavior as Self-Defeating (3)The client was asked to list the negative consequences that have accrued because of their antisocial behavior.The client was assigned the Step One exercise from The Alcoholism and Drug Abuse Client Workbook (Perkinson).The client was asked to identify others who have been negatively affected by their antisocial behavior and to list the specific pain that these individuals have suffered.The client was asked to verbalize an acceptance of the powerlessness and unmanageability they have over antisocial behavior and addiction.The client was confronted with the fear, disappointment, loss of trust, and loss of respect that others experience as a consequence of self-centered behavior and lack of sensitivity.The client denied any negative or self-defeating consequences because of their antisocial/addictive behavior and was provided with tentative examples of how this occurs.The client has not completed the assigned Step One homework and was redirected to do so.
4 Recognize Reciprocity of Antisocial and Addictive Behavior (4)The client was presented with the concept of a reciprocal relationship between antisocial behavior and addiction.The client was asked to identify how substances have played a part in their choices regarding antisocial behavior.The client was asked to verbalize how antisocial behavior has encouraged their addiction.The client denied any connection between antisocial and addictive behaviors and was urged to remain open to this concept.
5 Administer Antisocial Behavior Rating Scales (5)The client was administered psychological instruments designed to objectively assess baseline levels of antisocial behavior, impulsivity, and/or aggression.The client was administered the Psychopathy Checklist–Revised (PCL-R).The client was administered the Aggressive Acts Questionnaire (AAQ).The client was administered the Barratt Impulsiveness Scale-11 (BIS-11).The client was provided feedback regarding the results of the assessment of antisocial behavior, impulsivity, and/or aggression.The client declined to participate in taking the instruments used to assess antisocial behavior, impulsivity, and/or aggression and was redirected to do so.
6 Recognize Insanity (6)The client was presented with the concept of how doing the same things over and over again but expecting different results is irrational.The client