behavior (e.g., doing the same thing over and over and expecting different results) is what 12-step recovery programs call insanity.The client was asked to identify their experience of insane and irrational behavior and how this concept applies to them.The client rejected the concept of their behavior being insane or irrational and was provided with remedial feedback in this area.
7 Assess Level of Insight (7)The client's level of insight toward the presenting problems was assessed.The client was assessed in regard to the syntonic versus dystonic nature of their insight about the presenting problems.The client was noted to demonstrate good insight into the problematic nature of the behavior and symptoms.The client was noted to be in agreement with others' concerns and is motivated to work on change.The client was noted to be ambivalent regarding the problems described and is reluctant to address the issues as a concern.The client was noted to be resistant regarding acknowledgment of the problem areas, is not concerned about them, and has no motivation to make changes.
8 Assess for Correlated Disorders (8)The client was assessed for evidence of research-based correlated disorders.The client was assessed in regard to the level of vulnerability to suicide.The client was identified as having a comorbid disorder, and treatment was adjusted to account for these concerns.The client has been assessed for any correlated disorders, but none were found.
9 Assess for Culturally Based Confounding Issues (9)The client was assessed for age-related issues that could help to better understand their clinical presentation.The client was assessed for gender-related issues that could help to better understand their clinical presentation.The client was assessed for cultural syndromes, cultural idioms of distress, or culturally based perceived causes that could help to better understand their clinical presentation.Alternative factors have been identified as contributing to the client's currently defined “problem behavior” and these were taken into account in regard to their treatment.Culturally based factors that could help to account for the client's currently defined “problem behavior” were investigated, but no significant factors were identified.
10 Assess Severity of Impairment (10)The severity of the client's impairment was assessed to determine the appropriate level of care.The client was assessed in regard to impairment in social, relational, vocational, and occupational endeavors.It was reflected to the client that their impairment appears to create mild to moderate effects on the client's functioning.It was reflected to the client that their impairment appears to create severe to very severe effects on the client's functioning.The client was continuously assessed for the severity of impairment, as well as the efficacy and appropriateness of treatment.
11 Review the Rules and Consequences for Failure to Comply (11)The client was presented with a list of rules that must be kept by participants in the treatment program.The client was presented with a list of general societal rules/expectations.The client was presented with appropriate consequences for failing to follow the rules.The client was praised as they have been able to maintain the rules of the program.The client has failed to follow the presented rules, and appropriate consequences have been implemented.
12 Review Rule Breaking and Natural Consequences (12)The client was presented with several examples of rule/limit breaking that have led to negative consequences for self and others.The client was asked to identify several examples of rule/limit breaking that have led to negative consequences for self and others.The client was consistently reminded of the pain that others suffer as a result of their antisocial behavior.
13 Teach About Empathy (13)Role-playing and role reversal techniques were used to teach the client the value of being empathetic to the needs, rights, and feelings of others.The client was assigned “How I Have Hurt Others” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was asked to commit to acting more sensitively to the rights and feelings of others.The client has not completed the assigned “How I Have Hurt Others” homework and was redirected to do so.
14 Teach About Criminal Thinking (14)The client was taught that actions do not spontaneously occur but rather are preceded by a variety of decisions.The client was asked to review how their decisions are sometimes based in criminal thinking.The client was asked to list five times that antisocial behavior led to negative consequences and also to list the many decisions that were made along the way.The client was helped to see how many negative consequences are preceded by decisions based in criminal thinking.It was pointed out to the client that they justify their antisocial attitude as the way that they learned to live because of childhood or other socialization processes.
15 Teach About the Effects of Dishonesty (15)The client was asked to list the positive effects for others when they are honest and reliable.The client was taught that pain and disappointment result when honesty and reliability are not given the highest priority in one's life.The client was asked to identify situations in which they could be more honest and reliable.The client identified ways in which they are being more honest and reliable, and these were processed.The client was confronted for continuing to be dishonest and unreliable.
16 Connect Criminal Activity and Low Self-Esteem (16)The client was taught about how the emotional dynamics of criminal activity lead to feelings of low self-esteem.The client was asked to identify personal examples of how criminal activity has led to feelings of low self-esteem.The client displayed a clearer understanding of the connection between criminal activity and feelings of low self-esteem, and this insight was reinforced.The client had difficulty displaying an understanding of the connection between criminal activity and low self-esteem and was provided with additional information in this area.
17 Link Criminal Thinking to Antisocial Behavior and Addiction (17)The client was taught how criminal thinking (e.g., super-optimism, little empathy for others, power orientation, a sense of entitlement, self-centeredness) leads to antisocial behavior and addiction.Personal examples of how criminal thinking has led to antisocial behavior and addiction in the client's life were processed.The client denied engaging in criminal thinking leading to antisocial behavior and addiction and was provided with remedial feedback.
18 Identify How Blaming Results in Continued Mistakes (18)The client was asked to identify how blaming others results in a failure to learn from mistakes.The client was confronted with a pattern of behavior that demonstrates a failure to learn from mistakes.The client was asked to list incidents from the past that are examples of blaming others, resulting in a failure to learn from mistakes.The client was assigned “Taking Inventory of Destructive Behaviors” in the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).Active listening was provided as the client displayed an understanding of how blaming others results in a failure to learn from mistakes and described situations in which the client was changing that pattern.The client was confronted for continuing to blame others for their own mistakes.
19 Explore Reasons for Blaming (19)The client's history was explored, with a focus on causes for the avoidance of accepting responsibility for behavior.The client's history of physical and emotional abuse was explored, and an association with denying responsibility for behavior was made.The client's early history of lying was explored as to causes and consequences.Parental modeling of projection of responsibility for their behavior was examined.
20 Confront Projection (20)The client was consistently confronted for failing to take responsibility for their own actions and for placing the blame onto others for them.The client was assigned “Letter of Apology” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).As the client's pattern of projecting blame onto others began to weaken, the client was reinforced for taking personal responsibility for their actions.The importance of taking responsibility for one's own behavior and the positive implications for this as a way to motivate change were reviewed.
21 Teach the Difference Between Antisocial and Prosocial Behaviors (21)The specific criteria for identifying antisocial behaviors and the opposite prosocial behaviors were brainstormed with the client.A commitment to practicing prosocial behaviors was developed.The client was assigned “Benefits of Helping Others” in the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma) or “Three Acts of Kindness” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was assisted in developing a list of prosocial behaviors (e.g., helping others) to practice each day.The client was helped to identify several instances in which they have been practicing prosocial behaviors.The client was confronted for persisting