and implementing an action plan, and reevaluating and refining the plan.The client was provided feedback on the use of the problem-solving strategies.The client was unable to make use of problem-solving strategies and remedial feedback was given.
33 Assign Problem-Solving Exercise (33)The client was assigned a homework exercise in which they solve a current problem about which they worry.The client was assigned a problem to solve as described in Mastery of Your Anxiety and Worry: Workbook (Craske & Barlow).The client was assigned “Applying Problem-Solving to Interpersonal Conflict” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was provided with feedback about ther use of the problem-solving assignment.
34 Engage in Behavioral Activation (34)The client was engaged in “behavioral activation” by scheduling activities that have a high likelihood for pleasure and mastery.The client was directed to complete tasks from the “Identify and Schedule Pleasant Activities” assignment from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).Instruction, rehearsal, role-playing, role reversal, and other techniques were used to engage the client in behavioral activation.The client was reinforced for success in scheduling activities that have a high likelihood for pleasure and mastery.The client has not engaged in pleasurable activities and was redirected to do so.
35 Develop Interpersonal Skills and Relationships (35)As interpersonal deficits were identified as a primary factor in the client's anxiety, they were assisted in developing new interpersonal skills and relationships.The client displayed a clear understanding of the new interpersonal skills and relationships and was reinforced for this success.The client has struggled in regard to developing new interpersonal skills and relationships and was redirected in this area.
36 Assign Homework on Social Skills (36)The client was assigned a homework exercise in which they implement social skills in everyday life.The client was assigned the homework exercise “Restoring Socialization Comfort” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client's use of homework exercises in daily life was reviewed, with reinforcement for success and corrective feedback toward improvement.The client did not complete homework exercises and was redirected to do so.
37 Use Acceptance-Based Therapies (37)Techniques from acceptance-based therapies were used to help the client accept worries and overcome avoidance.The client was assisted in identifying and expanding acceptance rather than judgment and avoidance or internal experiences.The client was assisted in promoting action in areas of importance.The client was asked to read The Mindful Way Through Anxiety (Orsillo & Roemer) and key concepts were reviewed.
38 Differentiate Between Lapse and Relapse (38)A discussion was held with the client regarding the distinction between a lapse and a relapse.A lapse was associated with an initial and reversible return of symptoms, fears, or urges to avoid.A relapse was associated with the decision to return to fearful and avoidant patterns.The client was provided with support and encouragement while displaying an understanding of the difference between a lapse and a relapse.The client struggled to understand the difference between a lapse and a relapse and was provided with remedial feedback in this area.
39 Discuss Management of Lapse Risk Situations (39)The client was assisted in identifying future situations or circumstances in which lapses could occur.The session focused on rehearsing the management of future situations or circumstances in which lapses could occur.The client was reinforced for appropriate use of lapse management skills.The client was redirected in regard to poor use of lapse management skills.
40 Encourage Continued Use of Strategies (40)The client was instructed to continue using new and effective therapeutic skills (e.g., relaxation, cognitive restructuring, exposure and problem-solving).The client was urged to find ways to build new strategies into their life as much as possible.The client was reinforced as they reported ways in which they have incorporated coping strategies into their life and routine.The client was redirected about ways to incorporate new strategies into their routine and life.
41 Develop a “Coping Card” (41)The client was given a “coping card” or other reminder on which new and effective worry management skills and other important information are available to the client for later use.The client was assisted in developing the “coping card” in order to list helpful coping strategies.The client was encouraged to use the “coping card” when struggling with anxiety-producing situations.
42 Schedule a “Maintenance” Session (42)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 they need to be seen prior to the “maintenance” session.The client's “maintenance” session was held and the client was reinforced for successful implementation of therapy techniques.The client's “maintenance” session was held and the client was coordinated for further treatment, as progress has not been sustained.
43 Process Family-of-Origin Experiences (43)Today's therapy session explored family-of-origin experiences for learning to be fearful and anxious.The client was asked to explore how childhood experiences relate to current anxious thoughts, feelings, and behavior.The client was encouraged to honestly and openly share regarding past rejection experiences, harsh criticism, abandonment, or trauma.The client was given support and affirmation regarding the uncomfortable feelings related to fear-producing situations from their family of origin.As the client has progressed in treatment, verbally expressing and clarifying feelings from the past have become easier.The client has continued to struggle with openly and honestly sharing feelings associated with past rejection experiences, harsh criticism, abandonment, or trauma and was urged to do so as they feel safer.
44 Assign Books on Shame (44)The client was assigned to read excerpts from books related to shame.The client was assigned to read Healing the Shame That Binds You (Bradshaw) and Facing Shame (Fossum & Mason).The client has followed through with learning about shame through books (e.g., Healing the Shame That Binds You [Bradshaw], Facing Shame [Fossum & Mason]), and the key concepts were processed.The client has not followed through on reading books related to shame (e.g., Healing the Shame That Binds You [Bradshaw], Facing Shame [Fossum & Mason]) and was redirected to do so.
45 Develop Positive Self-Descriptive Statements (45)The client was asked to make a list of 10 positive self-descriptive statements.The client was assigned “Positive Self-Talk” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client has followed through on making a list of positive self-descriptive statements, and these were reviewed.It was reflected to the client that they have developed a pattern of describing self more positively and have been feeling an increased level of self-esteem.The client has not followed through on developing a list of positive self-descriptive statements and was encouraged to do so.
46 Use Step 3 (46)The client was taught a 12-step program's third step, focusing on how to turn problems, worries, and anxieties over to a higher power.The client was taught about trusting that a higher power is going to help resolve the situation.The client has begun turning problems, worries, and anxieties over to a higher power and is trusting that the higher power is going to help resolve the situation; this progress was reinforced.The client rejected the idea of turning problems, worries, and anxieties over to a higher power and does not feel that this concept will be helpful in resolving anxiety; the client was urged to remain open to these concepts.
47 Develop Alternative Actions (47)The client was assisted in developing a list of situations in which they feel anxious and crave substances.The client was assigned “Coping With Stress” and “Benefits of Helping Others” in the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).The client was assisted in developing an alternative constructive plan of action for when they feel anxious and crave substances (e.g., relaxation exercises, physical exercise, call a sponsor, go to a meeting, call the counselor, talk to someone).The client was reinforced in implementing positive coping strategies to deal with situations that trigger anxiety and craving substance use.The client has resisted identifying anxiety-producing situations and times when they crave substances and is noted to be vulnerable to relapse because of this resistance.
48 Probe Family-of-Origin Experiences (48)Today's therapy session explored family-of-origin experiences for learning to be fearful and anxious.The client was asked to explore how childhood experiences relate to current anxious thoughts, feelings, and