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.
11 Assess for Correlated Disorders (11)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.
12 Assess for Culturally Based Confounding Issues (12)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.
13 Assess Severity of Impairment (13)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.
14 Identify Difficult ADHD Behaviors (14)The psychological testing was reviewed to assist the client in identifying the specific ADHD behaviors that have caused the most difficulty.The client was supported as they listed such things as distractibility, lack of concentration, impulsivity, restlessness, and disorganization as the most difficult.The client was assisted in identifying specific behaviors that will be treatment targets.The client was resistive to becoming specific about identifying ADHD behaviors that cause the most difficulty; the client was encouraged to do this as they feel capable.
15 Review Evaluation Results (15)The results of the psychological testing and physician's evaluation were reviewed again with the client in order to assist in the choice of the most difficult, problematic behaviors to address in counseling.The client was assisted in selecting those behaviors that are most difficult as focal points for treatment.The client was supported as they agreed to concentrate efforts to change on these most difficult behavior areas.
16 Have Others Rank ADHD Symptoms (16)The client was asked to have extended family members and close collaterals complete a ranking of the behaviors they see as interfering the most with daily functioning.Collateral contacts were asked to rate areas, such as the client's mood swings, temper outbursts, ease of being stressed, short attention span, and failure to complete projects.The client's extended family members’ and close collaterals’ rankings of the client's ADHD symptoms were reviewed and processed.
17 Develop Negative Consequences of ADHD (17)The client was asked to make a list of negative consequences of ADHD that the client has experienced.The client was asked to identify other problems that could result from continuation of problematic behavior.The client was assigned the exercise “Impulsive Behavior Journal” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was assisted in reviewing the list of negative consequences of ADHD.
18 Accept Powerlessness and Unmanageability Over ADHD Symptoms (18)The client was taught about the use of a 12-step recovery program's Step 1 exercise to acknowledge unmanageability of ADHD symptoms and addiction.The client was noted to accept the concept of being powerless and unable to manage ADHD symptoms and addiction problems.It was noted that the client has had increased serenity after accepting their powerlessness and inability to manage ADHD symptoms and addiction.The client rejected the concept of powerlessness and unmanageability over ADHD and addiction symptoms and was urged to monitor this dynamic.
19 Teach About the Relationship Between ADHD and Addiction (19)The client was taught, through the use of a biopsychosocial approach, about the relationship between ADHD symptoms and addictive behavior.The client was assisted in acknowledging several instances in which ADHD symptoms have prompted addictive behavior.As ADHD symptoms have decreased, the client has identified a corresponding decrease in addictive behavior; this progress was highlighted.
20 Develop an ADHD and Addiction Recovery Program (20)The client was assisted in developing a program of recovery that includes the elements necessary to bring ADHD and addictive behavior under control.The client was assigned the “Mastering Your Adult ADHD” exercise in Mastery of Your Adult ADHD: Client Workbook (Safren et al.).The client was reinforced while identifying specific portions of their ADHD/addiction recovery program, including the use of medication, behavior modification, environmental controls, aftercare meetings, and further therapy.It was noted that the client has begun to use the recovery program.The client has not used their specific recovery program and was redirected to pursue these elements.
21 Teach About a Higher Power (21)The client was presented with information about how faith in a higher power can aid in recovery from ADHD traits and addiction.The client was assisted in processing and clarifying ideas and feelings regarding the existence of a higher power.The client was encouraged to describe beliefs about the concept of a higher power.The client rejected the idea of a higher power and was urged to remain open to this concept.
22 Refer for Psychotropic Medication (22)A referral to a prescribing clinician was made for the purpose of evaluating the client for a prescription of psychotropic medications.The client was assigned “Why I Dislike Taking My Medication” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client has followed through on a referral to a prescribing clinician and has been assessed for a prescription of psychotropic medication, but none were prescribed.Psychotropic medications have been prescribed for the client.The client has been monitored for side effects of the medication.The client has refused a prescription of psychotropic medication provided by the prescribing clinician.
23 Monitor Medication Compliance and Effectiveness (23)The client reported that the medication has helped to improve their attention, concentration, and impulse control without any side effects, and the benefits of this were reviewed.The client was assigned “Evaluating Medication Effects” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, McInnis, & Bruce).The client reported little to no improvement while taking the medication and was redirected to their physician.The client has not complied with taking medication on a regular basis and was redirected to do so.The client was encouraged to report the side effects of the medication to the prescribing physician or psychiatrist.
24 Educate About ADHD (24)The client was educated about the symptoms of ADHD.The client was assigned “Symptoms and Fixes for ADHD” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The therapy session helped the client gain a greater understanding and appreciation of the symptoms of ADHD.The client was given the opportunity to express thoughts and feelings about having ADHD.The client has not reviewed information about how to cope with the client's ADHD symptoms and was redirected to this information.
25 Develop Rationale for Treatment (25)A discussion was held with the client in regard to the rationale for treatment.Treatment targets were identified, including organizational and planning skills, management of distractibility, cognitive restructuring, and overcoming procrastination.Concepts for the rationale for treatment were reviewed in accordance with the information provided in Mastery of Your Adult ADHD: Therapist Manual (Safren et al.).
26 Teach Self-Monitoring (26)The client was taught how to monitor their own ADHD symptoms.The client was assigned specific monitoring tasks for use in therapy.
27 Assign Reading on ADHD (27)The client was instructed to read information about ADHD in adults.The client was instructed to read Mastery of Your Adult ADHD: Client Workbook (Safren et al.) or The Attention Deficit