client's painful childhood experiences were explored.Active listening was provided as the client explained what it was like to grow up in their home environment, focusing on the abusive, neglectful experiences that they endured.The client was assisted in identifying the unhealthy emotional and behavioral patterns that have evolved from the painful family-of-origin experiences.The client was helped to identify a variety of emotional effects from the painful situations they endured in the family of origin.The client helped to identify a variety of behavioral patterns that have occurred owing to the painful experiences from the family of origin.The client was assigned “Share the Painful Memory” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client denied any pattern of unhealthy emotional or behavioral patterns that have occurred owing to painful experiences from the family of origin; this was accepted.The client has refused to discuss any details or feelings related to childhood emotional traumas; the client was urged to do so as they feel safe.
5 Administer Psychological Instruments (5)Psychological instruments designed to objectively assess childhood trauma effects on substance abuse were administered to the client.The Childhood Trauma Questionnaire (CTQ) was administered to the client.The Davidson Trauma Scale (DTS) was administered to the client.The Beck Depression Inventory–II (BDI-II) was administered to the client.The Beck Anxiety Inventory (BAI) was administered to the client.The Substance Abuse Subtle Screening Inventory–4 (SASSI-4) was administered to the client.The client was provided with feedback regarding the results of the psychological instruments administered.
6 Assess Level of Insight (6)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.
7 Assess for Correlated Disorders (7)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.
8 Assess for Culturally Based Confounding Issues (8)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 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.
9 Assess Severity of Impairment (9)The severity of the client's impairment was assessed to determine the appropriate level of care.The client was assessed in regard to their 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.
10 Encourage Feelings Expression (10)The client was supported and encouraged when they began to express feelings of rage, fear, and rejection relating to family abuse or neglect.The client was supported as they have continued to clarify their understanding of feelings associated with major traumatic incidents in childhood.As the client has clarified feelings and shared them within the session, feelings of emotional turmoil have diminished.The client continues to be very guarded about feelings of rage, fear, and rejection related to the family abuse or neglect and was encouraged to get in touch with these feelings as the client is capable of doing so.
11 Assign Feelings Journal (11)The client was assigned to record feelings in a journal that describes memories, behavior, and emotions tied to traumatic childhood experiences.The client was assigned “How the Trauma Affects Me” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client has followed through on the journaling assignment and has developed an increased awareness of the impact that childhood experiences have had on present feelings and behaviors; this progress was reviewed.The client was assisted in identifying how childhood experiences have influenced how the client parents their own children today.The client has not completed the assigned feelings journal and was redirected to do so.
12 Assign Books on Childhood Trauma (12)Reading materials relating to traumatic childhood experiences were recommended to the client to assist in developing insight.The client was advised to read It Will Never Happen to Me (Black), Outgrowing the Pain (Gil), or Healing the Child Within (Whitfield).The client has followed through on reading the recommended childhood trauma material, and insights related to that reading were processed.The client has not followed through on reading the recommended material and was redirected to do so.
13 Teach About Unhealthy Rules and Roles (13)The client was presented with information about the unhealthy rules and roles that develop in dysfunctional families.The client was assigned “Changing From Victim to Survivor” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was assisted in identifying the pattern of unhealthy rules and roles that occurred in the family of origin.The client was able to identify the role that they played within the family dynamics.The client struggled to identify or admit to an unhealthy pattern of rules and roles in the family of origin; tentative examples were provided.The client has not completed the assigned homework and was redirected to do so.
14 Connect Childhood Trauma With Trust Issues (14)The client was presented with the concept that childhood trauma experiences have precipitated problems with trust, anger, self-esteem, and depression.The client accepted the concept presented regarding problems with trust, anger, self-esteem, and depression because of childhood experiences.The client rejected the concept that childhood trauma experiences relate to their problems with trust, anger, self-esteem, or depression; tentative examples were provided.
15 Identify Addictive Behavior as an Unhealthy Coping Skill (15)The client was asked about addiction behavior as a means of coping with emotional pain.The client's addictive behavior was confronted as an inappropriate way to cope with emotional pain.The client was assisted in identifying the self-defeating, negative consequences of addictive behavior.Verbal reinforcement was provided as the client identified the self-defeating, negative consequences of the negative behavior.The client denied any pattern of addictive behavior as a way to cope with emotional pain and was provided with specific examples of how this can occur.
16 Teach Healthy Ways to Cope With Pain (16)The client was asked to identify healthier, more constructive means of coping with emotional pain.The client was assigned “Setting and Maintaining Boundaries” from the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma) or “Deep Breathing Exercise” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was assisted in identifying healthier, more constructive means of coping with emotional pain (e.g., sharing pain with others, attending 12-step recovery program meetings, confronting and then forgiving the perpetrator, turning issues over to a higher power).The client was reinforced in endorsing a variety of healthier, more constructive means of coping with emotional pain.The client was reinforced while reporting a pattern of using healthier means for coping.The client has struggled to implement healthier coping mechanisms and continues to rely on addictive behavior; brainstorming techniques were used.The client denied any significant negative consequences from addictive behavior; additional examples were reviewed.
17 Refer for Medication Evaluation (17)The client was referred for a medication evaluation to help stabilize moods and decrease the intensity of angry feelings.The client agreed to follow through with the medication evaluation.The client