psychotherapy treatment It is recommended that students review the e-book The Complete Adult Psychotherapy Treatment Planner (Jongsma, Peterson, & Br -

psychotherapy treatment
It is recommended that students review the e-book The Complete Adult Psychotherapy Treatment Planner (Jongsma, Peterson, & Bruce, 2014) for additional assistance in completing this assignment.
Clinical and counseling psychologists utilize treatment plans to document a clients progress toward short- and long-term goals. The content within psychological treatment plans varies depending on the clinical setting. The clinicians theoretical orientation, evidenced-based practices, and the clients needs are taken into account when developing and implementing a treatment plan. Typically, the clients presenting problem(s), behaviorally defined symptom(s), goals, objectives, and interventions determined by the clinician are included within a treatment plan.
To understand the treatment planning process, students will assume the role of a clinical or counseling psychologist and develop a comprehensive treatment plan based on the same case study utilized for the Psychiatric Diagnosis assignment in PSY645. A minimum of five peer-reviewed resources must be used to support the recommendations made within the plan. The Psychological Treatment Plan must include the headings and content outlined below.
Behaviorally Defined Symptoms

Define the clients presenting problem(s) and provide a diagnostic impression.
Identify how the problem(s) is/are evidenced in the clients behavior.
List the clients cognitive and behavioral symptoms.

Don't use plagiarized sources. Get Your Custom Assignment on

psychotherapy treatment It is recommended that students review the e-book The Complete Adult Psychotherapy Treatment Planner (Jongsma, Peterson, & Br

From as Little as $13/Page

Long-Term Goal

Generate a long-term treatment goal that represents the desired outcome for the client.

This goal should be broad and does not need to be measureable.

Short-Term Objectives

Generate a minimum of three short-term objectives for attaining the long-term goal.

Each objective should be stated in behaviorally measureable language. Subjective or vague objectives are not acceptable. For example, it should be stated that the objective will be accomplished by a specific date or that a specific symptom will be reduced by a certain percentage.

Interventions

Identify at least one intervention for achieving each of the short-term objectives.
Compare a minimum of three evidence-based theoretical orientations from which appropriate interventions can be selected for the client.
Explain the connection between the theoretical orientation and corresponding intervention selected.
Provide a rationale for the integration of multiple theoretical orientations within this treatment plan.
Identify two to three treatment modalities (e.g., individual, couple, family, group, etc.) that would be appropriate for use with the client.

It is a best practice to include outside providers (e.g., psychiatrists, medical doctors, nutritionists, social workers, holistic practitioners, etc.) in the intervention planning process to build a support network that will assist the client in the achievement of treatment goals.
Evaluation

List the anticipated outcomes of each proposed treatment intervention based on scholarly literature.

Be sure to take into account the individuals strengths, weaknesses, external stressors, and cultural factors (e.g., gender, age, disability, race, ethnicity, religion, sexual orientation, socioeconomic status, etc.) in the evaluation.

Provide an assessment of the efficacy of evidence-based intervention options.

Ethics

Analyze and describe potential ethical dilemmas that may arise while implementing this treatment plan.
Cite specific ethical principles and any applicable law(s) for resolving the ethical dilemma(s).

The Psychological Treatment Plan

209

IMPULSE CONTROL DISORDER

BEHAVIORAL DEFINITIONS

1. A tendency to act too quickly without careful deliberation, resulting in
numerous negative consequences.

2. Loss of control over aggressive impulses resulting in assault, self-
destructive behavior, or damage to property.

3. Deliberate and purposeful fire-setting on more than one occasion.
4. Persistent and recurrent maladaptive gambling behavior.
5. Recurrent failure to resist impulses to steal objects that are not needed

for personal use or for their monetary value.
6. Recurrent pulling out of ones hair resulting in noticeable hair loss.
7. Desire to be satisfied almost immediately and a decreased ability to delay

pleasure or gratification.
8. A history of acting out in at least two areas that are potentially self-

damaging (e.g., spending money, sexual activity, reckless driving,
addictive behavior).

9. Overreactivity to mildly aversive or pleasure-oriented stimulation.
10. A sense of tension or affective arousal before engaging in the impulsive

behavior (e.g., kleptomania, pyromania).
11. A sense of pleasure, gratification, or release at the time of committing

the ego-dystonic, impulsive act.
12. Difficulty waiting for thingsthat is, restless standing in line, talking

out over others in a group, and the like.

__. _____________________________________________________________

_____________________________________________________________

__. _____________________________________________________________

_____________________________________________________________

__. _____________________________________________________________

_____________________________________________________________

Jongsma, Arthur E., Jr., et al. The Complete Adult Psychotherapy Treatment Planner : Includes DSM-5 Updates, John Wiley & Sons, Incorporated,
2014. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ashford-ebooks/detail.action?docID=1598282.
Created from ashford-ebooks on 2020-09-13 18:43:23.

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THE COMPLETE ADULT PSYCHOTHERAPY TREATMENT PLANNER 210

LONG-TERM GOALS

1. Reduce the frequency of impulsive behavior and increase the frequency
of behavior that is carefully thought out.

2. Reduce thoughts that trigger impulsive behavior and increase self-talk
that controls behavior.

3. Learn to stop, listen, and think before acting.

__. _____________________________________________________________

_____________________________________________________________

__. _____________________________________________________________

_____________________________________________________________

__. _____________________________________________________________

_____________________________________________________________

SHORT-TERM

OBJECTIVES

THERAPEUTIC

INTERVENTIONS

1. Identify the impulsive
behaviors that have been
engaged in over the last six
months. (1)

1. Review the clients behavior
pattern to assist him/her in clearly
identifying, without minimization,
denial, or projection of blame,
his/her pattern of impulsivity.

2. List the reasons or rewards
that lead to continuation of an
impulsive pattern. (2, 3)

2. Explore whether the clients
impulsive behavior is triggered by
anxiety and maintained by anxiety
relief rewards; assess for bipolar
manic disorder or ADHD.

3. Ask the client to make a list of the
positive things he/she gets from
impulsive actions and process it
with the therapist.

3. Disclose any history of
substance use that may
contribute to and complicate
the treatment of Impulse
Control Disorder. (4)

4. Arrange for a substance abuse
evaluation and refer the client for
treatment if the evaluation
recommends it (see the Substance
Use chapter in this Planner).

4. Provide behavioral, emotional,
and attitudinal information
toward an assessment of
specifiers relevant to a DSM

5. Assess the clients level of insight
(syntonic versus dystonic) toward
the presenting problems (e.g.,
demonstrates good insight into the

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IMPULSE CONTROL DISORDER 211

diagnosis, the efficacy of
treatment, and the nature of
the therapy relationship.
(5, 6, 7, 8)

problematic nature of the
described behavior, agrees with
others concern, and is motivated
to work on change; demonstrates
ambivalence regarding the
problem described and is
reluctant to address the issue
as a concern; or demonstrates
resistance regarding acknowledg-
ment of the problem described,
is not concerned, and has no
motivation to change).

6. Assess the client for evidence of
research-based correlated disorders
(e.g., oppositional defiant behavior
with ADHD, depression secondary
to an anxiety disorder) including
vulnerability to suicide, if appro-
priate (e.g., increased suicide risk
when comorbid depression is
evident).

7. Assess for any issues of age,
gender, or culture that could help
explain the clients currently
defined problem behavior and
factors that could offer a better
understanding of the clients
behavior.

8. Assess for the severity of the level
of impairment to the clients
functioning to determine appro-
priate level of care (e.g., the
behavior noted creates mild,
moderate, severe, or very severe
impairment in social, relational,
vocational, or occupational
endeavors); continuously assess
this severity of impairment as well
as the efficacy of treatment (e.g.,
the client no longer demonstrates
severe impairment but the
presenting problem now is causing
mild or moderate impairment).

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THE COMPLETE ADULT PSYCHOTHERAPY TREATMENT PLANNER 212

5. List the negative consequences

that accrue to self and others as
a result of impulsive behavior.
(9, 10, 11)

9. Assign the client to write a list

of the negative consequences
that have occurred because of
impulsivity (or assign Recognizing
the Negative Consequences of
Impulsive Behavior from the
Adult Psychotherapy Homework
Planner by Jongsma).

10. Assist the client in making
connections between his/her
impulsivity and the negative
consequences for himself/herself
and others.

11. Confront the clients denial of
responsibility for the impulsive
behavior or the negative
consequences (or assign Accept
Responsibility for Illegal
Behavior from the Adult
Psychotherapy Homework Planner
by Jongsma).

6. Identify impulsive behaviors
antecedents, mediators, and
consequences. (12, 13)

12. Ask the client to keep a log
of impulsive acts (time, place,
feelings, thoughts, what was going
on prior to the act, and what was
the result); process log content to
discover triggers and reinforcers
(or assign Impulsive Behavior
Journal from the Adult Psycho-
therapy Homework Planner by
Jongsma).

13. Explore the clients past
experiences to uncover his/her
cognitive, emotional, and
situational triggers to impulsive
episodes.

7. Participate in imaginal
exposure sessions to decrease
the urge to act impulsively.
(14, 15)

14. Assist the client in composing a
script describing a typical situation
in which impulsive behavior
occurs, the urge to act, physical
symptoms, expected negative
consequences, and, finally,
resisting the urge.

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IMPULSE CONTROL DISORDER 213

15. Use the clients script in an
imaginal exposure session in which
the client is relaxed and the script is
read repeatedly.

8. Participate in an in vivo
exposure treatment procedure.
(16, 17, 18, 19)

16. Direct and assist the client in
construction of a hierarchy of
feared internal and external
impulsive behavior cues.

17. Assess the nature of any external
cues (e.g., persons, objects, and
situations) and internal cues
(thoughts, images, and impulses)
that precipitate the clients
impulsive actions.

18. Select initial exposures (imaginal
or in vivo) to the internal and/or
external impulsive behavior cues
that have a high likelihood of being
a successful experience for the
client; include response prevention
and do cognitive restructuring
within and after the exposure (see
Mastery of Obsessive-Compulsive
Disorder by Kozak and Foa; or
Treatment of Obsessive-Compulsive
Disorder by McGinn and
Sanderson).

19. Assign the client a homework
exercise in which he/she repeats
the exposure to the internal and/or
external impulsive behavior cues
using response prevention and
restructured cognitions between
sessions and records responses
(or assign Reducing the Strength
of Compulsive Behaviors in the
Adult Psychotherapy Homework
Planner by Jongsma); review
during next session, reinforcing
success and providing corrective
feedback toward improvement (see
Mastery of Obsessive-Compulsive
Disorder by Kozak and Foa).

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THE COMPLETE ADULT PSYCHOTHERAPY TREATMENT PLANNER 214

9. Verbalize a clear connection

between impulsive behavior
and negative consequences to
self and others. (10, 20)

10. Assist the client in making

connections between his/her
impulsivity and the negative
consequences for himself/herself
and others.

20. Reinforce the clients verbalized
acceptance of responsibility for
and connection between impulsive
behavior and negative
consequences.

10. Before acting on behavioral
decisions, frequently review
them with a trusted friend or
family member for feedback
regarding possible
consequences. (21, 22)

21. Conduct a session with the client
and his/her partner to develop a
contract for receiving feedback
prior to impulsive acts.

22. Brainstorm with the client who
he/she could rely on for trusted
feedback regarding action
decisions; use role-play and
modeling to teach how to ask
for and accept this help.

11. Utilize cognitive methods to
control trigger thoughts and
reduce impulsive reactions
to those trigger thoughts.
(13, 23, 24)

13. Explore the clients past
experiences to uncover his/her
cognitive, emotional, and
situational triggers to impulsive
episodes.

23. Teach the client cognitive methods
(thought-stopping, thought
substitution, reframing, etc.) for
gaining and improving control
over impulsive urges and actions.

24. Use the cognitive restructuring
process (i.e., teaching the
connection between thoughts,
feelings, and actions; identifying
relevant automatic thoughts and
their underlying beliefs or biases;
challenging the biases; developing
alternative positive perspectives;
testing biased and alternative
beliefs through behavioral
experiments) to assist the client
in replacing negative automatic

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IMPULSE CONTROL DISORDER 215

thoughts associated with education
and his/her ability to learn.

12. Use relaxation exercises to
control anxiety, urges, and
reduce consequent impulsive
behavior. (25, 26, 27)

25. Teach the client relaxation skills
(e.g., progressive muscle
relaxation, imagery, diaphragmatic
breathing, verbal cues for deep
relaxation), how to discriminate
better between relaxation and
tension, as well as how to apply
these skills to coping with
situations associated with
impulsive urges (e.g., see
Progressive Relaxation Training
by Bernstein and Borkovec).

26. Assign the client homework each
session in which he or she practices
relaxation exercises daily for at
least 15 minutes and applies the
technique to impulsive trigger
situations; review the exercises,
reinforcing success while providing
corrective feedback toward
improvement.

27. Assign the client to read about
progressive muscle relaxation and
other calming strategies in relevant
books or treatment manuals (e.g.,
The Relaxation and Stress Reduction
Workbook by Davis, Robbins-
Eshelman, and McKay; Mastery
of Your Anxiety and Worry
Workbook by Craske and Barlow).

13. Utilize behavioral strategies to
manage urges for impulsive
action. (28, 29, 30)

28. Teach the use of positive
behavioral alternatives to cope
with impulsive urges (e.g., talking
to someone about the urge, taking
a time out to delay any reaction,
calling a friend or family member,
engaging in physical exercise,
leaving credit cards with a family
member, creating needed item
shopping lists to avoid impulsive
buying, avoiding use of police and
fire scanners, etc.).

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THE COMPLETE ADULT PSYCHOTHERAPY TREATMENT PLANNER 216

29. Review the clients implementation
of behavioral coping strategies to
reduce urges and tension; reinforce
success and redirect for failure.

30. Teach the client covert sensitization
in which he/she imagines a negative
consequence (e.g., going to jail)
whenever the desire to act
impulsively appears (e.g., the desire
to steal); assign as homework;
review, reinforcing success and
problem-solving obstacles until
internalized by the client.

14. List instances where stop,
listen, think, and act has been
implemented, citing the
positive consequences. (31, 32)

31. Using modeling, role-playing, and
behavior rehearsal, teach the client
how to use stop, listen, and think
before acting in several current
situations.

32. Review and process the clients use
of stop, listen, think, and act in
day-to-day living and identify the
positive consequences.

15. Describe any history of manic
or hypomanic behavior related
to a mood disorder. (33)

33. Assess the client for a mood
disorder that includes manic
episodes with a lack of judgment
over impulsive behavior and its
consequences (see the Bipolar
DisorderMania chapter in this
Planner).

16. Identify situations in which
there has been a loss of control
over aggressive impulses
resulting in destructive or
assaultive behavior. (34)

34. Explore the clients history of
explosive anger management
problems; include this as
presenting problem if there have
been several such episodes of
aggressiveness grossly out of
proportion to any precipitating
psychosocial stressor (see the
Anger Control Problems chapter
in this Planner).

17. Comply with the recommen-
dations from a physician
evaluation regarding the

35. Refer the client to a physician for
an evaluation for a psychotropic
medication prescription.

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IMPULSE CONTROL DISORDER 217

necessity for psychopharma-
cological intervention. (35, 36)

36. Monitor the client for psychotropic
medication prescription
compliance, side effects, and
effectiveness; consult with the
prescribing physician at regular
intervals.

18. Implement a reward system
for replacing impulsive
actions with reflection on
consequences and choosing
wise alternatives. (37, 38)

37. Assist the client in identifying
rewards that would be effective
in reinforcing himself/herself for
suppressing impulsive behavior.

38. Assist the client and significant
others in developing and putting
into effect a reward system for
deterring the clients impulsive
actions.

19. Learn and implement problem-
solving skills to reduce
impulsive behavior. (39, 40)

39. Teach the client problem-
resolution skills (e.g., defining the
problem clearly, brainstorming
multiple solutions, listing the pros
and cons of each solution, seeking
input from others, selecting and
implementing a plan of action,
evaluating outcome, and
readjusting plan as necessary).

40. Use modeling and role-playing
with the client to apply the
problem-solving approach to
his/her urge for impulsive action
(or assign Problem-Solving: An
Alternative to Impulsive Action
from the Adult Psychotherapy
Homework Planner by Jongsma);
encourage implementation of
action plan, reinforcing success
and redirecting for failure.

20. Read recommended material
on overcoming impulsive
behavior. (41)

41. Recommend the client read
material on coping with impulsive
urges (e.g., Stop Me Because I
Can’t Stop Myself: Taking Control
of Impulsive Behavior by Grant and
Fricchione; Overcoming Impulse

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THE COMPLETE ADULT PSYCHOTHERAPY TREATMENT PLANNER 218

Control Problems: A Cognitive-
Behavioral Therapy Program
Workbook by Grant, Donahue,
and Odlaug).

21. Attend a self-help recovery
group. (42)

42. Refer the client to a self-help
recovery group (e.g., 12-step
program, ADHD group, Rational
Recovery, etc.) designed to help
terminate self-destructive
impulsivity; process his/her
experience in the group.

__ . ___________________________

___________________________

__ . ___________________________

___________________________

__ . ___________________________

___________________________

__ . ___________________________

___________________________

__ . ___________________________

___________________________

__ . ___________________________

___________________________

DIAGNOSTIC SUGGESTIONS

Using DSM-IV/ICD-9-CM:

Axis I: 312.34 Intermittent Explosive Disorder
312.32 Kleptomania
312.31 Pathological Gambling
312.39 Trichotillomania
312.30 Impulse Control Disorder NOS
312.33 Pyromania
310.1 Personality Change Due to Axis III Disorder
______ _______________________________________
______ _______________________________________

Axis II: 301.7 Antisocial Personality Disorder
301.83 Borderline Personality Disorder
799.9 Diagnosis Deferred
V71.09 No Diagnosis
______ _______________________________________
______ _______________________________________

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IMPULSE CONTROL DISORDER 219

Using DSM-5/ICD-9-CM/ICD-10-CM:

ICD-9-CM ICD-10-CM DSM-5 Disorder, Condition, or Problem
312.34 F63.81 Intermittent Explosive Disorder
312.32 F63.81 Kleptomania
312.31 F63.0 Gambling Disorder
312.39 F63.2 Trichotillomania
312.9 F91.9 Unspecified Disruptive, Impulse Control,

and Conduct Disorder
312.89 F91.8 Other Specified Disruptive, Impulse

Control, and Conduct Disorder
312.33 F63.1 Pyromania
310.1 F07.0 Personality Change Due to Another

Medical Condition
301.7 F60.2 Antisocial Personality Disorder
301.83 F60.3 Borderline Personality Disorder

Note: The ICD-9-CM codes are to be used for coding purposes in the United States through
September 30, 2014. ICD-10-CM codes are to be used starting October 1, 2014. Some ICD-9-
CM codes are associated with more than one ICD-10-CM and DSM-5 Disorder, Condition,
or Problem. In addition, some ICD-9-CM disorders have been discontinued resulting in
multiple ICD-9-CM codes being replaced by one ICD-10-CM code. Some discontinued ICD-
9-CM codes are not listed in this table. See Diagnostic and Statistical Manual of Mental
Disorders (2013) for details.

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. 147

EATING DISORDERS AND OBESITY

BEHAVIORAL DEFINITIONS

1. Refusal to maintain body weight at or above a minimally normal weight
for age and height (i.e., body weight less than 85% of that expected).

2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Persistent preoccupation with body image related to grossly inaccurate

assessment of self as overweight.
4. Undue influence of body weight or shape on self-evaluation.
5. Strong denial of the seriousness of the current low body weight.
6. In postmenarcheal females, amenorrhea (i.e., the absence of at least three

consecutive menstrual cycles).
7. Escalating fluid and electrolyte imbalance resulting from eating disorder.
8. Recurrent inappropriate compensatory behaviors in order to prevent

weight gain, such as self-induced vomiting; misuse of laxatives, diuretics,
enemas, or other medications; fasting; or excessive exercise.

9. Recurrent episodes of binge eating (a large amount of food is consumed
in a relatively short period of time and there is a sense of lack of control
over the eating behavior).

10. Eating much more rapidly than normal.
11. Eating until feeling uncomfortably full.
12. Eating large amounts of food when not feeling physically hungry.
13. Eating alone because of feeling embarrassed by how much one is eating.
14. Feeling disgusted with oneself, depressed, or very guilty after eating too

much.
15. An excess of body weight, relative to height, that is attributed to an

abnormally high proportion of body fat (Body Mass Index of 30 or
more).

__. _____________________________________________________________

_____________________________________________________________

__. _____________________________________________________________

_____________________________________________________________

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THE COMPLETE ADULT PSYCHOTHERAPY TREATMENT PLANNER 148

__. _____________________________________________________________

_____________________________________________________________

LONG-TERM GOALS

1. Restore normal eating patterns, healthy weight maintenance, and a
realistic appraisal of body size.

2. Stabilize medical condition with balanced fluid and electrolytes, resuming
patterns of food intake that will sustain life and gain weight to a normal
level.

3. Terminate the pattern of binge eating and purging behavior with a
return to eating normal amounts of nutritious foods.

4. Terminate overeating and implement lifestyle changes that lead to
weight loss and improved health.

5. Develop healthy cognitive patterns and beliefs about self that lead to
positive identity and prevent a relapse of the eating disorder.

6. Develop healthy interpersonal relationships that lead to alleviation and
help prevent the relapse of the eating disorder.

7. Develop coping strategies (e.g., feeling identification, problem-solving,
assertiveness) to address emotional issues that could lead to relapse of
the eating disorder.

__. _____________________________________________________________

_____________________________________________________________

__. _____________________________________________________________

_____________________________________________________________

__. _____________________________________________________________

_____________________________________________________________

SHORT-TERM

OBJECTIVES

THERAPEUTIC

INTERVENTIONS

1. Honestly describe the pattern of
eating including types, amounts,
and frequency of food consumed
or hoarded. (1, 2, 3, 4)

1. Establish rapport with the client
toward building a therapeutic
alliance.

2. Assess the historical course
of the disorder including the
amount, type, and pattern of
the clients food intake (e.g., too
little food, too much food, binge
eating, or hoarding food);

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EATING DISORDERS AND OBESITY 149

perceived personal and
interpersonal triggers and
personal goals.

3. Compare the clients calorie
consumption with an average
adult rate of 1,900 (for women)
to 2,500 (for men) calories per
day to determine over- or
undereating.

4. Measure the clients weight and
assess for minimization and
denial of the eating disorder
behavior and related distorted
thinking and self-perception of
body image.

2. Describe any regular use of
unhealthy weight control
behaviors. (5)

5. Assess for the presence of
recurrent inappropriate purging
and nonpurging compensatory
behaviors such as self-induced
vomiting; misuse of laxatives,
diuretics, enemas, or other
medications; fasting; or excessive
exercise; monitor on an ongoing
basis.

3. Complete psychological tests
designed to assess and track
eating patterns and unhealthy
weight-loss practices. (6)

6. Administer psychological
instruments to the client
designed to objectively assess
eating disorders (e.g., the Eating
Inventory; Stirling Eating
Disorder Scales; or Eating
Disorders Inventory-3); give the
client feedback regarding the
results of the assessment;
readminister as indicated to
assess treatment response.

4. Provide behavio

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