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The Adolescent Psychotherapy Treatment Planner, Fourth Ediiton provides treatment planning guidelines and an array of pre-written treatment plan components for behavioral and psychological problems, including anger management, blended family conflicts, low self-esteem, chemical dependence, eating disorders, and sexual acting out. Clinicians with adolescent clients will find this up-to-date revision an invaluable resource.

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• ISBN: 0471785393
• Publisher: Wiley, John & Sons, Incorporated
• Pub. Date: September 2006
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• Table of Contents
• Interviews & Essays
• Read an Excerpt
• Read a Sample Chapter

Table of Contents

Interviews & Essays

Question: How did the original Adult Psychotherapy Treatment Planner come about?

Arthur E. Jongsma Jr.: In 1993, I consulted for the Salvation Army Turning Point chemical dependence treatment program. JCAHO reviewers had been critical of the treatment plan documents being produced. They flagged lack of uniform quality, deficits in problem definitions, low measurability of objectives, and ambiguous interventions as issues.

I worked with the clinical director of the program, Mark Peterson, MSW, to develop a menu of treatment plan components for common presenting problems in that client population. The clinical and quality assurance staff eagerly embraced this lexicon and organization, finding that it dramatically cut the time they had to invest groping for words, yet enabled them to create high-quality, customized treatment plans. This guidebook was expanded to include general mental health issues and was published as The Complete Psychotherapy Treatment Planner. Little did I know then that this single guidebook to help mental health professionals would turn into a series of over 45 books as well as software!

Q.: What have you enjoyed most about working on the PracticePlanners® series?

AEJ: It is satisfying to hear both graduate students and seasoned therapists praise the contribution these books have made to their training and practice. Also, as the series has evolved, I've had the honor of collaborating with very knowledgeable experts in specialized fields such as addictions, couples and family therapy, group therapy, and gerontology. Working with these specialists has helped me broaden my own clinical skills.

Q: The bestselling status of the series certainly points to it being an unusually useful tool for therapists. Why do you think that is?

AEJ: The breadth and depth of the Treatment Planners content is unparalleled in the professional marketplace. We have tapped the resources of experts with many different treatment populations and treatment approaches. And when Treatment Planners are integrated with Progress Notes Planners, Homework Planners, and Documentation Sourcebooks, it gives mental health professionals a complete package of timesaving tools for comprehensive treatment planning and clinical record management.

Q: What is ahead for you and the series?

AEJ: We recently launched a new line of books, Progress Notes Planners, that are a natural extension of the Treatment Planners: helping mental health professionals continue to save time while not compromising patient or client care.

When I'm not collaborating on the books, I'm continuing in my private practice, and putting together a wish list of new projects for the series! Which reminds me, the chance to exchange ideas with colleagues is another thing I've greatly enjoyed about working on the series. I'd love to get more feedback and suggestions from mental health professionals.

Dr. Arthur E. Jongsma Jr. heads an independent group practice in Grand Rapids, Michigan. He serves as coauthor of most of the books in the PracticePlanners® series.

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PRACTICEPLANNERS ^® SERIES PREFACE

The practice of psychotherapy has a dimension that did not exist 30, 20, or even 15 years ago--accountability. Treatment programs, public agencies, clinics, and even group and solo practitioners must now justify the treatment of patients to outside review entities that control the payment of fees. This development has resulted in an explosion of paperwork.

Clinicians must now document what has been done in treatment, what is planned for the future, and what the anticipated outcomes of the interventions are. The books and software in this PracticePlanners series are designed to help practitioners fulfill these documentation requirements efficiently and professionally.

The PracticePlanners series is growing rapidly. It now includes not only the original Complete Adult Psychotherapy Treatment Planner, third edition; The Child Psychotherapy Treatment Planner, third edition; and The Adolescent Psychotherapy Treatment Planner, third edition, but also Treatment Planners targeted to specialty areas of practice, including: addictions, juvenile justice/residential care, couples therapy, employee assistance, behavioral medicine, therapy with older adults, pastoral counseling, family therapy, group therapy, neuropsychology, therapy with gays and lesbians, special education, school counseling, and more.

Several of the Treatment Planner books now have companion Progress Notes Planners (e.g., Adult, Adolescent, Child, Addictions, Severe and Persistent Mental Illness). More of these planners that provide a menu of progress statements that elaborate on the client's symptompresentation and the provider's therapeutic intervention are in production. Each Progress Notes Planner statement is directly integrated with "Behavioral Definitions" and "Therapeutic Interventions" items from the companion Treatment Planner.

The list of therapeutic Homework Planners is also growing from the original Brief Therapy Homework for adults to Adolescent, Child, Couples, Group, Family, Chemical Dependence, Divorce, Grief, Employee Assistance, and School Counseling/School Social Work Homework Planners. Each of these books can be used alone or in conjunction with their companion Treatment Planner. Homework assignments are designed around each presenting problem (e.g., Anxiety, Depression, Chemical Dependence, Anger Management, Panic, Eating Disorders) that is the focus of a chapter in its corresponding Treatment Planner).

Client Education Handout Planners, a new branch in the series, provides brochures and handouts to help educate and inform adult, child, adolescent, couples, and family clients on a myriad of mental health issues, as well as life skills techniques. Handouts are included on CD-ROMs and are ideal for use in waiting rooms, at presentations, or as newsletters.

In addition, the series also includes TheraScribe ^®, the latest version of the popular treatment planning, clinical record-keeping software. TheraScribe allows the user to import the data from any of the Treatment Planner, Progress Notes Planner, or Homework Planner books into the software's expandable database. Then the point-and-click method can create a detailed, neatly organized, individualized, and customized treatment plan along with optional integrated progress notes and homework assignments.

Adjunctive books, such as The Psychotherapy Documentation Primer, and Clinical, Forensic, Child, Couples and Family, Continuum of Care, and Chemical Dependence Documentation Sourcebook contain forms and resources to aid the mental health practice management. The goal of the series is to provide practitioners with the resources they need in order to provide high-quality care in the era of accountability--or, to put it simply, we seek to help you spend more time on patients, and less time on paperwork.

ARTHUR E. JONGSMA, JR.
Grand Rapids, Michigan

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ACADEMIC UNDERACHIEVEMENT

BEHAVIORAL DEFINITIONS

1. History of academic performance that is below the expected level, given the client's measured intelligence or performance on standardized achievement tests.
2. Repeated failure to complete homework assignments on time.
3. Poor organization or study skills.
4. Frequent tendency to postpone doing homework assignments in favor of engaging in recreational and leisure activities.
5. Positive family history of members having academic problems, failures, or disinterest.
6. Feelings of depression, insecurity, and low self-esteem that interfere with learning and academic progress.
7. Recurrent pattern of engaging in acting out, disruptive, and negative attention-seeking behaviors when encountering frustration in learning.
8. Heightened anxiety which interferes with performance during tests.
9. Parents place excessive or unrealistic pressure on client to a degree that it negatively affects client's academic performance.
10. Decline in academic performance that occurs in response to environmental stress (e.g., parents' divorce, death of loved one, relocation, or move).

LONG-TERM GOALS

1. Attain and maintain a level of academic performance that is commensurate with intellectual ability.
2. Complete school and homework assignments on a regular and consistent basis.
3. Achieve and maintain a healthy balance between accomplishing academic goals and meeting social and emotional needs.
4. Stabilize mood and build self-esteem sufficiently to cope effectively with the frustrations associated with academic pursuits.
5. Eliminate the pattern of engaging in acting out, disruptive, or negative attention-seeking behaviors when confronted with frustration in learning.
6. Reduce the level of anxiety related to taking tests to a significant degree.
7. Parents establish realistic expectations of the client's learning abilities.
8. Parents implement effective intervention strategies at home to help the client achieve academic goals.
9. Remove emotional impediments or resolve family conflicts and environmental stressors that will allow for improved academic performance.

SHORT-TERM OBJECTIVES

1. Complete a psychoeducational evaluation. (1, 3, 4)
2. Complete psychological testing. (2, 3, 4, 41)
3. Parents and client provide psychosocial history information. (1, 2, 3, 4)
4. Cooperate with a hearing, vision, or medical examination. (5, 47)
5. Comply with the recommendations made by the multidisciplinary evaluation team at school regarding educational interventions. (1, 6, 7, 10)
6. Move to an appropriate classroom setting. (1, 6, 8, 9)
7. Parents and teachers implement educational strategies that maximize the child's learning strengths and compensate for learning weaknesses. (7, 8, 9, 17, 31)
8. Participate in outside tutoring to increase knowledge and skills in the area of academic weakness. (8, 9, 13)
9. Cooperate with the recommendations offered by the private learning center. (9, 11, 12, 14, 15)
10. Implement effective study skills, which increase the frequency of completion of school assignments and improve academic performance. (11, 14, 15, 16)
11. Implement effective test-taking strategies, which decrease anxiety and improve test performance. (12, 15, 22, 23)
12. Parents maintain regular communication (i.e., daily to weekly) with teachers. (16, 17, 18, 19, 21)
13. Use self-monitoring checklists, planners, or calendars to remain organized and help complete school assignments. (14, 15, 16, 34)
14. Complete large projects or long-term assignments consistently and on time. (15, 16, 21, 34)
15. Establish a regular routine that allows time to engage in leisure or recreational activities, spend quality time with the family, and complete homework assignments. (17, 19, 21, 25)
16. Parents increase praise and positive reinforcement toward the client for improved school performance. (19, 20, 31, 36)
17. Parents and teachers identify and utilize a variety of reinforcers to reward client for completion of school and homework assignments. (19, 20, 29, 36)
18. Parents identify and remove all marital, parenting, or family conflicts which may be a hindrance to client's learning. (24, 25, 32, 41)
19. Parents increase time spent involved with the client's homework. (18, 19, 31, 32)
20. Parents verbally acknowledge their unrealistic expectations or excessive pressure on the client to perform. (26, 27, 29, 30)
21. Parents decrease the frequency and intensity of arguments with the client over issues related to school performance and homework. (22, 23, 25, 26)
22. Parents verbally recognize that their pattern of over-protectiveness interferes with the client's academic growth and assumption of responsibility. (28, 29, 32, 33)
23. Increase the frequency of on-task behaviors at school, completing school assignments without expressing the desire to give up. (20, 22, 35, 38, 39)
24. Increase the frequency of positive statements about school experiences and about confidence in the ability to succeed academically. (35, 37, 39, 40)
25. Decrease the frequency and severity of acting-out behaviors when encountering frustration with school assignments. (38, 39, 46)
26. Identify and verbalize how specific, responsible actions lead to improvements in academic performance. (10, 42, 43, 44)
27. Develop a list of resource people within the school setting who can be turned to for support, assistance, or instruction for learning problems. (13, 44, 45)
28. Take prescribed medication as directed by the physician. (2, 47)

THERAPEUTIC INTERVENTIONS

1. Arrange for psychoeducational testing to evaluate the possibility of the client having a learning disability and determine whether the client is eligible to receive special education services.
2. Arrange for psychological testing to assess whether ADHD or emotional factors are interfering with the client's academic performance.
3. Gather psychosocial history information that includes key developmental milestones and a family history of educational achievements and failures.
4. Provide feedback to the client, his/her family, and school officials regarding psychoeducational and/or psychological evaluation.
5. Refer the client for hearing, vision, or medical examination to rule out possible hearing, visual, or health problems that are interfering with school performance.
6. Attend an Individualized Educational Planning Committee (IEPC) meeting with the parents, teachers, and school officials to determine the client's eligibility for special education services, design educational interventions, and establish educational goals.
7. Consult with the client, parents, and school officials about designing effective learning programs or intervention strategies that build on the client's strengths and compensate for his/her weaknesses.
8. Recommend that parents seek privately contracted tutoring for the client after school to boost the client's skills in the area of his/her academic weakness (i.e., reading, mathematics, or written expression).
9. Refer the client to a private learning center for extra tutoring in the areas of academic weakness and assistance in improving study and test-taking skills.
10. Help the client to identify specific academic goals and steps needed to take to accomplish goals.
11. Teach the client more effective study skills (e.g., remove distractions, study in quiet places, develop outlines, highlight important details, schedule breaks).
12. Teach the client more effective test-taking strategies (e.g., study in smaller segments over an extended period of time, review material regularly, read directions twice, recheck work).
13. Consult with teachers and parents about using peer tutor to the assist client in his/her area of academic weakness and help improve study skills.
14. Encourage the client to use self-monitoring checklists to increase completion of school assignments and improve academic performance.
15. Direct the client to use planners or calendars to record school or homework assignments and plan ahead for long-term projects.
16. Utilize the "Break It Down into Small Steps" program in the Brief Adolescent Therapy Homework Planner (Jongsma, Peterson, and McInnis) to help client complete projects or long-term assignments on time.
17. Encourage the parents to maintain regular (daily or weekly) communication with teachers to help the client remain organized and keep up with school assignments.
18. Assist the client and his/her parents in developing a routine daily schedule at home that allows the client to achieve a healthy balance of completing school/homework assignments, engaging in leisure activities, and spending quality time with family and peers.
19. Encourage the parents to give frequent praise and positive reinforcement for the client's effort and accomplishment on academic tasks.
20. Design and implement a reward system and/or contingency contract to reinforce client's responsible behaviors, completion of school assignments, and academic success.
21. Encourage the parents to demonstrate and/or maintain regular interest and involvement in the client's homework (i.e., attend school functions, review planners or calendars to see if client is staying caught up with schoolwork).
22. Teach the client positive coping mechanisms (e.g., relaxation techniques, positive self-talk, cognitive restructuring) to utilize when encountering anxiety, frustration, or difficulty with schoolwork.
23. Train the client in use of guided imagery or relaxation techniques to reduce anxiety before or during the taking of tests.
24. Conduct family sessions to identify any family or marital conflicts that may be inhibiting the client's academic performance.
25. Assist the parents in resolving family conflicts that block or inhibit learning and establishing new positive family patterns that reinforce the client's academic achievement.
26. Conduct family therapy sessions to assess whether the parents have developed unrealistic expectations or are placing excessive pressure on the client to perform.
27. Confront and challenge the parents about placing excessive pressure on the client.
28. Encourage the parents to set firm, consistent limits and utilize natural, logical consequences for the client's noncompliance or refusal to do homework.
29. Encourage the parents not to protect the client from the natural consequences of poor academic performance (e.g., loss of credits, detention, delayed graduation, inability to take driver's training, higher cost of car insurance) and allow him/her to learn from mistakes or failures.
30. Instruct the parents to avoid unhealthy power struggles or lengthy arguments over homework each night.
31. Assign the parents to observe and record responsible behaviors by the client between therapy sessions that pertain to schoolwork. Reinforce responsible behaviors to encourage the client to continue to engage in those behaviors in the future.
32. Assess the parent-child relationship to help determine whether the parents' over-protectiveness and/or overindulgence of the client contributes to his/her academic underachievement.
33. Assist the parents in developing realistic expectations of the client's learning potential.
34. Consult with school officials about ways to improve the client's on-task behaviors (e.g., sit the client toward the front of the class or near positive peer role models, call on the client often, provide frequent feedback, break larger assignments into a series of small steps).
35. Reinforce the client's successful school experiences and positive statements about school.
36. Help the client identify what rewards would increase his/her motivation to improve academic performance and then make these reinforcers contingent on academic success.
37. Conduct individual therapy sessions to help the client work through and resolve painful emotions, core conflicts, or stressors that impede academic performance.
38. Teach the client positive coping and self-control strategies (e.g., deep breathing and relaxation skills, positive self-talk, "stop, look, listen, and think") to inhibit the impulse to act out or engage in negative attention-seeking behaviors when encountering frustration with schoolwork.
39. Confront the client's self-disparaging remarks and expressed desire to give up on school assignments.
40. Assign the client the task of making one positive statement daily to himself/herself about school and his/her ability and recording it in a journal or writing it on a sticky note and posting it in the bedroom or kitchen.
41. Instruct the client to draw pictures reflecting how academic underachievement or failures affect his/her self-esteem and family relationships.
42. Assess periods of time when the client completed schoolwork regularly and achieved academic success. Identify and encourage the client to use similar strategies to improve his/her current academic functioning.
43. Examine coping strategies that the client has used to solve other problems. Encourage the client to use similar coping strategies to overcome his/her problems associated with learning.
44. Give the client a homework assignment of identifying three to five role models and listing reasons he/she admires each role model. Explore in next session the factors which contributed to each role model's success; encourage the client to take similar positive steps to achieve academic success.
45. Identify a list of individuals within the school to whom the client can turn for support, assistance, or instruction when he/she encounters difficulty or frustration with learning.
46. Consult with teachers to assign the client a task at school (e.g., giving announcements over intercom; tutoring another student in his/her area of interest or strength) to demonstrate confidence in his/her ability to act responsibly.
47. Arrange for a medication evaluation of the client if it is determined that an emotional problem and/or ADHD are interfering with learning.

DIAGNOSTIC SUGGESTIONS

Axis I:
315.00 Reading Disorder
315.1 Mathematics Disorder
315.2 Disorder of Written Expression
V62.3 Academic Problem
314.01 Attention-Deficit/ Hyperactivity Disorder, Combined Type
314.00 Attention-Deficit/ Hyperactivity Disorder, Predominantly Inattentive Type
300.4 Dysthymic Disorder 313.81 Oppositional Defiant Disorder
312.9 Disruptive Behavior Disorder, NOS

Axis II:
317 Mild Mental Retardation
V62.89 Borderline Intellectual Functioning

ADOPTION

BEHAVIORAL DEFINITIONS

1. Questions regarding family of origin or biological parents.
2. Statements that reflect a feeling of not being a part of the family (e.g., "I don't fit here," or "I'm different").
3. Asking to make a search to get additional information about or make contact with biological parents.
4. Marked shift in interests, dress, and peer group, all of which are contrary to the adoptive family's standards.
5. Exhibiting excessive clingy and helpless behavior which is inappropriate for developmental level.
6. Extreme testing of all limits (e.g., lying, breaking rules, academic underachievement, truancy, stealing, drug and alcohol experimentation/use, verbal abuse of parents and other authority, or promiscuity).
7. Adoptive parents express anxiety and fearfulness because the child wants to meet his/her biological parents.
8. The adoption of an older special-needs child or sibset.
9. Parents express frustration with the adopted child's development and level of achievement.

LONG-TERM GOALS

1. Termination of self-defeating, acting-out behaviors and acceptance of self as loved and lovable within an adopted family.
2. The weaving of an acceptable self-identity that includes self, biological parents, and adoptive parents.
3. Resolution of the loss of a potential relationship with the biological parents.
4. Completion of the search process that results in reconnection with the biological parents.
5. Successful working through of all unresolved issues connected with being adopted.
6. Resolution of the question, "Who am I?"

SHORT-TERM OBJECTIVES

1. Develop a trusting relationship with the therapist in which feelings and thoughts can be openly communicated. (1)
2. Family members commit to attending and actively participating in family sessions. (2, 15)
3. Verbally identify all the losses related to being adopted. (1, 3)
4. Express feelings of grief connected to the losses associated with being adopted. (4, 5)
5. Report decreased feelings of abandonment and rejection. (6, 7, 8)
6. Verbalize a resolution of feelings of shame and guilt for being adopted. (6, 7, 8, 9)
7. Attend an adoption support group. (10)
8. Identify positive aspects of self. (11, 12)
9. Verbalize a decrease in confusion regarding self-identity. (13, 14)
10. Identify questions that exist about the biological parents. (7, 8, 15)
11. Parents verbalize an understanding of the dynamics of the struggle with adoption status by adolescents who are searching for identity developmentally. (16, 17)
12. Parents report reduced level of worry and fear around the client's interest in and search for information and possible contact with biological parents. (10, 15, 18)
13. Parents verbalize support for the client's search for biological parents. (19)
14. Parents verbalize a refusal to support a search for the biological parents and insist it be postponed until the client is 18 or older. (20)
15. Verbalize an acceptance of the need to delay the search for the biological parents until age 18. (20, 21)
16. Verbalize anxieties associated with the search for the biological parents. (22, 23, 24)
17. Create an album of life experiences that could be shared with the biological parents. (25)
18. Begin the search for the biological parents. (26)
19. Share any increased knowledge of the biological parents and their backgrounds that is attained from the search. (27)
20. Verbalize and resolve feelings associated with not being able to contact the biological parents. (28)
21. Inform the adoptive parents of information discovered about the biological parents and feelings about it. (29)
22. Make a decision to pursue or not pursue a reunion with the biological parents. (10, 15, 24, 30)
23. Identify and express expectations and feelings around impending reunion with the biological parents. (10, 24, 31, 32)
24. Attend and participate in a meeting with the biological parents. (33)
25. Verbalize feelings regarding first contact with the biological parents and expectations regarding the future of the relationship. (34)
26. Reassure the adoptive parents of love and loyalty to them that is not compromised by contact with the biological parents. (35)
27. Verbalize a realistic plan for a future relationship with the biological parents. (35, 36)

THERAPEUTIC INTERVENTIONS

1. Actively build the level of trust with the client in individual and family sessions through consistent eye contact, active listening, and unconditional acceptance to increase his/her ability to express thoughts and feelings.
2. Solicit a commitment from all family members to faithfully attend and participate in family therapy sessions.
3. Ask the client to identify losses connected to being adopted and to process them with the therapist.
4. Assist, guide, and support the client in working through the process of grieving each identified loss associated with being adopted.
5. Assign the client to read Common Threads of Teenage Grief (Tyson) and to process the key concepts he/she gains from the reading with the therapist.
6. Help the client identify and verbally express feelings connected to issues of rejection or abandonment.
7. Assign the client to read Why Didn't She Keep Me? (Burlingham-Brown) to help him/her resolve feelings of rejection, abandonment, and guilt/shame.
8. Ask the client to read How It Feels to Be Adopted (Krementz) and list the key items from each vignette that he/she identifies with. Process completed list.
9. Assist the client in identifying irrational thoughts and beliefs (e.g., "I must have been bad for Mom to have released me for adoption, I must have been a burden," etc.) that contribute to his/her feelings of shame and guilt. Then assist him/her in replacing the irrational thoughts and beliefs with healthy, rational ones.
10. Refer client and/or parents to an adoption support group.
11. Have the client complete "Three Ways to Change Yourself" in the Brief Adolescent Therapy Homework Planner (Jongsma, Peterson, and McInnis) to help the client identify and express his/ her needs and desires.
12. Assign a self-esteem-building exercise from SEALS & PLUS (Korb-Khalsa, Azok, and Leutenberg) to help develop self-knowledge, acceptance, and confidence.
13. Provide education to the client about his/her "true and false self or artificial and forbidden self" (see Journal of the Adopted Self [Lifton]) to give him/her direction and permission to pursue exploring who he/she is.
14. Assign the client the task of creating a list that responds to the question, "Who am I?" Ask him/her to add daily to the list and to share the list with the therapist each week for processing.
15. Create in a family session a genogram that is complete with all family members and what is known about each. Ask the child and the parents what they know or have been told about the biological parents and their families. Make a list of questions that the client and the parents have about the biological parents and their families.
16. Encourage the parents to read either The Whole Life Adoption Book (Schooler) or Making Sense of Adoption (Melina) to increase their knowledge and understanding of the adopted child in adolescence.
17. Teach the parents about the developmental task of adolescence that is focused on searching for an independent identity and how this is complicated for an adopted adolescent.
18. Conduct a session with the adoptive parents in which their fears and concerns are discussed regarding the client searching for and possibly meeting the biological parents. Confirm the parents' rights and empower them to support, curtail, or postpone the client's search.
19. Hold a family session in which the client's desire to search for his/her biological parents is the issue. If the parents give support to the search, ask them to state verbally their encouragement in going forward. Then elicit from the client a commitment to keep his/her parents informed about the search at a mutually agreed upon level.
20. Hold a family session in which the client's desire to search for his/her biological parents is the issue. If the parents are opposed, support their right, since the child is a minor, and ask them to state their rationale. Affirm the client's right to search after he/she is 18 if he/she still desires to.
21. Affirm the parents' right to refuse to support a search for the client's biological parents at present, and assist the client in working to a feeling of acceptance of this decision.
22. Locate an adult who is adopted and who would agree to meet with the client and the therapist to tell of his/her search experience and answer any questions that the client has.
23. Prepare the client for the search by probing and affirming his/her fears, hopes, and concerns. Develop a list of questions that he/she would like to have answered.
24. Ask the client and the parents to read Searching for a Past (Schooler) to expand their knowledge and understanding of the search process.
25. Have the client review with the therapist his/her "life book" filled with pictures and mementos; if he/she does not have one, help him/her construct one to add to the search/reunion process.
26. Refer the client to the agency that did his/her adoption or to an adoption agency that has postadoption services to begin the search process.
27. Debrief the client on the information he/she receives from the search. Identify and support his/her feelings around what is revealed.
28. Assist the client in working through his/her feelings of disappointment, anger, or loss connected to a dead end regarding possible contact with the biological parents.
29. Monitor the client's communication to the adoptive parents of information regarding the search to make sure it is occurring at the agreed-upon level.
30. Help the client reach a decision to pursue or postpone contact or reunion with the biological parents, reviewing the pros and cons of each alternative.
31. Prepare the client to have contact with the biological parents by examining his/her expectations to make them as realistic as possible and to seed and reinforce the message to let the relationship build slowly.
32. Role-play with the client a first meeting with the biological parents and process the experience.
33. Arrange for and conduct a meeting with the client and the biological parents facilitating a complete expression of feelings by all family members; explore with all parties the next possible steps.
34. Process with the client his/her first contact with the biological parents and explore the next step he/she would like to make in terms of a future relationship.
35. Assist the client in creating a plan for further developing his/her new relationship with the biological parents, with emphasis on taking things slowly, keeping expectations realistic, and being sensitive to the feelings of the adoptive parents who have provided consistent love and nurturing.
36. Conduct a family session with the client and the adoptive parents to update them on the meeting with the biological parents and the next possible step. Offer appropriate affirmation and explore how the new family arrangement might work.

DIAGNOSTIC SUGGESTIONS

Axis I:
309.0 Adjustment Disorder With Depressed Mood
309.4 Adjustment Disorder With Mixed Disturbance of Emotions and Conduct
308.90 Alcohol Dependence
300.4 Dysthymic Disorder
312.8 Conduct Disorder
313.81 Oppositional Defiant Disorder
314.01 Attention Deficit/ Hyperactivity Disorder, Combined Type

Axis II:
799.9 Diagnosis Deferred
V71.09 No Diagnosis

ANGER MANAGEMENT

BEHAVIORAL DEFINITIONS

1. Repeated angry outbursts that are out of proportion to the precipitating event.
2. Excessive screaming, cursing, or use of verbally abusive language when frustrated or stressed.
3. Frequent fighting, intimidation of others, and acts of cruelty or violence toward people or animals.
4. Verbal threats of harm to parents, adult authority figures, siblings, or peers.
5. Persistent pattern of destroying property or throwing objects when angry.
6. Consistent failure to accept responsibility for loss of control, accompanied by repeated pattern of blaming others for his/her anger control problems.
7. History of engaging in passive-aggressive behaviors (e.g., forgetting, pretending not to listen, dawdling, procrastinating, stubborn refusal to comply with reasonable requests or rules) to frustrate or annoy other family members, adults, or peers.
8. Strained interpersonal relationships with peers due to anger-control problems and aggressive or destructive behaviors.
9. Underlying feelings of depression, anxiety, or insecurity that contribute to angry outbursts and aggressive behaviors.

LONG-TERM GOALS

1. Express anger through appropriate verbalizations and healthy physical outlets on a consistent basis.
2. Significantly reduce the intensity and frequency of angry verbal outbursts.
3. Terminate all acts of violence or cruelty toward people or animals, and destruction of property.
4. Interact consistently with adult authority figures in a mutually respectful manner.
5. Markedly reduce the frequency of passive-aggressive behaviors by expressing anger and frustration through controlled, respectful, and direct verbalizations.
6. Resolve the core conflicts which contribute to the emergence of anger-control problems.
7. Parents establish and maintain appropriate parent-child boundaries, setting firm, consistent limits when the client reacts in a verbally or physically aggressive or passive-aggressive manner.
8. Demonstrate marked improvement in the ability to listen and respond emphatically to the thoughts, feelings, and needs of others.

1. Complete psychological testing. (1, 3)
2. Complete a psychoeducational evaluation. (2, 3)
3. Complete a substance abuse evaluation and comply with the recommendations offered by the evaluation findings. (3, 4)
4. Cooperate with the recommendations or requirements mandated by the criminal justice system. (4, 5, 6, 7)
5. Move to an appropriate alternative setting or juvenile detention facility. (5, 6, 7)
6. Parents establish appropriate boundaries and follow through consistently with consequences for anger-control problems. (8, 9, 17, 19, 25)
7. Comply with rules at home and school without protesting or venting strong feelings of anger. (8, 9, 19, 25)
8. Increase the number of verbalizations that reflect the acceptance of responsibility for angry outbursts and destructive or aggressive behaviors. (10, 11, 12, 13)
9. Decrease the frequency of verbalizations that project the blame for anger-control problems onto other people. (11, 12, 13)
10. Express anger through controlled, respectful verbalizations and healthy physical outlets. (8, 10, 14, 15, 23)
11. Reduce the frequency and intensity of angry, verbal outbursts when frustrated or stressed. (14, 15, 16, 17, 20)
12. Decrease the frequency of arguments with authority figures. (8, 9, 11, 16, 25)
13. Decrease the frequency and severity of destructive or physically aggressive behaviors. (7, 8, 16, 17, 48)
14. Reduce the frequency of passive-aggressive behaviors. (9, 10, 16, 38, 39)
15. Parents agree to and follow through with the implementation of a reward system or contingency contract to reinforce positive control of anger. (8, 17, 18, 19)
16. Parents increase the frequency of praise and positive reinforcement of the client for demonstrating good control of anger. (17, 19, 21, 22)
17. Directly communicate thoughts and feelings to parents in an assertive, controlled, and mutually respectful manner. (9, 16, 23, 40)
18. Uninvolved or detached parent(s) increase time spent with client in recreational, school, or work activities. (24, 26, 27)
19. Recognize and verbalize how feelings of insecurity or other painful emotions (e.g., depression, anxiety, helplessness) are connected to anger-control problems. (28, 29, 30)
20. Identify and verbalize unmet emotional needs directly to significant others. (28, 29, 40, 41)
21. Verbalize an understanding of how current anger-control problems are associated with past neglect, abuse, separation, or abandonment. (28, 31, 34, 35)
22. Identify and verbally express feelings associated with past neglect, abuse, separation, or abandonment. (31, 34, 35, 36, 37)
23. Parents verbalize appropriate boundaries for discipline to prevent further occurrences of abuse and ensure the safety of the client and his/her siblings. (29, 32, 33)
24. Identify the irrational beliefs or maladaptive thoughts that contribute to the emergence of destructive or aggressive behaviors. (38, 39, 42)
25. Increase the verbalizations of positive self-statements to improve anger control. (43, 44, 45, 46)
26. Increase the frequency of positive interactions with parents, adult authority figures, siblings, and peers. (34, 35, 36, 47, 50)
27. Increase participation in extracurricular activities or positive peer group activities. (44, 46, 48, 49)
28. Engage in exercise on a regular basis to provide a healthy outlet for anger. (45)
29. Establish and maintain steady employment to deter aggressive or destructive behaviors. (48, 49)
30. Recognize and verbalize how anger-control problems negatively affect others. (11, 12, 49, 50)
31. Increase verbalizations of empathy and concern for other people. (47, 49, 50)
32. Express feelings of anger through medium of music or art (e.g., drawings, paintings). (51, 52, 53)
33. Parents acknowledge conflicts within the marital relationship. (25, 33, 54)
34. Take medication as prescribed by the physician. (1, 55)

THERAPEUTIC INTERVENTIONS

1. Arrange for psychological testing to assess whether emotional factors or ADHD are contributing to anger-control problems.
2. Arrange for psychoeducational evaluation to rule out the possibility of a learning disability that may be contributing to anger-control problems in the school setting.
3. Provide feedback to the client, his/her parents, school officials, or criminal justice officials regarding psychological and/or psychoeducational testing.
4. Arrange for substance abuse evaluation and/or treatment for the client.
5. Consult with criminal justice officials about the appropriate consequences for the client's destructive or aggressive behaviors (e.g., pay restitution, community service, probation, intensive surveillance).
6. Consult with parents, school officials, and criminal justice officials about the need to place the client in an alternative setting (e.g., foster home, group home, residential program, or juvenile detention facility).
7. Encourage and challenge the parents not to protect the client from the natural or legal consequences of his/her destructive or aggressive behaviors.
8. Assist the parents in establishing clearly defined rules, boundaries, and consequences for angry outbursts and acts of aggression or destruction.
9. Establish clear rules for the client at home or school; ask him/her to repeat rules to demonstrate an understanding of the expectations.
10. Actively build the level of trust with the client in therapy sessions through consistent eye contact, active listening, unconditional positive regard, and warm acceptance to help increase his/her ability to express anger and underlying painful emotions.
11. Firmly confront the client about the impact of his/her angry outbursts and destructive or aggressive behaviors, pointing out consequences for himself/herself and others.
12. Confront statements in which the client blames others for his/her anger-control problems and fails to accept responsibility for his/her destructive or aggressive behaviors.
13. Explore and process the factors that contribute to the client's pattern of blaming others for anger-control problems.
14. Teach mediational and self-control strategies (e.g., "stop, look, listen, and think"; take deep breaths and count to 10) to help the client express anger through appropriate verbalizations and healthy physical outlets.
15. Train the client in the use of progressive relaxation or guided imagery techniques to help calm self and decrease intensity of angry feelings.
16. Teach the client effective communication and assertiveness skills to express angry feelings in a controlled manner and meet his/her needs through constructive actions.
17. Design a reward system and/or contingency contract for the client to reinforce good anger control and deter destructive or aggressive behaviors.
18. Design and implement a token economy to increase the client's positive social behaviors, improve his/her anger control, and deter destructive or aggressive behaviors.
19. Encourage the parents to provide frequent praise and positive reinforcement to the client for displaying good anger control in situations involving conflict or stress.
20. Encourage the client to use self-monitoring checklists at home or school to develop more effective anger control.
21. Employ the "Anger Control" exercise in the Brief Adolescent Therapy Homework Planner (Jongsma, Peterson, and McInnis) to help the client learn to express anger in a controlled manner. Utilize a reward system and contract to reinforce good control of anger.
22. Inquire into what the client does differently on days when he/she controls anger and does not lash out verbally or physically toward siblings or peers. Process the client's responses and reinforce any positive coping mechanisms used to manage anger.
23. Assign the client to read S.O.S. Help for Emotions (Clark) to help the client manage anger more effectively; process reading with the client.
24. Conduct family therapy sessions to explore the dynamics that contribute to the emergence of the client's anger-control problems.
25. Assign parents to read Negotiating Parent/Adolescent Conflict (Robin and Foster) to help resolve conflicts more effectively and diffuse the intensity of the adolescent's angry feelings.
26. Utilize the family-sculpting technique, in which the client defines the roles and behaviors of each family member in a scene of his/her choosing, to assess family dynamics.
27. Give a directive to uninvolved or disengaged parents to spend more time with the client in leisure, school, or work activities.
28. Assist the client in making a connection between underlying, painful emotions (e.g., depression, anxiety, helplessness) and angry outbursts or aggressive behaviors.
29. Use the "Surface Behavior/Inner Feelings" exercise in the Brief Adolescent Therapy Homework Planner (Jongsma, Peterson, and McInnis) to help the client recognize how underlying emotional pain contributes to angry outbursts.
30. Explore the client's family background for a history of physical, sexual, or substance abuse, which may contribute to his/her anger-control problems.
31. Encourage and support the client in expressing feelings associated with neglect, abuse, separation, or abandonment.
32. Confront the parents to cease physically abusive or overly punitive methods of discipline.
33. Implement the steps necessary to protect the client or siblings from further abuse (e.g., report abuse to appropriate agencies, remove client or perpetrator from home).
34. Assign the client the task of writing a letter to the absent or abusive parent. Process the content of the letter to help the client express and work through feelings of anger, sadness, and helplessness about past abandonment or abuse.
35. Use the empty chair technique to coach the client in expressing angry feelings in a constructive manner toward the absent or abusive parent.
36. Explore and discuss the client's willingness to forgive the perpetrators of emotional or physical pain as a process of letting go of anger.
37. Instruct the client to write a letter of forgiveness to a target of anger as a step toward letting go of anger. Process the letter in session and discuss what to do with the letter.
38. Direct the client to develop a thorough list of all targets of and causes for anger.
39. Ask the client to keep a daily journal in which he/she documents persons and situations that evoke strong feelings of anger.
40. Assign the client to list significant life experiences that have produced strong feelings of anger, hurt, or disappointment.
41. Assist the client in first identifying unmet needs and then expressing them to significant others.
42. Identify and confront irrational thoughts that contribute to the emergence of anger-control problems; replace irrational thoughts with more adaptive ways of thinking to help control anger.
43. Reinforce positive self-statements by the client to improve his/her self-esteem and anger control.
44. Assign the client the task of making one positive self-statement daily and recording it in a journal.
45. Encourage the client to participate in extracurricular activities or engage in regular exercise to provide a healthy outlet for anger and improve self-esteem.
46. Refer the client to an anger-management group.
47. Utilize the Odyssey Islands Game (available from Childswork/ Childsplay, LLC) in session to help the client develop positive social skills and improve self-control.
48. Instruct the client to seek and secure employment in order to have funds available to make restitution for aggressive or destructive acts, to assume responsibility, and to gain income to meet his/her needs in an adaptive manner.
49. Assist the client in identifying more age-appropriate ways of establishing control and/or power than through intimidating or bullying others.
50. Assign the client the task of showing empathy, kindness, or sensitivity to the needs of others (e.g., assist younger sibling with homework, perform cleaning task for ailing family member).
51. Direct the client to draw pictures of three events or situations which commonly evoke feelings of anger. Process the client's thoughts and feelings after he/she completes drawings.
52. Tell the client to draw an outline of a human body on a large piece of paper or poster board; then ask the client to fill in the mural with objects, symbols, or pictures which reflect who or what the client is angry about in his/her life. Process the content of the artwork in session.
53. Instruct the client to sing a song or play a musical instrument that reflects feelings of anger, then have the client tell of a time when he/she felt angry about a particular issue.
54. Assess the marital dyad for possible conflict and triangulation that places the focus on the client's anger-control problems and away from marriage issues; refer for marital counseling if indicated.
55. Refer the client for medication evaluation to help stabilize moods and improve his/her anger control.

DIAGNOSTIC SUGGESTIONS

Axis I:
313.81 Oppositional Defiant Disorder
312.34 Intermittent Explosive Disorder
312.30 Impulse-Control Disorder NOS
312.8 Conduct Disorder/ Adolescent-Onset Type
312.9 Disruptive Behavior Disorder NOS
314.01 Attention-Deficit Disorder, Predominantly Hyperactive-Impulsive Type
314.9 Attention-Deficit Hyperactivity Disorder NOS
V71.02 Adolescent Antisocial Behavior
V61.20 Parent-Child Relational Problem

Axis II:
799.9 Diagnosis Deferred
V71.09 No Diagnosis

ANXIETY

BEHAVIORAL DEFINITIONS

1. Excessive anxiety, worry, or fear that markedly exceeds the normal level for the stage of development.
2. High level of motor tension such as restlessness, tiredness, shakiness, or muscle tension.
3. Autonomic hyperactivity such as rapid heartbeat, shortness of breath, dizziness, dry mouth, nausea, or diarrhea.
4. Hypervigilance such as feeling constantly on edge, concentration difficulties, trouble falling or staying asleep, and a general state of irritability.
5. A specific fear that has become generalized to cover a wide area and has reached the point where it significantly interferes with own and the family's daily life.
6. Excessive anxiety or worry due to parent's threat of abandonment, overuse of guilt, denial of autonomy and status, interference with physical activity, or friction between parents.

LONG-TERM GOALS