class="bi x0 y0 w0 h1"
Therapist's Guide
to
Clinical
Intervention
The
1-2-3's
of
Treatment
Planning
Second
Edition
This page intentionally left blank
Therapist's
Guide
to
Clinical Intervention
The
1—2—3's
of
Treatment Planning
Second Edition
SHARON
L
JOHNSON
ACADEMIC PRESS
An
imprint
of
Elsevier Science
Amsterdam

form
or by any
means,
electronic
or
mechanical, including photocopy, recording,
or any
information
storage
and
retrieval system, without permission
in
writing
from
the
publisher.
Permissions
may be
sought directly
from
Elsevier's Science
&
Technology Rights
Department
in
Oxford,
UK:
phone:
(+44) 1865
843830,

Academic Press
84
Theobald's
Road, London WC1X 8RR,
UK

Library
of
Congress Catalog Card Number:
2003109372
International Standard Book Number: 0-12-386588-3
PRINTED
IN THE
UNITED STATES
OF
AMERICA
03
04 05 06 07 9 8 7 6 5 4 3 2 1
CONTENTS
Introduction xvii
Level
of
Patient Care
and
Practice Considerations
xix
Decision Tree
of
Evaluation
and

AND
INTERVENTIONS
Disorders Usually First Evident
in
Infancy, Childhood,
or
Adolescence
1
Mental
Retardation (MR)
1
Pervasive Developmental Disorders
(PPD)
5
Disruptive Behavior Disorders
7
Attention
Deficit
Hyperactivity
Disorder (ADHD) Oppositional
Defiant
Disorder,
Conduct Disorder
7
Separation Anxiety
13
Avoidant Disorder
14
Overanxious Disorder
16

32
Defining
Specific
Dementias
34
Psychoactive Substance Abuse Disorders
37
Substance
Abuse
and/or Dependence
38
Categories
of
Pharmacological
Intervention
41
Treatment Settings
41
List
of
Symptoms
Leading
to
Relapse
42
Schizophrenia,
Delusional,
and
Related
Psychotic

Children
61
Bipolar
Disorder
Hypersexuality
62
Antidepressant
Medication
and
other
Treatment
63
Additional
Treatment
Considerations
64
Anxiety
Disorders
65
Anxiety
Disorders
65
Cycle
of
Anxiety-Provoked
Emotional
Distress
69
Trauma Response
70

84
Impulse Control Disorders
84
Psychological
Factors
Affecting
Physical
Condition
86
Psychological Factor
Affecting
Physical Condition
86
Personality
Disorders
88
Avoidant
Personality Disorder
89
Compulsive Personality Disorder
90
Dependent Personality Disorder
92
Passive-Aggressive
Personality Disorder
94
Paranoid Personality Disorder
95
Schizotypal Personality Disorder
97

Depression
And
Anxiety Screening
111
Depression
111
Anxiety
111
Structured Interview
for
Depression
112
Cycle
of
Depression
113
Suicide
115
Suicide
Assessment Outline
115
Adolescent Suicide
116
Treatment
Focus
and
Objectives
117
Depression
and

127
Treatment Focus
and
Objectives
127
Activities
of
Daily
Living
128
Living Situation
129
Self-Care
Skills
129
Level
of
Required
Assistance
129
Care
of
Environment
and
Chore Responsibilities
129
Meals
129
Child Care
129

Identifying
Traumatic
Stress
135
Recovering from Traumatic Stress
135 How
Does
a
Traumatic
Event
Affect
Someone?
136 The
Effects
of
Time
137
Traumatic Stress
and
Vehicular Accidents
137
Assessment
of
Phobic Behavior
139
Postpartum Depression
and
Anxiety
141
Definitions

the
Challenges
of
Long Term
Illness
151
Working Through
the
Challenges
and
Fears
Associated
with
Long-Term Illness
154
Contents Vii
Chronic Pain: Assessment
and
Intervention
157
Factors
Affecting
the
Experience
of
Pain
157
Clinical Interview
158
Assessment

The
Patient with Psychosomatic Illness
Who has an
Underlying
Personality Disorder
165
Eating
Disorders
Screening
Questionnaire
167
The
Mood
Eating Scale
169
Eating History
169
Eating
Disorder
Evaluation:
Anorexia
170
Eating Disorder Evaluation: Bulimia
172
Adult
ADD
Screening
174
ADHD Behavioral Review
177

Domestic
Violence
194
Objectives
195
Child Abuse
and
Neglect
195
Prevention
195
Indicators
of
Abuse
196
Treatment
197
Child Custody Evaluation
198
Guidelines
for
Psychological
Evaluation
198
Ability
of
the
Child
to
Bond

202
Child's
Own
Scenarios
203
Family Dynamics
and
Environment/
Situtational Issues
203
Criteria
for
Establishing Primary Custody
203
Behaviors
of
the
Parents
204
Children
205
Three Categories
of
Parental
Alienation
206
Viii
Contents
Evaluation
and

213
Identifying
Information
213
Description
of
Client
at
Time
of
Interview
213
Descriptions
of
Client's Current Complaints
213
History
of
Present Illness
213
Occupational History
214
Past
Psychiatric History
and
Relevant Medical History
214
Family
History
214

Injury
With Clients Description)
216
DSM-IV Diagnosis (Multiaxial,
Using
DSM
Criteria
and
Terminology)
216
Summary
and
Conclusions
216
Psychological Pre-Employment Evaluation
217
Report Outline
217
Compulsory Psychological Evaluation
218
Compulsory
Psychological Evaluation
218
Forensic Evaluation
219
Report
Outline
220
Competency
220

Stress Management
226
Early
Warning Signs
of
Stress
228
Stress Signals
228
Stress
Busting
229
Effective
Management
of
Stress
229
Critical
Problem Solving
229
Assertiveness
230
Conflict
Resolution
230
Time Management
230
Self-Care
230
Tips

234
Self-Care Plan
235
How to Get The
Most
Out of
Your
Day 236
Emotional
IQ 237
Relaxation
Exercises
238
Deep
Breathing
238
Mental Relaxation
239
Tensing
the
Muscles
239
Mental Imagery
239
Brief
Relaxation
241
Brief
Progressive Relaxation
241

Developing Good Problem-Solving Skills Equips Individuals
To: 248
Stages
of
Problem Solving
(As
Therapist Facilitates Skill Development
in
Individual):
248
Steps
for
Problem Solving
249
Problem Solving Diagram
249
Assignment
1 250
Sample
Problems
250
Assignment
2 250
Assignment
3 251
Risks
252
Components
of
Effective

Assertiveness Inventory
258
Nonverbal
Communication
260
Developing Assertiveness
261
Nonverbal Assertive Behavior
261
Personal
Bill
of
Rights
262
Assertiveness
262
The
Steps
of
Positive Assertiveness
263
Practicing Assertive Responses
263
Ten
Steps
for
Giving Feedback
264
Saying
"No"

Difficult
Feelings
266
How You Can
Deal with
Uncomfortable
Feelings
266
Writing
267
Areas
of
Potential Conflict
268
List
of
Potential
Conflicts
268
List
of
Feeling Words
269
Pleasant
Feelings
269
Difficult/Unpleasant
Feelings
269
Time Management

274
Steps
for
Setting Priorities
274
Rational
Thinking:
Self-Talk,
Thought
Stopping,
and
Reframing
274
Self-Talk
274
Thought Stopping
276
Reframing
277
Thinking Distortions
278
Realistic Self-Talk
279
Practice Reframing
How You
Interpret Situations
281
Defense
Mechanisms
282

Anger
287
Decrease
the
Intensity
of
Anger
287
Barriers
to
Expressing Anger
288
Inappropriate Expression
of
Anger:
Violence
and
Rage
288
Penalties
for Not
Expressing Anger
288
Ways
to
Deal
with
Anger
289
Ten

Employee
Stress
296
Adjusting/Adapting
298
Life
Changes
298
Developmental Perspective
299
Contents
XI
Learning
History
300
Losses/Opportunities
301
What
is
Meant
by
Resolving
Grief/Loss?
301 Why Are
People
Not
Prepared
to
Deal
with

302
Grief Cycle
303
Definition:
The
Natural
Emotional Response
to the
Loss
of a
Cherished Idea,
Person,
or
Thing
303
Grief
304
Never Happened
304
Bargaining
305
Depression
305
Acceptance
306
History
of
Loss Graph
307
Example

and
Keep
a
Support System
312
Recognizing
the
Stages
of
Depression
313
Decreasing
the
Intensity
of
Depression
313
Managing Depression
314
The
Causes
of
Depression
314
Depression Symptom Checklist
315
Surviving
the
Holiday
Blues

Overwhelmed
and
Desperate
325
Feeling like Your
Life
is Out of
Control
326
Guilt
327
Loneliness
329
Chemical Imbalance
329
Xll
Contents
Low
Self-Esteem
330
The
Self-Esteem Review
332
Ten
Self-Esteem Boosters
333
Affirmations
for
Building Self-Esteem
334

of
Losses
342
Fatigue
or
Sleep Deprivation
344
What
is
Panic Anxiety?
344
Symptoms
345
Treatment
345
Post-Traumatic
Stress
Disorder
(PTSD)
346
Managing Anxiety
347
What
Do You Do 349
Survey
of
Stress Symptoms
350
Psychological
Symptoms

Relapse
Cycle
355
Warning Signs
of
Relapse
356
Systematic
Desensitization
357
The Ten
Steps
of
Systematic Desensitization
357
What
is
Dementia?
358
Symptoms
358
Conditions Causing Reversible Symptoms
358
Conditions Causing Dementia That
Are Not
Reversible
359
Diagonosis
359
Understanding Schizophrenia

Caretaker
365
Tips
for the
Caretaker
366
Advice
for
others Close
to the
Situation
366
Ten
Warning Signs
of
Caregiver Stress
366
Sleep
Disorders
367
Treatment Focus
and
Objectives
367
Contents
XIII
Ten
Tips
for
Better Sleep

by The
National
Institute
of
Health
375
Benefits
of
Depression Treatment
375
Depression
Is
Often
Undiagnosed
and
Untreated
375
Effective
Treatment
for
Depression
376
Eating
History
376
How to
Stop Using Food
as a
Coping Mechanism
377

380
Guidelines
for
Family Members/Significant Others
of
Alcoholic/Chemically
Dependent Individuals
381
Detaching
with
Love Versus
Controlling
382
The
Enabler—The Companion
to the
Dysfunctional/Substance-
Abusing Person
383
Substance Abuse/Dependence Personal
Evaluation
385
List
of
Symptoms Leading
to
Relapse
386
What
is

Children
of
Codependents
392
What
Can You Do 392
Stages
of
Recovery
392
Characteristics
of
Adult Children
of
Alcoholics
393
Guidelines
for
Completing Your First Step Toward Emotional Health
394
Relationship Questionnaire
396
Healthy
Adult
Relationships:
Being
a
Couple
396
Special

Your Home
400
Have
Money
and
Keys
400
Create
a
File
with
Your
Important
Documents
400
Pack
a
Suitcase
401
Know When
and How to
Leave
401
Why
Victims
of
Domestic Violence Struggle with Leaving
401
Improved Coping Skills
for

407 Be An
Active Parent
407
A
Healthy
Family
Means
All
of
Its
Members
are
Involved
407
Encourage
Communication
407
Guiding
Your Child
to
Appropriately Express Anger
408
The
Family Meeting
409
Guidelines
409
Developing Positive
Self-Esteem
in

a
Child
413
Your
Child's
Mental
Health
415
Warning Signs
of
Teen Mental
Health
Problems
416
Talking
to
Children
417
Rules
for
Listening
418
Rules
for
Problem Solving
and
Expressing
Your
Thoughts
and

421
Successful
Stepfamilies
422
Honor
422
Validation
422
Respect
422
Responsibility
422
Communication
423
Discipline
423
Parent-Centered Structure
423
Helping Children Cope with Scheduling Changes
423
Is
Your Behavior
in the
Best
Interest
of
Your Children?
425
The
Rules

Consult Information
435
General Clinical Evaluation
436
Contents
XV
Treatment Plan
439
Mental Status Exam
442
Contents
of
Examination
442
Mental Status Exam
444
Mental
Status Exam
445
Initial Case Assessment
447
Initial
Evaluation
449
Brief
Mental
Health
Evaluation Review
451
Life

Parent's Questionnaire
475
Question
475
Self-Assessment
477
Brief
Medical History
478
Illnesses
and
Medical Problems
479
Medical Review Consult Request
for
Primary Care Physician
of an
Eating
Disorder (EDO) Patient
480
Substance
Use and
Psychosocial Questionnaire
481
Treatment
History
482
Family
History
483

498
Social Security Evaluation,
Medical
Source
Statement,
Psychiatric/
Psychological
499
Worker's Compensation Attending
Therapist's
Report
500
Progress
500
Treatment
500
Work
Status
500
Disability Status
500
Brief
Psychiatric Evaluation
for
Industrial
Injury
502
Brief
Level
of

517
Fee
Agreement
for
Deposition
and
Court Appearance
517
Limits
on
Patient Confidentiality
519
Release
of
Information
519
Treatment Contract
520
Contract
for
Group Therapy
521
Release
for the
Evaluation
and
Treatment
of a
Minor
522

to
Return
to
Work
or
School
527
Notice
of
Discharge
for
Noncompliance
of
Treatment
528
Duty
to
Warn
529
Missed Appointment
530
Receipt
531
Receipt
532
Balance Statement
533
Client Satisfaction Survey
534
Form

as a
comprehensive resource
tool.
Because
of the
positive response
to the
organization
of the
original
text,
the
format
has
remained
the
same.
The
Therapist's
Guide
to
Clinical
Intervention
is
divided into
four
sections: Treatment Planning, Special Assessment, Skill-Building Resources,
and
Clinical/
Business

resourcefulness
of the
text
has
been added.
In
addition
to
being
a
time-management
tool,
helping
the
therapist
to
meet
the
increasing demands
of
documen-
tation
requirements
and the
expectation
of
therapeutic
effectiveness
in
identifying

and the
challenge
of
max-
imizing
effectiveness
has
increased with
it.
Managed care companies
and
consumers alike
expect
to be
informed
of the
expected number
of
sessions necessary
to
resolve
the
present-
ing
issue(s)
and for the
therapist
to
collaterally communicate with
the

has
con-
tinued
to flourish. The fiscal
agenda
of the
managed care company
is
clear. What
has
become
more surprising
is
that
many consumers also
are
seeking
brief
therapy
in
association with
clearly
defined
goals. Therefore,
in
many cases, both
the
consumer
of
services

that
is
well documented
and
research supported.
The
Therapist's
Guide
to
Clinical
Intervention facilitates
the
ease
of
accomplishing these expectations
by
combining
the
afore-
mentioned significant aspects
of
practice.
All of
this
is
provided
in a
single resource, which
saves
a

and
introduce this format
to
those
who are new to the
Therapist's
Guide
to
Clinical Intervention,
we
will provide
a
brief
summary
on the
four
sections
of the
text.
The first
part
of the
book
is an
outline
of
cognitive-
behavioral treatment planning. This organization
of
goals

save time. There
is a
list
of
central goals derived
from
identified
diagnostic symptoms
and the
associated treatment objectives
for
reaching
those
goals
from
a
cognitive-behavioral perspective.
It
goes
without
saying
that
not all
individuals
or
diagnoses
are
amenable
to
brief

referral
to an
appropri-
ate
therapeutic group
or
psychoeducational group.
The
second part
of the
book
offers
a
framework
for
assessing special circumstances, such
as
those involving
a
danger
to
self,
danger
to
others,
the
gravely disabled, spousal abuse/
domestic violence,
and so
forth. Additionally, this section

increasing client competency.
The
information
in
this section
is to be
used
as an
educational resource
and as
homework
related
to
various issues
and
needs presented
by
clients. This information
is
designed
to
sup-
port
cognitive-behavioral therapeutic interventions,
to
facilitate
the
client's increased under-
standing
of

part
of the
book
offers
a
continuum
of
clinical/business forms.
The
develop-
ment
of
forms
is
extremely time consuming. Some
of the
forms
have only minor variations
due
to
their
specificity,
and in
some cases they simply
offer
the
therapist
the
option
of

basic
framework
of
such
forms
continues
to
offer
a
substantial time-saving advantage.
This
text
is a
compilation
of the
most
frequently
needed
and
useful
information
for the
time-conscious therapist
in a
general clinical practice.
To
obtain thorough utilization
of the
resources provided
in

in
this book
is
substan-
tial,
each user
of
this text must consider
her or his own
expertise
in
providing
any
services.
Professional
and
ethical guidelines require
that
any
therapist providing clinical services
be
competent
and
have appropriate education, training, supervision,
and
experience. This
would include
a
professional ability
to

chological
services
to
have
a
thorough
appreciation
and
understanding
of the
influence
of
ethnic
and
cultural
differences
in
one's case conceptualization
and
treatment,
and to see
that
such
sensitivity
is
always utilized.
xx
Level
of
Patient

Problem
Solving
Choices/Alternatives
Self
efficacy
Education
Prevention
Didactic/educational Groups
Community/church
based support groups
Therapeutic classes/groups
focused
on
developmental Issues
Recommended
reading
2.
Patient
demonstrates
mild-to-
moderate symptomology which
interferes
with adaptive
functioning
Cognitive
restructing
Behavior
Modification
Decrease symptomology
Self

self-management
Stabilization
Daily
activity schedule
Productive/pleasurable activities
Symptom management
Development
and
utilization
of
social supports
Urgent care
Intensive
outpatient (OP)
Reinitiate
outpatient treatment with
possible
increased frequency
Medication evaluation/monitoring
Therapeutic/educational groups
Case management
4.
Patient demonstrates
severe
symptomology
Danger
to
self
Danger
to

outpatient
Partial
hospitalization
23-hour unit
Inpatient treatment
Safely
maintained
in
structural/monitored
setting with adequate social support
Home health intervention
Reinitiate
individual treatment when adequately stabilized
5.
Patient demonstrating
acute symptomology
Provide
safe
environment
and
rapid stabilization
Stabilization
Decreased symptomology
Psychopharmacology
Monitoring
Increased
OP
therapy contact
Urgent
care

Urgent
care
Partial
hospitalization
Intensive
OP
Individual
therapy
Support group
Medication monitoring
Case
management
a
Treatment
goals
are
cumulative,
i.e.,
a
patient
at a
functioning level
of 6
with
acute
symptomology
may
include
treatment
goals