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Issues Discussed In This Therapy Session

Affect, Emotion or Mood:

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afraid to be alone

anger

anxiety

anxiety about driving

ashamed

clt. not feeling well

depressive symptoms

disappointed

disorganized speech

displayed blunted affect

embarrassed

fear of abandonment

fear of embarrassment

fear of engulfment

fear of failure

fear of flying

fear of leaving the house

fear of loss of control

fear of medication

fear of own neediness

fear of relapse

fear of what other people think

fears being rejected

feeling abandoned

feeling aggravated

feeling agitated

feeling anxious

feeling apprehensive

feeling blamed

feeling calm

feeling confused

feeling content

feeling criticized

feeling depressed

feeling despondent

feeling disrespected

feeling entitled

feeling frustrated

feeling ignored

feeling inadequate

feeling irritable

feeling judged

feeling needy

feeling numb

feeling overwhelmed

feeling powerless

feeling resentful

feeling responsible

feeling sad

feeling scared

feeling unappreciated

feeling unfulfilled with current career

feeling unloved

feeling unmotivated

feeling unworthy

feeling useless

feeling victimized

feeling worried

feelings of emptiness

feels invisible, unseen

flat

flat affect

guilt

irritability

lonely

overreactive

relief

resentment

upbeat

worried

Behavior:

alcohol use

attempting to "get my life in order"

avoiding all things that are reminders of the sexual assault

avoiding being alone

avoiding uncomfortable situations

clt. no show to session

clt. rescheduled therapy appoinment

dealing with rudeness

difficulty assessing the nature of relationships

difficulty coping with the terminal illness of a family member

difficulty letting go of ended relationship

difficulty maintaining a reasonable diet

difficulty relaxing

difficulty trusting

disorganized behavior

doing healthy behaviors (exercise, eating balanced diet, getting sufficient sleep)

experimentation phase of substance abuse

frequent crying

going through a breakup

going through a divorce

going through a separation

having an affair

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hypervigilant

impulsive

in recovery from substance abuse

inability to engage in social activity due to anxiety

inability to make decisions

inability to tolerate own emotions

indecisive

insufficient exercise

obsessing

passive-aggressive

procrastination

rejecting others before being rejected

relationship problems

road rage

self abusive cutting behavior

social isolation

spending too much time in socially isolated activities

suicide attempt

watching an excessive amount of television

Family or Partner Interactions:

acquiescing to family's preferences but feeling resentful

acquiescing to partner's preferences but feeling resentful

alcoholism of a parent

alcoholism of a spouse or partner

ambivalence about a relationship

arguing with family

arguing with partner

caregiving role with an ill partner

child acting out

concern about an adult child

concern about an aging grandparent

concern about an aging parent

concern about child acting out

concern about grandchild or grandchildren

concern over child with special needs, or medical issues

concerned about effects of divorce on children

coping with changes resulting from forming a new relationship

dealing with verbal abuse from partner

death of a grandparent

death of a parent

difficulty discussing sexual behavior with a partner

difficulty ending relationship

difficulty setting boundaries

disagreement over child rearing practices

disagreement over household responsibilities

disagreement over how money is spent

disagreement with a partner over the frequency of sexual interaction

disappointment in the behavior of a partner

disappointment that family is emotionally unsupportive

domestic violence

emotional intimacy issues

estranged from family

how conflict was handled in the family of origin

lack of trust

lacking a social network of other couples

left unsupervised for extended periods

maintaining more involvement with an ex-spouse than desired

molest by a family member when the patient was a child

partner maintaining more involvement with ex-spouse than patient desires

physical abuse by a parent when the patient was a child

sexually assaulted by partner or spouse

taking a child role with a partner

taking a parental role with a partner

unspoken expectations

unstable relationships

verbal abuse by a parent when the patient was a child

wanting emotional distance from a partner

wanting emotional intimacy with a partner

wants to end relationship

Interpersonal Interactions:

conflict with fellow student(s)

conflicts with management at work

difficulty interpreting the behavior of others

difficulty maintaining interpersonal boundaries

disappointment in the behavior of a friend

experiencing harassment in the workplace

has high expectations of others

holding grudges

how current behavior parallels patient's role in the family of origin

identify grief triggers

interpersonal conflict with a coworker

interpersonal conflict with a friend

interpersonal conflict with a neighbor

molestation by an acquaintance/friend during childhood

poor social skills

sexual assault by an acquiantance

Medical Problems or Physical Concerns:

adjustment to life threatening illness

dealing with a physical disability

dealing with an occupational injury

diabetes

eating disorder

experiencing side effects of psychiatric medication

fatigue

headaches

hiv/aids

impending artifical insemination

irregular pap smear

medical and mobility problems due to weight

multiple sclerosis

patient obsessing over recent physical diagnosis

physical pain

poor body image

restless sleep

sleep disturbances

stomach problems

Thoughts:

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catastrophizing

client reports having thoughts about hurting others. frequency: sometimes or often? plan? hx of violent behavior? identified person(s)? action taken if homicidal ideation high: person contacted/warned? police notified? 5150?

doubting ability to have a healthy relationship

figuring out goals

flashbacks of trauma

homicidal

hopelessness

intrusive thoughts or flashbacks of sexual assault

irrational thinking

lack of self esteem

negative intrusive thoughts

obsessive thoughts about food

obsessive thoughts of being punished

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ruminating

suicidal ideation

suicidality

systemic, high functioning asperger stylized thinking

unfulfilled expectations

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Unclassified, Miscellaneous:

academic difficulties

birth of child with down's syndrome

case conference

concern about impending psych internship

considering gastric bypass/weight loss surgery

dealing with stressful situations at work

developmentally delayed

difficulty finding a job

difficulty holding on to a job

financial problems

having placed disabled child for adoption

having repeated nightmares about experience of child sexual abuse

loss of job

molest by a stranger when the patient was a child

one person is on active duty/deployed overseas

patient not allowed to return to work

pms

rape

recieved a poor performance evaluation at work

unhappy with job

unspecified learning disability

whether jury duty is feasible or would result in substantial emotional difficulty

whether this patient can sustain the concentration and attention necessary for jury duty

Clincal Observations / Mental Status

adequate grooming

confusion

cyberporn or excessive time spent in compulsed sexual behavior

digressive speech

experiences auditory hallucinations

experiences episodes of dissociation

experiences visual hallucinations

expresses ideas of reference

expresses paranoid ideation

frequent crying

good eye contact

neatly dressed

nervous laughter

oriented in time

oriented to person

oriented to place

parents are disengaged

poor eye contact

press on speech

well groomed

Interventions Used In This Therapy Session

active listening to help clarify feelings

advised patient to seek a medication evaluation

assertiveness training

assessment and admission to hospital partial program

assigned journaling

assist in dealing with retirement issues

assisting with identification of strengths and weaknesses

behavioral rehearsal

biofeedback

brainstorm different choices

case management

challenged patient's denial

challenged patient's procrastination

challenging depressive thoughts

cognitive behavioral therapy

communication skills training

community referral - sex and love addicts anonymous

created a new ritual for christmas

crisis intervention

develop no-suicide contract

discussed partial hospitalization

discussed possible projections the patient may be making

discussed the effects of excessive caffeine

discussed the most likely outcome of current patient behaviors

discussed voluntary hospitalization

education about and identifying feelings

encouraged individuation

encouraged patient to use thought stopping

encouraged patient to use thought substitution

explained use of thought records to achieve balanced thoughts

explored childhood experiences

explored history of relationships

explored schemas in a relationship

exploring family conflict

exploring grief feelings

family therapy

gave book recommendation

genogram

giving examples of boundaries and appropriate ways to set boundaries

grief therapy

harm reduction/abstinence

helped client take inventory of progress made in therapy

identify anger triggers

identifying and challenging irrational thoughts

identifying and creating needs list

in depth assessment for generalized anxiety disorder and social phobia

made suicide assessment

parent training

play therapy

positive reinforcement

provide instructions for deep muscle relaxtion to reduce anxiety

psychoeducation about normal reactions to trauma

psychoeducation regarding tactics of abusive people

referral to a 12-step program

referral to anger management group

referral to domestic violence support group

referral to psychiatrist for medication evaluation

referral to rape survivors group

referred to domestic violence victim's class

referred to parenting class

reframed the situation to point out client's strengths

reframing an event so that it is perceived as less negative

reinforce adult to adult interactions

reinforce efforts to be more physically active

reinforce efforts to be more socially active

relaxation skills training

relaxation, emdr, or hypnosis to decrease anxiety

roleplaying a conflict with another person

roleplaying internal conflicts

safety planning

social skill training

systematic desensitization to reduce anxiety about a feared event

teaching conflict resolution

teaching use of "I" messages

Changes Patient Has Made

able to identify distorted thinking

able to set boundaries within a friendship

altered unrealistic expectations of others

began taking anti-anxiety medication

began taking antidepressant medication

being more assertive

crying less frequently

decreased feeling of guilt

decreased shoplifting

entering into reciprocal relationship

improved interaction with parents

increased communication of needs to loved ones

increased physical activity

increased use of journaling

increasing autonomy

maintained contract for no self harm

more willing to discuss important issues in the therapy session

participated in a social event

positive self-statements

talking more directly and openly to a partner

Obstacles To Progress In Therapy

antidepressant medication has been tried and has not been effective

excessive time on internet

excessive time spent in isolation

family/partner not supportive of patient being in therapy

lack of financial resources to buy medications

lack of resources to pay for therapy

patient reports difficulty tolerating the side effects of medication

poor attendance at therapy sessions

retreats into the primitive defense of withdrawal when challenged

substance abuse

unwilling to consider taking antidepressant medication

Reasons For Lack Of Improvement

family/partner sabotage of therapy progress

frequent episodes of pain inhibit consistent social interactions

lack of adherence to scheduled appointments

receives very little social support

recent medication changes

Progress Made Toward A Treatment Goal

becoming more assertive

client able to recognize anger triggers

client increased ability to verbalize feelings increased insight

client reports consistent use of healthy coping skills

client self-advocating to file disability claim

consistently taking psychiatric medication

contact documentation

decreased sleep disturbances

exercising more often

fewer negative intrusive thoughts

has begun to do volunteer work

has started working part time

increase in insight

increase time spent in pleasurable activities

increased ability to advocate for self

increased ability to identify feelings

increased empowerment

increased time spent in family focused activity

socializing more frequently

started back to school

termination process