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 Amsterdam Boston London New York Oxford Paris San Diego San Francisco Singapore Sydney Tokyo This book is printed on acid-free paper. (cid:2)∞ Copyright © 2004, Elsevier, Inc. All Rights Reserved. No part of this publication may be reproduced or transmitted in any 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, fax: (+44) 1865 853333, e-mail: [email protected]. You may also complete your request on-line via the Elsevier homepage (http://elsevier.com), by selecting “Customer Support” and then “Obtaining Permissions.” Academic Press An imprint of Elsevier 525 B Street, Suite 1900, San Diego, California 92101-4495, USA http://www.academicpress.com Academic Press 84 Theobald’s Road, London WC1X 8RR, UK http://www.academicpress.com 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 Intervention xxi Levels of Functioning and Treatment Associated Considerations xxii High-Risk Situations in Practice xxiii Treatment Plan xxiv Solution-Focused Approach to Treatment xxv Case Conceptualization xxvi Common Axis 1 and Axis 2 Diagnoses xxviii Chapter 1 TREATMENT PLANNING: GOALS, OBJECTIVES, 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 • Eating Disorder (EDO) 18 Preventing Weight and Body Image Problems in Children 24 Recommendations for Family Members of Anorexic Individuals 25 Identity Disorder 26 Children 28 Organic Mental Syndromes and Disorders 31 v Dementia 32 Dementia and Organic Mental Disorders 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 Disorders 45 Thought Disorders 45 • Phases of Treatment 49 Treatment Settings 49 • Summary of Treatment Recommendations for Patients with Perceptual Disturbances 49 Mood Disorders 51 Depression 52 • Depression Co-occurring with other Illness 56 Mania 58 • 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 Somatoform Disorders 72 Somatoform Disorders 72 • Psychosomatic Illness and Personality Disorder 75 Interpreting Functional Presentations of Symptomology 77 Dissociative Disorders 78 Dissociative Disorders 78 Sexual Disorders 80 Sexual Disorders 80 Adjustment Disorders 81 Adjustment Disorders 82 Impulse Control Disorders 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 Schizoid Personality Disorder 98 • Histrionic Personality Disorder 99 Narcissistic Personality Disorder 100 Borderline Personality Disorder 101 Physical Factors Affecting Psychological Functioning 104 Stages of Adjustment 105 vi Contents Chapter 2 ASSESSING SPECIAL CIRCUMSTANCES Assessing Special Circumstances 109 Cognitive-Behavioral Assessment 109 • 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 Suicide Risk Relapse 118 Dangerousness 119 Dangerousness Assessment Outline 120 • Clarifying Risk of Harm 121 Treatment Focus and Objectives 122 Cycle of Phobic Anxiety 124 Obsessional Disorders: An Overview 125 Assessment of Obsessional Disorders (OD) 125 Gravely Disabled 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 • Financial 129 • Shopping 129 Transportation 130 Chronic Mental Illness (CMI) 130 General Guidelines for Assessing the Chronic Mentally III 131 Crisis Evaluation 132 Crisis Intervention 133 Critical Incident Stress Debriefing (CISD) 134 • Screening for Survivors 135 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 141 • Postpartum Crisis Psychosis 143 • How to Break the Postpartum Cycle 144 Professional Guidelines for Crisis Intervention 145 Self-Care Behaviors 146 Counseling the Individual in a Medical Crisis 147 Treatment Framework and Conceptualization 148 The Central Crisis Issue 149 Dealing with the Challenges of Long Term Illness 151 Working Through the Challenges and Fears Associated with Long-Term Illness 154 vii Contents Chronic Pain: Assessment and Intervention 157 Factors Affecting the Experience of Pain 157 • Clinical Interview 158 Assessment and Measuring Pain 158 Pain Identification Chart 160 Location and Type of Pain 160 Pain Management Scale 161 Interventions for Chronic Pain 162 • Six Stages of Treatment 162 Interventions 162 Somatic Problems: A Brief Review 164 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 Chemical Dependency Assessment 179 Chemical Dependency Psychological Assessment 182 Withdrawal Symptoms Checklist 185 Psychological 185 • Somatic 185 Spousal/Partner Abuse 187 Assessing Spousal/Partner Abuse 187 The Stage Model of Domestic Violence 191 Assessing for Domestic Violence 192 Intervention Categories 193 Counseling Victims of 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 199 Ability of the Parent to Bond and Other Pertinent Information 199 Child Custody Evaluation Report Outline 200 • Parental Behavior 201 Interaction Between Parent-Child(Ren) 201 • Bonding Study Versus Custody Evaluation 201 Parental Alienation Syndrome 202 Parental Programming 202 • Subtle and Unconscious Influencing 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 Disposition Considerations for Families where Parental Alieneation Occurs 207 Questions to Ask Children 208 • Questions to Ask the Parents 209 Parental Alienation Syndrome Treatment 209 Visitation Rights Report 211 Visitation Rights Report 211 Dispositional Review: Foster Placement; Temporary Placement 211 Dispositional Review Report Outline 212 Psychiatric Work-Related Disability Evaluation 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 • Developmental History 215 • Social History (Distinguish Prior to Disability, Disability Concurrent, After Injury) 215 Mental Status Exam 215 • Review of Medical Record 215 Findings from Psychological Assessment 215 • Interviews With Collateral Sources and Review of Employment or Personnel Records (Compare Description of Industrial 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 • Competency to Plead and/or Confess 220 Competency to Stand Trial 220 • Mental Status at Time of Offense 220 Chapter 3 SKILL-BUILDING RESOURCES FOR INCREASING SOCIAL COMPETENCY What is Stress? 223 Stress Review 225 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 for Stress Management 230 ix Contents