| SHORT-TERM OBJECTIVES | THERAPEUTIC INTERVENTIONS |
| 1. Tell the story of the parents' separation or divorce. (1) | 1. Actively build the level of trust with the client through consistent eye contact, active listening, unconditional positive regard, and warm acceptance to improve his/her ability to tell the story of the parents' separation or divorce. |
| 2. Identify and express feelings related to the parents' separation or divorce. (2, 3, 4) | 2. Explore, encourage, and support the client in verbally expressing and clarifying his/her feelings associated with the separation or divorce (or assign “Initial Reaction to Parents' Separation” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). 3. Use the empty-chair technique to help the client express mixed emotions he/she feels toward both parents about the separation or divorce. 4. Ask the client to keep a journal in which he/she records experiences or situations that evoke strong emotions pertaining to the divorce; review the journal in therapy sessions. |
| 3. Describe how the parents' separation or divorce has impacted personal and family life. (5) | 5. Develop a timeline where the client records significant developments that have positively or negatively impacted his/her personal and family life, both before and after the divorce. Allow the client to verbalize his/her feelings about the divorce and subsequent changes in the family system (or assign “Impact of Parents' Separation/Divorce” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). |
| 4. Complete a substance abuse evaluation and comply with the recommendations offered by the evaluation findings. (6, 7, 8) | 6. Arrange for or conduct a substance abuse evaluation and refer the client for treatment if indicated (see the Substance Use chapter in this Planner). 7. Explore the client's underlying feelings of depression, insecurity, and rejection that led him/her to escape into substance abuse. 8. Assist the client in constructing and signing an agreement to refrain from using substances. |
| 5. Provide behavioral, emotional, and attitudinal information toward an assessment of specifiers relevant to a DSM diagnosis, the efficacy of treatment, and the nature of the therapy relationship. (9, 10, 11, 12, 13) | 9. Assess the client's level of insight (syntonic versus dystonic) toward the “presenting problems” (e.g., demonstrates good insight into the 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 acknowledgment of the “problem described,” is not concerned, and has no motivation to change). 10. 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 appropriate (e.g., increased suicide risk when comorbid depression is evident). 11. Assess for any issues of age, gender, or culture that could help explain the client's currently defined “problem behavior” and factors that could offer a better understanding of the client's behavior. 12. Assess for the severity of the level of impairment to the client's functioning to determine appropriate 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). 13. Assess the client's home, school, and community for pathogenic care (e.g., persistent disregard for the child's emotional needs or physical needs, repeated changes in primary caregivers, limited opportunities for stable attachments, persistent harsh punishment, or other grossly inept parenting). |
| 6. Express thoughts and feelings within the family system regarding parental separation or divorce. (14, 15, 16) | 14. Assist the client in developing a list of questions about the parents' divorce, then suggest ways he/she could find possible answers for each question (e.g., asking parents directly, writing parents a letter). 15. Hold family therapy sessions to allow the client and siblings to express feelings about the separation or divorce in the presence of the parents (or assign the client to complete and share “My Thoughts, Feelings, and Beliefs About Divorce” from the Adolescent Psychotherapy Homework planner by Jongsma, Peterson, and McInnis). 16. Encourage the parents to provide opportunities (e.g., family meetings) at home to allow the client and siblings to express feelings about separation/divorce and subsequent changes in family system. |
| 7. Recognize and affirm self as not being responsible for the parents' separation or divorce. (17, 18) | 17. Explore the factors contributing to the client's feelings of guilt and self-blame about parents' separation or divorce; assist him/her in realizing that his/her negative behaviors did not cause parents' divorce to occur (recommend Now What Do I Do?: A Guide to Help Teenagers With Their Parents' Separation or Divorce by Cassella-Kapusinski; or The Divorce Workbook for Teens: Activities to Help You Move Beyond the Breakup by Schab). 18. Assist the client in realizing that he/she does not have the power or control to bring the parents back together. |
| 8. Parents verbalize an acceptance of responsibility for the dissolution of the marriage. (19, 20) | 19. Conduct family therapy sessions where parents affirm the client and siblings as not being responsible for separation or divorce. 20. Challenge and confront statements by parents that place blame or responsibility for separation or divorce on the children. |
| 9. Identify positive and negative aspects of the parents' separation or divorce. (21) | 21. Give a homework assignment in which the client lists both positive and negative aspects of parents' divorce; process the list in the next session and allow him/her to express different emotions. |
| 10. Identify and verbalize unmet needs to the parents. (22, 23) | 22. Give the parents the directive of spending 10 to 15 minutes of one-on-one time with the client and siblings on a regular or daily basis to identify and meet the children's needs (consider assigning “One-on-One” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). 23. Assign the client homework in the middle stages of therapy to help him/her list unmet needs and identify steps he/she can take to meet those needs (or assign the “Unmet Emotional Needs—Identification and Satisfaction” exercise from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). |
| 11. Reduce the frequency and severity of acting-out, oppositional, and aggressive behaviors. (24, 25) | 24. Empower the client by reinforcing his/her ability to cope with the divorce and make healthy adjustments. 25. Assist the client in making a connection between underlying painful emotions about divorce and angry outbursts or aggressive behaviors (or assign “Surface Behavior/Inner Feelings” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). |
| 12. Express feelings of anger about the parents' separation or divorce through controlled, respectful verbalizations and healthy physical outlets. (26, 27) | 26. Assist the client in identifying appropriate and inappropriate ways for the client to express anger about parents' separation or divorce. 27. Teach relaxation and/or guided imagery techniques to help the client learn to control anger more effectively (or assign “Progressive Muscle Relaxation” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). |
| 13. Parents verbally recognize how their guilt and failure to follow through with limits contributes to the client's acting-out or aggressive behaviors. (28, 29) | 28. Encourage and challenge the parents not to allow guilt feelings about the divorce to interfere with the need to impose consequences for oppositional-defiant behaviors. 29. Assist the parents in establishing clearly defined rules, boundaries, and consequences for acting-out, oppositional, or aggressive behaviors (or assign “Clear Rules, Positive Reinforcement, Appropriate Consequences” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). |
| 14. Complete school homework assignments on a regular basis. (30, 31) | 30. Assist the parents in establishing a new study routine to help the client complete homework assignments (or assign “Break It Down Into Small Steps” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). 31. Design and implement a reward system and/or contingency contract to reinforce completion of school and homework assignments or good academic performance. |
| 15. Decrease the frequency of somatic complaints. (32) | 32. Refocus the client's discussion from physical complaints to emotional conflicts and the expression of feelings. |
| 16. Noncustodial parent verbally recognizes his/her pattern of overindulgence and begins to set limits on money and/or time spent in leisure or recreational activities. (33) | 33. Explore the noncustodial parent's pattern of trying to win the favor of his/her child; encourage the noncustodial parent to set limits on the client's misbehavior and refrain from overindulging the client during visits. |
| 17. Noncustodial parent assigns household responsibilities and/or requires the client to complete homework during visits. (34) | 34. Encourage the noncustodial parent to assign a chore or have the client complete homework assignments during visits to reinforce the supervisory role of the parent. |
| 18. Reduce the frequency of immature and irresponsible behaviors. (35, 36) | 35. Teach how enmeshed or overly protective parents reinforce the client's immature or irresponsible behaviors by failing to set necessary limits. 36. Have the client and parents identify age-appropriate ways for the client to meet his/her needs for affiliation, acceptance, and approval. Process the list and encourage the client to engage in age-appropriate behaviors. |
| 19. Parents cease making unnecessary, hostile, or overly critical remarks about the other parent in the presence of the children. (37) | 37. Confront and challenge the parents to cease making unnecessary hostile or overly critical remarks about the other biological parent in the presence of the client (or assign the client to complete and share “Stop the Fighting” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). |
| 20. Parents recognize and agree to cease the pattern of soliciting information about and/or sending messages to the other parent through the children. (38, 39) | 38. Counsel the parents about not placing the client in the middle by soliciting information about the other parent or sending messages about adult matters through the client to the other parent (recommend The Co-Parenting Survival Guide: Letting Go of Conflict After a Difficult Divorce by Thayer and Zimmerman or New Beginnings for Divorcing Parents: Co-Parenting Divorce Workbook by Turner). 39. Challenge and confront the client about playing one parent against the other to meet needs, obtain material goods, or avoid responsibility. |
| 21. Disengaged or uninvolved parent follows through with recommendations to spend greater quality time with the client. (40, 41) | 40. Hold individual and/or family therapy session to challenge and encourage the noncustodial parent to maintain regular visitation and involvement in the client's life. 41. Give a directive to the disengaged or distant parent to spend more time or perform a specific task with the client (e.g., go on an outing to the mall, assist the client with homework, work on a project around the home). |
| 12. Identify and express feelings through artwork and music. (42, 43) | 42. Ask the client to draw a variety of pictures that reflect his/her feelings about the divorce, family move, or change in schools. 43. Instruct the client to sing a song or play a musical instrument that reflects his/her feelings about separation or divorce, then have the client verbalize times when he/she experienced those feelings. |
| 23. Increase participation in positive peer group, extracurricular, or school-related activities. (44) | 44. Encourage the client to participate in school, extracurricular, or positive peer group activities to offset the loss of time spent with the parents. |
| 24. Attend a support group for children of divorce. (45) | 45. Refer the client to group therapy to help him/her share and work through feelings with other adolescents whose parents are divorcing. |
| 25. Increase contacts with adults and build a support network outside the family. (46) | 46. Identify a list of adult individuals (e.g., school counselor, neighbor, uncle or aunt, Big Brother or Big Sister, clergyperson) outside the family who the client can turn to for support and guidance to help cope with the divorce. |
| 26. Identify and verbalize the feelings, irrational beliefs, stressors, and needs that contribute to sexually promiscuous or seductive behaviors. (47, 48) | 47. Provide sex education and discuss the risks involved with sexually promiscuous or seductive behaviors. 48. Explore the client's feelings, irrational beliefs, stressors, and unmet needs that contribute to the emergence of sexually promiscuous or seductive behaviors (or assign “Connecting Sexual Behavior with Needs” and/or “Looking Closer at My Sexual Behavior” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). |
| Axis I: | 309.0 | Adjustment Disorder With Depressed Mood |
| 309.24 | Adjustment Disorder With Anxiety | |
| 309.28 | Adjustment Disorder With Mixed Anxiety and Depressed Mood | |
| 309.3 | Adjustment Disorder With Disturbance of Conduct | |
| 309.4 | Adjustment Disorder With Mixed Disturbance of Emotions and Conduct | |
| 300.4 | Dysthymic Disorder | |
| 300.02 | Generalized Anxiety Disorder | |
| 309.21 | Separation Anxiety Disorder | |
| 313.81 | Oppositional Defiant Disorder | |
| 300.81 | Undifferentiated Somatoform Disorder | |
| Axis II: | 799.9 | Diagnosis Deferred |
| V71.09 | No Diagnosis |
| ICD-9-CM | ICD-10-CM | DSM-5 Disorder, Condition, or Problem |
| 309.0 | F43.21 | Adjustment Disorder, With Depressed Mood |
| 309.24 | F43.22 | Adjustment Disorder, With Anxiety |
| 309.28 | F43.23 | Adjustment Disorder, With Mixed Anxiety and Depressed Mood |
| 309.3 | F43.24 | Adjustment Disorder, With Disturbance of Conduct |
| 309.4 | F43.25 | Adjustment Disorder, With Mixed Disturbance of Emotions and Conduct |
| 300.4 | F34.1 | Persistent Depressive Disorder |
| 300.02 | F41.1 | Generalized Anxiety Disorder |
| 309.21 | F93.0 | Separation Anxiety Disorder |
| 313.81 | F91.3 | Oppositional Defiant Disorder |
| 300.81 | F45.1 | Somatic Symptom Disorder |
| V61.03 | Z63.5 | Disruption of Family by Separation or Divorce |
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.