DIVORCE REACTION

CLIENT PRESENTATION

  1. Reduced Contact With a Parent (1)1
    1. The client has had infrequent or no contact with one of his/her parents since the separation or divorce.
    2. The client was guarded and reluctant to talk about the infrequency or loss of contact with one of his/her parents.
    3. The client expressed feelings of sadness, hurt, and disappointment about the infrequency or loss of contact with one of his/her parents.
    4. The client verbalized strong feelings of anger about the limited contact with one of his/her parents.
    5. The client has worked through many of his/her emotions surrounding the infrequency or loss of contact with one of his/her parents.
  2. Intense Emotional Outbursts/Sudden Shifts in Mood (2)
    1. The client has exhibited frequent, intense emotional outbursts and sudden shifts in mood since the separation or divorce.
    2. The client acknowledged that he/she has difficulty controlling his/her emotions when discussing topics related to the separation or divorce.
    3. The client exhibited a wide range of emotions when discussing the separation or divorce.
    4. The client's moods have begun to stabilize as he/she works through his/her feelings about the separation or divorce.
  3. Substance Abuse (3)
    1. The client has engaged in a significant amount of substance abuse since his/her parents' separation or divorce.
    2. The client acknowledged that he/she has often turned to alcohol or drug abuse to block out the emotional pain related to his/her parents' separation or divorce.
    3. The client verbalized an awareness of the negative consequences or potential dangers associated with his/her substance abuse.
    4. Instead of turning to drug or alcohol abuse, the client has started to develop more adaptive coping mechanisms to help him/her deal with the stress and emotional pain surrounding the separation or divorce.
    5. The client stated that he/she has terminated his/her substance abuse.
  4. Feelings of Grief and Sadness (4)
    1. The client has experienced strong feelings of grief and sadness since his/her parents' separation or divorce.
    2. The client was visibly sad when talking about his/her parents' separation or divorce.
    3. The client has begun to work through his/her feelings of grief and sadness about the separation or divorce.
    4. The client's affect appeared more happy and/or contented in today's therapy session.
    5. The client reported a significant recent reduction in the frequency and severity of his/her depressed mood.
  5. Low Self-Esteem (4)
    1. The client's self-esteem has decreased significantly since his/her parents' separation or divorce.
    2. The client verbalized feelings of low self-esteem, inadequacy, and insecurity.
    3. The client has begun to take steps to improve his/her self-esteem and develop a positive self-image.
    4. The client expressed positive self-descriptive statements during today's therapy session.
    5. The client has developed a healthy self-image after working through many of his/her feelings surrounding his/her parents' separation or divorce.
  6. Social Withdrawal (4)
    1. The client has become significantly more withdrawn and isolated since his/her parents' separation or divorce.
    2. The client appeared very quiet and withdrawn during today's therapy session and initiated few conversations.
    3. The client has gradually started to socialize more often with his/her peers.
    4. The client was more communicative and outgoing during today's therapy session.
  7. Feelings of Guilt/Self-Blame (5)
    1. The client expressed feelings of guilt about having in some way caused his/her parents' divorce.
    2. The client has continued to hold onto the unreasonable belief that he/she behaved in some manner that either caused his/her parents' divorce or failed to prevent it from occurring.
    3. The client has started to work through his/her feelings of guilt about his/her parents' separation or divorce.
    4. The parent(s) verbalized that the client is not responsible for the separation or divorce.
    5. The client has successfully worked through his/her feelings of guilt and no longer blames himself/herself for the parents' separation or divorce.
  8. Oppositional, Acting Out, and Aggressive Behaviors (6)
    1. The client has exhibited a significant increase in the frequency and severity of his/her oppositional, acting out, and aggressive behaviors since his/her parents' separation or divorce.
    2. The client appeared angry and irritable when discussing the separation or divorce.
    3. The frequency of the client's oppositional, acting out, and aggressive behaviors have gradually started to diminish.
    4. The client has recently demonstrated good self-control and has not engaged in a significant amount of oppositional, acting out, or aggressive behaviors.
    5. The client has successfully worked through many of his/her feelings surrounding the separation or divorce and has demonstrated a significant reduction in the frequency and severity of his/her oppositional, acting out, and aggressive behaviors.
  9. Decline in School Performance (7)
    1. The client's school performance has declined markedly since his/her parents' separation or divorce.
    2. The client verbalized that he/she has experienced a loss of interest or motivation to achieve academic success since the separation or divorce.
    3. The client has experienced a renewed interest in his/her schoolwork and has begun to take steps to improve his/her academic performance.
    4. The client reported completing his/her school or homework assignments on a regular basis.
  10. Sexually Promiscuous Behavior (8)
    1. The client described a pattern of engaging in sexually promiscuous or seductive behavior since his/her parents' separation or divorce.
    2. The client acknowledged that he/she has engaged in sexually promiscuous or seductive behavior to compensate for the loss of security or support within the family system.
    3. The client verbalized an awareness of the negative consequences and potential dangers associated with his/her sexually promiscuous behavior.
    4. The client has demonstrated good control over his/her sexual impulses and has not engaged in any risky or irresponsible sexual behavior.
  11. Pseudomaturity (9)
    1. The client has responded to his/her parents' separation or divorce by displaying an air of pseudomaturity.
    2. The client presented with a facade of pseudomaturity and coolly denied being troubled by any painful emotions about his/her parents' separation or divorce.
    3. The client has responded to the separation or divorce by often assuming parental roles or responsibilities.
    4. The client verbalized an awareness that his/her willingness to take on many parental roles or responsibilities has prevented him/her from meeting his/her own emotional or social needs.
    5. The client has achieved a healthy balance between fulfilling his/her school or household responsibilities and meeting his/her social and emotional needs.
  12. Psychosomatic Ailments (10)
    1. The client has demonstrated a significant increase in psychosomatic complaints since his/her parents' separation or divorce.
    2. The client complained of not feeling well when the issue of his/her parents' separation or divorce was being discussed.
    3. The client was resistant to the interpretation that his/her psychosomatic complaints are related to his/her underlying painful emotions about the separation or divorce.
    4. The client verbalized an understanding of the connection between his/her psychosomatic complaints and anticipated separations, stress, or frustration related to the parents' marital conflict.
    5. The client has demonstrated a significant reduction in the frequency of his/her psychosomatic complaints.
  13. Loss of Contact With Positive Support Network (11)
    1. The client has experienced a loss of contact with his/her previous support network due to his/her geographic move.
    2. The client expressed feelings of sadness about having to move after his/her parents' separation or divorce because it resulted in a loss of contact with his/her previous support network.
    3. The client expressed feelings of anger about having to move after his/her parents' separation or divorce.
    4. The client has taken active steps to build a positive support network since moving to a new geographic area.
    5. The client reported establishing a strong, supportive social network outside of his/her immediate family.

INTERVENTIONS IMPLEMENTED

  1. Build Therapeutic Trust (1)2
    1. The objective of today's therapy session was to establish trust with the client so that he/she can begin to express and work through his/her feelings related to the parents' separation or divorce.
    2. Attempts were made to build the level of trust with the client through consistent eye contact, active listening, unconditional positive regard, and warm acceptance.
    3. The therapy session was helpful in building a level of trust with the client.
    4. The therapy session was not successful in establishing trust with the client, as he/she remained guarded in sharing his/her feelings about the separation or divorce.
  2. Explore and Encourage Expression of Feelings (2)
    1. Today's therapy session explored the client's feelings associated with his/her parents' separation or divorce.
    2. The client was assigned the exercise “Initial Reaction to Parents' Separation” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    3. The client was given encouragement and support in expressing and clarifying his/her feelings associated with the separation or divorce.
    4. Client-centered therapy principles were utilized to assist the client in expressing his/her thoughts and feelings about the parents' separation or divorce.
    5. The client made productive use of today's therapy session and was assisted in expressing a variety of emotions related to his/her parents' separation or divorce.
    6. The client remained guarded in sharing his/her feelings regarding the separation or divorce, despite receiving encouragement and support.
  3. Utilize the Empty-Chair Technique (3)
    1. The empty-chair technique was used to help the client express the mixed emotions that he/she feels toward both parents about the separation or divorce.
    2. The empty-chair technique was helpful in allowing the client to identify and express the emotions that he/she feels toward both parents about the separation or divorce.
    3. The client appeared uncomfortable with the use of the empty-chair technique and was reluctant to share the emotions that he/she feels toward both parents about the separation or divorce.
    4. The empty-chair technique was useful in allowing the client to express his/her thoughts and feelings about the custodial and noncustodial parent.
  4. Assign Keeping a Journal (4)
    1. The client was instructed to keep a journal in which he/she records experiences or situations that evoke strong emotions pertaining to the separation or divorce.
    2. Active listening techniques were used as the client shared entries from his/her journal that reflected his/her thoughts and feelings about the separation or divorce.
    3. The use of the journal has proven to be helpful in allowing the client to express and work through his/her feelings about the separation or divorce.
    4. The client has failed to keep a journal reflecting his/her thoughts and feelings about the separation or divorce and was redirected to do so.
  5. Develop a Time Line (5)
    1. The client developed a time line on which he/she recorded significant developments that have positively or negatively impacted his/her family life, both before and after the separation or divorce, and this was reviewed in the session.
    2. The client was assigned the exercise “Impact of Parents' Separation/Divorce” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    3. The use of the time line was helpful in allowing the client to express his/her thoughts and feelings about the impact of the separation or divorce on his/her life.
    4. The use of the time line exercise was not helpful in facilitating a discussion about the impact of the parents' separation or divorce on the client's life.
    5. Active-listening skills were used as the client identified a number of positive and negative changes that have occurred within the family system since the parents' separation or divorce.
    6. The client used the time line to express his/her ambivalent feelings about the divorce and the subsequent changes within the family system; he/she was supported as these feelings were discussed.
    7. The client did not develop a time line and was redirected to do so.
  6. Arrange for Substance Abuse Evaluation/Treatment (6)
    1. The client was referred for a substance abuse evaluation to determine whether he/she has developed a substance abuse problem in response to his/her parents' divorce.
    2. The findings from the substance abuse evaluation revealed the presence of a substance abuse problem and the need for treatment.
    3. The chemical dependence evaluation did not reveal the presence of a substance abuse problem or the need for treatment in this area.
    4. The client acknowledged the existence of a substance abuse problem and agreed to follow through with treatment; his/her honesty was acknowledged as a keystone of recovery.
    5. The client denied the existence of a substance abuse problem and voiced his/her objection to seeking treatment in this area; he/she was urged to be more realistic.
  7. Explore Emotional Pain Related to Substance Abuse (7)
    1. Today's therapy session explored the underlying feelings of depression, insecurity, and rejection that have contributed to the client's escape into substance abuse.
    2. A psychoanalytic therapy approach was utilized to explore the etiology of the client's escape into substance abuse.
    3. Client-centered therapy approaches were employed to help the client discover how his/her escape into substance abuse has arisen out of underlying feelings of depression, insecurity, and rejection.
    4. A brief solution-focused therapy approach was used to help the client identify ways to cope with feelings of depression, insecurity, and rejection that are more effective than escaping into substance abuse.
    5. The client identified a list of resource people to whom he/she can turn for support when feeling the urge to drink or use drugs, and he/she was urged to use these supports.
  8. Develop Agreement to Refrain From Using Substances (8)
    1. An agreement was constructed and signed by the client to refrain from using substances.
    2. The client was encouraged to post the signed agreement to refrain from using substances in his/her room or on the refrigerator as a reminder.
    3. The client agreed to follow through with substance abuse treatment if he/she fails to refrain from using substances.
    4. The client refused to sign an agreement that he/she would refrain from using drugs or alcohol, and the focus of treatment was changed to the substance abuse.
  9. Assess Level of Insight (9)
    1. The client's level of insight toward the presenting problems was assessed.
    2. The client was assessed in regard to the syntonic versus dystonic nature of his/her insight about the presenting problems.
    3. The client was noted to demonstrate good insight into the problematic nature of the behavior and symptoms.
    4. The client was noted to be in agreement with others' concerns and is motivated to work on change.
    5. The client was noted to be ambivalent regarding the problems described and is reluctant to address the issues as a concern.
    6. The client was noted to be resistant regarding acknowledgment of the problem areas, is not concerned about them, and has no motivation to make changes.
  10. Assess for Correlated Disorders (10)
    1. The client was assessed for evidence of research-based correlated disorders.
    2. The client was assessed in regard to his/her level of vulnerability to suicide.
    3. The client was identified as having a comorbid disorder, and treatment was adjusted to account for these concerns.
    4. The client has been assessed for any correlated disorders, but none were found.
  11. Assess for Culturally Based Confounding Issues (11)
    1. The client was assessed for age-related issues that could help to better understand his/her clinical presentation.
    2. The client was assessed for gender-related issues that could help to better understand his/her clinical presentation.
    3. The client was assessed for cultural syndromes, cultural idioms of distress, or culturally based perceived causes that could help to better understand his/her clinical presentation.
    4. Alternative factors have been identified as contributing to the client's currently defined “problem behavior,” and these were taken into account in regard to his/her treatment.
    5. Culturally based factors that could help to account for the client's currently defined “problem behavior” were investigated, but no significant factors were identified.
  12. Assess Severity of Impairment (12)
    1. The severity of the client's impairment was assessed to determine the appropriate level of care.
    2. The client was assessed in regard to his/her impairment in social, relational, vocational, and occupational endeavors.
    3. It was reflected to the client that his/her impairment appears to create mild to moderate effects on the client's functioning.
    4. It was reflected to the client that his/her impairment appears to create severe to very severe effects on the client's functioning.
    5. The client was continuously assessed for the severity of impairment, as well as the efficacy and appropriateness of treatment.
  13. Assess for Pathogenic Care (13)
    1. The home, school, and community of the client were assessed for pathogenic care and concerns.
    2. The client's various environments were assessed for the persistent disregard of the child's needs, repeated changes in caregivers, limited opportunities for stable attachment, harsh discipline, or other grossly inept care.
    3. Pathogenic care was identified and the treatment plan included strategies for managing or correcting these concerns and protecting the child.
    4. No pathogenic care was identified and this was reflected to the client and caregivers.
  14. Develop a List of Questions (14)
    1. The client was assisted in developing a list of questions about the parents' separation or divorce.
    2. The client first identified the questions that he/she has about the separation or divorce and then was assisted in exploring possible answers for each question.
    3. The client carefully considered whether he/she wanted to ask the parent(s) specific questions about the separation or divorce; the pros and cons of this choice were reviewed.
    4. The client was encouraged to ask each parent specific questions about the separation or divorce to help him/her gain a greater understanding of the factors contributing to the separation or divorce.
    5. The client decided not to ask specific questions to each parent about the separation or divorce because of the possible negative responses that he/she might receive, and this was accepted.
  15. Facilitate Expression of Feelings (15)
    1. A family therapy session was held to allow the client and his/her siblings to express feelings and ask questions about the separation or divorce in the presence of the parents.
    2. The client was assigned the exercise “My Thoughts and Feelings About Divorce” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    3. The custodial parent was provided with positive feedback for being supportive in allowing the client and siblings to express their feelings and ask questions about the separation or divorce.
    4. The noncustodial parent was provided with positive feedback for being supportive in allowing the client and siblings to express their feelings and ask questions about the separation or divorce.
    5. The custodial parent was redirected when he/she became defensive when the client and siblings began expressing their feelings and asking questions about the separation or divorce.
    6. The noncustodial parent was redirected when he/she became defensive when the client and siblings began expressing their feelings and asking questions about the separation or divorce.
  16. Provide Opportunities at Home to Express Feelings (16)
    1. The parent(s) were encouraged to provide opportunities at home to allow the client and siblings to express their feelings and ask questions about the separation or divorce and subsequent changes in the family system.
    2. The parent(s) were encouraged to hold family meetings at home to allow the client and siblings an opportunity to express their feelings and ask questions about the separation or divorce and subsequent changes in the family system.
    3. The family members were helped to identify healthy and unhealthy ways to express their feelings about the separation or divorce and subsequent changes in the family system.
    4. The parent(s) were encouraged to explore the client's feelings about the separation or divorce and subsequent changes in the family system when he/she becomes more withdrawn or demonstrates an increase in emotional outbursts.
    5. The client and siblings were asked to identify the specific positive changes that they would like to see happen in the family.
    6. The client's parents have not allowed the client to regularly express his/her feelings (in a respectful manner) and were redirected to do so.
  17. Explore Guilt and Self-Blame (17)
    1. Today's therapy session explored and identified the factors contributing to the client's feelings of guilt and self-blame about the parents' separation or divorce.
    2. The client was encouraged to read portions of Now What Do I Do?: A Guide to Help Teenagers with their Parents' Separation or Divorce (Cassella-Kapusinski).
    3. The client was encourage to read portions of The Divorce Workbook for Teens: Activities to Help You Move Beyond the Break Up (Schab).
    4. The client indicated that he/she believes his/her rebellious behavior may have contributed to his/her parents' separation, and he/she was helped to understand that his/her negative behavior did not cause his/her parents' separation.
    5. Today's therapy session did not reveal any specific events that have contributed to the client's feelings of guilt and self-blame about the parents' separation, and he/she denied being troubled by these types of feelings.
    6. The client has continued to hold on to feelings of guilt that his/her negative behaviors caused his/her parents' separation and was provided with additional assurance that he/she is not responsible.
  18. Dissuade Client From Attempts to Reunite Parents (18)
    1. The client was gently confronted with the fact that he/she does not have the power or control to bring his/her parents back together.
    2. The client was confronted regarding his/her belief that his/her negative behavior can help bring his/her parents back together.
    3. The client has acknowledged that he/she does not have the power to decide whether his/her parents will remain together or divorced.
  19. Affirm Client as Not Being Responsible for Separation/Divorce (19)
    1. The custodial parent strongly affirmed that the client and siblings were not responsible for the separation or divorce, and the therapist emphasized this concept.
    2. The noncustodial parent strongly affirmed that the client and siblings were not responsible for the separation or divorce, and the therapist emphasized this concept.
    3. The parent(s) were supported for verbalizing responsibility for the separation or divorce.
    4. The client and siblings responded positively to the parents' affirmation that they are not responsible for the separation or divorce, and the meaning of this affirmation was elaborated.
    5. The client has continued to be troubled by feelings of guilt about his/her parents' divorce despite the parents' statements that he/she is not responsible, and this was normalized.
  20. Confront Blaming by Parents (20)
    1. The custodial parent was challenged and confronted about making statements that place the blame or responsibility for the separation or divorce on the client or siblings.
    2. The noncustodial parent was challenged and confronted about making statements that place the blame or responsibility for the separation or divorce on the client or siblings.
    3. The custodial parent was reinforced for a verbalized commitment to cease making statements that place the blame or responsibility for the separation or divorce on the client or siblings.
    4. The noncustodial parent was reinforced for a verbalized commitment to cease making statements that place the blame or responsibility for the separation or divorce on the client or siblings.
    5. The parent(s) have continued to make statements that place the blame or responsibility for the separation or divorce on the client or siblings despite challenges to cease making such remarks.
  21. List Positive and Negative Aspects of Divorce (21)
    1. The client was given a homework assignment to list both the positive and negative aspects of his/her parents' divorce.
    2. The client was reassured of the normalcy of feeling a variety of emotions while processing both the positive and negative aspects of his/her parents' divorce.
    3. The client was supported as he/she expressed his/her emotions about the negative aspects of his/her parents' divorce but was unable to identify any positive aspects.
    4. The client's failure to complete the homework assignment of listing both the positive and negative aspects of his/her parents' divorce appeared to be due to his/her desire to avoid dealing with any painful emotions, and this was reflected to him/her.
  22. Encourage Parents to Spend Time With Client (22)
    1. The parent(s) were given the directive to spend 10 to 15 minutes of one-on-one time with the client and siblings on a regular or daily basis, in order to identify the client's needs.
    2. The family was assigned the exercise “One-on-One” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    3. It was noted that the one-on-one time spent with the parent(s) has helped the client to decrease his/her feelings of depression.
    4. The client and parents reported that the one-on-one time spent together has helped to improve his/her anger control, and they were encouraged to continue this one-on-one time.
    5. The client and parents reported that they have spent little time together because of their busy schedules, and a specific time to be together was identified.
    6. The client and parents were strongly challenged to spend time together in order to help the client adjust to his/her parents' divorce.
  23. Develop Understanding of Unmet Needs and Help Satisfy Them (23)
    1. The client was assigned homework to list unmet needs and identify the steps that he/she can take to meet those needs.
    2. The client was assigned the “Unmet Emotional Needs—Identification and Satisfaction” exercise from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis) to help him/her identify unmet needs and the steps that he/she can take to meet those needs.
    3. The client completed the “Unmet Emotional Needs—Identification and Satisfaction” exercise, and it was noted that he/she has begun to take steps to meet his/her unmet needs.
    4. The client failed to complete the homework assignment and was asked again to work on it before the next therapy session.
  24. Reinforce Healthy Coping with Divorce (24)
    1. The therapy session focused on empowering the client's ability to cope with his/her parents' divorce.
    2. The client was asked to identify a list of behaviors or signs that would indicate he/she has made a healthy adjustment to the parents' divorce.
    3. The client was reinforced for the positive steps that he/she has taken to adjust to his/her parents' divorce.
    4. The client remains pessimistic and resistant to the idea that he/she can make a healthy adjustment to the divorce, but was encouraged to keep this possibility open.
  25. Connect Painful Emotions to Angry Outbursts (25)
    1. The session was helpful in identifying how the client's underlying, painful emotions about his/her parents' divorce are related to an increase in the frequency of his/her angry outbursts or aggressive behaviors.
    2. The client was assigned the exercise “Surface Behavior/Inner Feelings” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    3. The client was helped to verbalize an understanding of how his/her aggressive behaviors are connected to underlying feelings of sadness, hurt, or disappointment about his/her parents' divorce.
    4. Role-playing and modeling techniques were used to demonstrate appropriate ways for the client to express his/her underlying painful emotions.
    5. The client was asked to list ways to express his/her painful emotions about the divorce that would be more appropriate than reacting impulsively with anger or aggression.
    6. The client denied any connection between painful emotions and angry outbursts and was encouraged to reconsider this connection.
  26. Teach Appropriate versus Inappropriate Anger Expressions (26)
    1. The client was helped to identify appropriate and inappropriate ways to express or control his/her anger about the parents' separation, divorce, or changes in family.
    2. The client was taught mediational and self-control strategies (e.g., relaxation, “stop, listen, think, and act”) to help express anger through appropriate verbalizations and healthy physical outlets.
    3. The client was encouraged to utilize active listening skills to delay the impulse or urge to react with anger or physical aggression when upset about his/her parents' separation, divorce, or changes in family.
    4. The client identified healthy physical outlets for his/her strong feelings of anger and aggressive impulses, and positive feedback was provided.
    5. Despite being taught appropriate anger expression, the client continues to use inappropriate means to express his/her anger about the changes in the family structure and dynamics.
  27. Teach Relaxation or Guided Imagery Techniques (27)
    1. The client was taught relaxation and guided imagery techniques to help control his/her anger.
    2. The client was assigned the exercise “Progressive Muscle Relaxation” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    3. The client reported a positive response to the use of the relaxation or guided imagery technique to help control anger.
    4. The client has failed to consistently use the relaxation or guided imagery technique and, as a result, has continued to display anger control problems; he/she was redirected to the use of these techniques.
  28. Reinforce Parents in Setting Consistent Limits (28)
    1. The parents were strongly encouraged to set firm, consistent limits for the client's acting out, oppositional, or aggressive behaviors and not to allow guilt feelings about the divorce to interfere with the need to impose consequences for such behaviors.
    2. The parent(s) acknowledged the failure to follow through with firm, consistent limits for the client's acting out, oppositional, or aggressive behavior because of guilty feelings about the divorce; brainstorming techniques were used to develop ways to implement consistent limits.
    3. The parents reported that they have begun to set firm, consistent limits and were encour-aged for not allowing their guilt feelings to interfere with the need to impose consequences.
    4. The parents reported that the client has demonstrated improvements in his/her behavior since they began to set firm, consistent limits for his/her acting out, oppositional, or aggressive behavior, and the benefits of these limits were reviewed.
  29. Encourage Parents to Establish Clear Rules (29)
    1. The parents were helped to establish clearly defined rules and boundaries for the client.
    2. The client was assigned the exercise “Clear Rules, Positive Reinforcement, Appropriate Consequences” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    3. The client and parents were helped to identify natural, logical consequences for the client's acting out, oppositional, or aggressive behaviors.
    4. The client was asked to repeat the rules to demonstrate an understanding of the expectations of him/her.
    5. The client verbally disagreed with the rules and expectations identified by the parents, but the right of the parents to set these rules was affirmed.
  30. Assist Parents in Developing Homework Routine (30)
    1. The parents were assisted in establishing a new routine to help the client complete his/her school or homework assignments.
    2. The client and parent(s) were helped to develop a routine schedule of times to increase the completion of homework assignments.
    3. The parents were strongly encouraged to maintain regular communication with the teachers or school officials via phone calls or written notes regarding the client's academic progress.
    4. The client was assigned the exercise “Break It Down into Small Steps” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    5. A consultation was held with the teachers about sending home daily or weekly progress notes informing the parents of how well the client has been doing at completing his/her school or homework assignments.
    6. The parents have not developed a routine to help the client complete his/her school assignments and were redirected to do so.
  31. Develop Reward System to Improve Academic Performance (31)
    1. The client and parents were assisted in identifying a list of rewards to reinforce the client for completing his/her school or homework assignments on a regular basis.
    2. A reward system was designed to reinforce the client for completing his/her school or homework assignments.
    3. The client and parents were directed to sign a contingency contract specifying the consequences for his/her failure to complete school or homework assignments.
    4. The client and parents verbally agreed to the terms of the reward system and/or contingency contract developed to improve academic performance.
    5. The client and parents have not used the reward system to improve academic performance and were redirected to do so.
  32. Explore Relationship of Physical Complaints to Emotional Conflicts (32)
    1. Today's therapy session focused on the relationship between the client's somatic complaints and underlying emotional conflicts associated with the parents' divorce.
    2. Today's therapy session attempted to refocus the discussion away from the client's physical complaints and onto the underlying emotional conflicts and the expression of feelings associated with the parents' divorce.
    3. Today's therapy session explored the secondary gain that is achieved by the client's somatic complaints.
    4. Positive feedback was provided as the client verbally acknowledged that his/her somatic physical complaints are associated with the stress and conflict surrounding his/her parents' divorce.
    5. The client verbalized an understanding of how his/her somatic complaints are related to unfulfilled dependency needs and was assisted in developing these concepts.
  33. Encourage Limit Setting by Noncustodial Parent (33)
    1. The noncustodial parent was strongly encouraged to set firm, consistent limits for the client's misbehavior and to refrain from overindulging the client's desires during visits.
    2. The noncustodial parent was helped to identify logical, natural consequences for the client's misbehavior.
    3. The noncustodial parent verbally acknowledged how his/her pattern of overindulgence contributes to the client's immaturity and resistance to take on responsibilities and was urged to develop alternative behaviors.
    4. The noncustodial parent acknowledged his/her reluctance to set limits for the client's misbehavior because of his/her feelings of guilt and desire to avoid conflict during visits and was assisted in developing alternative behaviors.
    5. The noncustodial parent reported that the frequency of the client's misbehavior has decreased since he/she began setting firm, consistent limits on the client's acting out, and the benefits of this pattern of interacting was emphasized.
  34. Emphasize Assignment of Responsibilities by Noncustodial Parent (34)
    1. The noncustodial parent was given the directive to assign chore(s) to the client and siblings during their visits.
    2. The noncustodial parent was encouraged to schedule times for the client and siblings to complete their homework.
    3. The noncustodial parent acknowledged that he/she is reluctant to assign chores or require the children to complete homework because of the desire to avoid upsetting the client or siblings or creating potential conflict, and the long-term negative consequences of this pattern were emphasized.
    4. The noncustodial parent was helped to develop a reward system to reinforce the client and siblings for completing chores and homework during visits.
    5. The noncustodial parent was helped to identify consequences for the failure of his/her children to complete chores or homework.
  35. Teach Enmeshed Parent(s) to Set Limits (35)
    1. The enmeshed or overly protective parent was helped to see how his/her failure to set limits reinforces the client's immature or irresponsible behavior.
    2. The enmeshed or overly protective parent was helped to identify natural, logical consequences for the client's immature or irresponsible behavior.
    3. The parent(s) were encouraged to offer frequent praise and positive reinforcement for the client's responsible behavior.
    4. A reward system was designed to reinforce the client for behaving in a responsible manner.
  36. Identify Age-Appropriate Ways to Meet Needs (36)
    1. The client and parent(s) were helped to identify age-appropriate ways for the client to meet his/her needs for affiliation, acceptance, and approval.
    2. The client was given the homework assignment to engage in a specific, age-appropriate behavior three to five times before the next therapy session.
    3. Role-playing and modeling techniques were utilized to demonstrate age-appropriate ways to gain affiliation, acceptance, and approval from others.
    4. The client was taught effective communication skills to help meet his/her needs for affiliation, acceptance, and approval.
    5. Although the client has been taught age-appropriate ways to meet his/her needs, he/she often fails to use these techniques; he/she was redirected to increase his/her use of these healthy, helpful techniques.
  37. Urge Parents to Stop Criticizing Ex-Spouse (37)
    1. The parent was challenged and confronted about making hostile or overly critical remarks about the other parent in the presence of the client and siblings.
    2. The client's parent(s) verbally recognized that hostile or overly critical remarks about the other parent are upsetting to the client and siblings, and positive feedback was provided.
    3. The client reports that the parents have reduced their critical comments about one another since this issue was dealt with in counseling sessions.
  38. Teach Parents to Avoid Placing Client in Middle (38)
    1. The parent(s) were challenged to cease the pattern of placing the client in the middle role by soliciting information about the other parent or sending messages through the client to the other parent about adult matters.
    2. The parents were directed to read The Co-Parenting Survival Guide: Letting Go of Conflict after a Difficult Divorce by Thayer and Zimmerman.
    3. The parents were directed to read New Beginnings for Divorcing Parents: Coparenting Divorce Workbook by Turner.
    4. The parent(s) verbalized an awareness that placing the client in the middle role is upsetting to him/her, and assistance was provided in developing alternative roles.
  39. Confront Playing One Parent against the Other (39)
    1. The client was challenged and confronted about playing one parent against the other to meet his/her needs, obtain material goods, or avoid responsibility.
    2. Today's therapy session explored the reasons for the client's attempt to play one parent against the other.
    3. The parent(s) were encouraged to deal directly with the client and set limits on his/her manipulative behaviors.
    4. The client was helped to identify ways to meet his/her needs or obtain material goods that are more constructive than manipulating the parent(s).
    5. The client acknowledged that his/her pattern of playing one parent against the other is aimed at trying to bring the parents back together, and he/she was disabused of this notion.
  40. Encourage Noncustodial Parent to Maintain Visitation (40)
    1. The noncustodial parent was challenged and encouraged to maintain regular visitation and involvement in the client's life.
    2. The client asserted his/her wish in today's family therapy session for the noncustodial parent to maintain regular visitation and involvement in his/her life.
    3. Today's therapy session explored the factors contributing to the noncustodial parent's failure to maintain regular visitation and involvement in the client's life.
    4. The noncustodial parent was supported as he/she verbally recognized that the lack of regular visitation has exacerbated the client's adjustment problems to the divorce.
    5. The family therapy session focused on developing a regular visitation schedule between the noncustodial parent and the client.
  41. Assign Disengaged Parent to Increase Time with Client (41)
    1. The disengaged parent was given a directive to spend more quality time with the client and siblings.
    2. The disengaged parent was given a homework assignment of performing a specific task with the client.
    3. The client and disengaged parent were assisted in developing a list of tasks or activities that they would like to do together.
    4. The client reported that the increased time spent with the previously disengaged parent has helped the two of them establish a closer relationship, and the benefits of this involvement were reviewed.
    5. The client was supported as he/she reported that his/her relationship with the disengaged parent remains distant because the two have spent little time together.
  42. Utilize Art Therapy Techniques (42)
    1. The client was instructed to draw pictures reflecting his/her feelings about the parents' divorce, family move, or change in schools.
    2. The client's drawings were interpreted as reflecting his/her feelings of anger, sadness, and hurt about the parents' divorce.
    3. The client's drawings were interpreted as reflecting feelings of anger, sadness, and loneliness about the family move and/or change in school.
    4. After completing his/her drawings, the client was helped to verbalize his/her feelings about the parents' divorce, family move, or change in schools.
  43. Utilize Music Therapy Techniques (43)
    1. The client shared a song that reflected his/her feelings about the parents' separation or divorce, and this was processed.
    2. The client shared a song that led to a discussion of how the song reflects his/her feelings about the parents' separation or divorce and what he/she can do to cope with the changes in his/her life.
  44. Encourage Participation in Positive Peer Group Activities (44)
    1. The client was strongly encouraged to participate in school, extracurricular, or positive peer group activities to offset the loss of time spent with his/her parents.
    2. The client developed a list of school, extracurricular, or positive peer group activities that will help him/her cope with the parents' divorce and establish meaningful friendships, and these were reviewed.
    3. The client reported that the participation in school, extracurricular, or positive peer group activities has helped him/her cope with the parents' divorce and feel less depressed or lonely, and he/she was encouraged to continue.
    4. The client has continued to struggle with his/her parents' divorce, but as yet has not taken many steps to become involved in school, extracurricular or positive peer group activities; he/she was redirected to be more socially involved.
  45. Refer to Group Therapy (45)
    1. The client was referred for group therapy to help him/her share and work through his/her feelings about the divorce with other adolescents who are going through a similar experience.
    2. The client was given the directive to self-disclose at least once during the group therapy session about his/her parents' divorce.
    3. The client's involvement in group therapy has helped him/her realize that he/she is not alone in going through the divorce process.
    4. The client's active participation in group therapy sessions has helped him/her share and work through many of his/her emotions pertaining to the parents' divorce.
    5. The client has not made productive use of the group therapy sessions and has been reluctant to share his/her feelings about the divorce.
  46. Identify Supportive Adults (46)
    1. The client was assisted in developing a list of supportive adults outside of the family to whom he/she can turn for support and guidance in coping with the divorce.
    2. The client was given the homework assignment to seek guidance and support from at least one adult outside of the family before the next therapy session.
    3. The client reported that he/she has talked with other significant adults outside of the family who have been helpful in offering support and guidance, and the results were summarized.
    4. The client was reinforced as he/she has taken active steps to develop a network of significant adults outside of the family system to whom he/she can turn for guidance and support when needed.
    5. The client has failed to follow through with the recommendation to make contact with significant adults outside of the family because of his/her mistrust and expectation of experiencing further disappointment, but he/she was encouraged to seek out at least one adult.
  47. Provide Sex Education (47)
    1. The client was provided with sex education in an attempt to eliminate his/her pattern of engaging in sexually promiscuous behavior.
    2. The client was helped to identify the risks involved in his/her sexually promiscuous or seductive behavior.
    3. The client responded favorably to the sex education provided by asking several pertinent questions and openly sharing his/her past sexual experiences.
    4. The client displayed an attitude of cool indifference when discussing the potential risks involved in his/her sexually promiscuous or seductive behavior.
  48. Explore Reasons for Sexually Promiscuous Behaviors (48)
    1. The client's sexual history was gathered to help gain insight into the factors contributing to the emergence of his/her sexually promiscuous behavior.
    2. The client was assigned the exercise “Connecting Sexual Behavior with Needs” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    3. The client was assigned the exercise “Looking Closer at My Sexual Behavior” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    4. The client's irrational beliefs about his/her sexually promiscuous behavior were challenged.
    5. Psychoanalytic therapy approaches were used to explore the etiology of the client's sexually promiscuous behavior.
    6. Client-centered therapy approaches were employed to help the client discover ways to meet his/her unmet needs that are more effective than sexually promiscuous behaviors.
    7. A brief solution-focused therapy approach was utilized to help the client identify ways to cope with stress that are more effective than sexually promiscuous behaviors.