Adult Treatment Planner
18: Financial Stress
SNOMED Terms
- Adjustment disorder with depressed mood
- Adjustment disorder with mixed anxiety and depressed mood
- Antisocial personality disorder
- Borderline personality disorder
Goals
- Establish a clear income and expense budget that will meet bill payment demands.
- Contact creditors to develop a revised repayment plan for outstanding bills.
- Gain a new sense of self-worth in which the substance of one's value is not attached to the capacity to do
things or own things that cost money.
- Understand personal needs, insecurities, and anxieties that make overspending possible.
- Achieve an inner strength to control personal impulses, cravings, and desires that directly or indirectly
increase debt irresponsibly.
Behavioral Definitions
- Indebtedness and overdue bills that exceed ability to meet monthly payments.
- Loss of income due to unemployment.
- Reduction in income due to change in employment status.
- Conflict with spouse over management of money and the definition of necessary expenditures and savings
goals.
- A feeling of low self-esteem and hopelessness that is associated with the lack of sufficient income to cover
the cost of living.
- A long-term lack of discipline in money management that has led to excessive indebtedness.
- An uncontrollable crisis (e.g., medical bills, job layoff) that has caused past-due bill balances to exceed
ability to make payments.
- Fear of losing housing because of an inability to meet monthly mortgage payments.
- A pattern of impulsive spending that does not consider the eventual financial consequences.
Diagnoses
- Adjustment Disorder with Depressed Mood
- Bipolar I Disorder, Manic
- Bipolar II Disorder
- Major Depressive Disorder
- Borderline Personality Disorder
- Antisocial Personality Disorder
- Diagnosis Deferred
- No Diagnosis
Objectives and Interventions
- Describe the details of the current financial situation.
- Provide the client a supportive, comforting environment by being empathetic, warm, and sensitive to
the fact that the topic may elicit guilt, shame, and embarrassment.
- Explore the client's current financial situation.
- Assist the client in compiling a complete list of financial obligations.
- Isolate the sources and causes of the excessive indebtedness.
- Assist in identifying, without projection of blame or holding to excuses, the causes for the
financial crisis through a review of the client's history of spending.
- Verbalize feelings of depression, hopelessness, and/or shame that are related to financial status.
- Probe the client's feelings of hopelessness or helplessness that may be associated with the
financial crisis.
- Assess the depth or seriousness of the client's despondency over the financial crisis.
- Describe any suicidal impulses that may accompany financial stress.
- Assess the depth or seriousness of the client's despondency over the financial crisis.
- Assess the client's potential risk for suicidal behavior. If necessary, take steps to ensure the
client's safety (see Suicidal Ideation chapter in this Planner).
- Identify priorities that should control how money is spent.
- Ask the client to list the priorities that he/she believes should give direction to how his/her
money is spent; process those priorities.
- Review the client's spending history to discover what priorities and values have misdirected
spending.
- Describe the family of origin pattern of money management and how that pattern may be impacting own credit
crisis.
- Explore the client's family-of-origin patterns of earning, saving, and spending money, focusing on
how those patterns are influencing his/her current financial decisions.
- Meet with community agency personnel to apply for welfare assistance.
- Review the client's need for filing for bankruptcy, applying for welfare, and/or obtaining credit
counseling.
- Direct the client to the proper church or community resources to seek welfare assistance and support
him/her in beginning the humbling application process.
- Write a budget that balances income with expenses.
- If financial planning is needed, refer to a professional planner or ask partners to write a current
budget and long-range savings and investment plan.
- Review the client's budget as to reasonableness and completeness.
- Attend a meeting with a credit counselor to gain assistance in budgeting and contacting creditors for
establishment of a reasonable repayment plan.
- Refer the client to a nonprofit, no-cost credit counseling service for the development of a
budgetary plan of debt repayment.
- Encourage the client's attendance at all credit counseling sessions and his/her discipline of self
to control spending within budgetary guidelines.
- Meet with an attorney to help reach a decision regarding filing for bankruptcy.
- Review the client's need for filing for bankruptcy, applying for welfare, and/or obtaining credit
counseling.
- Refer the client to an attorney to discuss the feasibility and implications of filing for
bankruptcy.
- Identify personal traits that make undisciplined spending possible.
- Probe the client for evidence of low self-esteem, need to impress others, loneliness, or depression
that may accelerate unnecessary, unwarranted spending.
- Assess the client for mood swings that are characteristic of Bipolar Disorder and could be
responsible for careless spending due to the impaired judgment of manic phase.
- Honestly describe any of own or family members' substance abuse problems that contribute to financial
irresponsibility.
- Probe the client for excessive alcohol or other drug use by asking questions from the CAGE or
Michigan Alcohol Screening Test (MAST) screening instruments for substance abuse.
- Explore the possibility of alcohol or drug use by the client's family members or significant
other.
- Verbalize a plan for seeking employment to raise level of income.
- Review the client's income from employment and brainstorm ways to increase this (e.g., additional
part-time employment, better-paying job, job training).
- Assist the client in formulating a plan for a job search.
- Set financial goals and make budgetary decisions with partner, allowing for equal input and balanced control
over financial matters.
- Encourage financial planning by the client that is done in conjunction with his/her partner.
- Reinforce changes in managing money that reflect compromise, responsible planning, and respectful
cooperation with the client's partner.
- Keep weekly and monthly records of financial income and expenses.
- Encourage the client to keep a weekly and monthly record of income and outflow; review his/her
records weekly, and reinforce his/her responsible financial decision making.
- Offer praise and ongoing encouragement of the client's progress toward debt resolution.
- Use cognitive and behavioral strategies to control the impulse to make unnecessary and unaffordable
purchases.
- Role-play situations in which the client must resist the inner temptation to spend beyond reasonable
limits, emphasizing positive self-talk that compliments self for being disciplined.
- Role-play situations in which the client must resist external pressure to spend beyond what he/she
can afford (e.g., friend's invitation to golf or go shopping, child's request for a toy),
emphasizing being graciously assertive in refusing the request.
- Teach the client the cognitive strategy of asking self before each purchase: Is this purchase
absolutely necessary? Can we afford this? Do we have the cash to pay for this without incurring any
further debt?
- Urge the client to avoid all impulse buying by delaying every purchase until after 24 hours of
thought and by buying only from a prewritten list of items to buy.
- Report instances of successful control over impulse to spend on unnecessary expenses.
- Reinforce with praise and encouragement all of the client's reports of resisting the urge to
overspend.
- Hold conjoint or family therapy session in which controlled spending is reinforced and continued
cooperation is pledged by everyone.
Index