Adult Treatment Planner

Objectives and Interventions

• Identify the impulsive behaviors that have been engaged in over the last six months.
  • Review the client's behavior pattern to assist him/her in clearly identifying, without minimization, denial, or projection of blame, his/her pattern of impulsivity.
• List the reasons or rewards that lead to continuation of an impulsive pattern.
  • Explore whether the client's impulsive behavior is triggered by anxiety and maintained by anxiety relief rewards.
  • Ask the client to make a list of the positive things he/she gets from impulsive actions and process it with the therapist.
• List the negative consequences that accrue to self and others as a result of impulsive behavior.
  • Assign the client to write a list of the negative consequences that have occurred because of impulsivity.
  • Assist the client in making connections between his/her impulsivity and the negative consequences for himself/herself and others.
  • Confront the client's denial of responsibility for the impulsive behavior or the negative consequences.
• Identify impulsive behavior's antecedents, mediators, and consequences.
  • Ask the client to keep a log of impulsive acts (time, place, feelings, thoughts, what was going on prior to the act, and what was the result); process log content to discover triggers and reinforcers.
  • Explore the client's past experiences to uncover his/her cognitive, emotional, and situational triggers to impulsive episodes.
• Verbalize a clear connection between impulsive behavior and negative consequences to self and others.
  • Assist the client in making connections between his/her impulsivity and the negative consequences for himself/herself and others.
  • Reinforce the client's verbalized acceptance of responsibility for and connection between impulsive behavior and negative consequences.
• Before acting on behavioral decisions, frequently review them with a trusted friend or family member for feedback regarding possible consequences.
  • Conduct a session with the client and his/her partner to develop a contract for receiving feedback prior to impulsive acts.
  • Brainstorm with the client who he/she could rely on for trusted feedback regarding action decisions; use role-play and modeling to teach how to ask for and accept this help.
• Utilize cognitive methods to control trigger thoughts and reduce impulsive reactions to those trigger thoughts.
  • Explore the client's past experiences to uncover his/her cognitive, emotional, and situational triggers to impulsive episodes.
  • Teach the client cognitive methods (thought stopping, thought substitution, reframing, etc.) for gaining and improving control over impulsive urges and actions.
  • Help the client to uncover dysfunctional thoughts that lead to impulsivity; then, replace each thought with a thought that is accurate, positive, self-enhancing, and adaptive.
• Use relaxation exercises to control anxiety and reduce consequent impulsive behavior.
  • Teach the client techniques such as progressive relaxation, self-hypnosis, or biofeedback; encourage him/her to relax whenever he/she feels uncomfortable.
• Utilize behavioral strategies to manage anxiety.
  • Teach the use of positive behavioral alternatives to cope with anxiety (e.g., talking to someone about the stress, taking a time out to delay any reaction, calling a friend or family member, engaging in physical exercise).
  • Review the client's implementation of behavioral coping strategies to reduce urges and tension; reinforce success and redirect for failure.
• Implement the assertive formula, "I feel ... When you ... I would prefer it if ..."
  • Using modeling, role playing, and behavior rehearsal, teach the client how to use the assertive formula, "I feel ... When you ... I would prefer it if ..." in difficult situations.
  • Review and process the client's implementation of assertiveness and feelings about it as well as the consequences of it.
• List instances where "stop, listen, think, and act" has been implemented, citing the positive consequences.
  • Using modeling, role-playing, and behavior rehearsal, teach the client how to use "stop, listen, and think" before acting in several current situations.
  • Review and process the client's use of "stop, listen, think, and act" in day-today living and identify the positive consequences.
• Comply with the recommendations from a physician evaluation regarding the necessity for psychopharmacological intervention.
  • Refer the client to a physician for an evaluation for a psychotropic medication prescription.
  • Monitor the client for psychotropic medication prescription compliance, side effects, and effectiveness; consult with the prescribing physician at regular intervals.
• Implement a reward system for replacing impulsive actions with reflection on consequences and choosing wise alternatives.
  • Assist the client in identifying rewards that would be effective in reinforcing himself/herself for suppressing impulsive behavior.
  • Assist the client and significant others in developing and putting into effect a reward system for deterring the client's impulsive actions.
• Attend a self-help recovery group.
  • Refer the client to a self-help recovery group (e.g., 12-step program, ADHD group, Rational Recovery, etc.) designed to help terminate self-destructive impulsivity; process his/her experience in the group.