Adult Treatment Planner

Objectives and Interventions

• Demonstrate a level of trust with therapist by disclosing feelings and beliefs.
  • Actively build level of trust with the client through consistent eye contact, active listening, unconditional positive regard, and warm acceptance to help increase his/her ability to identify and express feelings.
  • Demonstrate a calm, tolerant demeanor in sessions to decrease the client's fear of others.
• Identify those people or agencies that are distrusted and why.
  • Explore the nature and extent of the client's paranoia, probing for delusional components.
  • Explore the client's basis for fears; assess his/her degree of irrationality and ability to acknowledge that he/she is thinking irrationally.
• Identify feelings of vulnerability.
  • Probe the client's fears of personal inadequacy and vulnerability.
  • Interpret the client's fears of his/her own anger as the basis for his/her mistrust of others.
  • Explore historical sources of the client's feelings of vulnerability in family-of-origin experiences.
• Identify and replace core belief that others are untrustworthy and malicious.
  • Explore the client's basis for fears; assess his/her degree of irrationality and ability to acknowledge that he/she is thinking irrationally.
  • Review the client's social interactions and explore his/her distorted cognitive beliefs operative during interactions; replace those core beliefs that are distorted and that trigger paranoid feelings.
• Comply with a psychiatric evaluation and take psychotropic medication prescribed.
  • Assess the necessity of the use of antipsychotic medication to counteract the client's altered thought processes (see Psychoticism chapter in this Planner).
  • Arrange for the client to be evaluated by a physician for a psychotropic medication prescription.
  • Monitor the client's psychotropic medication prescription for compliance, effectiveness, and side effects; report to the prescribing physician and confront the client if he/she is not taking medication as prescribed.
• Complete a psychological evaluation to assess the depth of paranoia.
  • Arrange for a psychological evaluation to assess the client for possible psychotic process; give feedback as to results.
• Comply with a neuropsychological evaluation to rule out the possibility of organic etiology.
  • Refer the client for or perform neuropsychological evaluation; if organic factors are found refer him/her to a neurologist for consultation.
• Acknowledge that the belief about others being threatening is based more on subjective interpretation than on objective data.
  • Explore the client's basis for fears; assess his/her degree of irrationality and ability to acknowledge that he/she is thinking irrationally.
  • Review the client's social interactions and explore his/her distorted cognitive beliefs operative during interactions; replace those core beliefs that are distorted and that trigger paranoid feelings.
  • Assist the client in seeing the pattern of distrusting others as being related to his/her own fears of inadequacy.
  • Ask the client to complete a cost-benefit analysis (see The Feeling Good Handbook by Burns) around his/her specific fears; process the exercise.
• Verbalize trust in significant other and feel relaxed when not in his/her presence.
  • Conduct conjoint sessions to assess and reinforce the client's verbalizations of trust toward significant other.
  • Provide alternative explanations for significant other's behavior that counters the client's pattern of assumption of other's malicious intent.
• Increase social interaction without fear or suspicion being reported.
  • Encourage the client to check out his/her beliefs regarding others by assertively verifying conclusions with others.
  • Use role-playing, behavioral rehearsal, and role reversal to increase the client's empathy for others and his/her understanding of the impact that his/her distrustful, defensive behavior has on others.