Adult Treatment Planner

Objectives and Interventions

• Describe the pattern of pressured, driven living.
  • Assess examples of pressured lifestyle.
  • Assist the client to see self as others do.
• Comply with psychological assessment.
  • Administer measure to assess and track the client's breadth and depth of Type A behavior (e.g., Jenkins Activity Survey by Jenkins, Zyzanski, and Rosenman).
  • Review and process results of testing with the client.
• Identify the beliefs that support driven, overachieving behavior.
  • Probe personal history including family of origin history for role models of and/or pressure for high achievement and compulsive drive.
  • Ask the client to make a list of his/her beliefs about self-worth and the worth of others; process it with the therapist.
  • Assist the client in making key connections between his/her overachieving/driven behavior and the desire to please key parental figures.
• Verbalize a desire to reprioritize values toward less self-focus, more inner and other orientation.
  • Explore and clarify the client's value system and assist in developing new priorities on the importance of relationships, recreation, spiritual growth, reflection time, giving to others, and so on.
  • Ask the client to read biographies or autobiographies of spiritual people (e.g., St. Augustine, Thomas Merton, Albert Schweitzer, C. S. Lewis); process the key beliefs they lived by.
• Verbalize a commitment to emphasize the values of inner and other orientation.
  • Ask the client to commit to attempting attitude and behavior changes to promote a healthier, less Type A lifestyle, learning new approaches to managing self, time, relationships.
• Work on one task at a time with less emphasis on pressure to complete it quickly.
  • Encourage and reinforce the client focusing on one activity at a time without a sense of urgency.
• Decrease the number of hours worked daily and the frequency of taking work home.
  • Review the client's pattern of hours spent working (at home and office) and recommend selected reductions.
• Learn and implement calming skills to manage pressure situations.
  • Teach the client calming techniques (e.g., muscle relaxation, paced breathing, calming imagery) as part of a tailored strategy for responding appropriately to feelings of pressure when they occur.
  • Assign the client to implement calming techniques in his/her daily life when facing trigger situations; process the results, reinforcing success and redirecting for failure.
• Increase daily time involved in relaxing activities.
  • Assign the client to do one noncompetitive activity each day for a week; process this experience.
  • Ask the client to try one area of interest outside of his/her vocation that he/she will do two times weekly for 1 month.
  • Assign the client to watch comedy movies and identify the positive aspects of them.
  • Reinforce all the client changes that reflect a greater sense of life balance.
• Identify and replace distorted automatic thoughts that motivate pressured living.
  • Assist the client in identifying distorted automatic thoughts that lead to feeling pressured to achieve; assist him/her in replacing these distortions with positive, realistic cognitions.
• Verbalize a recognition of hostility toward and impatience with others.
  • Explore the client's pattern of intolerant, impatient interaction with others.
  • Assist the client in identifying his/her critical beliefs about other people and connecting them to hostile verbal and behavior patterns in daily life.
• Verbalize the distinction between respectful assertiveness and insensitive directness or verbal aggression that is controlling.
  • Train the client in assertive communication, with emphasis on recognizing and refraining from aggressive ignoring of the rights of others.
  • Monitor, point out, and reframe the client's actions or verbalizations that reflect a self-centered or unempathetic approach to others; practice alternatives using behavioral strategies such as modeling, role-playing, and/or role reversal.
• Implement problem-solving and/or conflict resolution skills to manage interpersonal problems.
  • Teach the client conflict resolution skills (e.g., empathy, active listening, "I messages," respectful communication, assertiveness without aggression, compromise) and problem-solving skills (e.g., define specifically, brainstorm options, evaluate, implement, reevaluate) using modeling, role-playing, and behavior rehearsal to work through several current conflicts.
• Implement new calming, communication, and problem-solving skills to manage anger.
  • Assist the client in constructing a client-tailored strategy for managing pressure that combines any of the somatic, cognitive, communication, problem-solving, and/or conflict resolution skills relevant to his/her needs.
  • Select situations in which the client will be increasingly challenged to apply his/her new strategies for managing anger.
  • Use any of several techniques, including relaxation, imagery, behavioral rehearsal, modeling, role-playing, or in vivo exposure/behavioral experiments to help the client consolidate the use of his/her new anger management skills (or assign "Alternatives to Destructive Anger" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).
• Demonstrate decreased impatience with others by talking of appreciating and understanding the good qualities in others.
  • Assign the client to talk to an associate or child, focusing on listening to the other person and learning several good things about that person; process the experience.
  • Assign the client and family to attend an experiential weekend that promotes self-awareness (e.g., high-low ropes course or cooperative tasks); process the experience afterward.
  • Assign the client to go with a group on a wilderness camping and canoeing trip, on a work camp project, or with the Red Cross as a disaster worker; process the experience.
  • Encourage the client to volunteer for a nonprofit social agency, school, or the like for 1 year, doing direct work with people (i.e., serving food at a soup kitchen or tutoring an inner-city child); process the positive consequences.
• Increase interest in the lives of others as evidenced by listening to others talk of their life experiences, and by engaging in one act of kindness per day.
  • Encourage and monitor the client in doing one random, spontaneous act of kindness on a daily basis and explore the positive results.
  • Encourage the client to express warmth, appreciation, affection, and gratitude to others.
  • Assign the client to read the book The Road Less Traveled (Peck) and to process key ideas with therapist.
• Develop a daily routine that reflects a balance between the quest for achievement and appreciation of aesthetic things.
  • Assign the client to read "List of Aphorisms" in Treating Type A Behavior and Your Heart (Friedman and Ulmer) three times daily for 1 or 2 weeks, then to pick several to incorporate into his/her life.
  • Ask the client to list activities he/she could engage in for purely aesthetic enjoyment (e.g., visit an art museum, attend a symphony concert, hike in the woods, take painting lessons) and incorporate these into his/her life (or assign "Identify and Schedule Pleasant Activities" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).