Therapist's Guide to Clinical Intervention - Sigmund Freud

Treatment Focus 1. Assess for Referral for Medication Evaluation. Patients with heightened
and Objectives anxiety, withdrawal, lack of sleep, obsessive thoughts, and compulsive
behaviors may benefit from the use of psychotropic medications. If there is
comorbidity of depression, convey this information to the referred physician.
2. Feelings of Anxiety and Fear
A. Validate person's emotional experience
B. Identify factors contributing to anxiety
C. Problem-solve factors contributing to anxiety
1. What is the problem?
2. Brainstorm various choices for dealing with the problem if it is within the
person's control
3. Make a decision and follow through. Have a contingency plan.
4. If it is out of the person's control, encourage the person to let go of it
D. Explore methods of managing anxiety
1. Relaxation techniques, including deep breathing
2. Distracting, pleasurable activities
3. Exercise
4. Meditation
5. Positive self-talk
E. Assess medication for effectiveness and for adverse side effects
F. Educate regarding signs of escalating anxiety and various techniques for
interrupting the progression of these symptoms (refer to section on Managing
Anxiety). Also explore possible physical etiology of exacerbation of anxiety.
G. Fear
1. Explore the source of the fear
2. Clarify the reality of the fear base. Encourage venting of feelings of fear. If the
fear is irrational, the person must accept the reality of the situation before any
changes can occur
3. Develop alternative coping strategies with the active participation of the
person
4. Encourage the person to make hi/her own choices and to be prepared with a
contingency plan
5. Use systematic desensitization to eliminate fear with gradual exposure to the
feared object or situation (exposure can be real or through visual imagery)
6. Use implosion therapy where exposure to the feared object or situation is not
gradual but direct (referred to as "flooding")
7. Educate person regarding role of internal, self-talk to feelings of fear, and
develop appropriate counter statements
H. Manage obsessive thoughts and compulsive behaviors
1. Patients with obsessive thoughts should be encouraged to engage in reality
testing and to redirect themselves into productive and distracting activity
2. Patients with compulsive behavior should develop a stepwise reduction in the
repetition of ritual behaviors (medication can be very helpful for managing OCD)
I. Positive feedback and reinforcement for efforts and accomplishments
3. Ineffective Coping
A. Identify factors that escalate anxiety and contribute to difficulty coping
B. Identify ritualistic patterns of behaviors
C. Educate regarding the relationship between emotions and dysfunctional/compulsive
behavior
D. Develop daily structure of activities
66 i. Treatment Planning: Goals, Objectives, and Interventions