PIRP progress note (IN PROGRESS)
PURPOSE OF SESSION: : O/P therapy is reasonable and necessary to improve client's mental health and prevent it from worsening and developing additional mental and/or health problems. The purpose of this session was to [checkbox name="display_concern_fields" value="address the clients concerns with "][conditional field="display_concern_fields" condition="(display_concern_fields).is('address the clients concerns with ')"][checkbox name="concern" value="anxiety|depression|PTSD|adjusting to change|attachment/codependency issues|communication issues|decision-making skills|emotional dysregulation|family of origin conflict|grief/loss/bereavement|identity/self-awareness issues|intimate relationship conflict|interpersonal/intrapersonal conflicts|parenting|personal development|self-acceptance"][/conditional][checkbox name="reasons" value="review homework|assess mood/functioning|provide psychoeducation|review progress|review diagnostic conclusions/recommendations"][checkbox name= "treatment_pan" value= "address the client's goal of|address the client's objective of|other"] INTERVENTIONS: A [checkbox name="modalities" value="cognitive behavioral|DBT-informed|acceptance and commitment therapy|strengths based|person centered|trauma informed CBT|trauma informed|psychodynamic |supportive therapy|other"] approach was used in this session including [checkbox name="general_terms" value="recommending ancillary services|providing community referrals|discharge planning|reviewing informed consent/confidentiality|reviewing homework|reviewing client's treatment plan and discussing progress towards goals|conducting tests/assessments|setting appropriate boundaries |Tx plan review|active listening|using active listening to understand the incongruencies and congruences between the client’s feelings and words|empathy|using empathy to focus attention on the client and stimulate self-exploration|open-ended questions|feedback for continuous improvement|an emphasis on self-expression|normalization|interpretation|validation|rapport building|positive reinforcement|clarification|reframing|praise and encouragement|reassurance|encouragement|therapeutic silence|reviewing family Hx/dynamics|role playing|using paraphrasing and summarizing to gain clarity about the client's experience|modeling|use of metaphor|modeling adaptive behavior|use of role-play|problem-solving|ventilation of thoughts and feelings|interpretation and assumption| pointing out discrepancies| making the unconscious conscious|noting and analyzing defenses| uncovering hidden meanings underneath the surface of communication|connecting past experiences to present behaviors|normalizing client's experience| providing a safe environment for client to ventilate without interruption| providing supportive prompts to stimulate client interaction| navigating the client through the use of open and close ended questions|mirroring the client's emotional responses|emphasis on here-and-now functioning|emphasis on self-monitoring of thoughts, emotions and behavior"] [checkbox name="other_blank" value="" memo="other"] [comment memo="general terms"]
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