Client Termination Summary
Termination Status: Planned termination; The client met nearly all and the most important treatment goals
Presenting problem: Mr. M, a 33-year-old African American male. He lives with his wife and a daughter. The client presented for treatment with the wife. The wife reported that Mr. M was experiencing various psychotic symptoms characterized by paranoid delusions, delusions of reference and thought insertion. For instance, the wife reported that Mr. M would express delusional beliefs such as believing that some unknown people were conspiring against him. The client strongly expressed that unknown people were plotting evil against him but he was not exactly sure about the nature of the conspiracy. He reported that he would spend so many hours thinking about these thoughts, and this had negatively impacted his work. The paranoid thoughts also interfered with his ability to carry out his usual activities like shopping or going for a movie. He had withdrawn socially, avoided interacting with people, including his colleagues and this had forced him to work from home. He also reported anxiety and a feeling of impending doom. The client self-reported a long history of depression and anxiety. The client further reported negative thinking patterns and reflections about his self-esteem emanating from paranoid thoughts such as “people think am funny and ridiculous” and “people are condemnatory towards me”. This was the first psychotherapy consultation for this client. Client Termination Summary Sample
Major Psychosocial Issues: Social anxiety and paranoid delusions. The therapy focused on addressing both conditions.
Type of Service Rendered: Individual, Acceptance and Commitment Therapy (ACT). The treatment goal was to ensure the client lived more congruently despite the paranoid thoughts and anxiety. The treatment also aimed to address the anxiety and paranoid thoughts.
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Overview of Treatment Process: The first stages of the therapy aimed to help the client explore his beliefs and values and how they impacted his life. Identification of his values and beliefs aimed to determine any processes that hindered the client from living a valuable life. Avoidance was a major element of his life and thus a value-based plan provided an appropriate platform to work from (Gaudiano et al., 2017). The Acceptance and Commitment Therapy thus aimed to equip the client with positive coping mechanisms.
Cognitive defusion was used to help the client cope with maladaptive and uncomfortable thoughts and feelings (Gaudiano et al., 2017). Mindfulness techniques aimed to separate authentic events and verbal assessments. The client practiced defusion strategies such as verbalizing the paranoid thoughts in affects accents. Willingness was used in connecting the line of thought for the client to the valued direction; the client was engaged and exposed to the feared situations (graded exposure). (Zhang et al., 2018). During the graded exposure, the client reflected on activities he feared and provoked anxiety and delusional paranoia. Strategies to address such activities were developed first together with the therapist and then as homework exercises for the client. The client would often reflect on his progress and any obstacles during the therapy. A diary was utilized to ensure efficient management of all scheduled activities and to remind the client about his values; this enabled him to strongly focus on the activities (Heydari et al., 2018).
Two weeks before the end of the treatment, the client was notified about the forthcoming end of the treatment. This was done to emotionally prepare the client about therapy termination.
Nature of Termination
The therapy came to an end after the treatment goals for this client were achieved as indicated by the client resuming his normal daily activities including work. The client was also able to face the experiences he initially avoided. The paranoia and anxiety levels had improved significantly. Client Termination Summary Sample
The goal of the therapy was to ensure the client lived more congruently despite the paranoid thoughts and anxiety. The treatment also aimed to address the anxiety and paranoid thoughts. The client manifested significant improvement throughout the treatment duration. The client was able to increase his activity levels. During the treatment period, the client had started performing activities he initially avoided and reported that anxiety levels had significantly reduced and enjoyed the freedom of spontaneity. Even though the client reported that he sporadically experienced some paranoia episodes; unlike before, this did not prevent him from continuing his plans and activities. He had resumed working from office without any problem. By the time the therapy was coming to an end, the client reported less anxiety, reduced paranoid episodes, the ability to perform his usual duties without any avoidance, and effectively coping with any paranoia attack.
The therapy did not address the root cause of anxiety and paranoid delusions.
Remaining Difficulties: The client still manifests some low level of paranoia; however, he has satisfactorily resumed his usual activities without any avoidance traits.
Recommendations: The client has made noteworthy progress. The client should continue utilizing the learned coping skills even after the end of the treatment. This will enable him to perform all his planned activities; attend work and perform his work duties successfully; carry out his daily activities without any fear.
Follow up Plan: The client was advised to come back for review after four weeks.
Instructions for Future Contact: The client was instructed to contact the therapists any time he considered necessary.
Gaudiano B, Davis C, Gary E, Johnson J, Kim M & Ivan M. (2017). Acceptance and Commitment Therapy for Inpatients with Psychosis (the REACH Study): Protocol for Treatment Development and Pilot Testing. Healthcare (Basel). 5(2), 23.
Heydari M, Masafi S, Jafari M, Saadat S & Shima S. (2018). Effectiveness of Acceptance and Commitment Therapy on Anxiety and Depression of Razi Psychiatric Center Staff. Open Access Maced J Med Sci, 15; 6(2), 410–415.
Zhang C, Emily L, Smith P, Chung P, Hagger M & Haves S. (2018). Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach. Front Psychol. 8(2350).
Client Termination Summary Sample