how to write a biopsychosocial report

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You may think that your students are only interested in fiction readingbut the truth is that children are fascinated by the world around them. Studies have long touted the benefits of teaching students how to read nonfiction. Nonfiction text helps students develop background knowledgewhich in turn assists them as they encounter more difficult reading throughout their school years. Nonfiction can also help students learn to read text features not often found in works of fiction, including headings, graphs, and charts. Students used to rely on nonfiction non fiction book report activities for research projects from science to art. With the rise of digital sources, many students choose to simply do their research online.

How to write a biopsychosocial report addendum resume

How to write a biopsychosocial report

Just a warning, if you are a big fan of the show and have not seen season twelve there might be a couple of spoilers! The referring therapist was concerned because she had a session with him where he tried to psychoanalyze his sister, friends, and father rather than talking about himself or his own problems. He says that he has had issues with these people since he was about ten years old.

After speaking with his family and friends they say been concerned about him since he was about that old. His family is worried about his manipulative behavior, constant lying, and often highly unethical conduct with women. The client is currently not a risk to himself.

There is some concern for danger to others. At this time I would assess the risk level at high, given his past behavior. There have been incidents where he has coerced women into sexual contact with him. There have also been times when he has manipulated children into helping him lie and steal for his own personal gain.

He then described enjoying the feeling so he continued this with three more crows. Dennis has no other known mental health diagnosis. Aside from seeing his sisters therapist one time he has never had psychiatric care. The client has no known history of head injuries or whiplash.

The client has never been hospitalized. He has never had any self-harm behavior and says he has never had suicidal thinking, intent, or attempts. The client has had some history of substance abuse. Roughly ten years ago he was addicted to crack for a few months. Him and his sister became addicted to the substance together.

However, he was able to stop using crack on his own and reports that he has not had problems with drugs since. Two years ago he thought he had the flu and therefore did not drink alcohol. In reality the flu like symptoms were from alcohol withdrawal and they became worse when he continued to not drink. He ended up drinking alcohol again and his withdrawal symptoms subsided. However, neither him nor his family and friends report the alcohol use as being problematic.

The client reports that he does not have any medical problems. When the client was eight years old his parents got divorced. His sister says this was a very difficult time for herself and her brother. However, the client denies that he was effected by the divorce. His mother died when he was 35 years old. The client was briefly married three years ago for just about one month and until recently was paying his ex wife alimony. She died accidentally by falling off a building roughly one month ago.

He describes feeling relived that he does not have to give her money anymore. The client completed high school and attended some college. He preformed adequately in school but says that he was disinterested in it because it did not challenge him. His father and sister drink roughly the same amount of alcohol as he does.

None of his family members have any documented or suspected mental disorders. He grew up upper-class and he often still relies on his father for financial support. He now lives a middle class life. He shares an apartment with his best friend, Mac, who has expressed sexual feelings for the client.

The client is adamant that he is not gay. Additionally, the client has one child who is two years old with a woman in Iowa who he had a one night stand with. He wants nothing to do with the woman or the child. His friends and family knew nothing of this child until a few weeks ago. The client has never had a significant relationship.

His marriage was impulsive and brief and he describes never actually having feelings for her. He has never been in a relationship for more than a couple of dates. The client is an outspoken atheist and was not raised with any particular culture or religion. This has been a steady source of employment.

However, it is not always a steady source of income. The client often makes very little money due to the mismanagement of the bar. His father pays for any large expenses that he cannot afford. He wore a button down shirt and slacks to our first meeting. His hair and nails were well kept. The client is oriented by four. He has poor insight and is unaware that any of his behavior is problematic. His activity level is normal. His behavior is mostly normal.

However, he will hold eye contact for long periods of time in a way that feels intimidating. He will also mutter things under his breath and smile to himself occasionally. His affect is appropriate. He seems to have some grandiose thinking. Client is now estranged from her mother and has limited contact with her father, despite living in the same town. She sees her younger siblings twice yearly, Christmas and 4th of July.

She has worked steadily since completing college in positions of increasing responsibility. During highs school and college, she waited tables. She denies any violent relationship, physically, verbally or emotionally. She is calm and there is no evidence of tremors, tics or muscle spasms. Her affect is appropriate to the conversation, and her mood is depressed.

Speech is soft. Her thoughts flow logically and are organized with no perseverations, loose associations or thought blocking. There is no evidence of hallucinations or delusions. She is oriented to time, place and person. She does place devaluation on herself that is not supported by her situation.

You are commenting using your WordPress. You are commenting using your Google account. You are commenting using your Twitter account. You are commenting using your Facebook account. Notify me of new comments via email. Notify me of new posts via email. Example-Biopsychosocial Assessment The following is an abbreviated example of a BPS Assessment to demonstrate the basic components and content. Client reports regular use of caffeine, up to five beverages per day of coffee and sodas.

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Her violence is always directed at objects, never at peers. When having to share the experience with group mates she will often become caustic or withdrawn. Katherine has sleep disturbances where she has nightmares reliving the trauma.

She also has some intrusive thoughts where she fanaticizes about killing her mother or abusers. Because her abusers were Hispanic men, she avoids all people who look to be of Hispanic origin. If she encounters Hispanic people in public, it is possible that she will either disassociate or start crying.

Katherine qualifies for generalized anxiety disorder and stays in a state of high alert riddled with worry Saddock; Saddock, She worries about her personal safety, being left alone with men, not having enough food, feeling sexually aroused, and encountering a trigger.

She occasionally has episodes of panic where she experiences disassociating, difficulty breathing, and weeping. Katherine rarely remembers anything that happens while she is in a state of panic. While in residential placement, her panic attacks are not externally violent towards her peers or others. Additionally, Katherine has clear criteria for trichotillomania.

She pulls hair out of her face and head to relieve feelings of anxiety. She does not hoard or eat the hair. One year ago, she began pulling her hair out on her head and face resulting in near baldness and no eyelashes or eyebrows. She also started compulsively binge eating and has gained over thirty pounds. She will hoard large amounts of food in her bedroom and when she feels like she has enough she will engage in a binge.

A final recent presenting issue is an extreme aversion to showering or hygiene practices resulting in noticeable body odor. Katherine says that she is aware of the odor and comforted by it. Staff members are trying to motivate her to bathe, but are not currently having much success. Because of her previous unsafe behaviors, impulse control, and poor boundaries with peers — residential treatment does seem appropriate.

I also think that having the group process is important to give Katherine a chance to practice her treatment goals with her peers. Another beneficial element to the group therapy approach for this client is building a feeling of solidarity in being a sexual abuse survivor with other child survivors in the group.

Many of the children at the facility say that their relief in knowing that they are not alone in their experience, regardless of how the experience has effected them. The caretaking figures in the treatment facility could also reinforce this during her activities of daily living. Also providing psycho-education on connecting feelings of anxiety to hair pulling behaviors and outbursts would help her get control of those feelings.

Another option would be some pharmacotherapy for anxiety. This could help reduce her constant feeling of anxiety and allow her develop coping skills to self-regulate her emotions. American Psychiatric Association. Cohen, J. Trauma focused cognitive behavioral therapy for children and adolescents: An empirical update. Journal of Interpersonal Violence, 15 11 , Riviere, S. Short-term play therapy for children with disruptive behavior disorders.

Schaefer Eds. Short-term Play therapy for Children pp. New York: Guilford Pres. Sadock, B. Concise textbook of Child and Adolescent Psychiatry. You are commenting using your WordPress. You are commenting using your Google account. You are commenting using your Twitter account. You are commenting using your Facebook account.

Notify me of new comments via email. Notify me of new posts via email. Create a free website or blog at WordPress. RSS Feed. Current Placement Katherine is now placed in a residential treatment facility. Client strengths and weakness Katherine is a thoughtful and affectionate child. Physical and Medical Issues One year ago, she began pulling her hair out on her head and face resulting in near baldness and no eyelashes or eyebrows.

Treatment Considerations Because of her previous unsafe behaviors, impulse control, and poor boundaries with peers — residential treatment does seem appropriate. Resources American Psychiatric Association. Journal of Interpersonal Violence, 15 11 , Riviere, S. Share this: Twitter Facebook. Like this: Like Loading One response » dawn October 14, at pm. Thanks this was great Reply. Leave a Reply Cancel reply Enter your comment here Additionally, the client has one child who is two years old with a woman in Iowa who he had a one night stand with.

He wants nothing to do with the woman or the child. His friends and family knew nothing of this child until a few weeks ago. The client has never had a significant relationship. His marriage was impulsive and brief and he describes never actually having feelings for her. He has never been in a relationship for more than a couple of dates. The client is an outspoken atheist and was not raised with any particular culture or religion.

This has been a steady source of employment. However, it is not always a steady source of income. The client often makes very little money due to the mismanagement of the bar. His father pays for any large expenses that he cannot afford. He wore a button down shirt and slacks to our first meeting. His hair and nails were well kept. The client is oriented by four.

He has poor insight and is unaware that any of his behavior is problematic. His activity level is normal. His behavior is mostly normal. However, he will hold eye contact for long periods of time in a way that feels intimidating. He will also mutter things under his breath and smile to himself occasionally. His affect is appropriate. He seems to have some grandiose thinking. He did not say anything that would indicate suicidality or homicidality.

He did make a few comments about controlling or manipulating women that leave me concerned that he might coerce or force more women into sexual contact with him. His thought process was coherent. His speech was normal but occasionally would become loud and pressured when he got angry or irritable. He has poor insight demonstrated by his thinking that he has no problems but everyone else in his life does.

The client demonstrates disregard for and violation of the rights of others in a number of ways. He lied to the woman he had a baby with about his name and profession, he manipulated a child into pretending to be his daughter so that he could impress a woman, and he frequently lies to his family.

He is irritable and aggressive with his friends and family, he also demonstrated his anger during our session. He fails to conform to social norms by breaking laws such as serving minors alcohol at his bar and paying a homeless man for a favor in drugs.

He demonstrates a lack of remorse for his behavior saying that these people often deserve it because they are stupid. He meets criteria B for the diagnosis because he is over 18 years old. Finally, these symptoms do not occur during schizophrenia or a bipolar disorder because I have found no evidence for either of those. It will focus on trying to have the client see that acting in a more prosocial way will help him avoid negative consequences.

The majority of the therapy will be individual. The treatment will take place in an outpatient office with someone who specializes in personality disorders. However, he might need a higher level of care for the alcohol dependence in the future. I would consider referring the client for a psychiatric evaluation. Although there is no medication that is approved for the treatment of antisocial personality disorder there is some evidence that other psychiatric medications like lithium might help with aggression.

July 24 Overview If you are a new clinician or still in school you might be wondering how to write up a thorough biopsychosocial assessment for a client. Current Risk The client is currently not a risk to himself. Substance Use The client has had some history of substance abuse.

Family History When the client was eight years old his parents got divorced. Personal History The client completed high school and attended some college. Behavior His activity level is normal. Thought Process and Content His thought process was coherent.

Diagnosis F Plan Goals The client will be open to counseling Short-term objective: the client will attend one counseling session per week. Interventions: contracting with the client for counseling attendance. I will ask the client to attend one session per week for the next ten weeks.

Increase therapeutic compliance by framing therapy as a way to help the client avoid problems and their negative consequences. Long-term objective: the client will have an increased willingness to recognize that there are problems in his life and he is responsible for the problems. Interventions: Cognitive therapy to help the client recognize the areas of his life that are problematic. Cognitive reframing to help the client see that these problems are not caused by everyone else but rather that he has some responsibility for them.

Interventions: cognitive behavioral therapy to help the client realize the real or possible consequences of his sexual misconduct. Framing less sexual conduct as being in his best interest as a way of avoiding these possible negative consequences. Short-term objective: His family will also report less instances of him exploiting or manipulating women. Interventions: Have the client sign an ROI so that I can speak with his family and have them report on his dangerousness to others.

Psycho-education about antisocial personality disorder for people he allows to be involved in the therapy. Long-term objective: the client will demonstrate less manipulative and exploitative behavior of friends, family, and others.

DISSERTATION DESIGN METHODOLOGY

To show you what to cover, here are descriptions of each component:. The American Psychological Association APA defines biological factors as any chemical, physical, neurological or genetic condition associated with psychological disturbances. According to the National Institute of Mental Health , many mental disorders are caused by a combination of biological, psychological, genetic and environmental factors. You might take the following information about your client into account:.

You might ask questions such as:. To understand your clients better, consider psychological factors and related information, such as:. You might also ask the following questions:. For example, according to the review, studies show a correlation between poor mental health and lower incomes. Also, emotional support is considered a protective factor against common mental health disorders. You might ask:. Your report will help you understand your client as a whole individual to devise an effective treatment plan.

You can also share your assessment with colleagues or physicians to coordinate care. Address the following areas when writing your report:. You might offer the following information:. Here are tips to help communicate your assessment with colleagues and other care providers:.

Writing a biopsychosocial assessment is just part of your documentation workload as a behavioral health professional. In addition to evaluations, you likely have progress notes , psychotherapy notes, treatment plans, medical records, privacy notices and consent forms to complete, organize and keep secure.

If you need assistance managing documentation in your practice, ICANotes electronic health record EHR software for behavioral health can reduce the amount of time you spend writing, organizing and searching for critical documents. ICANotes was designed by a clinical psychiatrist for behavioral health professionals and is a comprehensive EHR system.

With ICANotes, you can:. Him and his sister became addicted to the substance together. However, he was able to stop using crack on his own and reports that he has not had problems with drugs since. Two years ago he thought he had the flu and therefore did not drink alcohol. In reality the flu like symptoms were from alcohol withdrawal and they became worse when he continued to not drink.

He ended up drinking alcohol again and his withdrawal symptoms subsided. However, neither him nor his family and friends report the alcohol use as being problematic. The client reports that he does not have any medical problems. When the client was eight years old his parents got divorced.

His sister says this was a very difficult time for herself and her brother. However, the client denies that he was effected by the divorce. His mother died when he was 35 years old. The client was briefly married three years ago for just about one month and until recently was paying his ex wife alimony. She died accidentally by falling off a building roughly one month ago.

He describes feeling relived that he does not have to give her money anymore. The client completed high school and attended some college. He preformed adequately in school but says that he was disinterested in it because it did not challenge him. His father and sister drink roughly the same amount of alcohol as he does.

None of his family members have any documented or suspected mental disorders. He grew up upper-class and he often still relies on his father for financial support. He now lives a middle class life. He shares an apartment with his best friend, Mac, who has expressed sexual feelings for the client. The client is adamant that he is not gay. Additionally, the client has one child who is two years old with a woman in Iowa who he had a one night stand with.

He wants nothing to do with the woman or the child. His friends and family knew nothing of this child until a few weeks ago. The client has never had a significant relationship. His marriage was impulsive and brief and he describes never actually having feelings for her. He has never been in a relationship for more than a couple of dates. The client is an outspoken atheist and was not raised with any particular culture or religion. This has been a steady source of employment. However, it is not always a steady source of income.

The client often makes very little money due to the mismanagement of the bar. His father pays for any large expenses that he cannot afford. He wore a button down shirt and slacks to our first meeting. His hair and nails were well kept. The client is oriented by four. He has poor insight and is unaware that any of his behavior is problematic. His activity level is normal. His behavior is mostly normal. However, he will hold eye contact for long periods of time in a way that feels intimidating.

He will also mutter things under his breath and smile to himself occasionally. His affect is appropriate. He seems to have some grandiose thinking. He did not say anything that would indicate suicidality or homicidality.

He did make a few comments about controlling or manipulating women that leave me concerned that he might coerce or force more women into sexual contact with him. His thought process was coherent. His speech was normal but occasionally would become loud and pressured when he got angry or irritable. He has poor insight demonstrated by his thinking that he has no problems but everyone else in his life does.

The client demonstrates disregard for and violation of the rights of others in a number of ways. He lied to the woman he had a baby with about his name and profession, he manipulated a child into pretending to be his daughter so that he could impress a woman, and he frequently lies to his family.

He is irritable and aggressive with his friends and family, he also demonstrated his anger during our session. He fails to conform to social norms by breaking laws such as serving minors alcohol at his bar and paying a homeless man for a favor in drugs. He demonstrates a lack of remorse for his behavior saying that these people often deserve it because they are stupid.

He meets criteria B for the diagnosis because he is over 18 years old. Finally, these symptoms do not occur during schizophrenia or a bipolar disorder because I have found no evidence for either of those. It will focus on trying to have the client see that acting in a more prosocial way will help him avoid negative consequences. The majority of the therapy will be individual.

The treatment will take place in an outpatient office with someone who specializes in personality disorders. However, he might need a higher level of care for the alcohol dependence in the future. I would consider referring the client for a psychiatric evaluation. Although there is no medication that is approved for the treatment of antisocial personality disorder there is some evidence that other psychiatric medications like lithium might help with aggression.

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His activity level is normal. His behavior is mostly normal. However, he will hold eye contact for long periods of time in a way that feels intimidating. He will also mutter things under his breath and smile to himself occasionally. His affect is appropriate. He seems to have some grandiose thinking. He did not say anything that would indicate suicidality or homicidality. He did make a few comments about controlling or manipulating women that leave me concerned that he might coerce or force more women into sexual contact with him.

His thought process was coherent. His speech was normal but occasionally would become loud and pressured when he got angry or irritable. He has poor insight demonstrated by his thinking that he has no problems but everyone else in his life does. The client demonstrates disregard for and violation of the rights of others in a number of ways. He lied to the woman he had a baby with about his name and profession, he manipulated a child into pretending to be his daughter so that he could impress a woman, and he frequently lies to his family.

He is irritable and aggressive with his friends and family, he also demonstrated his anger during our session. He fails to conform to social norms by breaking laws such as serving minors alcohol at his bar and paying a homeless man for a favor in drugs. He demonstrates a lack of remorse for his behavior saying that these people often deserve it because they are stupid. He meets criteria B for the diagnosis because he is over 18 years old.

Finally, these symptoms do not occur during schizophrenia or a bipolar disorder because I have found no evidence for either of those. It will focus on trying to have the client see that acting in a more prosocial way will help him avoid negative consequences. The majority of the therapy will be individual. The treatment will take place in an outpatient office with someone who specializes in personality disorders. However, he might need a higher level of care for the alcohol dependence in the future.

I would consider referring the client for a psychiatric evaluation. Although there is no medication that is approved for the treatment of antisocial personality disorder there is some evidence that other psychiatric medications like lithium might help with aggression. July 24 Overview If you are a new clinician or still in school you might be wondering how to write up a thorough biopsychosocial assessment for a client.

Current Risk The client is currently not a risk to himself. Substance Use The client has had some history of substance abuse. Family History When the client was eight years old his parents got divorced. Personal History The client completed high school and attended some college. Behavior His activity level is normal. Thought Process and Content His thought process was coherent.

Diagnosis F Plan Goals The client will be open to counseling Short-term objective: the client will attend one counseling session per week. Interventions: contracting with the client for counseling attendance. I will ask the client to attend one session per week for the next ten weeks. Increase therapeutic compliance by framing therapy as a way to help the client avoid problems and their negative consequences.

Long-term objective: the client will have an increased willingness to recognize that there are problems in his life and he is responsible for the problems. Interventions: Cognitive therapy to help the client recognize the areas of his life that are problematic. Cognitive reframing to help the client see that these problems are not caused by everyone else but rather that he has some responsibility for them.

Interventions: cognitive behavioral therapy to help the client realize the real or possible consequences of his sexual misconduct. Framing less sexual conduct as being in his best interest as a way of avoiding these possible negative consequences. Short-term objective: His family will also report less instances of him exploiting or manipulating women. Interventions: Have the client sign an ROI so that I can speak with his family and have them report on his dangerousness to others.

Psycho-education about antisocial personality disorder for people he allows to be involved in the therapy. Long-term objective: the client will demonstrate less manipulative and exploitative behavior of friends, family, and others. Interventions: Cognitive behavioral therapy to help the client change the way he thinks about manipulation and exploitation as well as helping him to actually change those behaviors.

Working with the client to teach prosocial behavior and encouraging with validation when he demonstrates such behavior. The client will address issues related to substance abuse Short-term objective: the client will report a reduction in the number of drinks he has per week. Interventions: motivational interviewing to reduce substance abuse behavior. Using a harm reduction approach to try to help the client reduce the number of drinks per week. Long-term objective: the client will recognize and process some of the underlying feelings that led to alcohol dependence.

Interventions: psychoanalytic approaches to address unresolved underlying feelings. EMDR if there is any unresolved trauma. The client will be better able to regulate feelings of anger Short-term objective: the client will demonstrate an ability to self-soothe in session when anger arises.

Interventions: teaching deep breathing techniques to help the client engage the parasympathetic nervous system during times of dis-regulation. Long-term objective: the client will report an ability to self-soothe when anger arises in daily life. Interventions: Teaching mindfulness so that the client will have awareness of when he is starting to feel angry or irritable. Teaching deep breathing techniques to family members as well so they can model regulated behavior. Individual and Family Therapy The majority of the therapy will be individual.

Location and Frequency The treatment will take place in an outpatient office with someone who specializes in personality disorders. Katherine always expressed remorse about the destruction of property and expressed anxiety that her father would throw her out. She would try to engage in problem solving saying that she would fix the broken furniture.

No family members were injured while she was destroying property, but she occasionally threatened to hurt them with pieces of the destruction. Her father and stepmother became increasingly concerned about her destruction. A good goal for Katherine would be building a healthy relationship with food and trusting that her caretakers will provide it for her. I believe this directly correlates with her aversion to hygiene; Katherine believes the body odor she achieves from days of not bathing helps protect her from people wanting to be near her or hurt her.

Play therapy has proven significantly useful into gaining insight for many of her externalized behaviors Riviere, With regards to the trichotillomania, it is classified as an impulse control disorder as is binge eating in the DSM-IV. Katherine uses hair pulling to relieve feelings of anxiety.

When she pulls her hair out she feels this instant sense of reprieve from thinking about her sexual abuse. Katherine says that the discomfort of pulling out the hair distracts her from unpleasant thoughts from her earlier childhood. However, she also expresses distress at her baldness because her peers make malicious comments. Additionally, because she was bald, many people in the general public would refer to her as male, which she found upsetting.

In order to relieve some of the distress Katherine experienced by being in public, Katherine would wear a wig. Katherine is a thoughtful and affectionate child. She likes creating bonds with her peers and adults. Katherine understands a working friendship and tries to foster them with other children. Katherine smiles and laughs easily and often.

She rarely expresses violence toward her peers or herself in the placement facility. She is an excellent listener and follows directions with ease. Katherine can excel in the classroom when given thorough instructions and time to complete the assignment. Katherine shows a strong capacity and desire to change. Her immediate goal is to manage the trichotillomania and strongly desires to regrow her hair. She often carries a photo of herself with hair to encourage her.

Katherine lacks the capacity to trust in adults and often fears that they will leave or harm her. Katherine harbors anger toward her father because she blames him for her out-of-home placement; this anger is waning over the course of treatment and she reports more positive feelings about her father and looks forward to their visits. She knows how to be a friend, but often crosses lines with physical touch.

It is likely that her friendliness towards other children is a grooming behavior to earn their trust. Katherine needs to re-learn boundaries for peer and adult relationships. I chose the posttraumatic stress disorder because of the behaviors that started because of her sexual abuse experience and chronic neglect American Psychological Association, She shows evidence of disorganized thinking, fear, extreme anxiety, and cognitive distortions.

Katherine has violent outburst when encountering a trigger that reminds her of her abuse. Her violence is always directed at objects, never at peers. When having to share the experience with group mates she will often become caustic or withdrawn. Katherine has sleep disturbances where she has nightmares reliving the trauma. She also has some intrusive thoughts where she fanaticizes about killing her mother or abusers. Because her abusers were Hispanic men, she avoids all people who look to be of Hispanic origin.

If she encounters Hispanic people in public, it is possible that she will either disassociate or start crying. Katherine qualifies for generalized anxiety disorder and stays in a state of high alert riddled with worry Saddock; Saddock, She worries about her personal safety, being left alone with men, not having enough food, feeling sexually aroused, and encountering a trigger. She occasionally has episodes of panic where she experiences disassociating, difficulty breathing, and weeping.

Katherine rarely remembers anything that happens while she is in a state of panic. While in residential placement, her panic attacks are not externally violent towards her peers or others. Additionally, Katherine has clear criteria for trichotillomania. She pulls hair out of her face and head to relieve feelings of anxiety. She does not hoard or eat the hair. One year ago, she began pulling her hair out on her head and face resulting in near baldness and no eyelashes or eyebrows.

She also started compulsively binge eating and has gained over thirty pounds. She will hoard large amounts of food in her bedroom and when she feels like she has enough she will engage in a binge. A final recent presenting issue is an extreme aversion to showering or hygiene practices resulting in noticeable body odor.

Katherine says that she is aware of the odor and comforted by it. Staff members are trying to motivate her to bathe, but are not currently having much success. Because of her previous unsafe behaviors, impulse control, and poor boundaries with peers — residential treatment does seem appropriate.

I also think that having the group process is important to give Katherine a chance to practice her treatment goals with her peers. Another beneficial element to the group therapy approach for this client is building a feeling of solidarity in being a sexual abuse survivor with other child survivors in the group. Many of the children at the facility say that their relief in knowing that they are not alone in their experience, regardless of how the experience has effected them.

The caretaking figures in the treatment facility could also reinforce this during her activities of daily living. Also providing psycho-education on connecting feelings of anxiety to hair pulling behaviors and outbursts would help her get control of those feelings.