Forms for the Therapist (Practical Resources for the Mental Health Professional)

✍ Scribed by Allan G. Hedberg

• Publisher: Academic Press
• Year: 2010
• Tongue: English
• Leaves: 526
• Edition: 1
• Category: Library

✦ Synopsis

Allan Hedberg has been in private practice as a psychologist for over 30 years. In this book, Dr. Hedberg has put together a one-stop source of every imaginable form for the early career therapist. The book is not geared exclusively to psychologists, but to all types of practitioners including psychologists, psychiatrists, social workers, marriage and family counselors, alcohol counselors, rehabilitation, recreational, occupational, physical, and speech therapists. The forms have been provided by experienced, seasoned professionals who have refined their content over the course of many years in practice. In addition to the forms themselves, practical guidelines on their use and helpful information on developing personalized forms is included. The book is written in a concise format and the forms are easy to duplicate or adapt for the busy professional.    The website with electronic forms from this book can be found at: http://booksite.academicpress.com/hedberg/forms.   * Forms are designed for early career therapists and obtained from experienced, seasoned therapists Includes all types of forms including surveys, questionnaires, informal tests, informational ratings sheets, and "homework assignments" to be used between sessions Information is geared toward all types of practitioners and forms are easily duplicated or adapted, saving professionals valuable time

✦ Table of Contents

Cover Page
......Page 1
Front matter......Page 3
Copyright......Page 4
List of Icons......Page 5
List of forms by type......Page 6
Contributors......Page 19
About the editor......Page 21
Preface......Page 22
Acknowledgments......Page 23
Starting and Managing Your Clinical Practice......Page 24
Forms for Setting Up and Defining Your Practice......Page 25
Example professional resume (web version)......Page 26
Professional practice profile......Page 28
Vision implementation planner......Page 29
Strategic planning worksheet......Page 30
Professional will and instructions......Page 31
Codicil to personal or professional will Percentage of Adjusted Gross Estate......Page 34
Professional profile documents needed......Page 35
Business development and professional relationships......Page 36
Making a business plan......Page 37
Intentional strategic planning......Page 39
What are the components of a mission statement?......Page 40
Office set up and marketing needs......Page 41
Letter of introduction to the community......Page 42
The 14 Ps of marketing a practice, program or service......Page 43
Marketing by mail (1)......Page 44
Marketing by mail (2)......Page 45
General marketing guidelines......Page 46
Free use of the media......Page 47
Sample letter for a proposed community workshop......Page 48
Going green in the office......Page 49
Process Checklist......Page 50
Strategic planning vs. vision thinking......Page 51
A swot analysis of the practice......Page 52
Forms Related to Fees......Page 53
Structuring payment plans for patients who cannot afford standard fees......Page 54
Office financial policy......Page 55
Cancellation and missed appointments notice......Page 56
Notice of missed appointments......Page 57
Actions to take when patients miss appointments......Page 58
Payment agreement for past service rendered......Page 59
Past due letter requesting payment......Page 60
Doctor’s lien and authorization of payment......Page 61
office daily billing sheet......Page 62
Fee agreement for psychological expert witness services......Page 63
Fee schedule for clinical services
......Page 64
Fee schedule for medicAL/legal services......Page 66
insurance authorization log......Page 67
Insurance direct payment authorization......Page 68
HIPAA/Patient Privacy Forms......Page 69
HipAa office staff guidelines......Page 70
Hipaa complaint and resolution form......Page 71
Authorization for release or exchange of information......Page 73
Permission to allow information from a session to be used for research, teaching, lecturing, and/or publication purposes......Page 74
Patient records access form......Page 75
Request for no records to be kept......Page 76
Limits on patient confidentiality......Page 77
Guidelines for the release of psychological test data......Page 78
Medicare advance beneficiary notice......Page 79
General Informational Handouts for Patients......Page 81
Medication and Hospitalization......Page 82
Specialized Services......Page 83
The ways management might address these issues include the following......Page 84
Overview......Page 85
Disclosure of Risks and Benefits Regarding the Use of Psychotherapeutic Medications......Page 86
10 Steps to a healthier brain......Page 87
User guidelines......Page 88
Advice for patients seeking services on the internet......Page 89
Personal bill of rights......Page 90
Patient bill of rights......Page 91
Forms Related to Referral and Consulting Services......Page 92
Contract for Consulting Services: Brief Form......Page 93
Consulting Services Agreement with Other Professionals......Page 94
A Sample Contract......Page 95
Agreement for Psychological Expert Witness Services......Page 97
Confidential Referral......Page 98
Expert Witness Guidelines......Page 100
What to look for when reviewing a contract......Page 101
Approach to assessment......Page 102
Client’s Consent to Assessment......Page 103
Ethical Guidelines in Interdisciplinary Care......Page 104
Guidelines for Medication Referrals......Page 105
10 Networking tips......Page 106
Fitness for Duty and Workers’ Compensation Forms......Page 107
Notice of Unfitness for Duty......Page 108
Notice of Return to Duty......Page 109
Workers‘ Compensation Information Intake Form......Page 110
Workers’ Compensation Lien Cover Letter......Page 111
Forms Related to Patient Services......Page 112
We Value Your Trust
......Page 113
Confidentiality......Page 114
My training and approach to therapy......Page 115
Client Consent to Psychotherapy
......Page 116
Patient Confidential Information Form......Page 117
Confidential Alternate Communications Request......Page 118
Documenting All Services Rendered......Page 119
Behavioral Therapy Plan......Page 120
Needs Appraisal and Services Plan......Page 121
Review of Behavioral Medication by Physician......Page 122
Monitoring of Antecedent Events to Self-Defeating Behavior......Page 123
Components of a Patient‘s Chart: a Checklist......Page 124
Comments......Page 125
Patient Satisfaction Questionnaire......Page 126
Patient Satisfaction: Therapy’s Greatest Public Relations Approach......Page 127
How has it gone since the last session?
......Page 128
Jury Duty Excuse......Page 129
Forms Related to Therapist’s Professional Activities......Page 130
Continuing Education Log......Page 131
Weekly Travel Expense Sheet......Page 132
Expense Account......Page 133
Supervision Documentation Form......Page 134
Managing an Office Staff......Page 135
Program Staff Meeting Minutes......Page 136
For Use in a Multi-Staff Clinic......Page 137
Annual Survey of Office Staff......Page 138
Peer Evaluation of Employee......Page 139
Employee Self-Evaluation Form......Page 140
Employer Feedback to Employee from Annual Review......Page 141
A Notification System
......Page 142
Annual Employee Satisfaction Survey......Page 143
Unusual Incident Report Form......Page 144
Request for Time off......Page 145
Request for Early Dismissal or Overtime Authorization......Page 146
Employee Exit Interview......Page 147
Authorization to Release Employment Information......Page 149
Authorization for Letter of Reference......Page 150
Signs to notice and take seriously......Page 151
Professional Staff Meeting Agenda......Page 152
Emergency Action Needed: “Ina”......Page 153
What depressed employees need to know......Page 154
Leadership in Today’s World ......Page 155
Leadership in the Workplace......Page 156
A Check List and Plan for Improvement
......Page 157
Rules in crisis communication......Page 158
Dealing with “confrontational crisis”......Page 159
Termination of Treatment/Practice Forms......Page 160
Release from responsibility for discharge......Page 161
Letter to terminate services to a patient......Page 162
The practice profile
......Page 163
Psychotherapy Practice For Sale
......Page 165
Forms for Session Notes......Page 166
Session notes: version 1......Page 167
Session notes: version 2......Page 168
Session notes: version 3......Page 169
Session notes: version 4......Page 170
Relaxation training and biofeedback therapy session notes......Page 171
Group therapy notes......Page 172
Clinical Errors, Bad Habits, Ethical Complaints, and Law Suits......Page 173
12 Steps for reducing your risks in a malpractice suit
......Page 174
Four issues to be addressed in determining negligence in a civil law suit
......Page 175
Ways to respond to a complaint......Page 176
Guidelines for managing unintended errors and mistakes......Page 177
Bad habits to avoid as a therapist......Page 178
Medication consultation by psychologist
......Page 179
Expanding Your Practice......Page 180
Informed consent procedures for telemedicine......Page 181
Negotiating successfully......Page 182
Professional variables......Page 183
My plan to go forward......Page 184
Coaching Includes Your Choices of:......Page 185
Executive coaching to accelerate learning......Page 186
The general steps to be followed......Page 187
Intake Forms and Initial Assessment Tools for Evaluating Patients......Page 188
Organizing Your Charts and Evaluations......Page 189
Outline for a comprehensive clinical evaluation......Page 190
Discharge......Page 194
Disclosure forms......Page 195
Outline for a standard clinical evaluation and summary report......Page 196
General Assessments: Intake, Brief, Comprehensive, and More......Page 197
Getting to know you......Page 198
The intake process – issues to assess......Page 199
Legal intake form......Page 200
Intake assessment and proposed treatment plan......Page 201
Brief clinical assessment......Page 202
Brief Assessment and diagnostic Summary......Page 207
Brief diagnostic structured clinical interview......Page 208
Sentence completion-work......Page 209
Psychopathy checklist......Page 211
Critical events time line......Page 212
Assessments Related to Specific Tests and Scales......Page 213
Introduction......Page 214
Permeable boundaries......Page 215
Global assessment of relational functioning (garf) scale......Page 216
Gaf evaluation......Page 217
Social and occupational functioning assessment (sofa) scale......Page 218
Assessments Related to Risk, Competency, Health, and Neuropsychology......Page 219
Competency to stand trial status exam......Page 220
Assessing lifestyle and health......Page 221
Informal diagnostic exercises of aphasia......Page 223
What will the results tell me?......Page 224
Key benefits......Page 225
Forms, Exercises, and Information for Treating Specific Disorders......Page 226
Anxiety and Stress Relief with Relaxation Assessment and Exercises......Page 227
A Checklist
......Page 228
BALANCING YOUR PRIORITIES......Page 229
Identifying most critical issues......Page 231
Achieving your goals … together......Page 232
Progressive relaxation......Page 233
Stress and anxiety management......Page 234
Stressful life events......Page 235
Well-being scale......Page 236
How well do you cope with life’s circumstances?......Page 237
Fear and its management......Page 238
Pain control statements......Page 239
Emotional fitness......Page 240
Calm Down and Live in Peace......Page 241
Stress is not a stocking stuffer......Page 242
Identifying traumatic stress......Page 243
What management can do to minimize employee stress......Page 244
Depression and Self-Esteem......Page 245
Depression myths......Page 246
Triple-column technique to understand and change my depression......Page 247
Bipolar: how to be self-defeating......Page 248
Bipolar disorder hypersexuality......Page 249
Feeling overwhelmed and desperate......Page 250
The happiness factor......Page 251
What are the symptoms of sad?......Page 252
Side effects......Page 253
Practicing spirituality......Page 254
A Personal Pursuit Exercise......Page 255
The self-esteem review......Page 256
10 Self-esteem boosters......Page 257
Insomnia and Sleep Therapy......Page 258
10 Tips for better sleep......Page 259
Helpful hints for easing into sleep......Page 261
How can i learn more to help me sleep?......Page 262
Sleep improvement program......Page 263
My sleep diary......Page 264
My sleep chart......Page 265
Sleeping improvement log......Page 266
Helping sleep through use of medication......Page 267
Importance of good sleep habits......Page 268
Addictive behavior......Page 269
Signs of alcoholism
......Page 270
Alcohol addiction questionnaire......Page 273
Alcohol involvement scale......Page 274
Other considerations......Page 275
How, how much......Page 276
Two questions on gambling......Page 277
Do i have a gambling problem?......Page 278
My gambling pattern in the past year
......Page 280
Are you Living with a Compulsive Gambler?
......Page 281
Caffeine consumption questionnaire......Page 282
Reasons to quit smoking......Page 283
Suicidal Behavior......Page 284
SUICIDE RECOVERY FOR FAMILY......Page 285
RISK FACTORS......Page 286
A Guideline for Detecting Dangerousness
......Page 287
No Harm Agreement......Page 288
Pain Management and Coping with Medical Disorders......Page 289
Seek immediate medical care if …......Page 290
Successful treatment......Page 291
Clinical interview......Page 292
Assessment and measuring pain......Page 293
Patient Pain Assessment......Page 294
Pain Identification Chart......Page 295
Charting Perceived Pain......Page 296
Physical Disorders Associated with Psychological Distress......Page 297
Patient Report of Illnesses and Medical Problems......Page 299
Treatment focus and objectives......Page 300
Dizziness Questionnaire......Page 302
Medications Being Taken by Patient......Page 304
Things to Do or Take to Manage GERD Symptoms......Page 305
WINNING OVER DEPRESSION:......Page 306
Anger and Violent Behavior......Page 307
How to handle angry people ......Page 308
Anger and how to deal with it......Page 309
Hostility discomfort scale......Page 310
Behavioral anger scale......Page 311
Anger inventory......Page 312
Behavioral hostility checklist......Page 313
My anger story… About Which I Am Not Proud......Page 314
My diagnostic anger map......Page 315
Five steps of anger control......Page 316
Dangerous propensities of a minor......Page 317
Risk for re-offending as a sex offender......Page 318
Skill Building Strategies and Tools for Personal Growth and Life Improvement......Page 320
Strategies and Tools for Personal Growth and Health Awareness......Page 321
My Developmental Experiences of Personal Growth and Development......Page 322
My Self-Analysis......Page 323
Considerations in Self-Image Building......Page 324
My Friendship Circle......Page 325
My Life’s Journey of Growth Experiences......Page 326
exercise......Page 327
Journal......Page 328
The Motivation Worksheet
......Page 329
My Daily Journal......Page 330
Test of Personal Meaning
......Page 331
exercise......Page 332
Happiness and Optimism Exercises......Page 333
Good Habits for Healthy Living......Page 334
Components of Brain Functioning......Page 335
Journal Writing......Page 336
Communication Tips and Exercises......Page 338
Communication tips from the tennis court......Page 339
What kind of listener am i?......Page 340
Communication exercises in the perception of feelings......Page 341
Model of communication patterns......Page 342
Obstructive styles of communication......Page 343
The listening skills ladder......Page 344
The stings and thorns of communication......Page 345
Nonverbal communication checklist......Page 346
Assertiveness inventory
......Page 348
Eating and Exercise Logs......Page 350
Personal Exercise Record......Page 351
Weekly Home Exercise Program......Page 352
Eating Behavior Schedule......Page 353
Helping Patients Live an Active Lifestyle......Page 354
Tips to Manage Weight Loss......Page 355
Cultural Diversity Appreciation Exercises......Page 356
Movies and Videos Focusing on Diverse Populations......Page 357
Q & A......Page 358
Procedure......Page 359
Questions for the therapist to consider and discuss......Page 361
Conflict Resolution and Problem Solving......Page 362
Walking Around the Edges of Conflict......Page 363
The Five Steps to Problem Solving......Page 364
Non-violent problem solving......Page 365
Violent problem solving......Page 366
Problem Solving Diagram......Page 367
The Problem Solving Worksheet......Page 368
A Therapy Work Sheet......Page 369
Thinking Distortions: Information and Patient Exercises......Page 371
How to stop it: an exercise to bring about change......Page 372
Thinking Distortions......Page 373
Behavioral Monitoring Logs......Page 374
behavior Monitoring Graph......Page 375
monitoring of Antecedent Diagnostic Events to Self-defeating Behavior......Page 376
A Look at my Self-defeating Behavior Pattern......Page 377
Charting of the daily progress at home and work......Page 378
behavioral Observations Chart for Daycare and Hospital patients......Page 379
Dealing with Crisis......Page 380
How Best to Respond to a Crisis
......Page 381
Crisis Intervention......Page 382
Along the path of a crisis......Page 384
Post-trauma Do’s......Page 385
Post-trauma Don’ts......Page 386
Trauma Response
......Page 387
Getting unstuck in recovery from trauma......Page 388
Dealing with Specific Types of Patient Problems and Issues......Page 389
Serving Children and Their Families......Page 390
The Family Needs Help to Change......Page 391
How long will therapy take?......Page 392
For family therapy, who will actually come to the sessions?......Page 393
Teaching Children How to Make Wise Choices......Page 394
Functional and Dysfunctional Families......Page 395
The Eight Vital Characteristics of a Functional Family......Page 396
The unhealthy process of raising children......Page 397
Check Your Family’s Vital Signs......Page 398
The Dysfunctional Family......Page 399
THE PLAN OF CARE......Page 400
Family Based Assessment......Page 401
An important word about “psychological testing”......Page 402
Family Life in the Home......Page 403
Child/Teen Brain System Checklist......Page 404
The Warning Signs
......Page 407
Learning Disabilities......Page 409
Children with Special Needs: Early Warning Signs......Page 410
Information I Need from You......Page 412
Multiple Intelligence......Page 413
Attention Deficit-Hyperactivity Disorder (ADD/ADHD)......Page 414
Problems for which to be alert and avoid......Page 415
Potential diagnostic confusion......Page 416
Key Benefits......Page 417
Possible Causes of Impulsivity and Hyperactivity......Page 418
ADHD Behavioral Review......Page 419
School Performance and Teacher Feedback......Page 420
Daily School Report
......Page 421
Weekly School Report
......Page 422
Weekly Schoolwork Review......Page 423
Teacher Feedback Form on Student Performance......Page 424
Student Rating Scale for Educational Planning......Page 425
Communication with Children......Page 426
10 Steps in Talking with Children......Page 427
A self-test on your communication with children today......Page 428
The Goodnight Formula for Children and Parents......Page 429
Agenda......Page 430
Family Locator and Connection Worksheet......Page 431
54 Ways to Say “Good for You”......Page 432
A Parent’s Pledge......Page 433
Basic Parental Behaviors to Use in Raising Boys......Page 434
The Making of Family Rules......Page 435
Exercises for Therapists to Get Children to Communicate......Page 436
Drawing a Face As a Rapport-Building Exercise......Page 437
Drawing a Dad Story for the Unforthcoming Child......Page 438
Drawing a Mom Story for the Unforthcoming Child......Page 439
Story Telling for the Unforthcoming Child......Page 440
Drug Use and Eating Disorders......Page 441
Parents and Teachers Combating Adolescent Drug Use......Page 442
Recommendations for Family Members of Anorexic Individuals......Page 443
Eating Disorder Evaluation: Bulimia......Page 444
Custody/Visitations......Page 446
The Visitation Conundrum
......Page 447
Parent to Parent Communication Form......Page 448
Child Custody and Visitation Preferences......Page 449
New Drivers......Page 451
The New Driver’s Learning Plan......Page 452
New Driver’s Contract......Page 453
Other Parenting Management Strategies......Page 454
Parent–Child Contingency Behavioral Contract......Page 455
Time Out as a Discipline Measure......Page 456
Parenting Events to Learn From......Page 457
26-Day Report Card on Bed Wetting......Page 458
Dealing with Geriatric Patients......Page 459
Assessment Scales and Checklists......Page 460
Geriatric depression scale (short form)......Page 462
The geriatric hypochondriasis scale......Page 463
Geriatric depression scale (long form)......Page 464
Adult brain system checklist......Page 465
Treatment focus and objectives......Page 468
Successful Aging......Page 470
Aging with resiliency and longevity......Page 471
The centenarian support system......Page 472
Tips for retiring seniors (boomers)......Page 473
My retirement portfolio......Page 474
The long pathway of aging......Page 475
The aging brain......Page 476
Guidelines for healthy and effective family visitation......Page 477
Dementia and Alzheimer’s Disease......Page 479
Part b: daily-activities and social-independence test......Page 480
The 10-numbers test of memory:......Page 481
Precautions for care providers......Page 482
A few measures of alzheimer’s and ways to chart its progression:......Page 483
A Step Beyond Dementia
......Page 484
A cognitive friendly unit for alzheimer’s patients......Page 486
Caregivers and Caregiving......Page 487
Advantages and benefits in serving older people......Page 488
Making the caretaking experience rewarding......Page 490
A word for the care providers......Page 492
What family, friends, and guardians can do to prevent abuse?......Page 493
Couples Therapy and Relationship Assessements and Exercises......Page 494
A “perfect” marriage wish list......Page 495
Marital happiness scale......Page 496
Request for marital behavior change......Page 497
Marital Satisfaction: Husband......Page 499
Seven components to loving......Page 500
“You” and “I” Messages......Page 501
20 Diagnostic factors that indicate relationship anger......Page 502
How To Love You?......Page 503
Marital pointers......Page 504
Marital problem area questionnaire......Page 505
Pre-marital questionnaire......Page 507
Dimensions of intimacy......Page 509
Navigating the confrontations of a discovered affair......Page 510
The final thought......Page 511
Marital action steps for the long run......Page 512
Interpersonal relationship distinctions......Page 513
What can i do?......Page 514
Summary......Page 515
How to predict A potentially violent relationship......Page 516
Why victims of domestic violence struggle with leaving......Page 518
Form Development and Usage for a Clinical Purpose......Page 519
Professional Issues in Clinical Practice......Page 520
C......Page 522
G......Page 523
O......Page 524
S......Page 525
W......Page 526