Client indicates agreement with the therapist’s goals.
After the therapist has explicitly identified or described the purpose for therapy or the goals for the treatment, the client says something that indicates acceptance of the therapist’s perspective. The client might explicitly (“Yes, that’s good”) or more implicitly agree (e.g., “Well, that makes sense because...” or “Let’s get started then”).
Client describes or discusses a plan for improving the situation
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With or without prompting from the therapist, the client explicitly describes what he or she will do or think in working toward improvement. It could be an elaborate plan, such as “making sure to give each family member a compliment every day,” or a more diffuse idea, such as “trying to look on the bright side of the situation.” The client must explicitly articulate what he/she will do, not merely agree with the therapist’s plan or suggestion in order for this item to be checked.
Client introduces a problem for discussion.
With or without prompting from the therapist, the client identifies something specific that he/she would like to deal with in the session (e.g., “I think we need to talk more about how we communicate when we are angry”). The client must initiate the topic, not merely agree with the therapist’s suggestion or identification of a problem in order for this item to be checked.
Client agrees to do homework assignments.
A “homework assignment” might be specifically prescribed by the therapist (e.g., “Over the next week, I’d like you to...”), or might be a more general suggestion (e.g., “One thing you might try that has helped other people in your situation is to...”). The client must explicitly say something to indicate he or she will carry out the “assignment.” A mere head nod or “mhmm” is not sufficient to check this item. If, however, the client asks a question about the homework that suggests that he/she plans to do it, such as, “Should I also write down everything my wife does?”, this item can be checked.
Client indicates having done homework or seeing it as useful.
This item is checked either in response to the therapist’s questioning about the “homework” assignment (a specific plan or a general suggestion), or without being asked, the client mentions the value of the homework or at least indicates having attempted it. If the client indicates that he/she decided not to do the homework or could not find time to do it, this item should not be checked.
Client expresses optimism or indicates that a positive change has taken place.
With or without questions from the therapist, the client describes feeling hopeful or seeing that change is possible, either for him/herself, for other family members, or for the family as a whole. This item can be checked if there is a straightforward expression of “things are looking up,” or “we can make a change,” or “we’re getting somewhere now” or if the reference to optimism is indirect, such as “Well, I always think about the positives.” Optimism implies hope for positive change, whether it be a small behavioral difference, saving a marriage, or keeping a teen out of trouble. This item can also be checked if the client’s comment relates to a positive sense about the therapy, such as “Now that we’re here, we can really work on this.”
Client complies with therapist’s requests for enactments.
In response to the therapist explictly asking a client or some clients to do something in the session, the client does so. This might involve specific behaviors, such as changing chairs to face each other, or talking with another family member about something that the therapist suggests (e.g., “Why don’t you two talk and try to come to some understanding about how you are going to deal with...”). The “enactment” need not be an elaborate technique, like family sculpting, but simply following the therapist’s suggestion to do something or try something differently in the session (e.g., breathing deeply before speaking, holding hands, looking in each other’s eyes).
Client leans forward.
This item is only checked when the client moves to lean forward in response to something being discussed in the session or when being asked a question by the therapist or another family member. If the client is sitting forward throughout all or most of the session, this item is checked only once. If the client moves back and forth in the seat in response to what is being discussed, each discrete forward movement is checked.
Client mentions the treatment, the therapeutic process, or a specific session.
This item is to be checked when the client brings up the therapy as a topic (its value, the need for it, what is going on in the process, etc.). Examples would include remarking that the previous session brought up a lot of issues or that the client looks forward to the session or asks how long the therapist thinks the therapy will need to continue. If the client has negative things to say about the therapy, this item is not checked (see negative item about “feeling stuck”). Further, the item is not checked when the client merely responds to questions the therapist asks regarding the therapy (e.g., “How did you feel about last week’s session?” or “How do you think this process is going for you?” or “What would you like to talk about today?”). Note that if the client mentions in the treatment in the context of improvement or optimism (e.g., “Things have been better since we started coming here”), the item “client expresses optimism...” should take priority.
Client expresses feeling “stuck,” questions the value of therapy, or states that therapy is not or has not been helpful.
This negative item is checked when the client explicitly mentions dissatisfaction with the way the therapy is going, the need for it, or the direction it is taking. This expression of negative attitude or emotion may or may not be in response to the therapist’s question or to the question of some other family member. This item is not checked if the client’s response is vague, such as “I don’t know, “ or “Okay, I guess,” even if a negative attitude is suspected. Such vague expressions might be indicators of another negative item, i.e., showing indifference. That is, for this item to be checked the expression of dissatisfaction must be clear and overt.
Client shows indifference about the tasks or process of therapy (e.g., paying lip service, “I don’t know,” tuning out).
Paying lip service refers to superficial compliance with what is being asked or suggested by the therapist or other family members. Indifference may be shown nonverbally, as in doing something else (e.g., cleaning out a pocketbook, filing nails), not following the flow of conversation, looking around the room at what’s in the office. As with other nonverbal items, it is more than just a momentary lack of attention, and for this item to be checked, nonverbal behaviors need to be fairly obvious. Verbally, people can show indifference by a notable lack of energy or enthusiasm (e.g, “Sure, if you like, we can try that”). Indifference tends to be inferred from tone of voice. More obvious comments might be, for example, “Okay, but I doubt it will make any difference in the long run.” This item should not be checked for young children, who can be expected to let their attention wander during a session.