How to use a cognitive triangle worksheet with clients
Clearly illustrate the relationship between thoughts, emotion, and behavior to help your clients improve their well-being.
These treatment plans aren’t one-size-fits-all, but following a few key steps can ensure you provide the support your clients need.
One of the more common diagnoses you’ve likely encountered is adjustment disorder, which is a client’s mental or behavioral response to stressful life events. Many different evidence-based interventions can help a client better manage and adapt to stress, but it’s up to you as a therapist to determine which one to use.
Treatment plans for adjustment disorder aren’t one-size-fits-all, but following a few key steps can ensure you provide the support your clients deserve. Below, learn more about how to write an adjustment disorder treatment plan for your clients.
Diagnosing adjustment disorder requires certain criteria, which are outlined in the DSM-5. The following criteria apply to people of all ages:
Criterion A
The development of emotional or behavioral symptoms in response to identifiable stressors, all occurring within a span of three months from the onset of these stressor(s).
Criterion B
These symptoms or behaviors exhibit clinical significance, as demonstrated by one or both of the following criteria:
Criterion C
The stress-related disturbance does not meet the diagnostic criteria for any other mental disorder and is not merely an exacerbation of a pre-existing mental disorder.
Criterion D
The symptoms do not reflect normal bereavement.
Criterion E
Once the stressor(s) or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.
Keep in mind that onset and duration are important aspects of an adjustment disorder diagnosis. To qualify for adjustment disorder, symptoms must begin within three months of an identifiable stressor. These symptoms must resolve within six months after the stressor or its consequences are no longer present.
Generally, adjustment disorder is not a long-term, indefinite diagnosis. If symptoms persist beyond that timeframe, a different diagnosis—such as major depressive disorder or generalized anxiety disorder—should be considered. Further, adjustment disorder is not the right diagnosis if a client’s symptoms meet criteria for another disorder, like MDD, GAD, or post-traumatic stress disorder.
Key components covered in an adjustment disorder plan depend on the presenting concerns a client comes to therapy with, their goals for treatment, and how their adjustment disorder symptoms are presenting (in other words, the DSM-5 criteria they’ve met to warrant the diagnosis).
Because adjustment disorder can have subtypes, your intervention should focus on the primary presenting symptoms. All treatment plans should include a goal, objective, and intervention. You should also incorporate evaluation criteria to help you assess whether your client is improving.
Treatment is never one-size-fits-all, but typically, therapists include at least one goal and objective from each diagnostic criteria your client experiences. Your interventions should be based on psychological evidence and your clinical training.
Depending on the specific case you’re working with, you may include components that address the following aspects of adjustment disorder.
Because stress can be disruptive to your clients’ lives, you may help them develop tools to manage their emotional and physical stress.
Your client’s thoughts likely contribute to their emotional state during stressful circumstances. Your treatment plan may include tools that help your client reframe the thoughts causing them distress.
Adjustment disorder can result in symptoms of low mood or worry. You may decide to create goals that help clients manage their emotions in day-to-day life.
When stress is the result of relationship difficulties, it may be appropriate to help your client develop communication strategies to use with family, friends, and colleagues.
Every client and case is different, but following certain themes can help ensure you develop the best possible plan to support clients who have experienced trauma. Below, find a sample treatment plan for adjustment disorder.
Jordan is a 28-year-old marketing professional recently laid off from their job of five years. Since the layoff, Jordan has been experiencing excessive worry about financial stability, difficulty sleeping, and irritability. They avoid applying for new jobs, fearing rejection, and have withdrawn from social activities. Jordan’s distress has caused significant strain on their relationship with their partner and reduced their ability to focus on daily tasks.
Goal 1: Reduce distress and improve emotional regulation
Goal 2: Enhance coping skills and problem-solving abilities
Goal 3: Rebuild social connections and improve relationships
Clearly illustrate the relationship between thoughts, emotion, and behavior to help your clients improve their well-being.
Provide a helpful framework for your clients to commit to activities that may help their symptoms and improve their quality of life.
Here’s what you need to know, plus a treatment plan example.