Behavior Plan Template
Use this template to create behavioral plans for assignments in Weeks Two and Three. Fill in each section and provide additional information as needed.
Client Identifying Information
List all pertinent and known identifying information.
Name
Violet
Age
20
Gender
Female
Religion
Unknown
History
Describe all pertinent and known history.
Medical
Depression, sexually abused, started at age 12. Has used self-harm in an attempt to regulate her emotions.
Family
Conflicted relationship with mother. Foster care from age 12 to 18. Uncle that is 12 years older than Violet, whom began sexually abusing her at age 12.
Substance Abuse
Unknown at this time
Developmental and Social
Violet was raised by her mother, whom she had a conflicted relationship with, until she was 12 years old. She entered foster care from age 12 to 18 years old. During her time in foster care her Uncle (12 years her senior) would take her out to eat along with giving her money. At age 12 her Uncle began an incestuous relationship with her. Unknown how long the sexual abuse continued. Since becoming an adult she completed a career college and is employed for the first time as a dental assistant. Violet has been unable to have a healthy relationship with a man or women and is dependent on her relationships. She has received a total of six restraining orders since becoming an adult.
Course of Treatment
List two target behaviors and two interventions.
Target Behaviors
Co-dependency
Self-harming behavior
Frequency and Duration of Target Behaviors
At least six times, continues till the man or women get a restraining order.
Ongoing through adult life. Possibly started after sexual abuse at age 12.
Severity and Number of Relapses
Very severe. Has a total of six restraining orders.
Unknown how often, Violet says she uses self-harm to regulate her emotions.
Interventions
Rational Emotive Behavior Therapy- Violet needs to learn how to