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Appendix A - Reproducible Client Worksheets

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Sharing
Replay CD track 1 for more information on this technique.
Client answers the following questions regarding the way bipolar disorder has affected his or her relationships.
1. How has bipolar disorder affected my relationship as a whole?
2. How has it affected me as a person?
3. What is the hardest thing that I face daily regarding this illness?
4. What do I want to see change right now?
5. What do I need in my own life to find happiness?
6. If things stay as they are, where do I see my relationship in the future?

Self-Administered Quiz
Replay CD track 2 for more information on this technique.
Client answers following questions to help recognize their own behavior as a  result of bipolar disorder.
1. Has there ever been a period of time lasting two weeks or more when you  were not your usual self and you experienced five or more of the following:
a. Felt Sad, blue or down in the dumps?
b. Were uninterested in things?
c. Lost or gained more than 5% of you body weight?
d. Slept too little or too much?
e. Felt so good or so hyper that other people thought you were not your normal self?
f. Were so irritable that you shouted at people or started fights?
g. Felt much more self-confident than usual?
h. Got much less sleep than usual and found you didn’t really miss it?
i. Were much more talkative or spoke much faster than usual?

Listing Symptoms According to Category
Replay CD track 4 for more information on this technique.
Client reviews following categories and descriptions to categorize his or her own symptoms in order to better monitor them.
1. Expressions-common expressions that client says prior to or during a depressive or manic state.  Chad wrote, "I’m bored", "What’s the point?", "I’m sorry I’m such a burden", and "Things are not right in my life."
2. Thoughts-common thoughts client experiences prior to or during a depressive or manic state.  Chad wrote, "I have no friends", "Is this all there is?", "Things will never get better—never", and "Everything is difficult."
3. Actions-common actions client does prior to or during a depressive or manic state.  Chad wrote, "Listen to old, sad music", "Overanalyze everything", and "Focus on the past".
4. Physical signs-common traits client notices prior to or during a depressive or manic state.  Chad wrote, "Wring hands", "Have problems sleeping", "Don’t feel animated", and "crying or sobbing."
5. Sleep-common sleeping patterns client notices prior to or during a depressive or manic state.  Chad wrote, "Sleep through the afternoon", and "Wake up often during the night".
6. Relations with Others-common behavior towards other people prior to or during a depressive or manic state.  Chad wrote, "Very irritated and snappy," "Have trouble thinking of anyone but myself", and "Can’t call friends".
7. Work or School-common thoughts or feelings client exhibits prior to or during a depressive or manic state.  Chad wrote, "Work is boring", "I can’t seem to do a good job at work," and "Feel unappreciated for work I do."
8. Eating Habits, Alcohol, Drugs, and Medications-common habits and behavior regarding eating, alcohol, drugs and medication prior to or during a depressive or manic state.  Chad wrote, "Stop taking medications or take it sporadically", "Stop eating and notice significant weight loss", and "Take caffeine pills to get some energy."

Autoimmune Disorder Questionnaire
Replay CD track 5 for more information about this technique.
Client answers following questions to determine whether or not he or she is suffering from an autoimmune disorder along with bipolar disorder.
1. Have you ever experienced swelling or pain of the joints?
2. Has this swelling or pain ever caused you to walk with a cane or other assistance?
3. Have you ever noticed a red or purplish rash on your face or lesions on any part of your body?
4. Have you ever experienced a mild to severe seizure?

Borderline Personality Disorder Questionnaire
Replay CD track 5 for more information about this technique.
Client answers following questions to determine whether or not he or she is suffering from borderline personality disorder along with bipolar disorder.
1. Do you have difficulty defining for yourself who you are or who you want to be?
2. Do you have a history of very intense and unstable relationships?
3. Do you have a history of making great efforts to keep people from abandoning or leaving you?
4. Do you have difficulty controlling angry outbursts?
5. Do you have a history of impulsive or reckless behavior in sex, spending money, or eating?
6. Do you have a history of self-destructive acts?

Tips for a Good-Night’s Rest
Replay CD track 6 for more information about this technique.
Client follows guidelines to obtain maximum amount of rest.
1. Establish a regular bedtime and stick to it as much as possible.  Avoid naps, but if you find it necessary, limit them to about twenty minutes as continuous sleep is much more restful.
2. If you use caffeine, limit your consumption to early in the day.  If you smoke or drink alcohol, stop doing so within a few hours of bedtime.
3. Let yourself unwind an hour or so before bedtime.  Read a book or magazine, listen to music, meditate, play with a pet, or take a bubble bath. Avoid violent TV shows, and skip upsetting news reports.
4. Save the bedroom for sleeping and sex.  Although light reading may be okay, don’t bring work to bed.  And save discussions for another place and time.  This includes conversations about sexual problems.  If you begin to associate work or arguments with your bed, it will cause more anxiety than it is worth.
5. Don’t try to force yourself to sleep.  Just enjoy resting and feeling your muscles.  Or use a relaxation technique, such as the ones found on tracks 3 and 4.  Some people find listening to tapes or peaceful sounds helpful.
6. Adjust your sleep in advance when traveling to a different time zone. For very short trips, this may not be necessary, but for longer ones, adjust your sleep, meals, and medication dosage time to match the target time zone over several days.
7. Block out annoying distractions.  If light noise keeps you awake and you can’t block them out in other ways, cover your eyes with a black sleeping mask and wear ear plugs.

Suicide Questionnaire
Replay CD track 9 for more information about this technique.
Client answers following questions to confirm suicide risk.
1. Do you feel hopeless about life, or sometimes feel like life is too painful to continue living?
2. Are you suffering from constant worry, anxiety attacks, and/or the inability to sit still?
3. Are you fearful of the future, and do you have episodes of pacing?
4. What are your reasons for living at this point?
5. Do you have any thoughts of dying or ending your life?
6. Do you have a suicidal plan?
7. Do you have the means to carry it out?

Risk Factors
Replay CD track 9 for more information about this technique.
Review following checklist of suicide risk factors to better monitor a client’s suicidal tendencies.
1. Depression accompanied by severe anxiety, agitation, or rage.
2. Previous suicide attempt.
3. Family history of suicide or suicide attempts.
4. Anniversary of a family member’s suicide.
5. Statements about wanting to die or being tired of living.
6. Giving away possessions, paying off debts, or updating a will.
7. Physical or emotional illness.
8. Loss of a spouse, child or close friend, particularly if unexpected and sudden.
9. Excessive use of alcohol or drugs.
10. A sense of hopelessness and helplessness.

Advice to Family
Replay CD track 9 for more information about this technique.
Give following list of advice to family members of clients in case of suicidal behaviors manifested by the client.
1. Take seriously the person’s condition.
2. Stay calm, but don’t under-react.
3. Involve other people.  Don’t try to handle the crisis alone or jeopardize your own health or safety.  Call 911, if necessary,
4. Contact the person’s psychiatrist, therapist, crisis intervention team, or others who are trained to help.
5. Express concern.  Let the person talk about suicidal thoughts without loved ones appearing to convey shock and condemnation.  Give concrete examples of what leads you to believe the person is close to suicide.  If this understanding is conveyed to the patient, then he or she may feel less guilty about possessing such suicidal thoughts.
6. Listen attentively.  Maintain eye contact.  Use body language, such as moving close to the person or holding his or her hand, if it is appropriate.
7. Ask direct questions.  Inquire whether the person has a specific plan for suicide.  Determine, if possible, what method of suicide the person is thinking about.
8. Acknowledge the person’s feelings.  Be empathetic, not judgmental.  Do not relieve the person of responsibility for his or her actions, however.
9. Reassure.  Stress that suicide is a permanent solution to temporary problems.  Insist that the problem can be helped, even if past attempts have failed.  Provide realistic hope.  Remind the person that things can get better if the right help is made available.  Stress that you will help them find effective treatment.
10. Don’t worry about confidentiality.  Confidentiality is secondary to a life-and-death situation.  Don’t hesitate to speak with the person’s doctor in order to protect that person.
11. Do not leave the person alone, if possible, until you are sure that he or she is in the hands of competent professionals.

Affirmations
Replay CD track 10 for more information about this technique.
Client follows guidelines to create an effective list of affirmations to aid in self-esteem building.
1. List them on a tablet or compile them in a notebook.
2. Place them on cards small enough to carry in your wallet, purse, or pocket.
3. Post them on signs and sticky notes on the bathroom mirror, the refrigerator, a desk lamp, or some other surface you’ll see daily.
4. Call your answering machine and leave them as messages to yourself.
5. Use a computerized reminder program or a text-to-speech program.
6. Transfer them to audiotape.
7. Subscribe to an automated service

List of Circumstances
Replay CD track 11 for more information about this technique.
Give following list of circumstances to client to illustrate to them reasons for hospitalization.
1. When suicidal, homicidal, or aggressive impulses or actions threaten yours or others’ safety.
2. When you’re severely and dangerously agitated or psychotic.
3. When you have another dangerous medical condition such as diabetes, and are no longer managing it properly.
4. When your distress or dysfunction is so severe that it requires round-the-clock care your loved ones can’t provide.
5. When you’re so apathetic or depressed that you won’t eat.
6. When you have an ongoing substance abuse problem.
7. When doctors need to closely observe your reactions to medications.

Goal Setting
Replay CD track 13 for more information about this technique.
Clients review following instructions to maximize goal setting in battling substance abuse.
1. Around the same time on the same day each week, list the goals most on your mind.
2. Do this for three consecutive weeks.
3. Put the list away each week without looking at it until the fourth week.
4. On the fourth week, compare all of your lists.  Most likely, you’ll find some differences.
5. Make a master list and prioritize your goals.

List of Small Steps
Replay CD track 14 for more information about this technique.
Client follows guidelines for gradually easing into better living habits.
1. Find an activity-or preferably several-that you enjoy.
2. Make a commitment.  Plan regular workouts with a friend, join a gym, or take a class.
3. Keep your exercise gear packed and ready to go.  When you return from a workout, immediately repack your bag with clean exercise clothes.
4. Buy exercise videos or equipment (a standing bicycle, treadmill, rowing machine or weight set) if you prefer to exercise at home.
5. Start with something as simple as a regular 10 minute walk, and slowly build up.
6. Establish a regular bedtime and do your best to obtain adequate sleep. Make it a top priority.  (Refer to track 6 for more information about the sleep-wake cycle and helping clients regulate it.)
7. Eat regular meals and a balanced diet.  Unless you’re taking MAOIs, you can make dietary changes gradually.  Cut back on sugar and caffeine first, and make other changes as you feel ready.
8. If you’re not used to taking medication, and your doctor prescribes it, set up a way to help you manage it.
9. If you self-medicate with alcohol or drugs, get treated for substance abuse or join a self-help program such as AA.
10. Aim to reduce the stress in your life.  (Refer to track 12 for more information on reducing clients’ stress.

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