Get Help: (949) 200-7929 Verify Insurance

RTC Part 2 - Questionnaire

Name*

The field is required.

Email*

Invalid Input

F. Codependency and Boundaries Worksheet

Family Intensive Codependency and Boundaries Worksheet

Please watch the video and fill out the worksheet in response. (You may fill out answers as you watch if preferred)

** Enmeshment definition : A relationship that lacks independence of thought, values, opinions, etc. One person must always be and do the same as the other, and you lose touch with your own needs or desires. Enmeshed relationships lack boundaries and limits.

1. Codependency is a _____ addiction.*

This field is required.

2. What are the 2 parties in a codependent relationship? Which do you relate with the most? (Remember, it’s not if you’re codependent, it’s just a matter of when you are codependent)*

This field is required.

3. Codependency leads to enmeshment of decision making,__________, and __________ __________.*

This field is required.

4. In your own words, why can codependency interfere in someone’s healing or treatment process?*

This field is required.

5. For the tips given for rescuers and the rescued - which ones stand out to you the most that you need to start implementing?*

This field is required.

6. What’s the ultimate solution for codependency?*

This field is required.

7. What is the definition of boundaries? List 3 examples of boundaries given in the video*

This field is required.

8. How do you communicate boundaries?*

This field is required.

9. What are areas in your life that you need to set boundaries, or need to improve your boundaries?*

This field is required.

G. Screens Impact Summary

Family Intensive Screens Impact Worksheet

Based on your learning about screens, please provide a general summary below on how screens affect:

Dopamine
Atrophy
Mood/Focus/Motivation
Relationships & social skills

This field is required.

H. Behavior Worksheet

Family Intensive Behaviors Worksheet

Please watch the video and fill out the worksheet in response. (You may fill out answers as you watch if preferred)

1. What are the 3 pillars of behavior, meaning that if there are issues in any of these pillars you will see challenging behavior. What are these 3 pillars?

This field is required.

2. Give an example of a lagging skill and how that may lead to a behavior problem*

This field is required.

3. How do emotions and behaviors relate to each other in your own words? Please give an example of a specific unregulated emotion leading to a certain behavior.*

This field is required.

4. In your own words, how might a need not being met lead to a behavior issue? Please give an example of an unmet need leading to a certain behavior or reaction.*

This field is required.

5. Addressing these pillars can take time, what can be implemented to help stabilize the behavior in the meantime?*

This field is required.

6. What are the 4 functions of behavior (AKA the 4 categories of behavior)?

This field is required.

7. What is the basic human need that drives attention-seeking behavior? Why do you think is it important to know this need when addressing these behaviors?*

This field is required.

8. What are the positive ways to give or receive attention?*

This field is required.

9. What does escape mean? What are some things that can cause this behavior?*

This field is required.

10. Define Access to tangibles. What are some tangibles that motivate you?*

This field is required.

11. List a behavior that you personally would like to improve on. Based on what you learned in this video, what do you think is one of the primary drivers of your behavior? (you may relate it to the 3 pillars or 4 functions of behavior)*

This field is required.

12. Collaborative conversation helps you focus on _____ the _____ instead of hyperfocusing on the _____ . In your own words, why might this be more productive when addressing concerns with your loved ones? *

This field is required.

I. Reinforcements Worksheet

Family Intensive Reinforcements Worksheet

Please watch the video and fill out the worksheet in response. (You may fill out answers as you watch if preferred)

1. Define reinforcements. Which is more common and effective, positive or negative reinforcements?*

This field is required.

2. Reinforcements are key ways to motivate _____ in _____ and _____ .*

This field is required.

3. What is meant by we live in a “binge culture”? In your own words, how can giving reinforcements for basic, small efforts break this cycle?*

This field is required.

4. In your own words, why do you think it’s important when addressing behavior that privileges are earned?*

This field is required.

5. Why is clarity so important when laying out reinforcements to target behavior (for example - specific metrics, specific rewards, specific timeline)?*

This field is required.

6. What are behaviors or patterns that you want to change in your own life? What motivates you that you can use as a way to reinforce healthy change? (ex: motivated by small breaks, by social gatherings, snacks, guilty pleasures).*

This field is required.

J. Psyche During Admission

Family Intensive Psyche During Admission Worksheet

Please watch the video and fill out the worksheet in response. (You may fill out answers as you watch if preferred)

1. What is the psyche that occurs during admission for almost every individual?*

This field is required.

2. What are some reasons that this psyche comes up? Which ones can you see coming up for you potentially?*

This field is required.

3. What is the honeymoon stage?*

This field is required.

4. Why is either of these mindsets listed above problematic? Why is it so important to work through these thoughts and finish strong?*

This field is required.

5. Please list the 5 ways to work through this psyche mentioned in the video:

This field is required.

6. What is your personal goal for treatment (for yourself or your loved one) that you can hold to in order to finish strong?*

This field is required.

7. What do you think the speaker means when she says that mental health struggles cause you to lose time?*

This field is required.

Recaptcha

Contact

Solstice Pacific
26732 Crown Valley Parkway
Suite 443
Mission Viejo, CA 92691
info@pacificsolstice.com
Get Help: (949) 200-7929

[chatbot]

RTC Part 2 - Questionnaire

F. Codependency and Boundaries Worksheet

Family Intensive Codependency and Boundaries Worksheet

G. Screens Impact Summary

Family Intensive Screens Impact Worksheet

H. Behavior Worksheet

Family Intensive Behaviors Worksheet

I. Reinforcements Worksheet

Family Intensive Reinforcements Worksheet

J. Psyche During Admission

Family Intensive Psyche During Admission Worksheet

About Us

Learn More

Start Here

Contact