DV Treatment Plan Review #1
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
1. What are your personal treatment goals?
*
2. How did your actions impact others related with the offense and similar behaviors leading up to it?
*
3. What patterns and behaviors are you taking accountability/responsibility for leading up your arrest (describe specific behaviors)?
*
4. What have you learned about your behaviors as it relates to the offense? What are your attitudes and thoughts about your behavior now compared to when you started therapy?
*
5. What changes do you need to continue to make when you feel frustrated and/or upset?
*
6. How are you establishing and respecting boundaries in your relationships?
*
7. How has alcohol/drug use impacted your relationships? What steps are you taking to address these issues?
*
8. How do you plan on addressing unhealthy patterns of behaviors from being passed down to children? (COMPLETE ONLY IF CHILDREN WERE INVOLVED, PUT N/A IF NOT APPLICABLE)
*
9. What forms of abuse that you committed were present during the incident and/or at previous times in your relationship(s)?
*
Therapist Comments (for NIC therapist to complete):
Submit
Should be Empty: