DV Treatment Plan Review #1

Name*

First NameLast Name

Date*

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):