Detective Sgt. Friday used to say in the television show and then the movie Dragnet, “Just the facts.” In cognitive-behavioral therapy (CBT), obvious fact refers to any perception that can be recorded by a video camera, cell phone, audio recorder or some other mechanical recording device. Your human brain works much like a camera. That’s why it’s important that you learn how to do the camera check on your conflict-related perceptions.

To do a camera check, ask yourself this question: “Would a video camera have recorded the situation exactly as I said it happened?” If your answer is yes, then you probably have described the fact of the situation. But if your answer is no, or I don’t know, then you probably have described your opinion about the situation. It’s best to avoid calling your opinions facts.

Over the years, I have worked with a number of adolescents, and this issue of obvious fact is very important to the teenager’s experience of the emotion of jealousy. For example, imagine a teenage girl seeing the head cheerleader talking to her boyfriend down the hall at high school. She thinks, “Oh, she is hitting on my man!” or “He likes her more than me”. The camera check merely shows the two talking in the hallway and the girl thinks what she thinks, often with thoughts that are not based on facts.

As an adult, you too may jump to conclusions without knowing the facts. Once you believe something, you then feel and behave accordingly. Sometimes you find out later, after damage has been done, that you were wrong. Ask yourself before you feel irrational emotions or behave irrationally, “Is my thinking based on fact?” Remember, I don’t know is an acceptable answer.

Fact vs. Truth

Confusing truth with fact is one of the most common causes of stress and clinical emotional distress. But by using truth and fact in the operational ways described here, you can improve your own self control, your emotional well being and your relationships with others. The concepts of truth and fact must reference some perception.

Accepted truth is an idea that someone (you) believes. Believing an idea makes it true for the believer. But personal beliefs, and therefore truth, often have little or nothing to do with the facts of the situation, and a lot to do with a person’s hopes, fears, likes, dislikes and expectations.

Obvious fact exists in the real world independent of what people (you) think or believe. Obvious fact exists whether or not people know about it, accept it, believe it or like it. It is!

In the 1400s, sailors held on to a belief that the earth was flat. When a storm came up and they lost sight of land, many were scared, not because of the storm but because of their belief that they would fall off the end of the earth. Were they really afraid? Yes! Was their thinking based on fact? Today we know that it was not.

Accidents are often the result of human error. One human being thinks that it is OK to pass or to turn left when it is not OK, resulting in an accident. Remember, sometimes you can get hurt when your thinking isn’t based on fact.

I have enjoyed good success as the author of Global Criteria: The 12 Core Functions of the Substance Abuse Counselor – Fifth Edition, and I have motivated myself to write two workbooks. One is A Rational Workbook for Recovery from Addictions – Second Edition and the other is A Rational Workbook for Anger: Help For Those with a Co-occurring Substance Use Disorder, co-authored with my colleague, Theodore Burns. My goal for writing A Rational Workbook for Recovery From Addictions – Second Edition was to make the process of change as easily understood by the client as possible in a user-friendly workbook. The workbook becomes a journal, a document of recovery.

What makes A Rational Workbook for Recovery from Addictions – Second Edition different from other CBT workbooks or text books on theories and techniques? I believe that this workbook and the counselor skills that go with it lay a basic foundation of understanding for the client, thus increasing motivation for change. As a counselor, your initial sessions with a new client involve some teaching. Ask your client “What are the three things that you control in this life?” You may need to help the client identify all three – one’s own thoughts, feelings and behaviors. It doesn’t sound like a lot, but it is everything.

Next, I orient the client to some basic adult learning principles. Educators learn this – substance abuse counselors usually do not. I make 12 points; one characteristic of adult learners is WIIFM or “What’s in it for me?” I believe that clients change when they can see the “What’s in it for me?”

As substance abuse counselors we deal with client’s feelings on a regular basis. In CBT, I teach the four basic emotions – anxiety, anger, depression and contentment. All other emotions fall under the umbrella of these four basic emotions. I provide activities in the workbook to assist the client in identifying numerous other feeling words, thus expanding and preparing the client to be more aware of emotional feeling differences and to move them from strong, negative, self-defeating emotions to other positive, healthy or rational emotions.

I then provide more activities to help the client identify situations that occur and the emotional response to these situations. I purposefully do not ask, “What makes you feel _________” because that question would not be consistent with CBT principles. Other people or things outside of you do not make you feel; rather it is the thought or belief held by the client that makes him or her feel. I am preparing the client to identify situations and the subsequent emotional reactions to those situations.

Goleman wrote his book Emotional Intelligence in 1995. The five levels of emotional intelligence (EI) make sense not only to me but to many others, including clients. Using the motivational interviewing techniques we learn in our training, a counselor can reference the different levels of EI frequently as a client shares future practice efforts to use the CBT you teach. The five levels are: 1. Knowing our emotions; 2. Managing our emotions; 3. Recognizing the emotions in others; 4. Managing relationships with others; and 5. Motivating ourselves to achieve our goals. This fifth level is the one I find most (if not all) clients strive for.

I find that most counselors do not take a neuropsychology course, yet they do have a basic awareness of left and right hemisphere functioning. Clients know they have a left and right hemisphere and generally have a vague understanding of the role that each hemisphere plays. However, in laying a foundation of CBT skills, I go into detail to explain that the left hemisphere is the world of words and the right hemisphere is the world of non-words. I discuss Freud and his concepts of consciousness and unconsciousness, relating those concepts to the role that the left and right hemisphere plays in a client’s thoughts (left) and beliefs (right). I often get an “Aha” experience when I talk about how the client responds to some events without thinking, thus wrongly reinforcing that “it” made me. I reflect on the role that beliefs, habits, automatic responding and the right hemisphere play in creating negative, self-defeating feelings and behaviors.

Only after I lay this foundation of understanding do I then begin to teach an understanding of basic CBT concepts and principles that we, as counselors, have learned in our theories classes. I teach the ABCs of Albert Ellis while giving examples. I teach the client what’s rational. I teach them to ask themselves the five rational questions and, if they do not answer honestly three of the five as “yes”, that their thought or belief is irrational and it would be a good thing to change irrational thinking or believing to something else that is rational.

I have the client practice, practice and practice some more in writing Rational Self-Analyses (RSAs), paying particular attention to the rational debating or disputing of irrational beliefs. I teach about the IT Monsters and other self-defeating beliefs important to understanding irrational cognitions. I teach an imagery technique called Rational-Emotive Imagery, or REI, again encouraging a lot of practice.

I believe the foundational skills are best taught during individual counseling sessions, and that the practice and reinforcement of skills occurs during the group process. Groups are very important to the learning of CBT skills. Those clients with more time in a program become mentors for newer clients and model better efforts at debating irrational beliefs. The CBT-skilled counselor, knowing that all participants in the group have had the basic foundation skills, can point out common errors. The counselor listens for statements such as, “It made me scared” or “He or she made me angry,” and with the mere comment “It or he made you?” the client learns to self-correct.

In summary, A Rational Workbook for Recovery From Addictions – Second Edition lays a foundation of skills for the client to optimally benefit from CBT. One professor in an addictions counseling training school told me, “Wow. This workbook takes theory and shows my students how to put it into action”.

For me personally, Reports and Record Keeping has been perhaps the least enjoyable core function to perform. Like most of you, I am a front line counselor and I create reports, write progress notes, correspond with third parties, and read others’ reports. All of this is for client care and program accountability. I’ve been in this field for 35+ years. After being trained by the Air Force as a Drug and Alcohol Abuse Control Officer (a fancy name for a substance abuse counselor), I was stationed at MacDill AFB in Tampa Florida. I recall that we kept client records in a six-section folder. What went into each section was detailed in our Manual of Standard Operating Procedures. Each page was two-hole punched and we. We recorded client information on forms while writing progress notes by hand. Sound familiar? In the a field, most of us still do this. At my agency, Parallels in Lincoln, NE, we’ve improved and now keep our records in a three-ring binder and frequently use word processing assistance to type and print information. Now, the process of Reports and Record Keeping is changing.

President Omaha has stated  “Computerize all health records within five years. The quality of health care for all Americans gets a big boost, and costs decline.” The age of electronic record keeping is upon us. Medical facilities are ahead of substance abuse and mental health facilities with implementing digital processes, but MyCaseRecords Case Management System by Eccentex brings us into this future now.

In November of 2008, I was named Vice-President of the Behavioral Health Division of Eccentex Corporation in Culver City, CA (www.eccentex.com). I offered my agency, Parallels, as a beta site for the development of an electronic case management system called MyCaseRecords. Eccentex recently launched MyCaseRecords (www.mycaserecords.com) and with this the launch, the field of substance abuse counselors comes into the 21st century. This article will describe how electronic record keeping can help substance abuse counselors and facilities to streamline the tasks involved in the core function of Reports and Record Keeping.

What is MyCaseRecords?

“MyCaseRecords Case Management System was especially designed for behavioral health agencies and professionals. It is a full featured, End-to-End Case Management Solution that is affordable and user-friendly use right out of the box. Manage services, cases, paperwork, staff, healthcare providers, claims, billing, plans, authorizations, schedules, and much more in one easy-to-use solution.

MyCaseRecords was designed by behavioral health professionals to address the case management needs of substance abuse treatment services programs”

The power of MyCaseRecords lies in its platform designed by software engineers and behavioral health experts. The system is evolving each week to improve task completion for front-line counselors and the professionals responsible for clinical care and agency operations.

As a counselor, I want a system that saves me time, eliminates redundant data entry, and makes my task of writing reports and keeping records easier.
As a clinical director, I want a system that easily allows me access any client chart anytime, anywhere. I need to ensure that my staff is doing the paperwork in a timely, efficient and effective manner.
As a facility owner, I want a system that provides me reports on my programs; tracks important client variables; improves the processes for program audits, and saves me money.
As a researcher, I see many applications of MyCaseRecords conducting on-going research on variables of interest. MyCaseRecords does all of that.

The paragraphs that follow will explain how an integrated electronic case management system makes all the other eleven core functions easier and relieves some counselor stress of performance in the core function of Reports and Record Keeping.

Screening: Most screening is done on the telephone and the person doing the screening gathers pertinent information about the client. MyCaseRecords gathers this information by having the counselor type demographic information such as the name, address and phone number into an electronic database. One can use the Screening form provided in MyCaseRecords or design one’s own. The pending client can then be scheduled for the next step, Intake, with a specific counselor using the Schedule function.

Intake: At the intake session a person becomes a client. The information already recorded in MyCaseRecords from Screening is available to auto-populate the many forms a facility requires a client to complete in this core function. No more redundant writing of information!  Your agency may still have forms that require a client to handwrite information; however, the goal is to minimize this. The Case Management System has the capability to scan forms such as the signed HIPAA forms and authorizations to obtain or release information into the electronic records and associate the scanned form with the client for easy retrieval when necessary. Documentation of the Intake is often accomplished by a counselor writing a progress note. With MyCaseRecords the Progress Note is documented in an electronic form auto-populated with the pertinent client information.

Orientation: If the core function of Orientation is performed at the same time as the Intake, this can be documented on the same Progress Note as the Intake. If performed at another time, simply document again using the Progress Note in MyCaseRecords. The signed Client’s Rights and Responsibilities form can also be scanned into the client’s electronic record.

Assessment: In my role as Vice-President for Behavioral Health at Eccentex I’ve been involved for the past year in developing a new assessment form. I’ve been honored by having the form named after me – the Herdman Assessment Form or HAF. I’ve used the Addiction Severity Index, the ASI, for many years and have found it necessary to supplement the questions of the ASI with additional questions. I’ve incorporated the information gathered by the ASI and enhanced the process of gathering bio-psycho-social data. I’ve written logic for each possible client answer on the HAF and developed a reader-friendly narrative report. My goal was to not have the narrative sound like it was computer generated, but to have a flow and feel of an individualized report. Although the narrative reports client bio-psycho-social history, the HAF allows the counselor to add additional detail as appropriate for a specific client through an easy word processing function within the HAF. Also, it remains the counselor’s professional responsibility to diagnose, summarize, determine an appropriate level of care (LOC) for the client, and to provide individualized recommendations consistent with all of the data collected in the core function of assessment. The HAF assists in doing a substance abuse assessment; it is not a diagnostic form.

Unique to the HAF is the addition of Supplemental forms or instruments to streamline and enhance the assessment and the report. As an option, if the client took a SASSI-3, the client’s raw scores can be recorded and the HAF automatically calculates the percentile and T-Score. Then the narrative is written identifying any significant or very significant scores on the scales of the SASSI-3.

Some agencies use the University of Rhode Island Change Assessment (URICA) to assess a client’s readiness to change. You have the option of having the client take the URICA on the HAF during your session or have the client complete a traditional paper version and then type the responses into the HAF. The HAF then uses the calculation table available for scoring the URICA and the narrative reports the client’s readiness for change stage.

Many states and insurance companies require the use of the ASAM Patient Placement Criteria (ASAM: PPC-2R) to assist in determining level of care. The HAF provides a Table for the counselor to rate the client in the six dimensions of the ASAM on a 0-4 scale. The counselor remains responsible for rating the client, based upon all the data collected on the client, i.e., from the client interview, collateral information, and assessment tools and finally recommending an appropriate level of care.

The HAF has a Diagnostic Impressions section. The counselor still must make the appropriate diagnosis; however, the HAF with it’s processing power makes it easy to record DSM-IV TR diagnoses without having to memorize codes or spell the full diagnosis.

The HAF has a section called Summary and another called Recommendations. No computer program can write those sections, so a counselor must still write this.

Once the HAF and its optional sections are completed, the counselor clicks the “Generate Narrative” button and the report is ready for proofing and adding any additional comments by the counselor. The HAF saves time and provides a professional and individualized report.

Treatment Planning: Currently, MyCaseRecords has a Treatment Plan Form that allows the counselor to do the client treatment plan. I’ve been asked to incorporate some information from the HAF assessment into the Treatment plan and I am in the process of doing just that.

Counseling: A frequent core function for a counselor is Counseling. Every client counseling session needs to have a progress note completed. Most often progress notes used are for individual and group sessions, but family and other sessions also need to be documented. Using the Scheduling function, once a client is scheduled for an individual or a group session, a “Pending” Activity Form is automatically generated for completion. As an agency owner and Clinical Director, I know how easy it is for a counselor to “forget” to complete required paperwork. I’ve never had a counselor leave my agency without finding out later that a discharge summary or other document was missed. Counselors are human beings and I’m amazed at how much paperwork front-line counselors need to complete. MyCaseRecords makes it easier to document and to avoid missed paperwork that could relate to not getting paid or getting “dinged” during an audit.

Case Management: MyCaseRecords makes it easy to add a note to document the many case management activities for a client. On your home page in the application there is a Dashboard that lists all active clients for a counselor. To the left of the client name is an option to “Add Note”. This is where a telephone call or other case management documentation is recorded. The note then becomes part of the client history available for electronic recall at any time.

Crisis Intervention: It is imperative to document all client crises. Again, use a Progress Note to document the elements of the crisis, steps taken to resolve the crisis and any recommendation plan to change the treatment plan or to take further action.

Client Education: Documenting this core function can be accomplished in a number of ways. The educational topic can be recorded in an individual Progress Note, on a Group Note, or on a Note. Each agency can set procedures for this for all the counselors.

Referral: A counselor can also document the core function of Referral in a number of ways. A letter can be written and scanned into MyCaseRecords; a Progress Note can be prepared; or a Note can be used.

Reports and Record Keeping: The Case Management System allows the counselor to efficiently and effectively complete reports, document client progress and electronically file the reports of others – all organized within a client case for easy access and use.

Consultation: This core function can be recorded on a Note form. At Parallels, I’ve developed an Initial, Intermediate and Discharge staffing form to use with MyCaseRecords. My counselors use these forms to document staffing and consultations for individual clients.

The future of electronic record keeping is now. Medical facilities are ahead of substance abuse and mental health facilities, but MyCaseRecords brings us into this future. I know that the software engineers at Eccentex are dedicated to providing the leading software for substance abuse and mental health counselors and facilities. The platform (AppBase) allows easy changes thus facilitating keeping pace for continuous quality improvement. Eccentex is working on a billing module to complete HICFA forms, individual and third-party billing compatible with accounting programs to avoid double entry, thus saving time and money. I am working on improving the Treatment Planning form and integrating that with the Assessment and with documenting individual and group progress notes. We will continue to enhance the HAF thus giving counselors and agencies additional options to include in client assessment.

Eccentex Names Vice-President for it’s New Behavioral Health Division
November 11 , 2008 – Culver City, CA -

Eccentex Corporation, a leader in development and implementation of hosted process-centric solutions announced today the appointment of John Herdman, Ph.D. as a Vice-President for Eccentex’s new Behavioral Health Division. Dr. John Herdman was selected following an extensive and thorough search process and will be responsible for development and clinical aspects of Eccentex’s new case management system for substance abuse facilities called MyCaseRecords.com.

“It was important for us to find not just a clinical expert in the field of behavior science, but someone with a combination of vision, integrity and compassion,” said Alex Stein, Eccentex’s CEO “John has just this combination. His wealth of private and community experience, track record of success and solid commitment to the field of behavioral science will be a valued asset not just to Eccentex but to all substance-abuse treatment professionals and their clients.”

Dr. Herman joins the Eccentex team with a 35-year background in behavioral science, human services and both corporate and nonprofit administration. His highly diversified career portfolio includes work with organizations serving the needs of many different constituencies. Dr. Herdman is the owner and clinical director of Parallels, a mental health and substance abuse treatment clinic in Lincoln, NE. He is the author of three books and his consulting and workshop presentations have given him national exposure. Most recently, he contracted with Loyola Marymount University in Los Angeles for both workforce development and curriculum consultations.

“I am very grateful at having been selected for this position at Eccentex from a pool of highly qualified candidates” said Dr.Herdman. “I look forward to working with our Board of Directors, our talented staff, as well as substance abuse facilities across the nation to help streamline their operation, improve compliance and clinical outcomes with MyCaseRecords.com.”

Dr.Herdman has worked with a cross section of public and private sector entities to advance the field of behavior health. His career has been dedicated to creating programs and services that promote behavioral health in children and adults, and to advocating for policies that elevate the competency skills of alcohol and drug abuse counselors. He has served on community boards and advisory committees and has worked as a behavioral science expert for national, state and local organizations.

Dr. Herdman has authored and co-authored a long list of publications in the field of behavioral science including such well-known text as Global Criteria: The 12 Core Functions of the Substance Abuse Counselor – Fifth Edition.

Dr.Herdman holds a Ph. D. in School Psychology from Penn State University and is a licensed psychologist and a licensed alcohol and drug counselor in Nebraska. His postgraduate experience includes Adjunct Professor, Graduate Program in Counseling, Doane College, Lincoln, NE., Adjunct Professor of Psychology and Sociology, University of Tampa, and Adjunt Professor at Loyola Marymount University Extension. Dr.Herdman retired as a Lieutenant Colonel from the U.S. Air Force Reserve where he served his last 13 years as the Deputy Director of Human Resource Developmetn at Headquarters, United States Air Force, the Pentagon.

About Eccentex
Eccentex was founded in early 2005 by a team of executives with over 18 years experience in implementing complex software solutions for both small and large organizations worldwide. Eccentex offers AppBase (www.appbase.com), next-generation application development platform for rapid deployment of SAAS business applications. Please visit www.eccentex.com for more information.

For decades I’ve been fascinated in the various detective shows on TV. I remember watching Dragnet and Sgt. Friday who says “Just the facts.” Now there are the CSI dramas to keep me entertained. Maybe that is why I’m so interested in neuro-psychology and how the brain works. When there is a murder, the detectives start by interviewing the usual array of suspects. If a spouse is murdered, they look to the surviving spouse and then other family, friends, enemies, etc. It is rare to have a murder committed by a total stranger. This is true in your own life. When you feel anger, anxiety or depression, or find yourself engaging in addictive behaviors, look for the Usual Array of Suspects.

Once you have studied and identified your Irrational Triggers, Cognitive Distortions, and Self-Defeating Beliefs, you are on your way to knowing what thoughts and self-defeating beliefs make you feel the emotions you feel. You can identify the thoughts and beliefs that lead you to engage in self-defeating behaviors.

List your own “Usual Array of Suspects.” Are you a “People Pleaser”, a “Perfectionist”, or do you have “Low Frustration Tolerance?” Do you “Should” on other people? Should the world be “Easy?” As Fallible Human Beings we all have a few Irrational Triggers (ITs) and Self-Defeating Beliefs that we can call our “Usual Array of Suspects.”

Excerpt from A Rational Workbook for Recovery From Addictions – Second Edition by John W. Herdman, Ph.D., LADC