What are their beliefs about self/others/world? What ideas have they internalized?.Psychodynamic: recurring themes throughout one’s life, chronic primitive defenses.Interpersonal: Chronic/unresolved dysfunctional relationships, interpersonal conflicts, or role transitions.Dialectical: help-seeking and help-rejecting, chronic emotional dysregulation and poor distress tolerance.Cognitive: chronic negative thoughts and reinforcing environment.One or more perpetuating psychological processes: What are the degree of the symptoms right now?.How is patient responding to hospitalization?.Chronic medical problems, chronic pain, or disability?. Lack of treatment or follow up for mental illness.Lack of medication optimization (suboptimal doses).Do they have a chronic illness, functional impairment caused by cognitive deficits, or a learning disorder?.Perpetuating (What chronic things are going on?) “history repeating itself”)? For example, they might have had a loss, separation etc.
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