Treatment Planning Unit Four Reading

Treatment planning  New clients to psychological services often express enthusiasm in the first meeting about changing their behaviors. The typical attitude is that “nothing will stop me from recovery (or getting better or learning).” Though there is a qualitative difference between the attitudes of a client who has been yearning to change for years from one who is mandated to treatment by family members or the state, most clients express a desire to get better, at first.

Treatment Plan  Then, there are clients who are resistant to receiving any type of psychological service altogether. The attitude that clients express upon enrollment in services directly relates to their willingness and ability to identify and analyze potential obstacles to completion of treatment.

Treatment Planning  Whether a client insists that he or she is completely free from obstacles or if a client insists that there are too many obstacles, the psychologist can help the client to identify obstacles, analyze their potential impact on success in treatment, and create a strengths based plan to reduce the severity of the impact if they arise.

Treatment Planning  Strength-based plans are created using the client’s individual strengths and support systems as the basis of minimizing or resolving exposure to an obstacle. For example, if your client is a child who can read and write proficiently, any exposure to severe stressors can be minimized if the child learns to write about his or her feelings about it.

Treatment Plan  Another example would be if a client enrolled in substance abuse treatment might identify transportation to the facility as an obstacle might know how to use the bus system. So, with free bus passes, your client can resolve that potential obstacle.

Treatment Planning  A client who worries about financial pressures such as feeding her children and who has strong family support might be able to have her children stay with her relatives while she fully engages in her treatment program—thus reducing the stressor of feeding her children and maintaining a job.

1. Identify Obstacles  Psychologists and clients work together to identify the potential obstacles likely to interfere with the client’s completion of treatment.

Identify Obstacles  Be prepared as many clients refuse to acknowledge these obstacles and often because past attempts at treatment have failed.  At times, clients unconsciously use these obstacles as a way out of committing to working on behavior/life changes especially when the work is unpleasant and tedious. For this reason, expect some resistance from clients during the obstacle identification stage.

Identify Obstacles  Another reason that clients resist this stage is that they simply do not understand how particular situations or circumstances affect their ability to function successfully in their lives.

Identify Obstacles  The first step in identifying obstacles is to ask the clients to explain why they stopped attending treatment or failed to change a behavior in the past.  Ask questions about their past behaviors to look for clues for patterns of destructive behaviors, such as using drugs after arguing with a family member or friend.

Ask Questions  Explore the client’s typical coping strategies when faced with particular situations such as feeling angry—does the client yell or hurt him or herself as a result of the anger (enrollment in anger management would be a requisite part of the client’s treatment plan if unhealthy coping strategies are used).

Explore and Ask Questions  Be certain to investigate as many possible avenues of stressors as possible: financial, transportation, childcare, marriage/partnership, anger management, drinking/drugging behaviors, work pressures, peer pressure, and coping strategies.

Analyze Potential Impact of Obstacles  Once the psychologist and the client have identified as many potential obstacles as possible, it is important to analyze each for anticipated impact on the client’s life and the likelihood that each might surface.  For example, if a client has identified that his or her partner does not support recovery (substance abuse), then, there is a strong likelihood that the client will not be successful in treatment while living with the partner.

Possible Consequences  It is possible that the partner could change his or her attitude or eventhat your client is misreading the level of support provided by the partner; however, this will be addressed in a later step.

Possible Consequences  It is important to consider how each obstacle might relate to the others, for example, if a client has a habit of not taking his or her medications when feeling good (a typical problem for mental health clients) and then has work and relationship problems as a result, these obstacles need to be considered together.

Possible Consequences  So, if the client learns strategies for taking his or her medication even when feeling good, there is less chance that he or she will create problems at work or at home. Preventing the client from not taking his or her medication could potentially keep the other problems from occurring.

Create Preventive Strategies/Solutions  If the client has identified transportation and child care issues as main stressors, it is likely that you have addressed these during the needs assessment stage of your work with the client.  So, if these are still reported as being problematic, parenting classes or lessons for using public transportation might be added to the client’s treatment plan.

Involve the Client in Treatment  Together, you and the client create strategies and generate possible solutions for the identified obstacles. This process will teach the client to take responsibility for preventing problems before they surface while also teaching basic problem solving steps.

Help with Decision Making  Many of your clients will have poor problem solving and decision making skills and a part of their treatment will be for you to help them to use their strengths to solve their own problems.  The best way to do this is to have the client identify times when he or she has successfully solved a problem or worked around an obstacle.

Explore Strategies  Point out the strategies that they used that helped in their success and teach your client to apply these strategies to new situations. You will discover that even your youngest client can be quite adept in problem solving using experiences.

Explore Assumptions  During this stage, it is important for you and the client to explore the validity of the client’s assumptions about the people who are in his or her life—you will discover that often a client’s perspective is tainted by their problem (e.g., substance abuse or mental health).

Explore History  Often, clients will report that a partner or family member is not supportive of his or her recovery or therapy. With some careful guidance, the client can see that this is not always the case.

HIPAA  It is essential for you to abide by HIPAA regulations while working with the client in creating preventive strategies as you might be tempted to verify his or her claims related to the amount of support that others offer in your client’s life.  However, you are prohibited from contacting family members, partners, and friends of the clients to validate the client’s perceptions of their support.

Action Steps  When writing this part of the treatment plan, note the obstacles that the client identified as being most problematic and then add action steps that the client will take to reduce the probability of the obstacles interfering with treatment completion.

Set Timelines  Include names of resources such as agencies that offer parenting classes and the action that the client is required to take (e.g., complete parenting classes in two months). Taking these precautions will help ensure that the clients will have a better chance of completing treatment and learning some self- sufficiency skills.