1. Chapter 15: Treatment Planning

2. Selecting a Path (Step 3)
Treatment plans
Address the problems you have identified in the case conceptualization and clinical assessment.
Numerous good plans can be developed for any one client.
Therapist may choose which theory and techniques are the best fit for:
A specific client.
A specific problem.
A particular therapist–client relationship.
Plan should be based on clinical experience, current research, and standards of practice.

3. A Brief History Symptom-based treatment plans
Treatment planning came from the medical field.
Symptom-based treatment plans
Focus solely on client’s medical symptoms.
These plans are relevant to those in the medical community; they do not help therapists conceptualize treatment in the most useful ways.
Danger of symptom-based treatment planning is that the therapist will underutilize theory, focus on symptoms, and forget to assess the larger picture.

4. A Brief History (cont.) Solution Theory-based treatment plan
Uses theory to create more clinically-relevant treatment plans than the symptom model offers.
Difficult for most students to address diagnostic issues and clinical symptoms in these theory-based plans because the language of these two systems is radically different.
Solution
A new “both/and” model, called the “clinical treatment plan,” which draws from the best of theory-based and symptom-based treatment plans and adds elements of measurability.

5. Clinical Treatment Plans
Provide a straightforward, comprehensive overview of treatment.
Includes the following parts:
Introduction
Therapeutic tasks
Client goals
Interventions
Client perspective

6. Writing Useful Therapeutic Tasks
The “training wheels” of the plan
Typically not be included in plans you send to insurance companies or third-party payers
Formulaic
One of the key places where therapists must adjust their approach to address diversity issues

7. Writing Useful Therapeutic Tasks
Initial phase
Establish a therapeutic relationship.
Assess individual, family, and social dynamics.
Develop treatment goals.
Case management:
Refer for medical/psychiatric evaluation; connect with needed community resources.
Rule out substance abuse, violence, and medical issues.
Working phase
Monitor the working alliance.
Monitor client progress.
Closing phase
Therapist makes themselves “unnecessary” in the client’s life.

8. Diversity and Treatment Tasks
For each treatment task, you should also note how you will address diversity issues such as culture, ethnicity, race, sexual orientation, gender orientation, religion, language, ability, age, gender, etc.
Examples:
Use of humor with teens and men.
Use of personalismo with Hispanic/Latino clients.
Including spirituality and religious believes and resources.
Use of present-focused, problem-focused approaches with clients who do not value exploring the past.
Assessing family-of-choice with gay, lesbian, bisexual, or transgendered clients.

9. Writing Useful Client Goals
Step 1: Case conceptualization and clinical assessment
Step 2: Crises or pressing issues
Step 3: Themes from the case conceptualization and clinical assessment
Step 4: Long-term goals
Step 5: Complete the goal writing worksheet

10. The Goal Writing Process
Three basic components:
Start with a key concept or assessment area from the theory of choice.
Start with “increase” or “decrease,” followed by a description using language from the chosen theory about what is going to change (this comes from the case conceptualization).
Link to symptoms.
Describe what symptoms will be addressed by changing the personal or relational dynamic (this comes from the clinical assessment).
Use the client’s name
Using a name (or equivalent confidential notation) ensures that it is a unique goal rather than a formulaic one.

11. Writing Measurable Goals
Most third-party payers require goals be “measurable.”
The client and therapist should know when the goal is achieved.
Starting the goal with “increase/ decrease” helps in this effort.
Specify criterion for goal to be met.
Ex.: Able to sustain ___________ for a period of _____ ❒ weeks ❒ months.

12. Client Goals Initial phase Working phase
Client goals generally involve stabilizing crisis symptoms.
Working phase
Address the dynamics that create and/or sustain the symptoms and problems for which clients came to therapy.
Goals that most interest third-party payers.
Closing phase
Larger, more global issues that clients bring to therapy and/or move the client toward greater “health” as defined by the therapist’s theoretical perspective.

13. Writing Useful Interventions
Guidelines for writing interventions
Use specific interventions from chosen theory.
Make interventions specific to client.
Include exact language when possible.

14. Client Perspectives
Considering the client’s perspective is crucial to designing an effective plan.
Therapists should discuss the plan directly with clients.
Ensure that there is a shared understanding about the goals, strategies for change, and outcomes.
Many agencies have moved to having clients sign the treatment plan to ensure agreement.
To avoid overwhelming the client, therapist should include only the client goals from the treatment plan.

15. Do Plans Make a Difference?
Yes! and No!
Therapy rarely goes according to plan, but treatment plans help by:
Enabling therapists think through which dynamics need to be changed and how.
Providing therapists with a clear understanding of the client situation so they can quickly and skillfully address new crisis issues or stressors.
Giving therapists a sense of confidence and clarity of thought that make it easier to respond to new issues.
Grounding therapists in their theory and in their understanding of how their theory relates to clinical symptoms.