Effective Treatment Planning By Carmi Thomas
Treatment Planning • Is based on a number of important factors. • According to Beutler and Clarkin (1990), “Effective treatment is a consequence of a sequence of fine-grained decisions” about a number of treatment variables that are linked together and contribute to “synergistically” to effective client change (pp. 20-21).
Treatment Planning • Includes the following: • Problem Selection • Problem Definition • Goal Development • Objective Construction • Intervention Creation • Diagnosis Determination
Problem Selection • Clinician determines most significant problems on which to the focus treatment process. • Usually a primary problem will surface, and secondary problems may be evident. • If clinician attempts to deal with too many of the client’s problems then treatment may loose its direction.
Problem Definition • Problems will behaviorally reveal themselves differently in each client. • Each problem will then require a specific definition about how it is evidenced in the particular client. • The symptom pattern should be associated with diagnostic criteria and codes such as those found in the DSM-IV.
Goal Development • Set broad goals for the resolution of the target problem. • The goals don’t necessarily need to be in measurable terms but can be global, long-term goals that indicate a desired positive outcome to the treatment procedures.
Objective Construction • Objectives must be stated in behaviorally measurable language. • It must be made clear for the managed care providers to see when the client has achieved the established objectives.
Intervention Creation • Interventions are the actions of the clinician designed to help the client complete the objectives. • There should be at least one intervention for every objective. • If a client doesn’t accomplish the objective after the initial intervention, new interventions should be added to the plan. • Interventions should be selected on the basis of the client’s needs and the clinician’s ability to provide the intervention necessary.
Diagnosis Determination • The determination of an appropriate diagnosis is based on an evaluation of the client’s complete clinical presentation. • The clinician must compare the behavioral, cognitive, emotional, and interpersonal symptoms that the client presents with the criteria for diagnosis of a mental illness condition as described by the DSM-IV.
Variables That Affect Treatment Planning • Functional Impairment • Coping Style • Resistance Level
Functional Impairment • The client’s level of impairment is determined by the level of social supports available to and used by the client and also by specific areas of functioning that are adversely affected by the client’s problems.
Coping Style • Two Approaches To “Reduce Uncomfortable Experiences” • 1. Internalized- Client tends to inhibit impulses and feelings, have a relatively low need to seek stimulation in their environments, and often are dominated by self-reflective, fearful ruminations and contemplations • 2. Externalized- Client is likely to anger, annoy, or irritate others and display behaviors seen as “too much”
Resistance Level • Resistance occurs when a client’s “sense of freedom, image of self, safety, psychological integrity or power is threatened. Resistance suggests that a client is trying to prevent or restore these threatened losses.
Sample Treatment Plan • Review a sample treatment plan for Borderline Personality.
Activity • Read the case scenario and develop a sample treatment plan for the person in the scenario.- 15 min.
Questions • Any????????????????????
References • Beutler, L., Clarkin, J., & Bongar, B. (2000). Guidelines for the systematic treatment of the depressed patient. New York: Oxford University Press. • Cormier, S., & Nurius, P. (2003). Interviewing and Change Strategies for Helpers. California: Thompson Learning Inc. • Jongsma, A. & Peterson, L. (2006). The Complete Adult Psychotherapy Treatment Planner. New Jersey: John Wiley & Sons. • Sadock, B. & Sadock V. (2003). Synopsis of Psychiatry. New York: Lippincott, Williams, & Wilkins.