T3 - Therapy Basics: Treatment Plans

Therapy isn't therapy without a treatment plan. This goes for fictional therapists and their clients, too. Contrary to how it's conveyed in popular shows like Frasier and In Treatment when the audience is privy to the talking but not the behind-the-scenes, therapy isn't just about the talking.

The conversational direction--i.e., the "talking"--should be towards an end that's already been specified between the therapist and the client. That's what a treatment plan is for.

Treatment plans look different depending on which therapist you go to. Here's the elements mine incorporates and the reason behind it.

1) Goals

Developing goals sounds much easier in theory than it actually is in practice. The reason? To make this worthwhile, the goals have to be specific, observable and quantifiable. So a therapist shouldn't just write down, "To decrease depressive symptoms." Yikes! This could be a legal nightmare were my file on that client to be subpoenaed.

So instead, a better way to put this goal would be: "Decrease depressive symptoms (as evidenced by crying, oversleeping and overeating) from 8-9 times a day to 1-2 times a day, as reported by client and her husband."

Now I've managed to convey how many times the symptom is happening and I've made the goal a measurable one by indicating how many times a day we would like the client to not be exhibiting depressive symptoms. It's often unrealistic to go from a certain number to zero, so I strive for reality in my goal-setting with clients.

Typical treatment plans have room for 2-3 goals.

2) Interventions

Then of course the therapist will want to spell out exactly what's in his or her bag of tricks that she will pull out to address the each specific goal. Interventions are as plentiful as goals, but to give you an idea of what I use frequently, say, with children:

art therapy, play therapy, bibliotherapy (reading books with messages/morals), role playing, modeling appropriate behavior, positive reinforcement, relaxation/anger management techniques, assertiveness training (to combat aggressiveness and teach the different), and so on.

3) Duration of Interventions

For sure we have to have a date we're working toward, if for no other reason than to revisit the goals at that time to see if we're on track. This can be 3 or 6 months from when the goals were initially discussed. Treatment plans expire after one year, so for sure a review needs to happen before then.

4) Termination Dates

Treatment plans expire after one year, so for sure a review needs to happen before then. If at the time of any review, it is determined that the goals have been met, then treatment is terminated, and this date is added to the treatment plan as evidence of the acknowledgment of both ther therapist and the client that treatment was satisfactorily concluded.

5) Changes to Treatment Plan

Sometimes changes are made to a specific goal during one of the reviews. In our example above, say the client's depressive symptoms swung mainly toward overeating. We might want to add as an intervention that the therapist referred the client to a nutritionist and exercise consultant (both of which would make the client hopefully feel better about herself and get her on the right track). I would note the date that this addition was made to the treatment plan and have the client initial it, as well.

This can be a hard one for therapists to remember. I know I did when I started out. But now, I just think of the client. Anything pertinent to their treatment should be noted not only for my own safeguard, but for theirs. A change in a goal or an added intervention is definitely pertinent.

6) Signatures

Signatures should be pretty self-explanatory, but sometimes even this can be complicated. Everyone privy to the treatment goals and interventions signs. So if I'm seeing a married woman, who on occasion brings in her husband, he would need to sign, too. If there are family therapy goals, then the family signs. i'f I'm seeing a minor or dependent adult, then the guardian would need to sign, as well. And every time there is a change, EVERYONE signs, which can be a major pain, just so you know. :)

Now we've covered treatment plans...next week we'll focus on session notes and you can once again enter the inner sanctum of a therapist's world.

Q4U: What are some topics you'd be interested seeing posted for Thursday Therapeutic Thoughts? I'm nearing the end of my Therapy Basics series and want to post what will help you the most. Thanks!