Mastering Competencies in Family Therapy

Chapter 15: Treatment Planning

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Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

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.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

A Brief History

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.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

A Brief History (cont.)

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.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Clinical Treatment Plans

Provide a straightforward, comprehensive overview of treatment.

Includes the following parts:

Introduction

Therapeutic tasks

Client goals

Interventions

Client perspective

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Writing Useful Therapeutic Tasks

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

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

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.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

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.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

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

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

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.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

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.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Client Goals

Initial 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.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Writing Useful Interventions

Guidelines for writing interventions

Use specific interventions from chosen theory.

Make interventions specific to client.

Include exact language when possible.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

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.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

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.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

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