Transcript Treatment Planning - USF College of Education home page

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, longterm 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.