How to build an effective treatment plan

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
• 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.)
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
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
• 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.