Chapter 5: Treatment

Planning
Case Documentation in Counseling and Psychotherapy
Diane R. Gehart

© 2014. Cengage. All rights reserved. For classroom use only.

Step 3: Select a Path
• Treatment Plans
• Address the problems you have identified in the case
conceptualization and clinical assessment
• Therapist may choose which theory and techniques
are the best fit for
• A specific client
• A specific problem
• A particular therapist–client relationship.

© 2014. Cengage. All rights reserved. For classroom use only.

BRIEF HISTORY OF MENTAL HEALTH
TREATMENT PLANNING
© 2014. Cengage. All rights reserved. For classroom use only.
Brief History
• Symptom-Based Treatment Plans
• Focus on “presenting problem” symptoms
• Theory-Based Treatment Plans
• Uses theory to generate clinically relevant treatment plans

© 2014. Cengage. All rights reserved. For classroom use only.

CLINICAL TREATMENT PLANS

© 2014. Cengage. All rights reserved. For classroom use only.

Clinical Treatment Plan Components
• Clinical Treatment Plans Include:
• Introduction
• Treatment Tasks
• Diversity
• Client Goals
• Interventions
• Client Perspectives

© 2014. Cengage. All rights reserved. For classroom use only.

TREATMENT TASKS

© 2014. Cengage. All rights reserved. For classroom use only.

Treatment Tasks (Slide 1 of 2)
• Treatment Tasks
• Treatment elements the counselor is responsible for
• Initial Phase Treatment Tasks
• Establishing foundation for counseling
• Working Phase Treatment Tasks
• Keep the ball rolling
• Closing Phase Treatment Task
• Develop aftercare plans and maintain progress

© 2014. Cengage. All rights reserved. For classroom use only.

Initial Phase Treatment Tasks
• 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

© 2014. Cengage. All rights reserved. For classroom use only.

Initial Phase of Treatment

© 2014. Cengage. All rights reserved. For classroom use only.

Working Phase Treatment Tasks
• Monitoring the Working Alliance
• Monitoring Client Progress

© 2014. Cengage. All rights reserved. For classroom use only.

Working Phase of Treatment

© 2014. Cengage. All rights reserved. For classroom use only.

Closing Phase Treatment Task
• Therapist Makes Themselves “Unnecessary” in the Client’s Life
• Develop Aftercare Plans
• What they did to make the changes they have made
• How they will maintain their success
• How they will handle the next set of challenges in their lives

© 2014. Cengage. All rights reserved. For classroom use only.

Closing Phase of Treatment

© 2014. Cengage. All rights reserved. For classroom use only.

Treatment Tasks (Slide 2 of 2)
• Diversity and Treatment Tasks
• Addressing diversity issues such as culture, ethnicity, race, sexual
orientation, gender, religion, age, etc.
• How to address counselor-client differences
• Examples of ow diversity may be addressed in treatment tasks:
• Use of humor with teens and men
• More formal, respectful relational style with immigrants or clients
from ethnic backgrounds that prefer such relations with
professionals (respecto with Latino clients)
• Use of personalismo with Hispanic/Latino clients
• Including spirituality and religious believes and resources

© 2014. Cengage. All rights reserved. For classroom use only.

CLIENT GOALS

© 2014. Cengage. All rights reserved. For classroom use only.

The Goal Writing Process
• Start with a Key Concept/Assessment Area from Theory of
Choice
• Link to Symptoms
• Use Client’s Name
• Anatomy of a Client Goal
• “Increase/Decrease” + [theoretical concept/assessment area] +
“to reduce” + [symptom]
• Sample Goals:
• Increase positive self-talk about body to reduce binging and body
image distortion. (Cognitive-behavioral)
• Reduce compliance to socially imposed “shoulds” related to making
others happy to reduce AF sense of hopelessness and depressed
mood. (Humanistic)

© 2014. Cengage. All rights reserved. For classroom use only.

Initial Phase Client Goals
• Initial Phase Client Goals
• Involve stablizing crisis symptoms and discussion of clinical goals
• Examples: stabilizing crisis symptoms, such as suicidal and
homicidal thinking, severe depressive or panic episodes,
stabilizing eating and sleeping patterns, managing child,
dependent adult, and elder abuse issues, addressing substance
and alcohol abuse issues, and stopping self-harming behaviors
such as cutting

© 2014. Cengage. All rights reserved. For classroom use only.

Working Phase Client Goals
• Working Phase Client Goals
• Address the dynamics that create and/or sustain the problem
• Framing the goal in the theoretical language used for
conceptualization
• Examples:
• Psychodynamic: Reduce rationalization to increase ability to
directly experience emotions and reduce depressed mood and
improve ability to emotionally connect in marriage.
• Humanistic: Increase ability to experience authentic emotions in
the present moment to reduce depressed mood and increase
sense of agency.

© 2014. Cengage. All rights reserved. For classroom use only.

Closing Phase Client Goals
• Closing Phase Client Goals
• Address larger, more global issues
• Move the client towards greater “health”
• Example:
• Later phase want to address relationship issues or an unresolved
issue with their family of origin for a depressed client
• In humanistic counseling, increased authenticity is a long-term goal
that is embedded in the theory that should be included in long-term
goals for clients

© 2014. Cengage. All rights reserved. For classroom use only.

Writing Useful Client Goals
• Writing Measurable Goals
• Knowing when the goal is achieved
• Starting goals with “increase/decrease”
• Examples:
• Able to sustain positive mood for period of 2 weeks
months.
• Able to sustain positive relational interactions for period of 2
weeks months.
• Able to sustain sobriety for period of 6 weeks months.

© 2014. Cengage. All rights reserved. For classroom use only.

Preparatory Steps to 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 Goal Writing Worksheet

© 2014. Cengage. All rights reserved. For classroom use only.

WRITING INTERVENTIONS

© 2014. Cengage. All rights reserved. For classroom use only.

Writing Useful Interventions
• Interventions
• Used to support each counseling task or goal
• Use specific interventions from chosen theory
• Specific to client
• Include exact language when possible

© 2014. Cengage. All rights reserved. For classroom use only.

CLIENT PERSPECTIVES

© 2014. Cengage. All rights reserved. For classroom use only.

Client Perspective
• Client Perspective Key To Successful Treatment
• Are these the things the clients want to change?
• Are these interventions and activities my clients would be willing
to try?
• Are there areas where the clients and I have different ideas about
what might be the source of the problem?
• Does the plan make sense to my client?

© 2014. Cengage. All rights reserved. For classroom use only.

Do Plans Make a Difference?
• Treatment Plans:
• Help counselors think through which dynamics need to be
changed and how
• Provide counselors with a clear understanding of the client
situation so that they can more quickly and skillfully address new
crisis issues or stressors that arise
• Give counselors a sense of confidence and increase clarity of
thought that makes it easier to respond on the spot to new issues
• Ground counselors in their theory as well as understanding of
how their theory relates to clinical symptoms

© 2014. Cengage. All rights reserved. For classroom use only.

QUESTIONS FOR PERSONAL
REFLECTION AND CLASS DISCUSSION
© 2014. Cengage. All rights reserved. For classroom use only.
Reflection Questions
• Do you think treatment plans are a good idea? Why or why
not?
• What particular issues do you think are most important to
consider when working with diverse clients?
• Who benefits more from treatment plans: the counselor or
client?

© 2014. Cengage. All rights reserved. For classroom use only.