(This post is definitely a work in progress)
I was talking with a supervisee two days ago about psychotherapy as one tends to do! Somehow the topic of treatment plans came up. A treatment plan is a plan that is formulated by the therapist which provides the therapist (and client) with the overall direction of therapy. It identifies the general direction the client needs to go.
When a client presents at a session usually they have some matter they wish to address. This can be seen as a micro issue. This is different to the treatment plan which is a much more global understanding of the client and their psychology. One deals with the micro issue presented by the client but it is seen to form only one part of the overall marco issue or the treatment plan. Whilst dealing with the micro issue the therapist does this in the context of the overall treatment plan. It’s like the therapist has the treatment plan always in the back of his mind and all discussions are done within the context of that plan.
Don't get lost in the micro issue
My supervisee then asked how one formulates such a plan and I was a bit flummoxed by the question. I did not have an answer and it seems I had never been asked that question before.
I presented a few responses as I thought on my feet at the time and have subsequently given it more deliberation. Again I find myself doing something in therapy that I did not know I was doing. I can not recall ever reading about such a thing. All I know is that in my early days as a psychotherapist in various training groups we always talked about treatment plans but I can not recall ever talking about their formulation, which seems a bit odd now. Maybe we did and I just cannot remember.
What I came up with was a short list of things which I consider when developing a treatment plan. I suspect this is by no means a complete list.
Client core issues versus secondary presenting issues - characterological structures of the personality.
Personality types - this relates to the core issues.
Fixated developmental stage
Current developmental stage
I will certainly muse on this some more as it is an important idea for therapists and I am intrigued by the fact that as a young therapist we used to often talk about treatment plans but one hears them not mentioned much at all these days.