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.
Graffiti
Dear Tony, formulating a treatment plan has always been important to me, and above all continuing to review and change it as one gets to know the client more. I remember Berne writing somewhere that a good therapist needs to be like a good metador, always knowing what he/she is doing. The points you mentioned, while extremely useful to forming a snap background profile of the client would help with formulating a treatment plan. For me the treatment plan would consist of keeping this profile in mind, referring to the goal of the therapy and formulating specific strategies to assist a particular client achieve her goal. Eg allowing a session or two just to decongest the Child, doing some chair work, to engaging in Child work, Engaging Adult through looking at options, etc. I just wanted to contribute my understanding and use of a treatment plan. But feel free to add or correct as I am still learning and the above is certainly very useful to me
ReplyDeleteThanx for your comment Tina,
ReplyDeleteI think you make some good points such as engaging the Child ego state in the ways you say. I am still articulating what a treatment plan is and it is not something that one directly addresses with a specific technique.
For instance if a client presents insomnia as a problem one can directly address that problem with looking at the pre sleep ritual and maybe even redecision with of a Don't get your needs met injunction. But that is not what I am meaning when I say a treatment plan. It is a far more global concept and the presentation of insomnia is only one small part of the client whereas a treatrment plan as I use the word is about how the client strucutres their view of the world overall.
I am not sure if I am making sense here but I will say more about it soon. I have spent the last two days with clients making sure I listen to my thinking about developing a treatment plan. It has been quite enlightening doing such a thing and being consciously aware of what I look for in developing a treatment plan.
Tony
Why treat the macro issue? If the client presents with a micro issue that can be treated in isolation, why look to treat the macro issue? Maybe they don't want that treated? Do you discuss the finer detail of the treatment plan with the client? Mind you, if you shared they may run away. So where is the happy medium?
ReplyDeleteThere are two comments that have been made. One by Rosemosie and one by evan that have not shown up on the blog. If they dont show up in a while I will post them
ReplyDeleteGraffiti
(Blog administrator)
Hello Kahless
ReplyDeleteAs to your question about sharing the treatment plan with the client, you should read my Facebook as someone asked the same question there.
I'm an FOI,
kinda guy!
Freedom of information is one of my soap box things. I"m all for giving clients information that I have about them. If they want to read their file I happily pass it over to them. In 30 years of practice that request has only been made 3 or 4 times that I recall.
regarding your other comments I will be addressing those in another post soon to be made.
Graffiti
So why didn't mine show up. Humph!! Discrimination? Double humph, Tony.
ReplyDelete