Chapter 3: Treatment Planning

Question 1

Counselor’s Job

Answer 1

Sheperd an effective intervention process that addresses the client’s concerns, through thr development of coherent, thoughtful treatment plans

Question 2

Contents of a Treatment Plan

Answer 2

A theory and techniques that are the best fit for this client
The specific problem
The particular counselor-client relationship

Question 3

Things that need to be considered for a Treatment Plan

Answer 3

Evidence base related to the client issue
Client demographics
Theory Chosen

Question 4

Where the Approved Approach to Treatment Planning came from

Answer 4

The medical field

Question 5

Symptom-Based Treatment Plans

Answer 5

Form of treatment planning focused on clients’ medical symptoms; strength is that they are revlevant to those in the medical community; the weakness is that they do not sufficiently help counselors to conceptualize their treatment in useful ways

Question 6

Danger of symptom-based treatment planning

Answer 6

The counselor will underutilize counseling theories to conceptualize and overfocus on symptoms

Question 7

Jongsma, Et. Al

Answer 7

Developed Symptom-Based Treatment Plans

Question 8

Theory Based Treatment Planning

Answer 8

Involves the use of theory to generate more clinically relevant treatment plans than the symptom model offers; developed by Gehart & Tuttle; goals used are informed by clinical theories

Question 9

Elements included in Treatment Plans

Answer 9

Counseling Tasks
Client Goals
Interventions

Question 10

Counseling Tasks

Answer 10

Standard practice tasks that the counselor should perform at each stage of counseling; informed by theory and ethical and legal requirements; Rarely included in other plans but spell out standards of practice that are important to consider and document

Question 11

Stages of Counseling

Answer 11

Initial Phase
Working Phase
Closing Phase

Question 12

Client Goals

Answer 12

Key element of all treatment plans, client goals are unique to each client and describe what behaviors, thoughts, feelings, or interactions will be either increased or decreased as result of treatment; client goals are derived from the assessment of the presenting problem and are in theory-specific language

Question 13

Interventions

Answer 13

Each goal includes two or three interventions that describe how the counselor plans to achieve therse goals using the counselor’s chosen theory. Interventions may or may not be included in other types of treatment plans

Question 14

Intitial Phase Counseling Tasks

Answer 14

Have most tasks in the initial phase of treatment; the counselor establishes the foundation for counseling;

Question 15

Initial Counselor Tasks Early in Counseling

Answer 15

Establish a Counseling Relationship

Assess individual, family, and social dynamics

Question 16

Working Phase Counseling Tasks

Answer 16

Continual monitoring to ensure that they maintain a strong rapport with clients

Question 17

Factors which can weaken the Counseling Relationship

Answer 17

Lack of Progress
Necessary Confrontation
Counselor's ill-timed self-disclosure
Misinterepreted comment
Random remark by a stranger
Outcome of a Google Search

Question 18

Monitoring Of the Relationship

Answer 18

Done by observation and verbally checking in every two weeks

Question 19

Closing Phase Counseling Tasks

Answer 19

Primary task is for counselors to make themselves unnecessary in clients’ lives; counselors work with clients to develop aftercare plans

Question 20

Aftercare Plans

Answer 20

Identifying what they did to make the changes they have made
Identifying how they will maintain their success
Identifying how they will handle the next set of challenges in their lives

Question 21

Forming a Working Counseling Relationship

Answer 21

Key counseling task which demands careful attention to diversity factors such as age, gender, ethnicity, sexual orientation, educational level, socio-economic class, and so on

Question 22

Writing Goals

Answer 22

Reveals clarity of thinking, ability to conceptualize and understand the complex interplay between your client’s presenting problem, personal dynamics, relational dynamics, and manifest psychiatric symptoms

Question 23

Meaningful Client Goals

Answer 23

Strategically target two or three key threads that link seemingly unrelated dynamics and issues

Question 24

Goal Writing Worksheet

Answer 24

Combines the client’s description of the problem and findings from the case conceptualization to help quickly identify the key personal and relational dynamics that should be targeted for change

Question 25

Steps in Completing the Goal Writing Worksheet

Answer 25

What does the client say is the problem (s)? Use client's words and phrases as much as possible Identify two to four of the most salient psychological symptoms or issues Dynamic (Salient psychological and relational dynamics) Problem (Identify which of the client's presenting problem this dynamic relates to) Symptom (Identify which symptom (s) is (are) likely to improve if the dynamic improves EBP RRL, Research related to client's presenting problem, diagnosis, personal demographics, and/or intended counseling approach. (Key Interventions, techniques or quidelines)

Question 26

Goal Writing Process

Answer 26

Start with a Key Concept/Assessment Area from Theory of Choice: begin goal with increase or decrease followed by a description using language from your chosen theory as to what is going to change Link to Symptoms: Describe what symptoms will be addressed by changing the personal/relational dynamic Use Client's Name: When you use the client's name (or equivalent confidential notation), you ensure that it is a unique goal rather than a formulaic one

Question 27

Anatomy of a Client Goal

Answer 27

Increase/Decrease + Theoretical Concept/Assessment area + To reduce +Symptom

Question 28

Function of Part A & Part B of Goal Statement

Answer 28

Part A: Gives the counselor a clear focus of treatment that fits with the theory of choice Part B: Provides third-party payers with a clear description of how psychiatric symptoms will be affected

Question 29

Initial Phase Client Goals

Answer 29

For first one to three sessions: involve stabilizing crisis symptoms, thinking,

Question 30

Working Phase Client Goals

Answer 30

Address dynamics that create and/or sustain the symptoms and problems for which clients come to counseling; goals that most interest third party payers; frame goal in the theoretical language used for conceptualization and then linking this language to the psychiatric symptoms;

Question 31

Sample Working Phase Client Goals for Depression

Answer 31

Psychodynamic: Reduce rationalization to increase ability to directly experience emotions and reduce depressed mood Humanistic: Increase ability to experience authentic emotions in the present moment to reduce depressed mood and increase sense of personal agency Cognitive Behavioral: Reduce negative self-talk related to social acceptance to increase positive mood Narrative: Reduce influence of family's and societal evaluations of self-worth to increase sense of autonomy and reduce depressed mood

Question 32

Closing Phase Client Goals

Answer 32

Address Larger more global issues that clients bring to counseling (takes the form of clients presenting with one issue and then later wanting to also address other issues in the later stages of counseling) and/or moving the client towards greater health as defined by the counselor's theoretical perspective (driven by a counselor's agenda)

Question 33

Guidelines for Writing Interventions

Answer 33

Use Specific Interventions from Chosen Theory (interventions should be clearly derived from the theory used to ceonceptualize counseling tasks and client goals; if intervention from another theory is integrated, the modifications should be clearly spelled out) Make Specific to Client (Use confidential notation to make the goal as specific and clear as possible) Include Exact Language when Possible (Counselors should use the exact question or language a counselor would use to deliver the intervention)

Question 34

Benefits of Using Treatment Plans

Answer 34

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