Module 4: Patient-Centered Treatment Plan

Time

Transcript

0:13

aye sir how you doing today I'm doing

0:16

all right yeah right I was hoping that

0:20

today since I've seen you for a few

0:23

sessions that we could do some treatment

0:25

planning okay yeah that'd be okay mm-hmm

0:28

so I like to divide a treatment plan

0:31

into a couple levels of goals and then

0:34

objectives which are like steps that you

0:37

would engage in to meet those goals okay

0:42

all right so like a broad goal and then

0:46

these specific objectives a familiar

0:49

this process or not yeah I think I had a

0:52

treatment plan before with another

0:53

therapist okay great so I know we've

0:57

talked over the last few weeks about

0:59

some different relational struggles

1:02

you've had and various elements but I

1:06

want to know and today I just want to

1:08

work on two goals and we might add to

1:11

that later but I would like to know a

1:14

couple of goals that you would have for

1:16

our Casa okay

1:20

so we'll just kind of start with the

1:22

first and then work out some objectives

1:24

for that and I'll move to the second and

1:27

more cost objectives for that so what

1:29

would be a goal of these counseling

1:34

sessions you might want to achieve well

1:38

you know lately I've been really having

1:40

a hard time I'm not getting a lot too

1:42

well with my with my brothers okay so I

1:45

would like to try to maybe work on work

1:48

on that I'm a better relationship with

1:49

my brother's so work on a better

1:51

relationship with your brothers so let's

1:53

say maybe improving the relationship

1:56

with your brother's yeah does that sound

1:58

right yeah okay so what do you think is

2:03

getting in the way of having a good

2:05

relationship with your brother's now

2:08

well they always are you know they say

2:15

sometimes I call them too often and then

2:17

I only call them when I have when I need

2:20

something or if I can if I want to

2:21

complain I don't feel like that's the

2:23

case but that's what they tell me and so

2:26

like they don't return my phone calls

2:29

that much anymore or you know they just

2:32

well they're not there for me support I

2:34

believe they go like I'm there for them

2:37

okay so there's a second like a

2:39

difference in the level of support you

2:43

mentioned before last week that

2:46

sometimes when you call you're angry

2:47

with them some things yeah because

2:52

sometimes they you know they act like

2:54

fools and somebody needs to you know I'm

2:57

their sister somebody needs to be honest

2:58

with them and tell them what they're

3:00

doing is wrong

3:02

do you think that's contributing to the

3:07

relational difficulties

3:09

I mean they know that I'm gonna tell

3:13

them like it is they know I'm gonna be

3:14

honest that's how I am so maybe maybe it

3:19

is so maybe before calling them kind of

3:27

looking at the content you were gonna

3:29

put in that call if it's angry maybe

3:31

waiting until you can adjust it to

3:34

something more neutral or positive so

3:40

not call them when I'm angry with them

3:42

yeah waiting until that emotion kind of

3:46

dissipates a little and you can replace

3:48

it with something more positive and we

3:51

can get into ways later on how to do

3:53

that with you know cognitive therapy but

3:56

I wonder if that might be a good a

3:57

little bit objective one of the

3:59

objectives yeah I think that might that

4:01

might help a little bit if I'm not as

4:03

angry when I call them it would help me

4:04

to not you know be so mean okay so do

4:10

one objective so no no calling when

4:13

angry and I guess part of it too won't

4:18

get to with the applying the cognitive

4:21

techniques so that you're able to do

4:22

that but that would be the objective

4:24

okay how about other objectives that go

4:32

of improving the relationship

4:34

well I know my one brother you know he

4:38

got really mad at me because I had

4:40

called my other brother and and told him

4:42

all this stuff you know that my brother

4:46

that that he did and I kind of was

4:49

talking badly about the one to the other

4:51

and kind of like a little device said

4:55

like splitting them apart yeah like kind

4:57

of pitting him against each other okay

4:59

and I know that caused a big problem he

5:02

didn't talk to me for a couple weeks

5:03

after that does that really bothered him

5:05

how'd you feel bad well you know it's

5:09

kind of like I said if you make me mad

5:11

or you do something I don't like I'm

5:12

gonna tell you how it is I'm gonna tell

5:14

everybody else how it is too so I kind

5:17

of felt like I wasn't making I wasn't

5:19

lying I was just being honest but he

5:22

didn't like that

5:24

I think over so well know they sort of

5:26

got in a fight between each other and

5:29

they both kind of stopped talking to me

5:31

for a little while so how important is

5:35

this goal of improving the relationship

5:37

with your brother's like say on a scale

5:39

of 1 to 10 with 10 being the most

5:41

important well it's important it's like

5:44

a nine so you know okay mm-hmm so you

5:48

mean with my parents gone it's just my

5:50

brothers that's all I have and I just

5:51

love them so much so it's a big part of

5:54

your big boy lies

5:55

big part of my life all right so even

5:58

though you feel justified in being

6:03

direct with them that seems to be

6:07

hurting the relationship a little and

6:08

that relationships important to you so

6:10

you're kind of a little stuck between

6:11

those two things

6:13

so having an objective like not not

6:18

talking to one about the other yeah I

6:22

think that's a good I think that's a

6:23

good one because that's what got me in

6:25

trouble last time with them when they

6:26

didn't talk to me for a while mm-hmm

6:28

that's what they seem to be the most mad

6:30

about so if you're gonna gonna say

6:33

anything about one to the other that has

6:37

to be kind of positive mm-hmm that's a

6:39

no negative okay yeah and again we'll

6:43

look at cognitive techniques really for

6:45

for a lot of these objectives we go

6:48

through to help you to be able to do

6:52

that but that would be the objective so

6:55

no negative talk to one brother about

6:58

the other okay that's something you can

7:01

do yeah I think I can try it

7:03

mm-hmm all right I know you mentioned

7:07

before to that even though you've had a

7:10

stressful relationship with your

7:12

brothers that they keep extending

7:14

invitations out to you yeah to come at

7:18

like to go to dinner or at their house

7:19

and you know go to the like their kids

7:22

sports games and stuff like that yeah

7:26

that's a big part of what we do as a

7:28

family that's important to them mm-hmm

7:31

what's happened when they've extended

7:36

those offers to sexualize well sometimes

7:40

I go but sometimes something things come

7:42

up you know like maybe I have a date or

7:45

I'm spending time with someone else

7:48

and it's like last-minute so I figure

7:50

there's going to be lots of baseball

7:53

games and there's lots of times that we

7:55

can have dinner together so sometimes I

7:57

don't always go when I say that I am

7:59

gonna be there

8:01

and how does they react to that

8:05

well they don't like it at all I mean I

8:09

missed my niece's school play and my

8:13

brother was really upset because I

8:15

missed the play but also because they

8:16

have bought tickets that were $25 each

8:18

and you know he was just really angry

8:21

with me and called me demanding the

8:23

money for the ticket since I didn't show

8:25

up and it was kind of a big fight and I

8:28

didn't really quite understand it

8:30

because I mean I told I was gonna go but

8:32

at the time my boyfriend at the time had

8:35

a really bad day at work and he just

8:36

wanted to stay in and you know that had

8:39

that was you know I had to come first

8:42

that came first for me so all right so

8:46

that that would you prioritize that over

8:49

socializing you know into social events

8:51

with your brothers yeah I guess I did

8:53

and and that's certainly a decision do

8:57

you think that if you gave your

9:00

brother's more priority with a social

9:02

that's that would improve the

9:03

relationship yeah I think they would

9:06

feel better about that if I showed up

9:09

when I said I was gonna show up

9:10

so maybe the objective would be if you

9:13

commit to join them in a social

9:17

gathering that you follow through yeah

9:20

mm-hmm now you mentioned there are some

9:22

things given away of that though yeah

9:25

like I mean I don't have a boyfriend

9:28

right now but when I do sometimes things

9:32

will come up and I would rather spend

9:35

time with the with my boyfriend then do

9:40

some up then do other stuff sometimes

9:42

so this will be this will be work for

9:44

you this will be a little tough do you

9:48

think that's an objective showing up

9:51

there's an objective you can fulfill

9:54

it's a realistic I mean I don't see why

9:59

I can't do it now my worry would be if I

10:02

was gone into another relationship I

10:05

think it might be harder for me to it

10:11

might be harder for me to always keep my

10:13

commitments like I can when I'm single

10:16

so this objective right now fairly easy

10:19

later on maybe not right okay so I have

10:23

to keep this in mind that if and when

10:28

you develop another relationship like a

10:30

romantic relationship this might be an

10:32

objective that is in jeopardy being

10:35

fulfilled so I mean in the past it's

10:37

been that way there's an historic place

10:39

when that way okay all right so we'll go

10:42

with those three objectives for

10:45

improving the relationship with your

10:47

brothers so that's one goal mm-hmm what

10:50

would be a second goal well like I said

10:53

I don't have a boyfriend right now but

10:56

you know I really I really feel like it

10:59

I would like to be a wife someday and

11:02

having a real relationship is important

11:05

to me so a romantic relationship

11:07

so one goal would be to try to keep and

11:10

maintain a healthy relationship because

11:12

my last one didn't go so well

11:14

it didn't didn't end well so really

11:18

finding a new relationship but also

11:21

maintaining it mm-hmm

11:25

what do you think has made that

11:29

difficult and

11:33

well my last boyfriend he would always

11:38

complain that I just was too needy and

11:42

too clingy and you know I didn't give

11:45

him enough space and all those types of

11:48

things that guys say you do believe that

11:51

I believe that's true I just think that

11:54

maybe he didn't love me as much as I

11:56

loved him cuz if you really love

11:57

somebody of course you want to be with

11:59

them all the time I mean that's isn't

12:01

that what love is so you're in your

12:06

value system as you kind of look through

12:10

that lens right we all grown values you

12:14

look at relationships and think that if

12:17

someone really loves you they're gonna

12:20

tolerate a lot of communication attempts

12:23

and calls I think mm-hmm so those

12:27

relationships fail because they were

12:32

yeah they weren't they didn't they

12:34

didn't seem to I think maybe like in the

12:36

beginning everything was fine but then

12:38

all of a sudden it's like you called me

12:40

too many times today or I don't feel

12:43

like going out tonight and you know if

12:48

they loved me then they would do what I

12:50

wanted wouldn't they want to talk to me

12:51

during the day I mean it's a long time

12:54

to go back to talking somebody you love

12:55

all day long I mean how many times would

12:58

you contact him in a day

13:00

oh maybe like

13:04

and our 12 maybe 15 times maybe 15 so

13:09

could you appreciate that for some

13:11

people their value systems may be

13:15

different like the way they would manage

13:16

relationships might be different that

13:18

might seem like Crowley I mean yeah it

13:24

must be different because it's been a

13:25

pattern of a problem for me so a lot of

13:29

people probably feel differently you've

13:31

heard this feedback before mmhmm yeah

13:33

all right so one of the objectives might

13:39

be to maybe restrict the number of

13:42

contacts to something that's maybe more

13:47

common

13:49

I know I'm gonna leave like five times a

13:52

day would have would have boyfriends in

13:56

the past indicated it would be well my

13:59

last boyfriend said that it would be

14:00

ridiculous to call any more than once a

14:02

day but I thought that was a little bit

14:05

extreme

14:07

so you're thinking five and from one

14:12

person in the past he was suggesting one

14:16

maybe for an objective we tried three

14:20

there's no perfect answer here is you

14:23

know it's just trying to get close to a

14:25

number that would maybe not have you

14:30

appear as cleaning your needy or

14:34

whatever they're seeing it as but still

14:36

satisfied you need to communicate I

14:40

think I could try three like maybe once

14:42

in the morning and once in the middle of

14:43

the day maybe once in the afternoon I

14:45

think I could try three so again like I

14:50

asked you at the other goal how

14:51

important is the disco love finding and

14:54

maintain your relationship oh really

14:56

important it's really important like so

14:58

I yeah okay

15:01

so again keep that in mind as you're

15:04

working through this objective right and

15:07

maybe this is something we revisit

15:09

depending on the relationship right

15:11

maybe a flight a boyfriend that wants to

15:13

be contacted more or less but won't go

15:17

with three for now okay let's see how

15:19

that works

15:21

what else has been a barrier in the past

15:29

well some you know it's kind of like

15:32

being Nene it's kind of the same thing

15:34

but some of my past boyfriends always

15:37

say that I like I move too fast or I

15:40

want a commitment that's too too early I

15:44

want the commitment to early or whatever

15:47

so again this is kind of an example

15:49

another example where your values or

15:55

your style of relationships a little

15:57

different than the men you've

15:59

encountered that's you you're looking

16:03

for commitment

16:03

earlier on mm-hmm is that I mean I just

16:07

feel like if you meet somebody and

16:08

things click you know pretty soon how

16:10

much you know soon if it's a good match

16:12

or not and why waste time if you have a

16:15

good match and if it's somebody you

16:16

really like you know why wait some why

16:21

waste time I wait and that's what you

16:25

believe but the men that you've

16:27

encountered they don't seem to

16:28

reciprocate I believe not all the time

16:32

now

16:34

so the the talk or the gestures

16:39

suggesting commitment seem to be scaring

16:43

them away mm-hmm yeah yeah I think so I

16:46

think that's happening have they were

16:48

kind of phrase it that way

16:50

no hey don't always say that but they

16:54

will say you're getting too serious too

16:55

fast or I'm not that serious about all

16:57

this and then they'll just stop calling

17:01

so there's a sense that they're being

17:02

scared woman

17:05

so if you look at your past

17:07

relationships and we'll just call it

17:09

commitment talk right it's kind of talk

17:11

I know you've had a few relationships in

17:16

the past how many times were you the one

17:21

to initiate the commitment talk before

17:24

they did Oh probably me all the time all

17:27

the time mm-hmm

17:28

because you know men don't like

17:30

commitment at all so the woman has to

17:32

sort of jump in I'm banning bring up a

17:36

commitment right so do you think that

17:40

I'm wondering here if there's not a way

17:42

to strike a balance with that level of

17:45

engagement meaning kind of engage at the

17:50

same level or a similar level of

17:53

commitment as they're expressing and

17:56

that's really hard to make concrete

18:01

that's kind of an abstract concept well

18:04

you see how I'm getting it's like a

18:05

balance between how much you would bring

18:07

it up and how much they would bring it

18:09

up so what if instead if there could be

18:11

maybe something we could measure a

18:13

little better like a time limit a time

18:16

limit

18:16

from when a relationship starts until

18:18

you introduce the idea of a commitment

18:23

well one relationship that seemed to

18:27

last a little bit longer than most of my

18:29

others I think that I did sort of move a

18:33

little slower it probably wasn't until

18:35

probably a couple months and until I

18:38

started talking about commitment I kind

18:40

of gave it a couple months so maybe like

18:42

two months try to wait two months before

18:45

I talk about commitment know in a past

18:47

relationship that was more successful

18:50

you were able to where you chose to wait

18:53

two months and that seems to be sauteed

18:58

up to a good relationship so wanna make

19:02

that objective is that's something you

19:04

think you can do is to restrict

19:07

commitment talk or gestures two to two

19:10

months mhm

19:11

like wait two months so make that a goal

19:15

and I'm thinking as I'm looking at the

19:18

other objective that the improving the

19:22

relationship goal rather the improving

19:24

relationships with your brothers that

19:26

anger was a factor there and I'm

19:28

wondering it for the finding and

19:30

maintaining relationships with the

19:32

romantic interest is anger has anger

19:35

been a factor in that yeah it has been

19:38

you know I mean there's been many a

19:41

times when I you know if somebody didn't

19:44

do what I wanted them to do or didn't

19:46

call me back you know it would be you

19:49

know a two-hour lecture when they came

19:52

in for Mark about why it's so important

19:54

to call me that on that core but you

19:57

know I can get really mean about things

19:59

if I feel like I'm being rejected or not

20:03

treated the way I think I should be

20:04

treated you know or if someone's acting

20:06

in a way that I don't think is right I'm

20:10

pretty blunt about tell them about it

20:12

so definitely been a lot of

20:16

big fights and a lot of my relationships

20:20

so this is similar to one of the

20:22

objectives in the first goal which was

20:24

the not client when angry but I'm

20:29

wondering if in your exchanges that

20:34

maybe weren't angry if the anger comes

20:35

up while you're on the phone or while

20:39

you within the person like so could

20:41

start out not angry like so you're

20:43

brothers you were calling them I let

20:45

them have it right I'm wondering these

20:47

relationships is that the way it's

20:49

working or you having a good discussion

20:51

with them in insurance angry it's more

20:53

like that this normally starts out okay

20:55

and then they'll say something that I

20:57

don't like or they'll let us think it is

20:59

generating rejection yeah so when when

21:03

that rejection is felt or perceived

21:06

that's when the I hear is coming yeah

21:09

like if they cut me off too quick on a

21:11

telephone call or they say they're not

21:14

gonna be home till late or something

21:16

like that I can get really angry pretty

21:19

quick pretty quickly mm-hmm so this

21:23

would be maybe I'm thinking the

21:25

objective here may be applying some of

21:27

the coping skills that we'll be

21:30

reviewing later on when you have

21:34

feelings of rejection this seems like

21:37

the feelings of rejection are kind of

21:39

leading to these are contributing to

21:42

these angry responses that sound right

21:45

yeah mm-hmm

21:47

so you're perceiving rejection and if it

21:51

feels like you're going right to anger

21:52

yeah because I feel like if you love

21:54

somebody you're not gonna reject them

21:56

you're not gonna do that something up I

21:57

just want somebody to love me as much as

22:00

I love them and when they don't yeah I

22:02

get really angry about it it hurts so it

22:06

is painful for you mm-hmm

22:07

so there's an intervening thought so

22:09

when somebody rejects you there's this

22:11

intervening thought that somebody who

22:14

would love you would not reject you

22:17

and then I thought sweeping to this

22:20

anger so well we call that automatic

22:23

thought we'll work on that later on how

22:27

to identify a lot of Matic thoughts and

22:29

how to respond to them but just for this

22:33

point we'll say apply coping skills when

22:38

receiving rejection okay you're gonna

22:43

teach me some coping skills well I'll

22:45

teach you the codes because yeah we'll

22:46

work through them yeah we're working

22:47

through them there's some cognitive

22:49

techniques so part of this is going to

22:52

be recognizing the rejection it seems

22:54

like you're able to do pretty well this

22:57

would be you know adding a coping skill

22:59

when you recognize that rejection okay

23:02

does that sound something that's

23:03

achievable yeah I think I can try it

23:06

yep okay are you satisfied with the two

23:11

goals and the two sets of three

23:15

objectives have it come up with four

23:16

yeah it sounds like a lot a lot of work

23:18

ahead of me hello we're dia yeah I think

23:22

something you will fall through with and

23:24

yeah because it's really important to me

23:26

to have a better relationship with my

23:27

brothers and to you know find a good

23:30

relationship for myself so yeah all

23:33

right well I'm going to type this up and

23:38

give you a copy of this okay and then

23:40

next time we meet well we'll look at

23:43

maybe a third goal I want you some time

23:46

to kind of review this making changes

23:48

you might want to make where we can talk

23:50

about that so look at it making notes

23:52

and we'll talk about if it needs to be

23:55

added or taken away and then we'll work

23:58

through the rest of the treatment plan

23:59

next time I see it and then

24:02

I'll move forward from there this kind

24:04

of structures what's gonna happen

24:06

my future session so it's important to

24:09

get this right but we can also change it

24:11

if it's not working okay or when goals

24:14

are met which hopefully will be the

24:15

result we can take those off if there's

24:18

other goals we need to substitute it we

24:20

can do that okay that's how I can plant

24:22

move it okay so I'll get this typed up

24:24

for you and get you sketch of that

24:26

appointment okay great thanks Sara thank