applying theory to treatment
Squirrel 2
applingtheorytotreatmentweek9.docx· Section 3: Putting it All Together and Applying Theory to Treatment Planning
Now that you have a foundation for a few of the MFT models, it is time to dive a bit deeper into considering how to apply these to treatment planning. When you meet a client, so many issues may surface that could influence the direction that you take with that client (e.g., type of insurance/payment, the facility you work for, the state you work in, the client population you work with, etc.) (Gehart, 2014). The first thing you might do is conduct some type of assessment. This could be as simple as “tell me what brings you in” to very specific measurements and assessments. From this process, you will develop a case conceptualization. A case conceptualization is a big-picture idea of what is going on with the client(s). What is important in the assessment and case conceptualization process is the theory that you will utilize. The theory provides the framework for how you see problems. For example, think about the Bowen paper that you completed. If you were assessing from the Bowen model, you would complete a genogram and consider differentiation and triangulation as part of how you might describe the case and what is occurring.
The next step is a treatment plan (Gehart, 2014). The treatment plan is a road map for what you anticipate doing with the client and when or how you think this might happen during the course of therapy. Treatment plans vary a great deal in the mental health fields; however, in this course, you will explore treatment planning through theory, meaning, you are honing in on a theory and considering how to apply a road map for what therapy will achieve based on the theory’s assumptions and interventions.
Finally, during weekly sessions, you will make progress notes. Progress notes indicate what you addressed during a specific session. There are many different types of progress notes and you will explore these a bit more during your practicum and internship experiences.
In Week 8, you will begin learning about these processes and considering your own decision-making process (what is important to you to address). Additionally, you will focus on theory and how theory might address a case differently. In Week 9, you will write a paper about the process of treatment planning and writing a treatment plan based on a particular model. In Weeks 10 and 11 you will write a paper that explores one model in more detail and also generates a case conceptualization, treatment plan, and progress note.
References
Gehart, D. R. (2014). Mastering competencies in family therapy. Belmont, CA: Brooks-Cole, Cengage Learning.
· Week 9
Treatment Planning
This week, you will learn more about the treatment planning process and write your own “mini” treatment plans. Treatment planning involves a careful understanding of the goals of the case and the direction that you hope to go in, given the case background.
There are different types of treatment plans, and they can be directed by the type of working environment you are in, the type of insurance that the client has, the presenting problem, and the theoretical orientation that you utilize. As a therapist, it is expected that you will understand the goals presented to you by a client and an expectation for how you will meet those goals. Treatment planning helps a therapist and a client solidify the direction of therapy.
Presenting a theory-based treatment plan helps you to understand how to visualize the change process from a specific perspective. Theories provide the language to help therapists define or hone specific elements that they view as needing to change and the tools that they feel they can utilize to help with this change.
Weekly Resources and Assignments
Review the videos and weekly resources to prepare for this week’s assignments. The resources may include textbook reading assignments, journal articles, websites, links to tools or software, videos, handouts, rubrics, etc.
Strategic Family Therapy II
Treatment Planning - Lecture III
· Week 9 - Assignment: Create Treatment Plans
Assignment
Top of Form
Due May 7 at 11:59 PM
Bottom of Form
For this week’s assignment, you will review the video role-play from the week on strategic therapy. Utilizing this role-play example, you will write two mini treatment plans from two different theoretical perspectives. For this assignment, pick two models that you have learned about in this course from this list:
· Strategic
· Structural
· Symbolic Experiential
· Human Validation Process
· Emotion Focused Therapy
· Bowen Intergenerational
· Contextual
· Psychoanalytic Family Therapy
· Cognitive-Behavioral Family Therapy
Then, write two treatment plans for this mother and child in the video clip, each of them based on a different model.
To achieve this, you will carefully consider a goal that your model might focus on and lay out the three phases of therapy and the objectives within those phases. Additionally, you will consider the interventions of that model to indicate what you think a therapist using that might do to approach that goal.
Overall, this could be a general guideline to your treatment plan:
Goal:
3. Initial phase objective(s)
10. Therapeutic interventions to meet this objective
3. Working phase objective(s)
11. Therapeutic interventions to meet this objective
3. Closing/termination phase objective(s)
12. Therapeutic interventions to meet this objective
After completing two treatment plans, reflect on the process by answering the following questions:
· What challenges or struggles did you encounter?
· When you view the case from a different “lens”, what were the similarities and differences of each treatment plan?
Length: 2-3 pages (each “mini” treatment plan should be less than one page, and the summary should be less than a page)
References: Include a minimum of 5 scholarly resources.
The completed assignment should address all of the assignment requirements, exhibit evidence of concept knowledge, and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly resources, reflect academic expectations and current APA standards, and adhere to Northcentral University's Academic Integrity Policy.
· Treatment planning with couples and families
Gehart, D. (2017). Treatment planning with couples and families. In J. Carlson & S. Dermer (Eds.), The sage encyclopedia of marriage, family, and couples counselling.
Treatment Planning With Couples and Families
· By: Diane Gehart
· In: The SAGE Encyclopedia of Marriage, Family, and Couples Counseling
· Chapter DOI:https://doi.org/10.4135/9781483369532
· Subject: Relationship Counseling , Family Therapy
· Keywords: case conceptualization ; couples therapy ; families ; family planning ; family therapy ; treatment ; treatment plans and treatment planning
As the term implies, a treatment plan outlines the expected course of treatment to address a client’s presenting concerns. Although few examples can be found in the formal professional literature, treatment planning is one of the commonly used written documents in 21st-century couples and family therapy. Widely regarded as standard practice in the field, treatment planning is arguably an ethical obligation in contemporary practice and is a central component to most licensing exams and agency documentation.
Treatment Plan Formats
Clinicians have several options for developing treatment plans in couples and family therapy, each serving different needs. Broadly speaking, treatment plans can be categorized as those used primarily for third-party reimbursement and those used for conceptualizing clinical interventions. Most clinicians will need to become skilled at both types of treatment plans to meet the demands of employers, supervisors, third-party payers, and competent care.
Symptom-Based Treatment Plans
Treatment plans used for reimbursement are closely modeled after treatment plans used by other health professionals, such as doctors and physical therapists, and generally focus on psychiatric diagnoses and symptoms. These plans are symptom focused and use almost exclusively behavioral and psychiatric terminology so that they are in a similar format to those of other health care professions. Treatment goals in these plans target specific symptoms, such as anxious behavior, depressed mood, hallucinations, compulsive behavior, and so on. Typically, they must identify an observable, measurable behavior and have a measurable target, such as to reduce food bingeing episodes to no more than one per month. Most often, these plans also include clinical interventions to achieve each goal. When working for government agencies, these plans are the standard.
Examples of symptom-based treatment plan goals include the following:
· Increase engagement in social activities to at least one outing per week.
· Decrease visual hallucinations to no more than one mild episode per month.
· Reduce panic attacks to no more than one mild episode per month.
· Reduce couple conflict to no more than one mild episode per week.
Clinically Focused Treatment Plans
Symptom-based treatment plans are often problematic when working with couples and families because—as required by third-party payers—these plans target a single person’s mental health symptoms. However, when working with couples and families, rarely is treatment conceptualized in terms of a single person’s psychopathology. Instead, couples and family therapists typically view individual pathology as part of a larger systemic dynamic, both influencing and being influenced by the system. Thus, most couples and family therapists find clinical treatment plans philosophically more appropriate as well as more clinically practical.
Clinically focused treatment plans are grounded in therapeutic theories rather than psychiatric language. So rather than a behavioral goal such as “reduce compulsive hand washing,” a clinically informed goal would address the underlying dynamic believed to be related to the psychiatric symptom: “Reduce enmeshment with mother in order to reduce compulsive hand washing.” For goals to be clinically relevant in couples and family therapy, the plan needs to describe how the practitioner plans to achieve symptom reduction. These plans are grounded in the therapist’s theory-informed case conceptualization of the client’s presenting concern; thus, these plans directly reveal the theoretical orientation the therapist plans to use for the case.
Below are some examples of clinical treatment goals:
· Increase parental hierarchy to reduce child’s tantrums. (Structural theory)
· Increase secure attachment between husband and wife to reduce conflict. (Emotionally focused therapy)
· Interrupt and reduce negative interaction cycle between father and son to reduce conflict. (Systemic theory)
· Reduce triangulation of mother-in-law to reduce couple conflict. (Bowen intergenerational theory)
Elements of Treatment Plans
Although there are endless possibilities for outlining treatment plans in couples and family therapy, most have the same key elements, which include a multipart organization, goals, and interventions; some plans also include treatment tasks.
Organization of Plans
Rather than a single list of goals, most treatment plans are divided into phases of treatment. For example, the more symptom-based plans developed by Arthur E. Jongsma and colleagues include (a) long-term goals and (b) short-term objectives. The more clinically oriented plans by Diane Gehart include (a) early, (b) working, and (c) closing phase goals. This phase-based organization helps outline the expected progression of therapy and helps clinicians identify when and where to intervene.
Goals
Goals are the key element of any treatment plan. An effective goal should clearly define how the symptom or problem dynamic will change, such as “increase self-confidence,” “reduce conflict,” and “improve congruent communication.” In addition, many agencies and third-party payers prefer that goals be behavioral and measurable. A behavioral and measurable goal requires stating the goal in such a way that a clearly identifiable behavior is targeted. Some examples of behavioral and measurable goals include the following:
· Reduce parent–child conflict to no more than one mild episode per week.
· Increase son’s cooperative behaviors to be measured by no more than one mild incident of disobedience per week.
· Increase secure emotional bond between mother and son to be measured by no more than one emotionally reactive outburst when mother makes requests per week.
· Reduce enmeshment between partners in couple to be measured by no more than one mild argument stemming from boundary issues per month.
Interventions
Most treatment plans also include interventions or techniques that will be used to achieve the stated goal. Virtually all interventions or techniques are derived from the therapist’s theory of choice. Examples of commonly used interventions in couple and family therapy include the following:
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Theory |
Interventions |
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Structural Therapy |
Enactments Boundary making Challenging worldview Intensity and crisis inductions Unbalancing Expanding family truths Shaping competence |
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Systemic and Strategic |
Reframing Therapeutic double bind Directives Circular questions Ordeal therapy Pretend techniques |
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Emotionally Focused Couples Therapy |
Validation Reflecting primary and secondary emotions Tracking interaction patterns and cycles Evocative responding Empathetic conjecture and interpretation Heightening Reframing in context of cycle and attachment needs Enactments Softening emotions |
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Solution-Focused Therapy |
Formula first session task Scaling questions Coping questions Compliments Miracle question |
Treatment Tasks
Treatment plans can also be written to convey all tasks-related treatment, including various elements of case management and case planning. These treatment tasks can include
· establishing a therapeutic relationship using a specific therapeutic approach;
· assessment and case conceptualization;
· setting goals for treatment;
· referrals for psychiatric assessment, medical evaluation, group therapy, support groups, and so on;
· monitoring for progress using clinical assessment tools such as the Session Rating Scale, Outcome Rating Scale, and Symptom Checklist; and
· developing after-care plans.
Treatment Plans for Couples and Families
Treatment plans for couples and families typically require a more sophisticated process of theory-based case conceptualization than working with an individual with a single issue, such as depression or anxiety. Typically, couples and families present with very similar presenting problems: conflict between couples, conflict between parents and child, loss of affection with couples, or simply “we don’t communicate well.” However, there are multiple and numerous potential causes to these similar-sounding issues. For example, using a structural therapy conceptualization, family conflict can arise with both enmeshed and disengaged boundaries; thus, the therapist must first conceptualize the reason for conflict in order to determine how the boundaries need to shift to reduce conflict—or whether the issue is more closely related to an ineffective or overly rigid parental hierarchy. Table 1 shows a sample clinical treatment plan for a couple with pursuit/withdrawal as the primary relational dynamic; note how the goals are based in the theoretical assumptions and language of the approach.
Table 1 Sample Emotionally Focused Treatment Plan for a Couple
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Initial Phase of Treatment |
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1. Increase couple’s awareness of negative interaction cycle and the primary emotions for each. a. Identify the negative interaction cycle with both secondary and primary emotions for each partner. b. Reframe their conflict in the broader systemic context of the negative cycle to help create a greater sense of unity and understanding. |
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Working Phase of Treatment |
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2. Increase emotional engagement and expression of withdrawn partner to reduce avoidance. a. Use empathy, validation, and conjecture to help withdrawn partner express attachment needs and primary emotions. b. Facilitate enactments to allow couple to directly communicate about attachment needs and to facilitate acceptance by partner. |
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3. Reduce criticism by pursuing partner and replace with increased nonblaming expression of underlying attachment needs. a. Heighten pursuer’s primary emotions to help facilitate softening of critical position. b. Facilitate enactments to promote acceptance and prompt new healing interaction cycles. |
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4. Increase the ability of both partners to respond to each other and create a sense of relational safety. a. Track interaction cycle to help couple develop new interaction patterns. b. Use enactments to help couple develop new ways of responding to each other. |
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Closing Phase |
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5. Increase couple’s ability to effectively respond to new stressors in the relationship. a. Track positive interaction cycles to identify what worked and how they affected each person’s sense of emotional safety. |
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6. Solidify secure bond by increasing the consistency of the positive interactions. a. Facilitate enactments that highlight how safety is created for each partner. b. Heighten new emotional responses. |
Diversity and Treatment Planning
When developing treatment plans, couples and family therapists should design goals that are appropriate for a client’s sociocultural context, which requires assessing diversity factors such as race, ethnicity, gender, sexual/gender orientation, religion, socioeconomic status, language, education, and immigration status. Often a client’s cultural or religious background informs particular forms of couple and family relationships; in such cases, each member’s level of acculturation plays a significant role in defining appropriate goals for the couple or family. When using theories that have predefined norms and theories of health—such as humanistic, psychodynamic, and cognitive-behavioral approaches—couples and family therapists need to take particular care to ensure that the long-term goals in these approaches are appropriate for the client’s particular sociocultural context. For example, when using a humanistic approach with an East Asian immigrant family, such as the Satir model that emphasizes direct and congruent expression of emotion, the therapist must carefully assess cultural norms, level of acculturation, and family preferences to set culturally appropriate and relevant goals. Similarly, couples and families from communal cultures will often have different norms for healthy boundaries, parental hierarchy, and the role of the first-born child than may be typical in more individualistic cultures, such as the dominant culture of the United States. Additionally, the concept family may include “family of choice” for gay, lesbian, bisexual, and transgendered clients, thus requiring treatment plans that include this expanded definition of family.
Do Plans Make a Difference?
Finally, some may wonder whether treatment plans are worth the effort because so often things seem to change in clients’ lives. In truth, therapy rarely goes according to plan: new problems arise, a crisis occurs, or a sudden positive turn of events changes relational dynamics drastically. However, even when therapy does not go according to plan, treatment plans are exceedingly valuable to clients and therapists. Creating a treatment plan helps a therapist to carefully think about how to help a particular client, which should help the therapist convey a sense of confidence and hope to clients. Common-factors research indicates that conveying such a sense of hope is significantly correlated with positive outcomes in therapy. Furthermore, having a clear plan can make it clearer when things are off course and can help the therapist determine the next steps when circumstances change. Additionally, a well-crafted treatment plan requires the therapist to prioritize and sequence therapy to maximize positive outcomes. Thus, treatment plans do make a significant difference for therapists and clients alike, even when therapy does not go exactly according to plan.
Diane Gehart
See also Goals, Treatment ; Practice Management ; Progress Notes for Couples and Families ; Stages of Family Therapy ; Therapeutic Contract
Further Readings
Datillio, F. M., & Jongsma, A. E. (2014). The family therapy treatment planner (2nd ed.). New York, NY: Wiley.
Gehart, D. (2014). Mastering competencies in family therapy: A practical approach to theory and clinical case documentation (2nd ed.). Pacific Grove, CA: Brooks/Cole.
Gehart, D. (2015). Theory and treatment planning in family therapy: A competencies-based approach. Pacific Grove, CA: Brooks/Cole.
Johnson, S. M. (2004). The practice of emotionally focused marital therapy: Creating connection (2nd ed.). New York, NY: Brunner/Routledge.
Jongsma, A. E., & Peterson, L. M. (2014). The complete adult psychotherapy treatment planner (5th ed.). New York, NY: Wiley.
McGoldrick, M., Giordano, J., & Garcia-Preto, N. (Eds.). (2005). Ethnicity and family therapy (3rd ed.). New York, NY: Guilford Press.
O’Leary, K. D., Heyman, R. E., & Jongsma, A. E. (2015). The couples psychotherapy treatment planner (2nd ed.). New York, NY: Brunner/Routledge.
Diane Gehart
· Entry
Trauma-Focused Cognitive-Behavioral Therapy
· Entry
Triangulation
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· On this page
· Symptom-Based Treatment Plans
· Clinically Focused Treatment Plans
· Goals
· Treatment Plans for Couples and Families
· Diversity and Treatment Planning
· Entry
Trauma-Focused Cognitive-Behavioral Therapy
· Entry
Triangulation
Read next in Sage Reference
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Reference
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Cultural Sociology of Divorce: An Encyclopedia
March 1, 2013
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Reference
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Dictionary of Existential Psychotherapy and Counselling
van Deurzen, Emmy, et al.December 31, 2012
·
Reference
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The SAGE Encyclopedia of Theory in Counseling and Psychotherapy
September 27, 2017
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Reference
· Encyclopedias
Encyclopedia of Behavior Modification and Cognitive Behavior Therapy
September 15, 2007
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Encyclopedia of Substance Abuse Prevention, Treatment, & Recovery
December 30, 2008
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Reference
· Encyclopedias
Encyclopedia of Trauma: An Interdisciplinary Guide
June 19, 2012
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