Tips for Developing Treatment Plans

I am working with adolescents who have a variety of presenting problems including grief and loss, depression, anxiety, and PTSD.  How can I develop an effective treatment plan for each of these presenting problems?

It has become standard practice in most behavioral health settings to develop a treatment plan with the client in the early sessions, to guide the direction of your work together.  Treatment plans have two parts: 1) the goal, objective or target for change in the client’s symptoms or behavior and 2) the interventions and therapeutic modality you will use, informed by a theoretical orientation.  I will discuss tips for each part of the treatment plan below.

The first part of the treatment plan, the target for change, is often written in behavioral terms in order to be clear about how you and the client will know that treatment is successful.  Clients sometimes begin treatment with a clear idea of what they want to change and other times are confused or vague.  Their initial discussion with you may focus on the desire for a change in others or a situation rather than something that is within their control.  If this is the case, you’ll need to take some time to talk about what is possible for you and the client to achieve.  With adolescents, you generally need to consider the priorities of parents and sometimes teachers and other school personnel in developing treatment goals.  Some negotiation may be necessary in developing treatment goals that are acceptable to all parties.

Once you and the client have agreed on the focus of change, identify goals that are achievable within the period of time you have to work together.  You will specify more modest goals if you have a limit of 12 sessions than if you are able to work for a school year of 8-9 months.  Your goals should also take into account the current baseline, length and severity of the problem, and complexity in terms of multiple diagnoses or family dynamics.  Your client and parents may be unrealistic about the degree of change that is possible or may transfer their feelings of pressure to you.  Sometimes you can compromise with writing shorter term goals that can be updated when they are reached.  For example, if a 17-year-old girl rates her depression at 8 on a 1-10 scale you might have a target of reducing to a 6 within 6 weeks, then a further reduction to a 5 within another 6 weeks if the initial target is reached.

The second part of the treatment plan, your interventions, comes from your case formulation of the reasons for the client’s presenting problems.  The case formulation is grounded in a theoretical orientation and provides an explanation for how and why the presenting problem developed and is held in place.  For example, you might develop a cognitive-behavioral formulation of your client’s depression with inferences about her automatic thoughts, leading to interventions targeting these thoughts.  You could also develop a family systems formulation with inferences about the client having an overly parentified position in the family, leading to interventions with the family system.  A psychodynamic formulation might view the client’s depression as a response to the anticipated loss of her needs for dependency as she and her parents plan for her to leave for college, leading to interventions interpreting her conflict about individuation.

Some clinicians believe that behavioral treatment goals require behavioral interventions, but this is not the case.  All approaches to psychotherapy exist for the purpose of facilitating change in the client including symptoms, emotions and behavior, and treatment goals can target any of these areas of change.  Your choice of interventions should be based on your preferred theoretical orientation and your client’s preferences and expectations, some of which are influenced by cultural identifications.  The choice of treatment modality, individual or family, is influenced by your theoretical orientation as well as the practices and policies of the setting in which you are working.

I hope you can use these tips for developing clear, effective treatment plans with your clients.  Please email me with comments, questions or suggestions for future blog topics.