WMHCA: Treatment Planning for Those Who Hate Treatment Planning

Presented By

2 CEs Recorded: February, 2024

This two-hour workshop will address therapists working in Existential-Humanist paradigms who feel intimated or at odds with treatment planning and working with managed care. This workshop will note common critiques of treatment planning and offer reframes to justify their authentic approach with the language of diagnoses and behavioral objectives.

Objectives After this training, participants will be able to:

● Identify three critiques of the medical model of mental health.

● Collaborate with clients to identify goals and generate behavioral objectives.

● Use diagnostic criteria to measure client progress.

Outline

Outline (2 hours total)

Introduction to Anthony (5 minutes)

Introductory participant discussion: (15 minutes)

● What words and feelings do you associate with treatment planning?

● What fears or concerns do you have about treatment planning?

Reviewing common critiques from the Existential-Humanistic approach to therapy. (15 minutes)

● Critiques of the medical model of mental illness.

● Critiques of treatment planning and managed care. Distilling the useful questions managed care is asking: (5 minutes)

● Is this treatment helping the client to get better?

● Is treatment providing value worth the money?

● Could all present agree that ideally we’d want the answer to be Yes to both questions?

Break (5-10 minutes)

Using the language of the medical model and evidence-based treatment to justify our approaches (15 minutes)

● Objectives attempt to measure what is immeasurable by using behavioral markers.

● Most important criteria: medical necessity. (Think: Symptoms!) Eliciting client goals from a client-centered perspective: (15 minutes)

● Client-identified problems and the desires within those problems.

● Grounding nebulous goals by guiding client to identify a behavioral outcome.

● “If you felt happier, what would you do differently in your life?”

● “What would being more confident make possible that you’re not doing now?”

● Diagnostic assessments to identify active distressing symptoms. Building a Treatment Plan: (20 minutes)

● List out three to five identified client goals or desires.

● For each goal or desire, identify one behavioral objective toward that from where client currently is.

● A goal is where the client ultimately wants to be. An objective is the next step toward that goal.

● Having less ambitious objectives reduces the pressure to perform.

● A series of achievable objectives also creates a narrative of documentation for an auditor to follow. Someone reviewing your treatment plans could see the progression of moving from trying to sleep 3 hours a night to 5, and eventually to 7.

● A measurable behavior could include client self-report, completing assessments, or self-assessment of “How happy are you on a scale of 1-10?”

● Ground at least one, ideally all, objectives in a symptom from their diagnosis. (“Increased sleep from 3 hours per night to 5 hours per night, per client report”).

● If suicidal ideation present, one objective is toward reduction of ideation.

● This is my own personal guideline.

● It is not client’s responsibility to reduce their ideation. Assumption is that ideation will reduce organically as treatment progresses.

● If client cannot identify goals, then first goal of treatment is to identify goals. Monitoring client progress (15 minutes)

● Don’t stress about it. Ideally have a place in your notes where you can track these goals.

● Again, assumption is that as therapy works, client will naturally move toward health objectives without necessarily actively “doing” them.

● Suicidal ideation decreases as emotional self-regulation improves.

● Sleep improves as anxiety or guilt decreases.

● Depression symptoms decrease as quality of life increases.

● Etc.

● I assume everything is progress, even when there’s a setback, because it’s progress that they can discuss it in therapy and we can address the problem more deeply.

● That said, occasionally you might add a check-in about questions that might not be self-reported in session.

Closing and checking out (5 minutes)

EPDC CE Hours: 2

Presenter: Anthony Rella, MA, LMHC

Anthony (Tony) Rella is an Internal Family Systems therapist and clinical supervisor in Seattle, Washington, working primarily with men's issues, complex trauma, LGBTQ+ issues, guilt and accountability, and other therapists.