Do you have a treatment plan?

I'm curious about if anyone here has a treatment plan and if so, what it includes? Is it written or verbal? How soon after beginning therapy do you get it? Does it include the length of time they estimate it will take? Is it always formal? Or sometimes informal, like just an understanding that "we are going to work on ____ together and we'll keep working on it until you show improvement/progress and it is resolved?"

I guess I'm just curious because I've heard of treatment plans but I don't think I have one. I remember once toward the beginning, my T said something like "you know best what you need to heal." So part of what we have done is prospect about and leave it up to me to bring up the most important things so we can deal with them, because only I know what they are. Does that make sense? Part of that has involved an evasive dance around the issues and a slow increase in self-knowledge, but my T has been patient. It seems to be working.

Just curious about everyone else's experience!

I don't really have a treatment plan, either - although at the moment I have been set a goal of eventually exposing myself to everything I've mentioned avoiding due to anxiety. But my therapist hasn't said how long this is likely to take - which makes sense to me, because I don't see how you can know how long it will take (it's going to be different for everybody, right?), but it annoys my parents. They want to know when I can stop seeing him and when I can start seeing him less often. It feels like practically every time I'm alone with them they'll ask me, and I wish they wouldn't.

Anyway, I don't think that was much help, sorry, but that's my experience.

Hi sunrise,

You're the best judge of whether it's working and it sounds like it is for you. yay!

I think treatment plans benefit others. Mostly insurance companies who like to sit there drumming their fingers asking "How long is this going to take!?!" It satisfies their authorization requirements, justifies how many visits and dollars to let loose of. And possibly treatment plans benefis supervisors if a T is in a group situation or in training.

I have a general one now. I have had specific ones in the past; but they changed as therapy progressed, just like goals and directions change in the therapy process as in life itself.

ECHOES

I used to have treatment plans. They involved a list of things I wanted to work on. They also involved a time estimate of around how long it was going to take for me to be showing some progress with those things.

I think that the official reason for treatment plans is 'accountability'. That has two translations:

Firstly, 'accountability' in the sense that since you are paying for a service and all you are entitled to some kind of estimation as to how long it is going to take (and by extension how much this is going to cost). You should know whether your therapist thinks you can make some solid gains in 6 weeks or 6 months or 6 years... You should also be entitled to work on what it is that you want to work on. For example, if you want a fear of flying treated so you can take a plane to get to a conference in one years time then you aren't getting the service you paid for if they want to talk to you about repressed childhood memories and the meaning of life.

Secondly, 'accountability' in the sense that since insurance companies (or government agencies) are paying for a service and all they are entitled to some kind of estimation as to how long it is going to take (and by extension how much this is going to cost). They like to see progress and little measures of progress. Some clients quite like this too. My DBT therapist joked about turning my daily mood ratings into a graph. She very nearly had to alter the treatment plan to include 'homicidal ideation' (just kidding).

;-)

If the therapy is more long term... If the expected gains are such things as feeling more connected to people and being more creative and feeling happier and the like then it is harder to do a treatment plan and it is harder to estimate when real gains are likely to occur. Most therapists want some idea of what it is that you think you need help with but different orientation (and different therapists) have a different notion as to whether they are going to 'attack' symptoms for fast gains or whether they are going to get to know you over time for more general nebulous hard to quantify kinds of changes...

Thanks for the answers, Rio, ECHOES, alexandra. I got to wondering about treatment plans because I was reading in another forum here on PsychCentral and someone commented "sounds like you need to revisit your treatment plan" or something like that (not said to me). And I started thinking, hmmmmm, does everyone here have a treatment plan except for me?

So I feel reassured by what you all wrote. I haven't felt like I was missing anything, but it sounds like maybe the plans exist at least in part to satisfy insurance requirements. After a long battle with 2 insurance companies, I recently learned they would not reimburse at all for my current therapist. (They paid for my previous one, up to 20 visits per year, but nope, not the new guy, who is a fantastic talent.) Well, that's another story.

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But my therapist hasn't said how long this is likely to take - which makes sense to me, because I don't see how you can know how long it will take (it's going to be different for everybody, right?), but it annoys my parents.

</div></font></blockquote><font class="post">That makes so much sense, Rio. I agree, you can't predict. I'm sorry about your parents not understanding. I remember once my previous T said that I wouldn't need 20 sessions in a year to deal with my problem, and lo and behold, there we were 20 sessions later with still a big problem. I reminded her once that she had said that, and she said, "I never should have said that," and shook her head, like she realized she had screwed up by saying that. They really can't know, so the whole idea of being able to tell the insurance companies how long it will take seems just a big fairy tale, or a hoop the T's have to jump through to satisfy insurance. There are other parts to a Treatment Plan, of course, besides how long.

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just like goals and directions change in the therapy process as in life itself

</div></font></blockquote><font class="post">That's so wise, ECHOES.

I doubt that every patient is aware of their treatment plan, as it's mainly the creation of the therapist to help keep the patient on track solving the presenting problem.

People who have been hospitalized are often brought in on the planning process as a means to engage them and show them hope for future...and to help them stay on track after discharge.

Certainly though, every good therapist has some kind of a treatment plan for each patient, once they are sure where the patient wants to go.

TC

With my previous 2 therapists I had a treatment plan - it was a requirement of the organization that they worked for - they both worked for the same organization - the first one left so I ended up with a different T. They were formal documents that spelled out goals, length of time, and approaches. I had to sign them as well as my T. They were then revisited every 3 months to see if I had reached my goals. For me they were very disrubtive - I hated it... though others might find them helpful.
My new T and I don't have goals or anything. I had found one that does long term therapy and my "goal" was getting support in my life....

I had to fight with my ins. co. to get authorization to go to the therapist I'm with now, because she was out of network, but the only therapists they had were males & I needed to go to a female. They also said if you try the therapists on their list & you don't "click" with them, they will authorize a therapist that you feel you can work with & benefit from who is out of the network. Try to see if you can get that kind of authorization.--Suzy A pain, for sure, but worth it money-wise. I couldn't afford to pay out-of-pocket. Also had to do this with my meds provider that I have been with for 6 yrs. My husband's co. changed ins. plans & mail-order drug plans & screwed everything up for me.

when i worked at the Phospital.......everyone had a treatment plan. i bet you have one. it's like Sky said...the T/Pdoc have something on paper about your visits and what they're thinking about for you. we met once a week and reviewed every patient's treatment plan.....

even i have one now with my Pdoc.....small, but i know what we're doing and what we're going to do......xoxoxo pat

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That makes so much sense, Rio. I agree, you can't predict. I'm sorry about your parents not understanding. I remember once my previous T said that I wouldn't need 20 sessions in a year to deal with my problem, and lo and behold, there we were 20 sessions later with still a big problem. I reminded her once that she had said that, and she said, "I never should have said that," and shook her head, like she realized she had screwed up by saying that. They really can't know, so the whole idea of being able to tell the insurance companies how long it will take seems just a big fairy tale, or a hoop the T's have to jump through to satisfy insurance. There are other parts to a Treatment Plan, of course, besides how long.

</div></font></blockquote><font class="post"> Thanks for understanding, sunrise. I know I'm probably being oversensitive (wouldn't be the first time ), but it does hurt when they keep asking. It makes me worried that they'll try and decide for me when I've had enough. Sorry your therapist made that mistake, it must have been frustrating.

Thanks everyone for your insights! I guess I do have a treatment plan, it's just not formal. I have shared my ultimate goal with my T, and we have agreed to work on past traumas that are making me stuck on a big issue in my life right now. Then when I'm able, move on to working on the big issue itself, which hopefully will be easier because I won't be so stuck anymore. How's that for a plan? Would the insurance companies like that one?

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I doubt that every patient is aware of their treatment plan, as it's mainly the creation of the therapist to help keep the patient on track solving the presenting problem

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Sky, I found your comment interesting that a T might keep a treatment plan hidden from a client. I think of the therapist-client as being a team, and it seems like it wouldn't benefit the client to be "in the dark" about the T's plan?

freewill, that system you describe with the plans every 3 months sounds very frustrating. I am glad you are past that. Since I'm paying for my therapy out of pocket, I would not stand for "my time" being wasted like that. Suzy, I tried to get two different insurance companies to reimburse for my T, but no luck. I am done with the fight, gave it my best, and it at least is good to have an official answer, even though it is "no." So I am using some of my savings to pay for therapy. At least for now, it is really worth it, as my T has helped me tremendously in a relatively short time. Pffft to insurance.

> we have agreed to work on past traumas that are making me stuck on a big issue in my life right now. Then when I'm able, move on to working on the big issue itself, which hopefully will be easier because I won't be so stuck anymore. How's that for a plan? Would the insurance companies like that one?

They would probably not consider that sufficiently operationalised ;-)

I had a therapist who made me operationalise my own treatment plan once...

Grr...

Talk about 'homicidal ideation' lol

The presenting problem isn't always the main issue. A good T can, after a few sessions, usually figure this out and make a plan to try and guide the patient to that realization. Yes, it's a team effort. The T can't (or shouldn't) drag a patient to a point the patient isn't ready for.

It's easy to tell someone what they need to do, what the REAL problem is, but as we all know even from here at PC, you can make the statements, but if someone isn't in a place to see or hear it, it is isn't accepted.

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The presenting problem isn't always the main issue. A good T can, after a few sessions, usually figure this out

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Sky, that is exactly what happened with me! There I was in session #1 with the new T, I told him the problem I was there to work on, which is his specialty, and he suggested, after listening to me for an hour, the reason I couldn't tackle this problem was because I was stuck on things from my past and then gave details, based on just one conversation. He was so insightful (my previous T had never figured this out). What he suggested totally resonated with me and I knew it was the truth. I am so glad he shared that with me up front so we could get down to work together. His insight really gave me hope and was hugely influential in my deciding to come back to him for subsequent sessions. If he had not shared his insight, maybe I wouldn't have returned. [/shudder]

Hey, i like the title of this thread....No, I do not have a treatment plan written up, but i certainly have one on my mental list. More a goal than a plan. For example, at one point I had a goal of 'in a year from now i want to be able to talk to talk to my mother', i didn't think about the goal every week, but a year later i looked back and said, hey, i accomplished that goal. it's been this way through the past five years of therapy. Then, our therapy changed course...long story short, i found that i was no longer setting goals nor achieving them. I am aware that was due to the waning trust i had in my therapist....now i started with a new t and just as soon as i feel i'm on solid ground with her i shall make a mental note of at least one goal i want for myself, to be achieved within the next year or so. I like to give myself enough time, so that i don't go into a panic about not having achieved my goal....

If there was a treatment plan in the works all this time, I doubt if my therapist would have been able to stick to it. Without fail there has always been some other issue of significant importance that had to be addressed. That in itself I find disruptive. It feels like no one issue can be thoroughly worked through. I know what should be added to my treatment plan if there still is one, and that would be a brain transfusion. A transfusion of healthy rational thoughts replacing the negative irrational thoughts. You think that's possible? I wish for it.

Calm

Hey I don't have a treatment plan. I did seek help for a particular problem but have found myself working on others. (Discovered that social anxiety was causing part of my problem and have to work on that too.) I wouldn't want a regular plan. I've even said to my therapist that I liked the fact that I could suddenly ask him for help with other things (at some point during therapy my dad became ill and we talked a lot about that -- that had nothing to do with my original goal in therapy). I'm sure if I did have a treatment plan, I'd ignore it. :-)

And yeah the whole insurance thing sounds really annoying. My therapist does not belong to my insurance company's network and so he doesn't submit anything to them. And I like it that way!

Sidony

Definitely no treatment plan for me.... It's psychoanalysis, so it's based upon free association... I guess the treatment plan would be, "Just talk."

Yes I have a treatment plan. the first day I saw my therapist she asked me why I decided to get therapy and what I expected out of therapy. Boy was my idea of what therapy was way off from what she told me it was. I expected to pay this lady money and talk for a bit and then she would be able to fix all my problems. She laughed and told me no. that I would be the one that had to fix my problems by doing things like keeping a journal and she gave me a list of workbooks and asked me which problem I wanted to start with and we matched that with a workbook from the list. I can pick from the book which things I want to do and sometimes she picks something from the books. We talk weekly too. She also took me on a "field trip" to the library (where I am right now) and helped me sign up for a library card because she said as we go along she sometimes has her clients do research assignments on their problems and mental disorders. Definately not what I expected having to work so hard on fixing my problems but I also did not expect to be having fun too. This weeks assignment is to find 5 things to do with touching all kinds of textures. She said its called stimulating my senses. So I am playing with playdough, cookie dough, jello, mashed potatoes and dry rice.

My ins. co. is asking for a treatment plan from my therapist in order to authorize more visits. I left a message on her voicemail that I would like to have a copy of it. I see her in a week or so. I'll let you know what it says! Sometimes I'm not sure what I'm doing there. I don't feel like I'm making any progress.--Suzy

yes but some doctors have never showed me even one paper. When i was in partial I did have a treatment plan and in the hospital. I loved the doctors dearly that never showed me a paper. The ones in the hospital were okay and they were nice about showing me stuff. In partial they were very nice about showing me stuff and were pretty nice doctors.

Yes.
Problem: Self-esteem
Long-term goal: Overall self-confidence
Short-term objective: Develop sense of self as competent
Be able to speak up for self more easily
Work toward professional identity (I am studying to be an addiction counselor and am afraid that I can't due to a lack of social skills and social anxiety at work)

Problem: Stress management
Long-term goal: Build skills to cope with normal stress (insult with that word normal in there)
Short-term objective: Work on having more positive expectations (brain transfusion might be easier)
Deal with situations up front or as they come up
Feel greater control over crying by talking with trusted freinds

I came up with most of this except T added "work on having more positive expectation" and "feel greater control over crying by talking with trusted friends." She re-phrased some of the stuff under self-esteem. I don't know if she has a length of time estimate. I doubt that she does because I picked rather long-term goals. I assume that my insurance has a copy of this. My T looks at the goals every session to see if it is time to review them. I don't know what the Pdoc thinks of them because they pre-date my relationship with him.
At times, I share with her about them. Other times, I toss them aside for some sessions. I think of a "treatment plan" as just a way to explain what it is that I want out of the relationship. I hope it will also help me to recognize when to end the relationship. My previous T wrote my two goals of self-esteem and stress management in a really academic way and made them have no meaning anymore. I started out with my current T with the crap goals and changed them when I had done enough reading and work to figure what I felt that I most needed to stop feeling depressed and prevent a re-occurence. I have also worked some on resolving some childhood isssues and guilt to do with a relative's death in sessions. Well, there you have a "treatment plan." I think her version has a question about obsticles to learning which I didn't feel comfortable reading near where I sign when ever we review the goals. The last time, I wrote up my own little thing on whether or not I had made progress on each of the objectives.
PS. I will be learning how to write "treatment plans" later this semester in school. I'd joke that I already almost wrote one myself. I mean I wrote most of it. She just quickly wrote it while I was rambling the list of goals and objectives.

my therapist is a doctoral intern..... because of her internship placement, they have to do a formal treatment plan all written out.. blah blah.... so we did that but she cant stand it.. neither can i.. it's so funny because when she did it, i could tell she was so not impressed with the supposed need and she feltthat treeatment plans.. you cant reallly PLAN for therapy... but general problems, goals and treatments could be written down however flexibility necessary and welcome... so for me.. it was positive that she had to do it but also didnt feel it needed to be treated like the 10 commandments of psychotherapy... lol