Do therapists actually make treatment plans?

As a T-in-training, it's quite normal to make a treatment plan without sharing that document with the client. It's really more for the T to have some direction with their interventions. Then you have to be flexible because goals change over time and what you planned might not work for the client. I do think that T's should verbally negotiate with clients about the goals of therapy and make sure the way they are doing therapy makes sense to the client.

I would share a treatment plan with a client if they asked, or if I was unsure about the direction of treatment and wanted to discuss it. Otherwise I probably wouldn't because it's something that would detract from the flow of a session and I'd wind up having to explain jargon and what certain interventions mean, something the client probably doesn't care about.

As a client, it is in no way reassuring to know those guys have secret plans and goals for me. I am in no way wanting a therapist to inflict their idea of what should happen upon me without my input. And I most assuredly care about what the therapist is doing or trying to do at me at all times.

I hardly think why I don't let the ones I see talk often is a mystery.

I wouldn't say it's secret. For example, a client may come in and say "I want to work on my relationship with my sister." I say "OK, we can work on that." On the treatment plan goes "Process relationship with sister" as a goal, then under interventions I write "Reflect content and feelings." So when my client talks about the sister, that means I listen and restate back to the client what she seems to be thinking and feeling.

Another example, a client comes in saying she wants to improve her self-esteem, and I agree we can work on it. I notice that she seems to have constant negative thoughts about herself. On the treatment plan goes "Improve self-esteem" as a goal and under interventions goes "Externalize self-critical voice" or if I'm very psychodynamic, "Restructure punitive superego" or something like that. I might ask the client what the critical voice says or how it feels to listen to it all the time.

Basically a goal shouldn't really go on the treatment plan if the client hasn't already agreed to it in some form, except if the client is in such bad shape that things like "stay alive" or "don't kill other people" aren't goals for them.

This is a frightening assumption.

Hang around this forum long enough and you might start to think everyone is a therapy geek, and this would also be a pretty inaccurate assumption. Most clients come to therapy to solve a problem, not to learn about therapy. But as I said, if you want to see your treatment plan do ask as you have the right to see it if you choose.

I know many people in therapy and they prefer to understand what is happening. As a therapist in training, you might want to check your assumptions.

A therapist deciding what I can and cannot understand or want to know or not know sounds rather paternalistic and condescending to me.

I would never want a client to feel like they don't understand what is happening. But if a client says something and I paraphrase back to them what they just said, they will probably understand that I'm trying to listen and let them know I'm listening. They don't necessarily need to know that what I did is called an empathic reflection which was first described by humanistic therapists such are Carl Rogers who believed in communicating empathy as one of the three foundational conditions of effective therapy. If you're going to use an intervention that wouldn't make intuitive sense to the client then I do think you'd better explain it. I myself have been dropped into accelerated psychodynamic attachment-based work as a first-time client with no explanation, and it's something I would never want to do to someone else.

I don't think you realize this is about trying to respect a client's time and the fact that they are paying by the hour. Your mechanic isn't going to sit there and educate you about transmissions for an hour then charge you for the time. They will fix your transmission and answer any questions you have about it. Think about when the last time was your doctor gave you a detailed molecular explanation of which receptor in the body a certain drug was working on. It doesn't mean they think you are stupid or can't handle the knowledge, they are trying to do their job.

The thing is, I wouldn't want a therapist who does something so mechanical as paraphrase what I say, so that right there would tell me this is not someone who gets me and I would not keep going. But back to the OP's point, the issue is whether or not a therapist shares the treatment plan. She has been asking for that in various ways, from what it sounds like, and I think the therapist should explain what the plan is. I'm very happy with the respect my therapist shows me in explaining her approach(es) and what she has in mind. It does not confuse me or detract from the work. It brings me along into it (if it makes sense; if not, I say so and she adjusts).

I guess I don't see why therapy should not be like any other profession where they say what they are doing. Surgeons, doctors, plumbers, mechanics have no problem explaining to me what they plan to do, what should happen as a result, what could go wrong, etc. Maybe if therapy clients were treated with more respect in this regard, there might be more accountability in this profession.

I don't see mds and the ones for my bff - we do ask for detailed explanation. My disgust with the viewpoint posted is that the therapist in your scenario decides for the client rather than inquiring what the client might want. I don't find deciding for me to be respect.

Also, I don't think asking for a treatment plan means someone wants to know citations and scholarly references. That's pretty black and white thinking. Again, it seems the OP simply wants to know what the plan is. That's a very reasonable thing to ask.

OK, well clearly I haven't read this thread thoroughly enough. As I thought I said, as a client you have a legal right to see your own treatment plan (and indeed your entire file) just by asking for it. I was just trying to explain why a T might not show the plan to a client unless they asked.

I understand your point, but my original concern was that the contracts these women have state that the client gets the treatment plan. And while I did get something, it was fuzzy, and by now we are rather far from my initial goals.

I am less concerned about an actual plan, more concerned with focus. However, when therapists are required to have a plan and also state that it will be shared with the client, attention should be paid to that. Just as I don't just hand my car over to the mechanic to fix without him giving me an explanation of what is wrong and what he needs to do, so too with therapy. It doesn't have to be in professional jargon. And I suspect a heck of lot of clients do care what their therapist is doing, not just me, stopdog, and ruh roh.

I did have a conversation with No. 2 about focus yesterday and she rather emphatically agreed with me, so things are getting back on track. I will speak with No. 1 next week.

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I am not sure I have read a truer statement anywhere on these forums.

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From my experience a formal treatment plan has to be shared with a client. Even if special circumstances don't permit this, someone - a parent, guardian or spouse for example, would have input. To me this is just informed consent - a client has the right to know what interventions you plan to use and why you plan to use them. I also doubt there's anything written in a plan that a client or family members wouldn't understand. And I think it should be left up to the client to let you now that they aren't interested in this info. It's always better to avoid making assumptions.

I don't know if she's made one or not. She's never shared one with me so I kinda doubt it. She's not the most traditional therapist on the block, that's for sure. I am grateful for this. I would not want a treatment plan per se, I would feel like I had to live up to it and would feel like a failure if I didn't live up to it exactly as laid out.

Discussing interventions with a client is not about minute details but rather finding out what your clients goals are and how they can be achieved. So if a client is self harming, you might suggest focusing on that and asking if they are interested in doing some DBT for emotion regulation. Or suggesting CBT techniques to someone with social phobia. I think you see most formally written treatment plans in hospitals or other programs since they are short term and solution focused. But even in private therapy many Ts and clients work collaboratively and frequently go over goals and progress (or lackthereof).

Yes, I never said I thought it wasn't normal to go over goals and progress and discuss what approach to take, or that it's not something I would do. I was just trying to explain why you might not look at the actual piece of paper that constitutes a treatment plan with a client (and you might, but in my experience, in most outpatient settings it's the exception). What I was trying to say is a treatment plan is usually a summation of what you've already agreed on with the client, but the language on a treatment plan might be less geared toward the client (because it may be for insurance purposes or sharing with other T's involved in treatment, or written in terms of a particular theory a T subscribes to which may have some jargon in it) and hence not the best tool to use for such a discussion.

I, myself, with three different T's have never seen my own treatment plan nor wanted to, but have often discussed the direction we were taking or what I'd like my T to do differently.

But I feel like what I am saying is not helpful to this conversation anyway so I'm going to bow out at this point...

The two I see have not said anything about goals past the first or second meeting with them.
I kept asking if there was a structure - but the denied it and so I read up a lot and imposed one - I doubt either of them know what my structure is or its purpose.
I am still rankled at the idea of a therapist-without asking me-deciding I won't understand or want to see their piece of paper. I certainly would want to see what they give an insurance company and I would never ever let them speak to any one else. If I want to spend my time and money going over their jargon - it is not for the therapist to decide it is not a good idea.

I know the times a formal treatment plan have been made (I've only experienced this in the hospital), it was discussed with me for my input, it was collaborative, and I had to sign the document. Personally, I found the formal treatment plans least useful and more about CYA. My most effective treatment over the years didn't involved any written, formal document laying out a plan for my treatment; rather, effective treatment was evolving, ongoing, and very flexible.