Systemic Treatment Planning
101
Robert W. Marrs, MS, LMFT
AAMFT Approved Supervisor
On Behalf of Wisconsin Association for Marriage and Family Therapy
What Is a Treatment Plan?
• A treatment plan is…
– A contract between you and the family about
what will happen during the course of treatment
– A statement about the nature of the therapeutic
relationship
– The clinical justification for everything you
choose to do over the course of treatment
What Is a Treatment Plan?
• A treatment plan is based on…
– The multidimensional clinical assessment (DHS
35.19, COA-MH 3)
•
•
•
•
Diagnoses & symptoms
Presenting problem/concerns
Client/family functioning, etc
Child developmental factors
What Is a Treatment Plan?
• The treatment plan consists of…
– Agreed upon goals, desired outcomes, and
time-frames for achieving them (COA-MH
3.02, DHS 35.19, 107.13).
– The method(s) to reduce or eliminate the
symptoms causing the client/family’s problems
or inability to function (DHS 35.19, 107.13).
– Developmental factors (DHS 35.19, 107.13)
What Is a Treatment Plan?
– The client/family’s strengths (DHS 35.19,
107.13)
– Additional supports or services to be provided,
and by whom (COA MH 3.02, DHS 107.13)
– Possibilities for maintaining and strengthening
family relationships (COA-MH 3.03)
– The client/family’s and provider’s signatures
(DHS 35.19, 107.13, COA-MH 3.02)
Writing Treatment Goals
• Treatment goals reflect both the final destination
(long term goals), the route for getting there (short
term goals), and the need for traveling (definition
of problem)
• Treatment goals (driving directions) should be:
–
–
–
–
Concrete and specific,
Systemic,
Behavioral, and
Within the client/family’s control
Writing Treatment Goals
E.g. “Client will demonstrate better anger
management skills as evidenced by
decreased outbursts at home and work,
elimination of violence and other forms
of physical aggression, decreased
incidents of disciplinary action by
employer.”
Writing Treatment Goals
E.g. “Client couple will demonstrate
increased intimacy as evidenced by
higher scores on MSI-R, decreased
conflict and contempt, increased sexual
activity, and better understanding of
wants and needs.”
When writing a treatment goal, use the phrase “as
evidenced by” to help you use behavioral language.
For more assistance learning how to write
systemic treatment goals, please consult the
following resource:
Dattilio, F. & Jongsma, A. (2000). The family
therapy treatment planner. New York: Wiley.
Treatment Plans as Anchors
• The treatment plan serves as the clinical
justification for the following:
–
–
–
–
–
–
Treatment System (those who will be receiving care)
Treatment Approaches
Treatment Modalities
Treatment Interventions
Treatment Recommendations
Treatment Referrals
Treatment Plans as Anchors
• Therefore, what happens over the course of
treatment should always be linked to the
agreed upon treatment plan.
– In other words, your progress notes should be
somehow connected to the goals of the
treatment plan.
Treatment Plans as Anchors
• Whatever you decide to do in therapy
should start with the question “how does
this serve the agreed upon treatment plan?”
Modifying the Treatment Plan
• Treatment plans must be modified when any of the
following change:
–
–
–
–
–
–
–
Definition of the problem / diagnosis
Client/family’s concerns
Client/family’s desired outcome
Goals are achieved
Treatment approaches
Treatment modalities (individual, couple, group)
Level of functioning / stability / risk
Reviewing the Treatment Plan
• Treatment Plans are to be reviewed every
90 days or every 6th session (whichever is
longer) by the client and provider in order to
assess client progress during treatment
• Completion of treatment goals should
indicate the need for a new treatment plan,
or readiness for termination
Individual vs. Couple & Family
• Once again, whatever you decide to do in
therapy should start with the question “how
does this serve the agreed upon treatment
plan?” If you expand into couple or family
therapy, refer pieces of the system to other
providers, offer individual therapy, etc., it
should all be in service to agreed upon
treatment goals and the desired outcome
Individual vs. Couple & Family
• Any changes in the methods/modalities of
treatment need to be reflected in a modified
treatment plan and approved by the client.
• Remember, all recipients of mental health
treatment must sign an informed consent. If
you are expanding into couple/family
therapy than you need to be sure those
members also sign the informed consent.
Termination
• Termination should occur when the goals of
treatment have been achieved, and the
client/family is able to function successfully
in day-to-day life
• Termination should include a review of the
services that were provided, the progress
that was made, and a recovery maintenance
plan.