Recently, radio host Michael Dresser made a very apt comparison. He said that it seems that therapy can be approached at least somewhat starting like a business. Having a business plan certainly helps and in terms of assessing goals, addressing budgetary concerns, and so on, the comparison holds. But what about in terms of time-frame projections, that is, target dates for progress? I contend that the business-plan model can work. In therapy, as in business, one should set target dates for achieving goals and schedule regular check-ins to make sure that things are on the right track.

Target dates are the optimal dates by which one or more treatment goals should be assessed and/or achieved. Will you arrive at your destination next Tuesday, or will you be on the road for a couple of months? Setting target dates is an essential part of your treatment plan.*

Both long- and short-term goals should be covered in the treatment plan, with short-term goals having priority. Larger goals should be broken down into more manageable sub-goals, and these, too, should have appropriate target dates for both check in and completion.

Check Ins: Simply put, you and your therapist should be checking in with your treatment plan every session or two and seeing if you’ve moved towards completing your goals.

Though many therapists and patients are comfortable setting 90-day target dates for goals, many goals can actually be accomplished in 60 or 30 days. I think setting at least one manageable goal in a short period of time is important—it helps motivate patients if they can see measurable improvement in a reasonable period of time.

Which brings us to an important question: How is improvement measured? Sometime it can seem as if mental health goals are vague, but part of your therapist’s job is to help you concretize those goals. For example, if we say that within 30 days Alexis will be able to better manage her symptoms of insomnia (or any other symptoms of her depression), we can compare past and present by using journals, diaries, rating systems, and so on. If, after 30 days, Alexis says her insomnia and accompanying anxiety doesn’t affect her nightly as it used to, perhaps only one or two days a week, or if the intensity has lessened (she might rate it a 4 whereas before she would regularly rate it a 9 or 10), then we have blast-off. It might be time to work on other goals, while still doing some work with this.

However, if by a set target date the kinds of progress we want to see hasn’t happened, Alexis and I will go back to the treatment plan. Are the kinds of interventions we’ve been using adequate? Has Alexis complied with my recommendations? Do we need to reevaluate our goals—perhaps they are too big for now? If my skill set isn’t a match for Alexis’s situation, or if Alexis isn’t motivated (and I am unable to find the key to unlock her motivation), or if Alexis feels that a different type of therapist might be a better choice, we can discuss making a referral to another therapist, perhaps someone who has more experienced in these matters.

Though this occurrence is rare, it does happen, and should. On a previous blog post, a commenter asked: “How devastating is that to most clients?” First, the therapist should make sure that this is framed correctly—he should make clear that this recommendation is not a failure of the patient, but simply an indication that a therapist with other skills would be a better match. Second, instead of being upset, the patient should be well and truly pleased: If your therapist says another therapist might be a better match, that most likely indicates that  the therapist you’ve been seeing has been professional, ethical, and most of all, compassionate. He cares about your successful outcome.

However, this changing-therapist scenario is not usually necessary when a thorough psychosocial evaluation and a comprehensively written and executed treatment plan have been put in place. An evaluation can help a therapist determine if he can treat a patient right from the outset. And, the treatment plan will help guide a therapist and give him ample opportunity to assess the methods he is using, make adjustments, and so on. Of course, sometimes there are simply style or personality issues which obviously are no one’s fault. **

*From Therapy Revolution: Find Help, Get Better, and Move On (Without Wasting Time or Money)

** Counter-transference, if it isn’t worked with effectively, can become a barrier as well.

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From Psych Central's website:
How Much Therapy Is Enough Therapy? | Therapy Soup (December 28, 2010)

    Last reviewed: 24 Feb 2010