To give our readers a better sense of what an effective mental health treatment plan looks like, I have been recreating a treatment plan here through a series of blog posts. To see other posts in this series, please click here.
The next section of the mental health treatment plan I use is called the Treatment Goal, or Goals. I’ll introduce this section with an excerpt from Therapy Revolution: Find Help, Get Better, and Move On (Without Wasting Time or Money):
Treatment goals are the patient’s clinical (and sometimes life) goals as described in the treatment plan. You and your therapist have to know where you are going in order to get there! Therapy that meanders on without a clearly defined destination (and perhaps a couple of important pit stops on the way) reminds me of a scene in an old movie where the distraught hero jumps into a cab. “Where’re you going, buddy?” asks the cabbie. Our hero says, “Nowhere in particular. Just drive.” That’s a fine idea if you’re a hero in a black-and-white movie trying to forget your broken heart, but a terrible idea if you are in therapy. Your primary destination must be the completion of your treatment goal(s).
I don’t believe in endless talk or chatter; I believe in getting patients the help they need to identify their problems, focus on their goals, and find meaningful and effective ways to make changes so they reach those goals. Then they can live their lives in the way that’s right for them—without needless emotional suffering; even with a sense of emotional well-being. This goal-oriented approach sounds direct, and it is, but even the most fragile, sensitive patient can benefit from this approach if it is presented gently, in bite-sized portions tailored to the individual. It is direct, but not aggressive.
When continuing Alexis’s session, I remind and encourage her to follow through on her psychiatrist’s recommendations, (which we will note later on in the treatment plan). The psychiatrist, Alexis, and I agree that Alexis has major depression that, at this point, requires medication intervention. I let Alexis know that if while on the medication she has any uncomfortable symptoms, whether or not she thinks they are from the medication, she should let the psychiatrist know right away.
Alexis says she hasn’t noticed any major benefits yet from taking medication. I explain that the medication will take some of the edge off her depression so that she can articulate what is going on without the symptoms overwhelming her. If it isn’t doing that, the psychiatrist will modify her dosage, but the medication might take some time to take effect.
I let Alexis know that I will help her develop ways of identifying and applying the things we learn in therapy to help her manage her symptoms. Then I introduce the topic of treatment goal-setting which will help us stay focused on what’s important. Like some patients who have been in therapy before, she counters with “But my last therapist said I should just talk about my feelings, and by talking I would come to my own insights and realizations. My last therapist never talked about goals.”
I explain that some therapists prefer that patients talk with little or no direction but I believe that using structured, goal-oriented sessions in conjunction with unstructured talk is generally the most effective way to help people feel better, quicker. “By focusing on goals,” I shared with Alexis, “you’ll still have the opportunity to talk about your thoughts and feelings. But by keeping the goals always in mind while you’re talking, we can locate the connections between the topics you are verbalizing and your depression. In other words, we can find out where your experiences and perceptions fit into the picture of your depression. Together we will examine what seems to be triggering your depression. We will explore how your attitudes, beliefs, values, other issues, and so on, help you or prevent you from reaching your treatment (and life) goals. When we discover the relationships between these things and your depression you will better understand your depression and how to manage it.”
It is important for Alexis to also understand that focusing on a main goal doesn’t mean that new goals or sub-goals won’t be addressed—but identifying and describing one main goal is the probably the best way to get started in this case.
In order to help Alexis visualize the importance of setting a treatment goal or goals, I give her an analogy. Let’s say therapy with lots of undirected talking, is like window shopping—sure she might stumble upon a treasure, but she will expend a lot of time doing so and this will probably prolong her suffering. I suggest Alexis imagine therapy is like a shopping trip to a store that has a great sale on warm winter coats—and she really needs a new, warm coat! In order to get to the store, Alexis has to walk down a street filled with cafes, boutiques, banks, and other businesses offering everything from hot apple pie to Christian Louboutin shoes to computers to gourmet dog biscuits—even plumbing fixtures.
Now, Alexis might want or need some of these items. She might be intrigued, or disgusted, or apathetic about some of them, too. She might happen to love window shopping stepping into some of these shops, perhaps buying something she wants or needs. But, one thing we know—Alexis really needs the protection and comfort of a warm winter coat. It’s cold out there!
I recommend patients head towards the coat sale and stay focused on getting to the coat store, finding a well-priced, warm coat in a reasonable amount of time—so they don’t shiver and turn blue out in the cold. We’ll still have some time to window shop—because there just might be a golden opportunity or serendipitous discovery along the way, and we wouldn’t want to miss that. But I recommend that patients don’t spend inordinate amounts of time window shopping until their wearing that new coat.
The warm coat represents the understanding of the mental health problem or life issue as well as the methods of dealing the problem. Patients like Alexis can “wear” the coat to keep warm, i.e.; to help prevent a depressive episode.
Because the treatment goals are often but not always the opposite of the problem statement, Alexis’s goal will be, too. You may remember that Alexis’s problem statement is: Alexis is exhibiting the signs and symptoms of depression. The opposite of that would be (and together, Alexis and I agree that the following should be her primary, and for now, only treatment goal):
2) Treatment Goal
Alexis will be free from the signs and symptoms of depression.
Next in the treatment plan blog series will be a discussion of section three, the therapist’s objectives.
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Last reviewed: 3 Feb 2010