What's the Problem?
A reader suggested that it would be helpful to see an actual mental health treatment plan. In order for you to better get a feel for what a treatment plan is, and why every therapy patient should have one, I am going to recreate a treatment plan here over the course of several blog posts.
It is important to understand that though there is common ground between treatment plans—especially treatment plans for patients facing similar problems, there is no such thing as a standard treatment plan because each treatment plan must be individualized for each patient.
Also, it is useful to note that psychotherapists have many different—and valid—ways of assembling a written treatment plan. My plan is a 10 section plan and is based on a synthesis of existing plans. I use this plan format because it works well for me and for patients, and I train my staff to use this approach as well. It is the plan described in my book, Therapy Revolution. However, as long as treatment plans are written, contain the basic information I will list in these blog posts, and are referred to and updated frequently during the course of treatment, the format used is immaterial.
Also, the treatment plan I am exploring here will be multi-disciplinary, meaning that it will note information from other people involved in the patient’s care so that we can all coordinate care so the patient receives the most supportive treatment possible. In this instance there will also be a couple of external treatment plans which coordinate care with the other providers. These will be taken into account in the creation of this plan.
First, let’s talk about our patient. I am using a composite of two former patients. I will call our patient Alexis. In the evaluation I learned that Alexis is an attractive, but somewhat thin twenty-four year-old single woman living in a medium-sized city with a female roommate. She is an assistant to an administrator at a hospital—a job she tolerates but doesn’t enjoy. She left college after two years, but hopes to return one day. Her parents are divorced and her mother is being treated for depression. Her older sister has been diagnosed with borderline personality disorder. Alexis thinks her younger brother has bipolar disorder, but he has never been diagnosed. Alexis visits her mom several times a year, and sees her dad in spurts—sometimes two or more years goes by before she sees him.
Alexis feels she is suffering from depression. She has problems sleeping, she feels restless and agitated, has trouble concentrating, barely talks to her roommate or her coworkers, cries every day, and though she hasn’t been eating much, she occasionally binges on macaroni and cheese, French fries, and chocolate pudding. She dresses in dark clothes, doesn’t like looking in mirrors, and hasn’t been on a date in 14 months, though she says she had always hoped to get married.
The impression I get of Alexis is that she is a kind person, even nurturing, and would like to have meaningful relationships but feels cut-off and unable to develop friendships of all types. She also is very sad—her sadness seems like a veil around her.
After evaluating Alexis (and after a psychiatrist I recommended evaluated her as well), we confirm Alexis’s suspicion that she was suffering from clinical depression. The next step is for Alexis and me to begin creating a written treatment plan together.
I introduce Alexis to the mental health treatment plan, telling her what it is and why it is important. I explain that this written plan, which we will be able to refer to as therapy progresses, will be like a map or guide to therapy. I tell her that the contents probably will change over time, but that it is important to have one so we can refer to it and chart her progress—and as we work on each section of the plan I will explain to her what we can do if we don’t see progress.
We begin by creating the first section of the written 10-part treatment plan, the problem statement(s). I explain that the treatment plan is based on the information gathered in the evaluation, but that we will create it together, and take into account any new information that arises from our discussions. Alexis and I will talk together about her problems and decide what the problem statement or statements should be. I explain that it is helpful to articulate her problems and then write them down in clear, simple language. This has the added benefit of making overwhelming problems seem more manageable.
She tells me she’s been very sad and feels her life is not so fulfilling. She again mentions her mother’s depression and says she is afraid of ending up like her, alone, with no husband or family. I say that based on what she has told me we may work on discovering and addressing what is triggering her depression. I also suggest the treatment plan might focus on alleviating the symptoms. Based on our discussion, together we write a simple problem statement.
1. Problem Statement
Alexis is exhibiting signs of depression.
This is a simple problem statement, but patients can have a few problem statements so that it they can deal with one issue at a time—a general statement can be overwhelming. The therapist and patient then have to prioritize which problems take precedence or decide they can address all of them once. (Additionally later on in this treatment plan the patient might have to be educated about what exactly depression is.)
For example, Alexis could break up this statement into two or more problem statements:
Alexis is exhibiting signs of depression.
Alexis feels her worst problem is her insomnia.
Alexis feels her secondary problem is her sadness.
And so on.
Keep in mind that many patients experience two or more pressing diagnoses at once. Patients with co-occurring disorders such as addiction and mental illness usually have to be treated for both problems at the same time. Their problem statements will reflect that.
The next part of the treatment plan blog series will be on section two, treatment goals. To read other posts in the series, please click here.
& C.R. Zwolinski, R. (2010). What's the Problem?. Psych Central. Retrieved on April 21, 2015, from http://blogs.psychcentral.com/therapy-soup/2010/02/the-treatment-plan-section-1-the-problem-statement/