A lot of clinicians struggle with constructing a usable treatment plan. It’s a conversation that I have with people pretty regularly in my consulting practice. One of those topics caught up in that which may get lost in all of the complexities of Goals and Objectives is the construction of Interventions.
So, what are interventions meant to be?
If you’ve heard any of my trainings on the topic of treatment planning, or podcasts where I’ve discussed the topic of treatment plan structure, the main material of the plan includes, generally, three parts.
The first part of the treatment plan is the goals. Goals are the things that will get accomplished through the course of treatment, which will signify that treatment has come to its conclusion. They are based on the initial assessment and typically focused on symptom reduction or functional improvements necessary for the client to “improve”.
They are directly related to the Medical Necessity for the client to need treatment in the first place.
Since goals are BIG items, things that will normally take a long while to achieve and so difficult for the client to work on altogether, we break the goal into pieces that we call objectives. These are the smaller pieces the client will achieve or master which will ultimately lead to the goal.
Put another way, if reaching the goal is the DESTINATION, then the objectives are the WAYPOINTS along the way.
The Interventions, then, are what you’re doing in the course of psychotherapy. And this can get confusing for some. I have seen in a lot of treatment plans over the years where clinicians attempt to document interventions, they simply document CBT, or DBT, or EMDR, or some other sort of modality they are going to utilize.
Unfortunately, this is not specific enough to meet basic community standards for a treatment plan.
There is an expectation that treatment plans are action oriented. Through the assessment process we have identified the symptoms and functional deficits that have built the framework of medical necessity of treatment. Our plan is the structure of how we are going to get the client to the place of addressing these symptoms and deficits.
The interventions are then the things we are going to do -- to help the client so they can achieve their goals.
And we will use enough language to be specific, without writing a paragraph.
So, let’s explore an example a little closer to home.
Let’s say we have a client with moderate depressive symptoms. Not suicidal -- but sad and isolated most days. They’ve had these symptoms before. This latest round of symptoms has been going on for a few months, apparently brought on by the ending of a close friendship.
The Client is certain that the friendship ended because they weren’t interesting enough and that no one will ever like them, and they feel so alone, and their boss is going to fire them any day because they don’t do a good job, even though they were the employee of the month two months ago.
So, maybe some of the sadness is related to negative self-talk. And the negative self-talk is being fed by a combination of jumping to conclusions and catastrophizing.
If the goal of treatment with this client would be to reduce or eliminate their depressive symptoms, and the first objective would be the client will be able to identify and challenge cognitive distorted thinking, the interventions – and there are probably two here – would be to process with client their current life experience to help identify cognitive distortions and teach techniques to address or challenge cognitive distortions.
Its not enough to say “CBT”, but its too much to describe a technique developed by Albert Ellis that he discussed in some book he wrote, including the page number and the publisher. The intervention should be specific, but useful.
Developed this way, these interventions will also fit really well in your progress notes as you begin to describe the work in therapy. As you work through the subjective material in the session, mentioning processing through cognitive distortions is a normal part of the work and addresses an intervention in the plan. Same thing with teaching techniques to address or challenge the thought distortion. That way you have a clear linkage between plan and the work in a way that makes sense.
The treatment plan is a plan and not just a scholarly pursuit. It is meant as the blueprint for what we are supporting the client to build. While new clinicians will struggle for a bit to develop an effective plan, and it might require more adjustments over time, an experienced clinician should be able to build a treatment plan in a relatively short period of time, particularly in a world where they are built in an electronic health record. You can see through the assessment where the challenges are, and you can draw from your experience to identify your best approach to address those symptoms and deficits. You just have to identify it, briefly, in your intervention.
In the world of receiving payments from insurance companies for services rendered, there is a specific expectation that the treatment plan exists, and it is used. But these plans do not need to be overly complicated.
In fact, I would argue that the more complicated the treatment plan, the less apt it is to be used. So, don’t overload yourself, but build a plan that describes the way forward that is clear and detailed --- and brief.