Should I Use a Treatment Planning Book?

Should I Use a Treatment Planning Book?

Like many answers to questions about mental health, the answer to this common question on whether or not you should use a treatment planning book is a bit more complicated than a simple yes or no.

When discussing treatment plans during my trainings, I often hear therapists say good things about The Wiley Treatment Planning books, The Complete Adult Psychotherapy Treatment Planner. Though treatment planning books have their place, truth be told, I don’t recommend relying on any treatment planning books for treatment planning.

Here are the pros and cons to using a treatment planning book.

WHEN NOT TO USE A TREATMENT PLANNING BOOK

Don’t use a treatment planning book until you have a good picture of what the client wants out of therapy. And then continue to beware because a treatment planning book can lead to generic plans that aren’t useful tools for guiding the healing work we all want to help our clients do.

Insurance company auditors want to know the therapist is treating an individual with specific and dynamic issues. Though symptoms may be the same from one depressed client to another, how the symptoms manifest in the client’s behavior will be different from one client to the next. Since change shows up in behavior, these differences are the key to writing a good and useful treatment plan.

Treatment plan starts with a diagnosis. The diagnosis is supported by symptoms. There must be enough symptoms to support the diagnosis. Treatment planning books address symptoms, but people are not just a bundle of symptoms. How do the symptoms impact the client’s daily functioning? Treatment is not just aimed at reducing symptoms, it is also geared at improving functioning.

A treatment planning book focuses on symptoms, not the behaviors of your client. The process of using a treatment planning book when writing a treatment plan can easily look like this:

• Click on the diagnosis and up pops symptoms.
• Click on the symptoms and up pop goals.
• Click on goals and up pop objectives.
• Click on objectives and up pop interventions.

The goals, symptoms, and interventions relate to the symptoms and sound impressive because they are all written in clinical language and “oh, that’s good too!”  So, you choose a bunch of them in each category. Pretty soon, the treatment plan is 4 pages long. These are generic and boiler plate treatment plans and insurance companies don’t like them. They look and sound impressive, but they don’t really give a snapshot of the individual we’re sitting with.

How do I know insurance companies don’t like them?  Because I once had 4 UBH reviewers in a 50-person training on documentation — and I asked. They unanimously agreed: they are not fans of treatment planning books. They do not want a treatment plan written for a diagnosis. They want it written for a specific client.

We’re treating the client, not the diagnosis.  

WHEN TO USE TO TREATMENT PLANNING BOOK

Treatment planning books are written using the language of Cognitive Behavioral Therapy. Since change shows up in behavior this language can be a good match when used cautiously.

Many new clinicians can benefit from being familiar with a treatment planning book. New clinicians often start out by relying on the techniques their therapist used with them (if they were fortunate enough to be in therapy themselves). They don’t always recognize that the therapy they are providing is really and truly therapy. Using a treatment planning book will help a new clinician recognize that the work they are doing is valid and help them put clinical language to practice.

Many seasoned therapists have taken so many trainings they often can’t remember where their interventions come from. Or they do not see themselves as CBT therapists. Again, a treatment planning book can provide the language of change.  

But using CBT language is not mandatory. It’s possible to use the language of the modality being used during session if that modality is evidenced-based. It’s also possible to use too much clinical language. When this happens, no one really understands the treatment plan, rendering it useless.

Use a treatment planning book to inform your work, not dictate it.

Use a treatment planning book for the clinical language. But recognize that your clinical voice is acceptable and even necessary.

Since change shows up in behavior, using behavioral language makes sense.  But you don’t need to be a CBT expert to write in ways that describe behavior. You may use Internal Family Systems, for example, and refer to “Cognitive Distortions” or “Core Beliefs” as “burdens” because these burdens make the client behave in specific ways that the client wants to change.

Here are questions you can ask yourself and the client to elicit behaviors that need to be address in treatment:

• What behaviors needs to change?
• How would you know that you’re changing?
• What positive behavior will replace the problematic behavior?
• What does the (depression/anxiety, etc.) make you do or not do?
• If your life was a movie, what would people see you do or not do that would show you’re depressed/anxious, etc.)?

You can even write a treatment plan using “lay language.” In fact, non-clinical people who read the plan will better understand the treatment if we don’t speak psychobabble, including the client!

I you want more information about how to write a treatment plan and the rest of your clinical documentation, check out Documentation Wizard’s Clinical Forms. If you need more guidance on how to write treatment plans, my workshop, Misery or Mastery: Documenting Medical Necessity for Psychotherapists gives you a step-by-step approach to turn your clinical intuition into thorough and effective documentation.

Beth Rontal, LICSW, a private practice therapist and the Documentation Wizard® is a nationally recognized consultant on mental health documentation. Her Misery and Mastery® trainings and accompanying forms are developed to meet strict Medicare requirements. Beth’s Documentation Wizard® training program helps clinicians turn their clinical skill and intuition into a systematic review of treatment that helps to pass audits, protect income, maintain professional standards of care, reduce documentation anxiety and increase self-confidence. Beth’s forms have been approved by 3 attorneys and a bioethicist and have been used all over the world. She mastered her teaching skills with thousands of hours supervising and training both seasoned professionals and interns when supervising at an agency for 11 years. Her newest initiative, Membership Circle, is designed to empower psychotherapists to master documentation with expert guidance, efficient strategies, and a supportive community.