“Managing your time without setting priorities is like shooting randomly and calling whatever you hit the target.”

Cozolino (2004) shared a clear perspective on case conceptualizations (CC) and treatment planning (TP). CC is how you apply your theory of counselling to a client, giving you a method of understanding the origins of distress and how to resolve it—with clear rationale. “It places the causes, effects, and complications of your client’s difficulties in a theoretical framework that creates a guidance mechanism for therapy.” 

A treatment plan bridges the interventions (i.e., means) to the goals. TPs need to be based in a theory and, once you’ve established goals with your client, you can clarify your TP—which is also an ongoing and collaborative effort. This keeps your treatment focused and will hopefully provide a feeling of stability and forward movement to clients. You can google this for many examples, search “[my favourite theory] treatment plan” or CC. Case studies are sometimes useful for this as well.

CCs speak to a particular view on human nature, while TPs work to apply that view to a particular client’s situation and goals. Metaphorically speaking,

Case conceptualizations try to define the laws of physics relative to this particular client, while treatment plans are the blueprint for the building the client wants to create in their current circumstance.

What is included in a written TP will vary by where you work and jurisdiction—some therapists might not even write one. I think it’s good practice to write down where you’re heading and why at least once every few sessions, and most codes of ethics state something similar. Certain approaches to therapy are more specific about TPs; for example, CBT has very clear examples that are almost manualized at times. Larger agencies often have a form that walks you through the TP.

There is great variety in how people write a treatment plan. At it’s core, it’s a collaborative document that explores and defends an ‘if/then’ statement: “if we take [some action], then [that desired outcome] is likely”. We have to provide compelling rationale that justifies why this approach should be helpful, based in a reasonable way to view how people learn, heal, and change.

There is a reasonable consensus of what elements could be included in a TP:

• History and assessment

• What theoretical orientation you are drawing from and why

• Presenting concern, why they sought treatment

• Goals for therapy defined clearly

• Interventions to meet those goals (i.e., means), perhaps with a timeline

• What is the role of the therapist? Of the client?

• Explore client’s support system

• How progress will be measured

• Strengths, challenges

• How will we know we’re ready to terminate therapy?

We want to maximize the chances our clients will experience success, so working together to detail the means to achieving their goals is essential. What are the small, realistic, and practical steps (i.e., “SMART” goals) the client can take over time to that end? 

More formal TPs are especially useful for cases that aren’t progressing, increasing awareness of what we’re missing, assuming, and so on. It’s challenging to notice the absence of things unless prompted, hence the utility of a set TP format. Good TPs can be important if we have to justify our work later to our licensing body or in front of a judge, and they make file transfers easier if you suddenly take an extended leave from work, get hit by a meteor, etc.

Writing treatment plans isn’t why I became a therapist, but as an investigation it frequently helps me recognize where I’m going wrong with clients. I see it as reflective practice and purposeful humility.

We’re deliberately trying to locate and examine the mistakes we’re making in a given case. This practice helps me be a more effective therapist, a state which I conceptualize as an active process.

Engagement:

• If you don’t have one, what structure can you create to assist you in regular case review (e.g., every 4th session with a given client)? How will it help you check your blind spots and bias?

• How do you conceptualize the difference between treatment plans and case conceptualizations?

• Is this kind of approach too formal or stifling to allow for ‘good’ therapy? Or not organized enough?

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