Treatment Planning for Psychotherapists: A Practical Guide to Better Outcomes

209 Pages·2003·3.117 MB·English

by  Richard B., M.D. Makover

TREATMENT
PLANNING FOR
PSYCHOTHERAPISTS
A Practical Guide to Better Outcomes
Second Edition
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TREATMENT
PLANNING FOR
PSYCHOTHERAPISTS
A Practical Guide to Better Outcomes
Second Edition
Richard B. Makover, M.D.
Lecturer in Psychiatry
Yale University School of Medicine
New Haven, Connecticut
Washington, DC
London, England
Note: The author has worked to ensure that all information in this book
is accurate at the time of publication and consistent with general psychi-
atric and medical standards, and that information concerning drug dosag-
es, schedules, and routes of administration is accurate at the time of
publication and consistent with standards set by the U.S. Food and Drug
Administration and the general medical community. As medical research
and practice continue to advance, however, therapeutic standards may
change. Moreover, specific situations may require a specific therapeutic
response not included in this book. For these reasons and because human
and mechanical errors sometimes occur, we recommend that readers fol-
low the advice of physicians directly involved in their care or the care of
a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the
views and opinions of the individual authors and do not necessarily rep-
resent the policies and opinions of APPI or the American Psychiatric As-
sociation.
Copyright © 2004 Richard B. Makover, M.D.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
07 06 05 04 03 5 4 3 2 1
Second Edition
Typeset in Adobe’s Berling Roman and GillSans
American Psychiatric Publishing, Inc.
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Arlington, VA 22209-3901
www.appi.org
Library of Congress Cataloging-in-Publication Data
Makover, Richard B., 1938–
Treatment planning for psychotherapists : a practical guide to better
outcomes / Richard B. Makover.—2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-58562-148-X (alk. paper)
1. Psychotherapy. 2. Psychiatry. I. Title.
[DNLM: 1. Psychotherapy—methods. 2. Planning Techniques.
WM 420 M235t 2003]
RC480.52.M35 2003
616.89′1—dc21 2003056061
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
CONTENTS
Preface to the Second Edition . . . . . . . . . . . . . . . . . . . .vii
Preface to the First Edition . . . . . . . . . . . . . . . . . . . . . . ix
Chapter 1
How Important Is Treatment Planning?. . . . . . . . . . . . 1
Chapter 2
Treatment Selection. . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Chapter 3
The Aim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Chapter 4
Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Chapter 5
Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Chapter 6
Tactics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Chapter 7
Formulation: The Critical Step in
Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Chapter 8
From Formulation to Treatment Plan . . . . . . . . . . . 113
Chapter 9
Putting It All Together. . . . . . . . . . . . . . . . . . . . . . . . 131
Chapter 10
The Practice of Planned Therapy . . . . . . . . . . . . . . . 147
Chapter 11
The Structural Impasse . . . . . . . . . . . . . . . . . . . . . . . 163
Chapter 12
Planning With “Difficult” Patients . . . . . . . . . . . . . . 171
Chapter 13
Learning to Plan Treatment . . . . . . . . . . . . . . . . . . . 183
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
PREFACE TO THE
SECOND EDITION
I wrote the original version of this book to present a system of treatment
planning that would combine a new theoretical structure with practical
methods for its clinical use. This new edition builds on that framework
with additional emphasis on the formulation as the source of successful
planning and on those aspects of the clinical assessment that lead to a use-
ful formulation.
Treatment planning has always been important, but the increasing re-
strictions of third-party and government sources of financing care con-
tinue to create a more pressing need for clear, concise, relevant, and
supportable plans. Treatment plans are needed for inpatient care, for dis-
charge to intensive outpatient facilities, and for the initiation and contin-
uation of office-based care. Professional liability issues and the intrusion
of regulatory agencies into the therapist-patient relationship also create
demands for documentation of specific treatment plans. Of more impor-
tance, however, is the way treatment plans help to create more effective
care and better outcomes, benefiting both clinicians and their patients.
I am grateful that Treatment Planning for Psychotherapists has contrib-
uted to this aspect of clinical practice and that it has been useful to men-
tal health professionals in their efforts to meet the need for better-
documented treatment planning. I hope this new edition, more concise
and with a more practical focus, will continue to be helpful.
vii
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PREFACE TO THE
FIRST EDITION
This book is about treatment planning for psychotherapists. It is also
about the partnership between us and our patients that will allow us to
pursue the best possible outcome for them. Patients come to us in emo-
tional distress and unable to function at their highest level. Planning a
course of psychotherapy and implementing that plan can more effec-
tively help them recover from their dysphoric and dysfunctional state.
Because of the wide scope required of any book on so complex a sub-
ject as psychotherapy, it is worth noting what this book is not about. It is
not about how to conduct psychotherapy, although I make liberal use of
examples drawn from the way I practice. It is not a survey of the many
types of therapy utilized today or an attempt to make any judgment
about the efficacy of one therapy over another. It is not about brief ther-
apy, even though treatment planning tends to shorten the length of ther-
apy through an economy of time and effort. It is not about whether
insight-expressive therapies are better or worse than directive-supportive
therapies. It is neutral in the turf battles among advocates of competing
theories. All of these topics have been debated by some of the best theo-
reticians and practitioners of the last hundred years.
My ideas about treatment planning evolved over the years as I super-
vised colleagues and trained new psychotherapists. I was impressed with
how often a therapy destined for impasse began without identifying the
key issues, without an understanding of the crisis that brought the patient
in for treatment, and without a clear idea of what might be the best out-
come of the work. I came to realize that effective and appropriate treat-
ment planning was a central and persistent challenge, not only for
beginning psychotherapists but also for more experienced practitioners.
ix