The treatment planning strategies and tools described below were shared with HOPE Consortium providers by DHS Contract Administrator Dave Nelson.
Treatment Goals and Objectives
Treatment goals should be:
- Consistent with the client’s long-range goal and definition of recovery
Define and Identify what Recovery Looks Like for Each Client
- When is counseling really done? What does a happy, healthy life look like for the client? As the client creates a new life, it is very important to help them establish a detailed picture they can use to visualize and emotionalize every day. This picture will vary, but typically includes goals like having housing, a car, or employment or being reunited with children. Help clients to write down their goals, make them precise, turn them into short-term objectives, and ensure that they are measurable.
The Treatment Plan
- A client’s treatment plan should incorporate goals and objectives that meet the criteria above and also consider the ASAM placement summary as an important part of the treatment plan. The resources below can help organize the process.
Brain Science and Cognitive Behavioral Therapy (CBT)
- As clients create their new life, they also need to create new neural pathways. These neural pathways are created by big picture goals with strong meaning. CBT emphasized what a person is thinking and doing while recognizing that feelings come and go. We help clients to understand that the only thing they can do to change their feelings, is to redirect their thinking and change their actions. We ensure that we are helping their brains to heal by giving them new ways to think, new ways to do, and providing feedback on how well they are doing. What are we trying to create and do?
- Using CBT in substance use disorder counseling moves the focus away from triggering, drug-related thoughts and instead creates new neural pathways. Help your clients to acknowledge the negative thought and invite it in without running from it. Encourage them to embrace the negative though, but to redirect it toward a long-range goal. “Hi, negative thought, I acknowledge you, but come watch me do x, so I can complete my goal of y.” This puts the client in control of new thoughts and behaviors and forges new neural pathways.
- The process of creating new neural pathways takes time. As a therapist, you can show clients their own resilience using their treatment plan. When they have a re-occurrence, validate them for coming into therapy because coming into therapy is a new behavior. Have them begin the process of observing their own thoughts and help them find opportunities for structured living in their daily lives. Sameness helps to regulate the limbic system and engage the prefrontal cortex for change. Once the client has developed a new structure, they will have more control and this can be integrated into treatment planning.
Keep it Simple and Measurable
- Charting or graphing treatment progress over time can help a client to visualize his or her own progress. Change can be very subtle over time and clients may not even be aware that change is happening. By being precise and measurable you can show them that they changes they are making are working.
- For example, graphing urine outcomes or pain levels is an easy way to show a client that their new behaviors are making a difference.