2. With any diagnosis, you will be addressing 5 main
issues:
1. Anxiety (Worries, Fears, Concerns, Stressors)
2. Depression (Sadness, Guilt, Grief, Blame)
3. Anger (Overt, Covert)
4. Self Esteem
5. Social Skills (Impulse Control, Parenting,
Bullying, Life Skills.)
3. SMART GOALS; EASY PEASY LEMON SQUEEZY!
Goal 1. What will they trust you with immediately, to work on within 30 days?
Treatment Plan: How will you gain their trust to accomplish the goal?
Smart Goal #1 Client will verbalize 2-3 triggers of Anxiety/Depression/Anger within 30 days.
Treatment Plan: Establish rapport with client using appropriate process skills (e.g. active
listening, reflective empathy, support, and instillation of hope.)
Why would we make a smart goal where they have to verbalize triggers? Often, people don’t know how
to verbalize feelings or even identify what they are feeling; fear becomes anger, jealousy becomes
anger, inadequacy becomes anger – they truly aren’t angry, but they don’t know how to identify or
express those “other” feelings appropriately in other ways. However, before they can do that step, they
have to be able to identify those feelings first.
My client isn’t Angry! Now what? You still have to build rapport with EVERY single client; practice this skill by
socializing with people you don’t “know” like your peers (if you catch yourself slipping into negative self talk “oh this is pointless, I’m not
talking to them”, THOSE are covert roadblocks to rapport that you are putting up with clients.)
4. My Client isn’t ANGRY, now what?!!???; Building Rapport is something that occurs in EVERY single
treatment goal number 1. Also, the clinical interview!
Treatment Plan: Establish rapport with client using appropriate process skills (e.g. active listening, reflective
empathy, support, and instillation of hope.) Assess nature and severity of client's symptoms using clinical interview.
Smart Goal #1 Client will verbalize 2-3 triggers of Anxiety within 30 days.
Treatment Plan: Establish rapport with client using appropriate process skills (e.g. active listening, reflective empathy,
support, and instillation of hope.) Assess nature and severity of client's symptoms using clinical interview.
Smart Goal #1 Client will verbalize 2-3 triggers of Depression within 30 days.
Treatment Plan: Establish rapport with client using appropriate process skills (e.g. active listening, reflective empathy,
support, and instillation of hope.) Assess nature and severity of client's symptoms using clinical interview.
Smart Goal #1 Client will verbalize 2-3 triggers of Anger within 30 days.
Treatment Plan: Establish rapport with client using appropriate process skills (e.g. active listening, reflective empathy,
support, and instillation of hope.) Assess nature and severity of client's symptoms using clinical interview.
5. Now, to work on that “verbalizing skill”, how
will you “teach that”?
Teaching a skill can be part of the treatment goal – Therapist will teach client how to identify
and differentiate feelings by using a feeling wheel. Therapist will teach client how to identify and
differentiate feelings by playing emotional charades, Therapist will teach client how to identify and
differentiate feelings by using object role play, Therapist will assign client journaling homework to
help identify moments when feeling anxious/depressed/angry (you will pick ONE, not all because
your treatment plan will be designed for your INDIVIDUAL client.)
Using Assessments and processing the results can be part of the treatment plan!
EXAMPLE: Smart Goal #1 Client will verbalize 2-3 triggers of anxiety within 30 days.
Treatment Plan: Establish rapport with client using appropriate process skills (e.g. active listening, reflective
empathy, support, and instillation of hope.) Assess nature and severity of client's symptoms using clinical
interview, and Beck's Anxiety Inventory. Evaluate client for suicidal thoughts, plans of gestures. Identify
negative self talk and catastrophisizing; help client identify how cognition's contribute to anxiety.
6. Depression Sampler
■ Smart Goal #1 Client will verbalize 2-3 triggers of Depression within 30 days.
■ Treatment Plan: Establish rapport with client using appropriate process skills (e.g.
active listening, reflective empathy, support, and instillation of hope.) . Assess nature
and severity of client's symptoms using clinical interview, and Beck's Depression
Inventory. Evaluate client for suicidal thoughts, plans of gestures. Use Object
role-play activity (encouraging reflection while taking the role of the client's object
such as a shoe, can provide some emotional distance, facilitating greater emotional
sharing earlier in the therapeutic process.). Teach client how to use feelings face
scale, and assign journaling activity using face scale.
7.
8. Tools to help you develop your treatments. (Depression/Sadness, Anger, Anxiety/Nervous, Self Esteem,
Social Skills)
Key words to use in your treatment plans: Teach (skill), Assign (homework sheet), Use (describe activity
and it’s use; object role play which is a Psychodrama activity that provides emotional distance)
Use these as whole, or in parts.
The Bexar County Bibliotech has 68 Mental Wellness Books available.
TF- CBT workbook
http://www.episcenter.psu.edu/sites/default/files/ebp/Your-Very-Own-TF-CBT-Workbook-Final.pdf
Therapy Worksheets (some are valuable, some are not as valuable – this all depends on your preference.)
http://www.therapistaid.com/therapy-worksheets/none/none
Free Play in Therapy techniques
http://www.creativecounseling101.com/play-therapy-counseling-techniques.html
Existentialist Eulogy/Epitaph http://www.riseglobal.org/uploads/pdfs/YourEulogyEpitaph.pdf
http://www.exploringlifesmysteries.com/existential-therapy/
9.
10. Where’s the rest of it?
■ You have to build it.
■ You are going to address 5 main issues. TRIAGE! What activities, what elements can you use to teach
your client, to empower them to move forward, to live – to do what they need to do to have a
functional life?
■ You will NOT be curing them, they simply need to be able to function; you can have anxiety and
function, you can be depressed and function. It’s an issue when it interferes with your day to day
routines – how can you address their ability to function? Journaling, counting breaths, blowing
bubbles, mashing playdoh, baking bread , roleplaying conversations…
■ They have admitted their triggers, now what can you do to help them to either work through the
triggers, and accept them as a part of life? Self soothing skills? What have you done to help them if
they do have some back sliding (so they don’t beat themselves up), have you connected them to any
outside support resources?
■ Rather use a book? Me too!
11. Still confused? use the Wiley’s books.Look for the “Long Term Goals” and adjust the wording as needed. This comes from the Sexual Abuse Victim and Sexual
Offender Treatment Planner
12. Remember Goal #1? Here’s some ideas
if working with a sexual abuse victim.
13. Using the Wiley’s Book to formulate
Goals 2 and 3
■ You need to get past the first 10 therapeutic interventions which generally involve
building rapport, testing, medical referrals, medication monitoring, and you referring
out for a Psychological evaluation.
■ In the printed books, it isn’t green. Only the digital versions are green.
■ At the beginning of each Diagnosis chapter is your TREATMENT GOALS (first is
Behavioral Definitions, then the Treatment Goals)
14. Wiley’s Developmental Disability Book, Goals on Anxiety (these
can work for ALL clients; they do not need to be disabled.)
You can use a Becks to do this.
19. Triage the 5: Depression, Anxiety, Anger,
Self Esteem, Social Skills.
■ What can they realistically do to make their life more functional within 30 days?
■ Every single 1st
Treatment Plan for Goal 1 will start with “Establish rapport with
client using appropriate process skills (e.g. active listening, reflective empathy,
support, and instillation of hope.) . Assess nature and severity of client's symptoms
using clinical interview.”
■ Add your plan to the treatment plan (you only need 1 idea.)
■ Build 2 off what you can accomplish within 60 days, and 3 off what you can
accomplish within 90 days.
