MAKING ARRANGEMENT/TREATMENT PLANNING
1. Insight
Before the start of the therapy or any type of treatment planning, it is important for the therapist to give the client an overview of his/her problem in a meaningful way. the therapist should tell the client about his /her problem what he has been perceived and also about the therapy. The therapist should not have to make any promises or any postulate regardless to the treatment of the patient, in other words, the therapist should have to give the client a general (meaning full) and concise picture of his or her problem.
The therapist should not have to make any decision just by seeing the client in the first session.
· No decision is made in the first session about the client.
· Do not make any promises that you can completely treat the client in just 2 sessions.
· Do not tell the client about what is completely going to happen to him or her because when the client completely knows about it affect the accuracy of the treatment.
· We cannot tell the client that if he comes to us next time he will be cured if we failed once.
Example by Lewis. R Wolberg
“now I have an overall idea about your problem, and I should like to give you some board view of the point of what is going to happen.do to a number of factors you have developed that kind of symptoms and you are preventing yourself from developing potentials. So, I think you need therapy that may be helpful for you in that condition.”
This step includes making arrangement for
1. Choosing the type of therapy
2. Session decides
3. Duration of therapy estimated
4. Fee arranging (telling him about the fee you will take)
5. Making the final arrangement with the patient
6. Referring the client to the other therapist.
CHOICE OF THERAPIST
· Area of disturbance
After the end of the initial interview, the therapist will be able to tell what type of treatment the client is needed and what is the area of disturbances which is needed to be treated.
· Training is needed
The therapist should also make note if the client needed any training or not on the behalf of therapy or not if the therapy that is going to give to the client and the training of the client is needed for the therapy that the client is also informed about it.
· Evaluate himself
The therapist should also have to evaluate himself that he or she can be able to give the client that level of training which helpful for him/her(client).
· Gave important to the client
Whatever the therapist chooses it to depend on his emotional response to the client, the therapist should also have to take note that what is the client area of interest (the therapist make the goal with the client like client-centered therapy of Corl rogers)
· Referral to another therapist
If the interviewer is not trained for the therapy or he/she does not know what kind of therapeutic approach/ therapy best suited for the client.it should also be noted. If the psychoanalysis is decided for the treatment of the client but the interviewer or client does not have any command on this so he/she should have to recommend the client to the other therapist.
Overall if any type of therapy which is suitable for the client but the therapist does not have any command on it he/she does not have to argue with the client he /she only have to make the client referred to the other therapist.
· Rapport building
If the therapist knows about everything but he is failed to make rapport or the emotional response of the client with an interviewer or the interviewer with the client is not good so they cannot work together.
· Client leaving the session in half
Whatever happen the therapist should have to prepare him/her self for everything.
· Gender differences
Sometimes the client does not want to work with the therapist of the same gender may be because he has the issue with his father and the therapist is also male so he cannot work well with the male therapist (regardless of the experience of the therapist). the client make start to make transference for the therapist. If the client has week ego or he has anxieties issue that is beyond their copping power he should have to be treated by the female therapist. The same happens for the girls too but this time it is the opposite. Borderline cases and some types of schizophrenia, alcoholism, and psychopathic personality are often more easily handled by a female therapist, possibly because existing dependency (oral) needs are symbolically gratified and there is no potentially threatening masculine authority figure.
· Age of the therapist
The age of the therapist may also affect the treatment some patient wants to get therapy from the older and more experienced therapist then the junior.
CHOICE OF TREATMENT METHOD
OVERVIEW
y Treatment planning is a practice and it is a goal of the therapist in which the client is motivated to attain such goals but his intellectuality, personality, and flexibility should be also taking in mind.
y According to Lewis and Usdin (1982)
Sometimes it is highly unsuitable for the client to work on a structured therapy. The therapist cannot take all the client on a treatment plan. For example, a highly appropriate classical psychoanalytic treatment plan may be designed for a personality problem, and when applied to a borderline or schizophrenic patient will be as effective as shooting buckshot in the air. Maybe the other therapy we are giving him first does not have any effect.
y In designing the therapeutic plan, it should also be noted that some client wants to get rid of his/her problem faster, they may do not want to work on the same big plan of that that and that steps whatever. Supportive therapy plan should also be made in that situation, it should also be helpful if the client ego strength is doubtful and his anxiety may be converted into depression a backup plan should also be created for the client. a supportive plan is that we can include his/her family into the therapy or we can show his positive points so his morale does not low but increase.
y The therapist should have to make supportive measure not the alternative measures for the clients who have no real motive for self-growth and who extract from their neurosis elements of profound secondary gain that they refuse to give up.
ü Supportive measure helps those clients whose ego strength is adequate but they have been beaten by the environmental stress but they want to rebuild them self as soon as possible.
ü Help each patient
Regardless of the diagnosis the therapist should have to help each of his/her clients regardless of the severity of their symptoms and it is the job of the therapist that all his patient should enter the path of maturity by help themselves for resolving their own inner issues by them self and help them to resolve their resistance for getting more intense help.
ADJUSTED PREVIOUS LIFE/ MAL ADJUSTED LIFE
If the person has a history of suitable alteration in his early life before the onset of the problem has been starting and he also has the satisfactory adjustment at the time of his illness, the chances of that person brought back to his normal self is very high in less amount of time. But what happens if the person has the maladaptive adjustment in his early life and him has never adjustment in his whole life before the problem the therapist should have to more constructive because he had to develop a thing which does not even exist.
If the therapy we are applying is not that much intense in its frequency level is low but we can still achieve some goals from it. Which may be a very great realistically approach in many cases.
o It would be futile to treat the patient’s symptoms with a supportive approach since he was living with conflicts that were stirring up symptoms. Attempting to remove his symptoms would be like blowing away smoke without smothering the flame.
Supportive Therapy
Those people who may get benefit from the supportive therapy or who can get benefit from it fall in the following category:
1. The patient who was severely disabled from psychosomatic symptoms they need supportive therapy.
2. Those who are suffering from severe major depression and acute anxiety we can also help them from supportive measures or therapy.
3. The patient who has a history of maladaptive adjustment and their ego is also lower can also help them from supportive measures.
4. Help people who have disturbance with a specific social environment (social phobia).
5. Help those people who have severe personality problem or character problems like excessive dependency or obstinate childishness.
6. Help people who suffer from severe Obsessive-compulsive behavior.
7. Also, help the people who are addictive or suffer from an excessive habitual problem.
Re-educative therapy
People who get benefit from this are ……
People who have a problem in expressing themselves (personality problem).
Reconstructive therapy
People who have the severe problem in relationship with not only parents but the other peoples who have the significant rule in their lives, produced block in their growth also can get help from this reconstructive therapy. people who are suffering from anxiety disorder, OCD, conversion disorder, a personality disorder may be their ego is strong but in which repression is the chief defense is most responsive. It is essential to know that the type of therapy we are going to give the client.
For example
If the client is badly depressed or upset and he needs supportive therapy so we first gave him supportive measures them we move to reconstructive or reductive therapy.
THERAPEUTIC APPROACHES IN DIFFERENT SYNDROMES(CONDITIONS)
A system of approaches has been made that help in dealing with a specific problem of any person. These approaches may be imagined as a chain of interacting links-biochemical, developmental as well as conditioned, interpersonal, social, intrapsychic, philosophical and spiritual that influence how a person thinks, how he feels and how he had behaved. Some of these factors directly associated with the complaints that have led the person to seek for relief.
The different links are so merged in each other’s so the feedback occurs throughout the chain when anyone link is functionally disturbed. What mostly concerned an individual is the most of the symptoms which usually end product of this feedback At the beginning, the therapist want to deal with both consequence and the sources of the client’s symptoms. But the person is not completely aware of the sources of the problem.
E.g.
if a person who may not seeks relief for depression or anxiety disorder but seek for the relief for marital discord (family problem). the final result of the problem is hopelessness and then depression. if the therapist main focus is symptoms of the patient depression and anxiety and treats disruptive biological link with antidepressant drugs.
But intrapsychic link and an interpersonal link may be influenced minimally but will cause great troubled. It would be considered marital therapy and individual therapy will help but the motivation of the client is very important.
The therapist should be focused on considering which of the link system the client is ready to deal with it or the client is more agreeable to change. There are many systems some of them are difficult to change they need intense therapy to change (the individual may be not willing to do it).
So, a link had been chosen that is prone to be influenced, the therapist would be hoped so that through suitable feedback the other upset system would change.at the same time, the therapist makes effort to create motivation that helps the client dealing with the client most guilty link that is mixed up with the client illness.
The therapeutic approach helps the therapist to choose which of the condition(syndrome) is best for the therapies.
Example
1.for mood disorder like major depression
As a medicine
tricyclic and antidepressant drugs can be used for therapy.
2.alcoholism
Group therapy =Inspirational groups are made
Medicine =Antabuse
3.speech disorders:
therapy we can use speech therapy or behavior therapy.
Important guidelines for the therapist
Ø the choice of the therapist to give the client suitable therapy mostly depends on the symptoms of the clients and the problem-solving ability of the client.
Ø But there are major expectations that can be found on the approaches when the referrals are made to the therapist from different training background.
1. Guidance
2. Environmental manipulation
3. Externalization of interest
The therapist detached from the patients when the goals of the treatment are cut short
4. Reassurance
5. Prestige suggestion and prestige hypnosis
For habitual disorders like nail biting etc. when the only goal of the therapist the only goal is the removal of the symptoms.
6. Persuasion
7. Pressure and coercion.
Patients who act out or compromise themselves in other situations when the treatment goal is limited.
8. Emotional catharsis and desensitization
9. Muscular relaxation
Ø Sometimes the therapy the therapist choose the therapy which is best for the client but the client family is against it by saying that this is against the ethics but if the therapy is best for the client then the therapy main focus on the treatment of the client rather than the ethics some time it is best for making hard decision for the therapist but some time the therapist should have to work in the ethical areas if the problem is not that much hard.
Ø Therapist must have to make adjust the therapeutic approach according to the client capacities the therapist cannot force the client over his potentials to do work which capacities, no matter how he hardly wants to help the client he should do not have to force client maybe it is hard to bear that goal for the client. The therapist should have to make the client work in his own potentials and limitations. But he will have to gradually increase the burden to the client has to learn the difficulties and the therapist will get the desired results.
TREATMENT MANUALS
There are many treatment manuals are made and standardize by the psychologist especially for the purpose of the research. Like….
1.cognative behavior therapy by (beck)
2.time-limited dynamics psychotherapy by (strupp& Binder)
The advantages of that kind of manuals are that they enable the therapist to not make any problem in giving treatment to the client. It also helps the judges to check whether the therapist is doing the right or he is doing wrong.
FREQUENCY OF VISITS
The number of the session conducted depends on the need of the patient of treatment. Sometimes a patient does well in one-week session for one disorder and for the same disorder more then one session is needed. Sometime at the beginning the therapist may see the client 3 times in a week if the problem of the client is severe may be the client is in the panic state, this will help the therapist to make a good relationship with the client and also help the therapist to reduce the client problems.
The disadvantage of one a week therapy is that the client may use other ways to reduce his anxiety he may start to taking alcohol.
ESTIMATING THE DURATION OF THERAPY
The duration of the therapy ends when the client is completely relieved from his problem it may be a lifelong procedure but not the relationship of the therapist and client their relationship ends when the client knows his problem and get relieved from his problem. We can check the client growth by taking the client history. His relationship become good if he has relationships problems.
DELAYS IN STARTING THERAPY
Sometimes the therapist does not have enough time for the client they the therapist delay the client if the problem is not that much hard but if the problem is that much hard the therapist should recommend the client to the other therapist.
FINAL ARRANGEMENTS
After making arrangement for very thing the therapist should have to make the final arrangement he should have to set the time for the therapy date of the sessions and tell the client the length of each session.
REFERRING THE PATIENT
If the therapist does not have time for the therapy then the therapist will have to refer the client to the other therapist but if the client does not want to move to the other therapist then we cannot send him to other if he is doing well with us.
Referral is also made if the interviewer does not work well or the client makes the transition with the therapist or the therapy suitable for the client but the therapist does not know how it works then it is good to referral the client to the other therapist.
THE INITIAL INTERVIEW: SECURING ESSENTIAL CONSULTATIONS
During the start of the or later in the interview it is important to consult with a number of professionals on the issues.
Consulting with the neurologist and psychiatric help the therapist the client does not have any biological issues. But if the client is referred by the physician that it is important to take their opinion and the whole history of the treatment of the client from the physician.
CASEWORK CONSULTATION
If the client is a worker or a job holder then the therapist should have to consult his coworker about his problem.
· Maybe the client has so finical problem
· Maybe he has just shifted his job
· Maybe the client needs some special health services
Consulting with the psychologist
It is important for the therapist to consult his client with the other therapist if he is needed to test the client but he does not have that test or the therapist does not have command on the therapy.
The Initial Interview: Important "Don'ts" during the Initial Interview
1. don’t argue or challenge the client
if the patient makes a point of view about something which may be based on prejudice but we cannot alter the client thinking or we cannot say him that he is wrong because if we do that he does not trust us and work well with us. The therapist should not have to criticize his client it may effort the rapport of the client with the clinicians.
2. Do not praise the client if he is not doing well or does not give the client false encouragement because it may affect the self-esteem of the client. The client thinks that the therapist does not have any intention for her and he does not care about his health.
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