NCMHCE Treatment Planning Review Part 2: Client Collaboration, Assessment, and Goal Setting

This episode, hosted by Dr. Dawn-Elise Snipes, delves into advanced treatment planning strategies for the NCMHCE exam, emphasizing a collaborative and client-centered approach. A core principle is that treatment plans should be developed *with* the client, not *for* them, ideally empowering clients to write their own. The process begins with exploring presenting issues, assessing readiness for change across various problems (e.g., depression, relationship issues, job dissatisfaction), and understanding the biopsychosocial factors contributing to the client's condition. This includes identifying biomedical conditions, mental health issues, nutritional deficits, sleep problems, and environmental stressors or mitigating factors.

The podcast highlights the importance of aligning interventions with client preferences and developmental levels, considering both chronological age and cognitive abilities. It details the use of various assessment instruments like the PHQ-9, BDI, STAI, BAI, MAST, SASSI, AUDIT, Strong Interest Inventory, and MBTI to facilitate client decision-making and track progress. A significant portion is dedicated to structured goal setting, advocating for positive, observable, and measurable language for both short-term and long-term objectives. Dr. Snipes provides a practical example of breaking down a broad goal like "being happier" into concrete, stepwise actions, such as improving sleep, managing caffeine intake, establishing sleep routines, and re-engaging socially.

Practical recommendations include helping clients identify personal strengths and systemic patterns of interaction that may contribute to or alleviate their symptoms. The episode also covers appropriate referrals, stressing the importance of knowing one's scope of practice and referring to medical professionals (for psychopharmacology, pain management, physical assessment), support groups, career services, social services (for housing, food assistance), and specialists for co-occurring trauma or addiction issues. It underscores that treatment for co-occurring disorders is most effective when managed by the same therapist.

Finally, the discussion emphasizes the critical role of discussing termination at intake. This practice helps clients conceptualize treatment as time-limited, empowers them by fostering self-efficacy, and plants seeds for future engagement even if they drop out initially. Clinicians are encouraged to guide clients in seeing how certain changes are necessary to achieve their goals, even if those changes are not their primary motivation. Regular progress review at each session is crucial for maintaining client motivation and focus, ensuring a dynamic and effective therapeutic journey.

"you don't write a treatment plan for them you write a treatment plan with them or ideally help them write their own treatment plan"

"we need to make sure that we think about what they're motivated to do and help them increase motivation"

"we want to educate the client about the biopsychosocial issues that may be contributing to the problem and get feedback"

"we want to discuss and align interventions with their preferences and developmental level"

"you need to be able to read that goal and anybody should be able to read that goal and be able to look at what sally has done or is doing and say yes she's happier or no she's not"

"know your acronyms on the exam you will see only acronyms a lot of the time so you don't want to assume that you're gonna see BEC anxiety in one course you need to know when you see Bai what that stands for"

"know your scope of practice one of the things Nancy MHC II is very particular on is knowing your scope of practice you are not a nutritionist you are not a dietitian you are not a medical doctor"

"treatment is much more effective if it is PO occurring which means the same therapist resistant addiction and the mental health issues"

"encourage them to think of writing our treatment plan like following a recipe writing a recipe down or putting together you know IKEA furniture it's very stepwise"

"discussing termination at the outset empowers the client and increases self-efficacy"