148 CHAPTER 4
Creating a Treatment Plan
We’ve considered many different types of treatment. How does a patient and his or
her mental health clinician decide on a particular course of treatment? Let’s review
the process of choosing one or more types of treatment for a given problem, using
Leon’s depression and social phobia as an example.Choosing a Specifi c Treatment
How would a clinician decide what type of treatment to offer to Leon, or any other
patient? The answer depends, in part, on the types of treatment the clinician has
been trained to provide. For instance, in general, psychologists may be more likely
to target psychological or social factors, whereas psychiatrists may be more likely to
target neurological factors.
The specifi c treatment or treatments provided to a patient also depend on what
types of treatment he or she is willing to try. Ideally, a patient has looked at reputable
Web sites to learn more about his or her symptoms and the types of treatments that
have been found to be effective. Leon might have developed a sense of what type of
treatment he wanted to try and might have sought out a clinician who was qualifi ed
to provide that treatment.
Which types of treatment might be most appropriate for Leon’s particular
problems—depression and social phobia? Given that his problems did not incapaci-
tate him or lead him to be likely to hurt himself or others, outpatient treatmentKey Concepts and Facts About Treatments That Target Social Factors
- Treatments that target social factors are designed to reduce
symptoms and/or improve quality of life by changing a person’s
relationships for the better and by creating, expanding, or
improving a person’s sense of community. - Interpersonal therapy (IPT) is intended to address a patient’s
problematic relationships and improve his or her interpersonal
skills so that relationships become more satisfying; the theory
is that as relationships improve, the symptoms of psychological
disorders will lessen. IPT focuses on four themes in problems
with relationships: unresolved grief, role transition, role dispute,
and interpersonal defi cits. The methods of IPT include focusing
on the consequences of patients’ actions, role-playing interac-
tions with signifi cant others, encouraging patients to heighten
their awareness of feelings they have minimized, and helping
patients to improve their communication skills. - Family therapy can be conducted using most theoretical
approaches; depending on the specifi c approach, the focus of
family therapy may be an individual patient in the context of his
or her family, or the family itself. In contrast, systems therapy
views the entire family as the unit of change and is designed
to improve communication or behavior patterns among family
members—who may not be the identifi ed patient—and in doing
so change the system. Methods of systems therapy include vali-
dating each family member’s experience, reframing the problem,
and using paradoxical intention. - Group therapy, in which several patients with similar needs meet
together with one or two therapists, can be based on various
theoretical approaches, such as psychodynamic therapy or
CBT; the theoretical approach determines the specifi c methods
employed.- Treatment can occur in different settings and with differing
levels of intensity, ranging from once-a-week outpatient treat-
ment to partial hospitalization, residential treatment, and inpa-
tient treatment. People can also receive help for psychological
disorders in self-help groups and through bibliotherapy. - Prevention programs target those at risk for a variety of
psychological disorders; these interventions may focus on
neurological, psychological, or social factors. - Treatments for children and elderly patients that target social
factors may need to be modifi ed for those specifi c populations. - Therapists should try to be aware of—and discuss with
patients—any cultural, demographic, or other significant
difference between themselves and their patients that could
affect the goals and expectations of treatment or create
miscommunication and misunderstanding. - Culturally competent mental health clinicians provide treatment
that is sensitive to people from different backgrounds. Mental
health services that are tailored to the needs of a specific
cultural or ethnic group are more likely to be used by members
of that group. - The bulk of the costs for mental health treatments are borne
by health insurance programs; managed care organizations in
particular may restrict treatment in an effort to minimize costs.