 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation, Adult Education and Teaching Skills to Improve Treatment Planning and Service Planning. Now obviously if you work with kids, this isn't as applicable. We're really talking about working with older adolescents, those that are 18 and above, but especially those in their 20s and above and helping them develop their service plans, treatment plans, goal plans, whatever you want to call them. And we're going to examine how adult learning theory can help us create more individualized plans and objectives. So what are treatment plans? They are not just a pain in your neck that you have to do in order to get reimbursed. That is part of what they are. They're a requirement for reimbursement, but they're supposed to serve as a roadmap and it's an opportunity to use it as a clinical tool. We can help teach clients problem solving skills. If you write the plan for them, they don't learn how to set smart goals and break it down into specific measurable objectives. And if you do it for them, you can't help them learn how to think, all right, here's this problem. How can I identify and use personal strengths? How was it that I've solved similar problems in the past? Or how is it that other people that I know of have solved similar problems? What resources do I have that I can tap into already instead of having to reinvent the wheel? They're dynamic documents. So you write it the first time or you and the client work together to write it the first time. And then you figure out, you know, a period for which that you're going to reassess treatment plans. Now, if you do IOP or PHP or even residential, some insurance companies require that you update treatment plans on a weekly basis and some people may be going, oh my gosh, I can't imagine doing that. It's not so hard. Where I've worked in the past, you know, clients are always given a copy of their treatment plan and I have a worksheet that they fill out at the end of every week. And when I was in residential, they would bring it to our team meeting. We had a meeting of everyone that was on my caseload once a week. They would bring their treatment plan summary to my meeting and they would identify what goals they worked on, what they did to work on those, how successful it was and if there were any needs for any changes in their treatment plan. And we would talk about that in group because then the group members could, you know, give support to people who are making a lot of progress and give them encouragement and for people who were stuck for some reason, you know, they could give them also support and encouragement, but maybe offer, you know, help with some brainstorming and do a sort of a group problem solving thing. Obviously, not every problem is appropriate for covering in sort of a group treatment planning review session, but a lot of them are and were because these people were in groups with one another. They were in therapy groups. They were in trauma groups. They were out there. So, you know, there was a lot that you can't there is a lot that you can do to review treatment plans and help people stay motivated. And that's the other thing we would look at in these groups and doing the treatment plan reassessment. I would listen and to how far people were going and how much progress they made and I kind of listen for the enthusiasm in their in their voice. And if I didn't hear it or if they seem to be stuck for some reason, we would talk about whether they were stuck because they didn't have the tools or their motivation was waning or kind of what was going on. And that was a place where we could intervene. The treatment plan occasionally needs to be updated or changed in order to address clients current functioning and needs. If you have a client who is going through treatment and then all of a sudden they have a death in the family. Well, you might need to adjust the treatment plan to address the grief issues or you have a client that's going through treatment and all of a sudden they're in a car accident and have to go to physical therapy for six months. Obviously, there are going to be a bunch of things involved with that that may need to cause you to alter the treatment plan. So we don't want to look at a treatment plan as one and done you do it and then you reassess it periodically at least every 30 days and make sure that you don't need to add or subtract any problems or maybe even break down some of your objectives a little bit smaller to make them doable for people. Treatment plans are great for evaluating clients progress towards specified goals and objectives. You know, I like to give my clients again, their treatment plan that they can look at and they can cross things off as they get them done and they can see how much work they've done. It guides treatment for identified problems or issues so they don't wake up and go, well, you know, I need to work on my depression. I guess I'll read a book on no, you know, you have goals and objectives and you have a clear plan just like you wouldn't decide. Okay, we're going to go on spring break and we're going to go for on vacation and just get in the car and start driving and who knows where you're going. You know, you know, you want to go somewhere fun, but that's about all you know. So you just kind of head out on the road. You would want to at least have a destination in mind, you know, a state if nothing else. Maybe you're going to Florida. Okay. Well, so how do you get to Florida? There are incremental steps to get there. You have to pack the car. Put gas in it, start driving and there are steps to get to the state and then, you know, once you get there, you can reassess what you're doing and make another plan for whether you want to go to Pensacola or Tampa or where, what beach you want to go to. But we want to be able to make sure that it provides a map for clients and treatment plans enhance multidisciplinary team communication. Cause when you work with a client, they're not going to have all the skills, tools and resources in themselves. Most of the time, you know, most of the time they're going to be relying on. They need to go to their physician to get a physical and rule out any physiological issues. They need to go to the psychiatrist to get their meds adjusted. They need to go to vocational rehab. You know, there may be different places they need to go and the treatment plan helps them identify what they need to do, where they need to do it and who's responsible for what? I mean, they're responsible for getting there and then, you know, such and so doctor is responsible for giving them a physical and doing their drug test or whatever the case may be. So we want to make sure that everybody on the team knows who's responsible for what. So there's no, well, I thought you were going to do that. And that's one of those things that happens a lot in co-occurring disorders treatment with drug testing. People start thinking, oh, well, the doctor is going to do it and the doctor thinks, oh, they're doing it over at IOP and the probation officer thinks, well, generally the probation officer is like, well, I'm doing it anyway, but it's to reduce redundancies in treatment. It's really important to have the treatment plans out there so everybody knows what their job is. Treatment planning is also a process in which the counselor and client identify and rank problems needing resolution. When clients come in and please share, but, you know, my experience has been that when clients come in, they don't just have one problem. You know, they may come in and they say, Doc, I'm depressed. Okay. So let's start talking about that. But then we'll figure out along the way that there are things that are precipitating that depression. So we identify those, you know, three, four, five things and we say, all right, you know, which ones are you most motivated to work on? Which ones are most important right now because you can't do five, six treatment plan problems at one time. It's just not possible. In Florida, we always use if we had somebody that was on TANF, which is Temporary Assistance to Needy Families, their treatment plan had to have three problems in it. And that was about the most that anybody could really expect to focus on and do a good job accomplishing in 30 days. You know, three problems is a lot, especially, you know, depending on how big you write the problems, but there was a lot for them to do. Think about yourself when you try to change something. If you wake up in the morning and you decide I'm going to get healthier, I'm going to start exercising, I'm going to start eating better, and I'm going to get to sleep and do better with my sleep. That's all well and good. But if you decide that you're going to start doing all three of those things on Monday, how likely is it that you're going to be effective at continuing to do all three of those things henceforth and forever more? It's a lot more effective if you can focus on one or two things, but three if you have to and really get those under your belt. That gives them a sense of self efficacy. That gives them a sense of hope and faith in the process. It gets the momentum going and any positive change in their existence, physical, cognitive, emotional, social is probably going to have significant positive changes on the rest of them, which means, you know, you're going to have a better mood, which is going to improve energy and, you know, yadda yadda. It's a wonderful spiral upwards effect, if you will. During treatment planning, you work together to establish agreed upon immediate and long-term goals. So you sit down and you say, okay, you want to start a new career. That's good. So do you know what career you want to start? All right. If you don't, let me refer you to these websites or go down to workforce development and figure out what you want to do and then you need to find out, you know, where you need to get the training and then sign up for the training and break it down incrementally. What exactly they need to do and you talk through it and I usually don't tell clients what they need to do. I say, okay, what's the first step you need? You think you need to take and then the second step and if they start taking steps, they're too big. I might suggest, you know, breaking it down a little bit. So they can accomplish whatever it is they're setting out to do in a reasonable period of time, especially at the beginning of treatment. I want them to have successes every week, preferably every day, but definitely every week where they can say, all right, I knocked something off my list. You're going to decide on treatment methods at this point. You know, some clients are going to be great with individuals. Some clients are going to prefer group. Some clients are going to want art therapy. Some will need workforce development, vocational rehabilitation. This is where we start deciding what types of services you need and are going to work best for you. If they've got trauma issues, they may want to be referred out to an EMDR specialist, for example. And then you identify necessary resources. You know, what you want to do, how you want to do it, the way you want to go about doing it. Now, what resources do you need to accomplish that? So the foundation for your treatment plan is always your biopsychosocial assessment. You're going to look at current stressors, coping skills, self-esteem, mental health, substance abuse, their social network and their physical health. We're going to figure out, you know, what is causing their main presenting issue? What is contributing to it? I mean, when you think about depression, lots of stress can contribute to depression. Maybe they've got 17 things going on. Poor coping skills. Can contribute low self-esteem, mental health issues, pre-existing depressive episodes. You know, they've got, you know, maybe they have some sort of biochemical imbalance that's also contributing to it. That's organic, not caused by stress or diet or anything. Substance abuse. We know that that can muck up the neurotransmitters and lead to depression. Their social network. Good social support usually buffers against depression. Poor social relationships may contribute to it and physical health, poor nutrition, lack of sleep, pain. Those are the big three that tend to contribute to depression. So we want to look when we do the biopsychosocial assessment and you're doing your integrated summary. You want to help clients see all these things and tie them together. You want to help them see how each one of these things may be contributing to their depression. So then they're like, oh, it makes sense why I feel pretty worn out and hopeless and hopeless right now. Makes sense why I have no energy. Yeah, it does. So let's figure out how we can start improving that. Where do you want to start? The individualized treatment plan. We use it. Some people call it service plans, whatever you call it in your facility. It's structured. You know, it's kind of like an outline. You have your your problem statement, you know, Jimmy's depressed. You have your goal statement. Jimmy will be happier or will report being between a three and a five on the happiness scale. Six out of every seven days as evidenced by mood reports and energy levels. You know, however you want to define it. Then you have sub goals. Just like when you're driving somewhere and Google gives you directions. It tells you drive 2.1 miles then turn left. And then stay on this road for a little while and drive 3.4 miles and turn left again. So we want to make sure that they've got the instructions. It has a schedule of services so they know when things should happen. Many of our clients, you know, if they come and they're depressed, they may not have a lot of energy and they're looking at it and it feels overwhelming to see all this stuff they've got to do or they just look at it and go. I don't even know where to start. Well, we need to help them make sure they know how and where to start. You know, what are you supposed to do this week? What are you supposed to do next week and break it down for them so they can see. Okay, I can do this a little bit at a time and too often we hand clients treatment plans and we say, okay, over the next 90 days, you're going to accomplish this stuff and they may not get started right away. I've also seen people and you remember grad school. You'd get your syllabus and there'd be a lot of stuff on there and you'd be really enthusiastic and you'd start out and then you kind of get into it. It seems pretty easy. So you start slacking off and then you get to the last month of courses and all of a sudden you've got 820 page papers you need to write or maybe that was just me, but clients are the same way with treatment plans. If we don't keep them on schedule, keep them on task give them a guide. A lot of times we don't need to micromanage, but checking in, which is why the weekly treatment plan updates can be really helpful to see the progress they're making. Even in individual, I have clients sit with me. I do the therapy 45 minutes 45, 50 minutes with them and then most of my clients don't have a problem staying the extra 10 minutes, which they would normally I would reserve it for documentation, but we do the progress note together and we talk about all right, what did we talk about this week? What did you work on last week? What goals did you accomplish according to your treatment plan? And a lot of times I will give them depending on the client. If they are really a verse to paperwork, I won't but a lot of clients I will give that same treatment plan review sheet that I give to my group people. So they're looking at it and making notes about throughout the week about what they're working on and how it's going. I can put that as an addendum with my progress note in there, but it helps them kind of really revisit where they're at, how far they've come and where they're going. It's a written document with treatment related goals and measurable objectives. Happy is not measurable. You know, I can look at Jim Bob over there and my impression may be that he's happy. You may look at him and go no, I'm not thinking so. So we want something observable. Now, a lot of times we do use Likert scales. So for happy on a scale of one to five, one being miserable, five being elated, three being content, four being happy and two being, you know, kind of blue or blah, where are you on that? And I always try to anchor it with words or pictures for clients so they can have pretty good test, retest reliability. So each day when they come in and they rank their mood, we're getting about the same, you know, scale that we're looking at. So you can use Likert scales, but I also encourage you to have them look at objective things too, because sometimes they'll have a difficult time figuring out where their mood is. So we want to look at did you feel rested? Did you? How many hours did you have energy for, you know, identify some things that are more concrete and interventions need to be grounded in the client's learning style. It drives me crazy and it breaks my heart at the same time when clients come in and we're trying to fit them into this little pigeonhole here. And they don't fit. I've had clients before when I worked at in Florida who didn't know how to read and that was not an uncommon situation in the facility that I worked at. So telling them that they had to read the big book and giving them a workbook to work out of. That was not culturally sensitive. That was not therapeutically appropriate and that's not how that client learned. So we wanted to figure out how to make it oral. And interactive because so adult learning, we're going to talk more about learning styles in a minute. Adults need to be involved in the planning and evaluation of their instruction. So when we use it in treatment, we want to make sure that they're involved in the treatment planning. Treatment planning is like making a syllabus for class and it helps the adults know where they're going and what they're going to be working on. Adults are most interested in learning subjects that are practical and have immediate relevance and impact to their job or personal life. So there are things we can have them work on like self esteem. That's one of those things that over the long haul is really going to help them. But we also need to be able to give them tools like cognitive behavioral or journaling or something that can help them or even experiential therapy that helps them grasp a topic in of to help them deal with whatever they're struggling with. But they need to be able to walk out and say, I got something out of that. It's immediately relevant. One of the things that I do at the end of all of my sessions is I have clients identify what is one thing that you got out of the session today that will be useful for you in the next week or that helped you make sense of something. So it gives them a chance to reflect on the immediate relevance. I have clients do the same thing if they're going to support group meetings. You know, when they get out, they need to think about what was one thing that they can take from it. That's relevant because too often I hear them belly ache and I don't want to go to that meeting. It's it's useless. It's pointless and it may be but at least for a couple of weeks. Let's try having you go and see if you can pull one thing out of it. That's useful to you. Let's see. Adults are more engaged when there's a presenting crisis. No, we don't want to throw our clients into crisis, but they are more engaged when they first come in and they are dysphoric for sure. So along the way, we want to be able to remind them about that crisis. Just like people are more motivated to stop smoking. If they're presented with evidence as it pertains to them, you know that says this is what's going to happen. We had a great film that we used to use that showed people when they were, you know, in their 20s and they started smoking and then it age enhanced them to 50 and it showed the effects that smoking has on physical appearance in addition to the it would show the lungs and everything else too. But for a lot of my clients, physical appearance, the outward physical appearance was more motivating to stop smoking than the lungs and everything else. So whatever it takes, but that created a little bit of a crisis for some of them. So you want to present the information in a way that triggers something meaningful for them, whether they're concerned about their appearance or their health or their finances. Those are usually the three big ones. Adult learning is problem centered rather than content oriented, which means, you know, we can teach content until the cows come home. You know, you can have somebody go into psycho educational groups every single day for three hours a day and that's fine, but it's not going to be really engaging unless they see how it relates to their problem. How does this particular subject or group or topic help me solve my problem? How does it apply to my problem and helping me get to my solution? We need to explain the reasons specific things are being taught. So they get that problem centeredness or solution focused part of it. An instruction should be task oriented instead of promoting memorization. So we want to make sure we engage clients and memorization can also be just have it standing there and lecturing. So they learn stuff. We want to get them task oriented, have clients do role plays have them do skits have them do activities have them, you know, go around the room in small groups and fill out flip chart papers. Whatever it takes so they're talking about it and they're kind of applying it to their life if nothing else instead of just speaking at them. Adult learners prefer collaboration and the ability to think critically. So, you know, most of the time and you know, I totally get this. I would rather be in a class where I'm able to talk with other people. When when I taught at UF my final exam, well, all my exams instead of having this closed book, you know, scary final, it was closed book, but I would break people into groups of four and I'd give each person a test and they were able to choose their own answers. They didn't have to choose the group answer, but they would go through each question and talk about what what the right answer would possibly be and some of them were multiple choice. A lot of them were short answer, short essay, but it gave them a chance to really flesh it out and see if they were thinking along the right lines. Instructions should take into account the wide range of different backgrounds of learners. It always flustered me because statistics and math is not my strong suit and I would go into a class and the instructor would just assume that you had a really good grasp of the basics and jump right into it or when I would take a class that was taught by the professor that wrote the textbook and they just assume that you know a lot more than than you really do and some students may and some students may not. So it's important to especially when we're dealing with clients. You know, some clients may be experts on nutrition and fitness. Others may not know a thing about it. So we want to find that happy balance and find a way to use the strengths. The people who do know stuff. Let's have them promote into some sort of a leadership role and the people who may not know as much, you know, so they can learn from the others. We can pair them up. We can do gamification is huge in adult learning because it makes it a little bit more fun and you can you can apply it to their particular situation. Since adults are self-directed instruction should allow learners to discover things and knowledge for themselves without depending on people. We want to encourage them to be able to go out and find the answers, not just spoon feed it to them. So ask them, you know, where would you find this information about treatments for depression or treatments for anxiety? Where would you find? How would you find support groups? Sometimes that can be homework and they the people can bring it back to the group and say, you know, one person's assigned to find support group resources another one's designed to find food food and housing resources or whatever. So people start learning how to navigate the system. And adults are juggling multiple responsibilities, especially if you're working with somebody who's in outpatient or IOP. You need to be cognizant of the fact that sometimes they're going to come in and they're not going to be mentally present because their kids at home sick with 104 fever and they had a bad day at work and their car broke down and other things are going on. So therapy that day not may not be the center of their universe. So we need to be flexible and recognize that people have other competing priorities and talk about, okay, how can we make this work for you this week? I hear that you've got all this other stuff going on and that helps them learn to be better better jugglers, so to speak. Adult learnings, adult learning methods, concrete learning. So role play or do an activity where somebody practices doing it, fill in the blank and worksheets, role play assertiveness. That's very concrete. Hands on. I got it. Reflective observation is when you do activities or you show them a movie or something and then you say, you know, what did you glean from that? How does this change your perception of communication or how do you think this will change how you interact with your boss in the future? Abstract conceptualization applies it to the life and other situations and I usually go further and say, okay, how could you teach this skill or concept to your kids or to the next group that's coming in to make sure because I find that you don't know what you don't know till you try to teach it. And I found that in psychology and I found that working, you know, with my kids and trying to help them with their homework. Just, you don't know what you don't know. And active experimentation is another method where you have clients apply what they're learning in a variety of texts and then contexts and then discuss it with the group. So they learn thought stopping for example in group and then over the next week they're encouraged to use thought stopping in different situations and then come back the next week and talk about how effective challenges they had with it, etc. You can also before you send them out into the into the world with it, you can role play a variety of situations and have people say, you know, stop the role play in the middle of a argument or something and say, okay, what skill should this person use in order to defuse this this conflict or in order to best approach this conflict. I obviously like using time out in role plays a lot. Because people are in engaged in it and then you say, all right, now in real life, you don't have time to stop and think, but right now you do. So they're frozen. What do you think this person should do next? Learning there are three parts to the learning process cognition, how you acquire knowledge through seeing it. So if you read it and I always say think about when you either get a new computer program, new computer program, computer, VCR, DVD player, whatever they are now. How do you learn how to operate it? Do you read the directions? Do you have somebody tell you how to do it? Or do you just start pushing buttons and see what happens? I'm a button pusher. I'm also a reader to a certain extent. It depends kind of depends on what it is, but I am not one that's purely auditory. That's probably my weakest learning style. My daughter on the other hand, that's one of her stronger ones. Conceptualization is how people process information. Once they get it in their brains, what do they do with it? Do they relate it to something abstract? Or do they relate it to something really specific? Depending on how they think about things, whether they think of things in terms of meta concepts or specific problems. Those are the memory pathways they're going to activate. So we want to encourage people to relate stuff to things that they know. And and consider, you know, if people want to relate it to a bigger global problem, or they want to relate it to something specific that happened last week. And affective. So they can get it in their head. They can figure out what it means, but then affective means do I really care about remembering this? And if we want them to remember it, it needs to matter to them. So we need to make sure what we're teaching matters. We've all had classes where the stuff we're listening to just didn't matter. I remember introduction to Greek Archaeology. It was a requirement to graduate and I just kind of sat there and I remembered it long enough to pass the test because it mattered to pass the test. And I don't remember darn thing about it now. So we want to make sure people are constantly telling themselves why whatever you're talking about or presenting matters. Active and reflective learners. So we're kind of building so seeing, hearing, doing. They've got to care about it. Active learners tend to be extroverts, not always, but they tend to be and they process information as they go along. Extroverts tend to talk things out and think at the same time. Those people do really well in group. Reflective learners take information in and they tend to be your introverts not always take information in mull it over, piece it together and then they have that aha moment. So your reflective learners probably take in what you're saying during the class or during the segment and then during break time they put it all together and they go, okay, I get it now. So we want to give people time to think. I usually hand out worksheets or note paper at the beginning of class and then every 10 minutes or so after every section of whatever we're going over in psychoed classes, for example, I have them stop and reflect on what they learned what how it might be helpful and paraphrase it on their on their paper. So that helps visual learners that helps kinesthetic learners because they're manipulating the information going okay, there's this information how does it relate to me and they're processing it. So try to give people time for reflection if. They don't seem to be as engaged. They're not always having their hand up or always wanting to talk. It may be because they need that reflection time not because they're not interested. Auditory hearing seeing and doing so we want to provide options for people to get that information in if you can record your psychoed groups so people can listen to them. If you can have a PowerPoint or outlined that they can look at that helps the visual learners and kinesthetic help them manipulate the material help them apply it to something so they're they're working with it and seeing how it fits into their recovery scheme. Attitudinal or emotional refers to how they conceptualize information. One of the ways to make sure they care about it is to tap into that and if you think about the Kyrsi or the MBTI thinking or feeling thinkers tend to go with what's logical what's right what's just feeling people tend to go with things that make them feel better and keep other people from feeling bad they want everybody to to be happy you know I tend to be more of a feeler and I think most of us in this field are probably more feeling we want to help people feel happy and feel their best and optimize themselves so we depending on what's you may need to present if you're doing a group you may need to present it in both ways why is this a logical thing to learn and how is this going to help you feel better and improve your relationships with others for example and global versus specific parts versus whole some people and I'm one of those I can't go to a movie without reading what it's about first I need to have this kind of global thing to put what I'm getting ready to watch in I need to have a structure other people can just go into a movie or turn on a show and start watching and put the pieces together as they go along another example is putting a puzzle together my grandmother always used to say it was cheating if you looked at the box while you were putting it together I on the other hand I need the box I want to see the box and I do the frame first and then I put the pieces together in the frame so I've got the global framework and that's how I learned that's how I think so it's important to know how your clients think and when you're presenting information in individual or group you know maybe you start out the session saying today we're going to talk about the ABC's of cognitive behavioral this technique is designed to do XYZ to help you deal with cognitive distortions or however you want to put it less jargony than that hopefully and that gives the if they're global that gives them an idea about okay what we're going to talk about today so then they can start sorting within their great big frame people who are specific they don't really care about the frame it doesn't bother them but they don't really care they do like to have an outline that they can follow that has the details about what bullet points you're going to hit so reflective learners think it through and often prefer working alone so if you can let people have in group have some alone time two three minutes it doesn't have to be huge where they can think about something instead of having to talk it over with somebody else active learners have difficulty sitting quietly through lectures love group work and need discussion and problem solving activities so you may be able to put active learners together in a group a subgroup of your group and reflective learners together in a subgroup where they're all contemplating the same issues but the reflective learners are doing it independently and then they talk whereas the active learners are going to gab the whole time if you have action without reflection you can be in trouble so if people are just talking as they work things out and they're not stopping to go okay let me think what I'm doing here you can spiral out of control and reflection without action those people who just think about things and don't actually take steps get stuck so we need to encourage people once you learn it you know active learners need to stop and go okay I've learned it now what do I do with it reflective learners need to say okay I've learned it let me get started on it kinesthetic learners like to mentally or physically work with material auditory learners need to hear it there are a lot of books on tape the big books on tape like I said if you can record any of your psycho educational lectures some people will prefer to listen to it while they're on the treadmill or driving or even just prefer being in a lecture type group visual learners need to see the material if for some reason you can't or won't print it out and you can't or won't have a PowerPoint up there encourage them to bring paper so they can take notes because at least they can see it as they're writing it down to meet different learning needs present material using notes and graphs talk about it and ask questions and have group activities periodically for thinkers and feelers present compelling information that appeals to their emotions and answers the question why do I care we want to create an emotionally and objectively meaningful attitudinal and global statements in them if we want them to use cognitive behavioral therapy to address their depression okay emotionally why do they care it's going to help address their depression and cognitive behavioral therapy is a technique which is objective and it's something we're giving them to address their depression to be happier we want to create steps and objectives to achieving that goal so make sure you have the sequential stuff out there write steps and objectives in a positive knowledge skills and abilities format you can't do a skill until you have the knowledge so for example learning to use a circular saw I couldn't learn I couldn't use it until I first had the knowledge about how to turn it on what it did and how to use it and then the ability is going on and actually using it after I've learned it learned the skill and then I can go on to use it on my own so you want to have statements like John will learn will practice will gain an understanding of you want to avoid the negatives not John will not smoke anymore well that's a problem statement that's not a goal the problem is you're smoking the goal is to do something besides smoking we need to put something in there a sub goal provide written information about it you know if smoking cessation is the key right here we're going to stay with that for a few minutes provide written information about techniques for smoking cessation discuss it with John what do you think might work for you what are your concerns about each approach and what can you do to help yourself stop smoking from what you've read and learned about smoking cessation techniques what will help you and then regularly address how each goal builds on the last so after the initial meeting with clients we know who they are we have a general idea about their issues and their learning style but we still need to know why they're motivated to change so we want to select the problem which is generally the is alcohol dependent as evidenced by yada yada is has major depressive disorder as evidenced by always have as evidenced by especially if you're in an accredited facility or you get audited because that's the objective information that tells the auditor or the reviewer how it is you came to this conclusion step two goal development what are you trying to achieve what does it look like when this problem has gone away John will be happier John will be a non-smoker and will have developed with his stress step three is the problem definition well that's actually step two sorry and objectives you want to look at now that you know that John's going to develop alternate skills to deal with stress and stop smoking then we need to look at the objectives what's the first objective go to his doctor to get medication or the patch or whatever that he needs to help him stop smoking step two get rid of all the cigarettes and nicotine products in the house step three yada yada so it's broken down very slowly and then interventions are what you're going to do the objective is go to the doctor ideally to get medication the intervention the doctor is going to give you medication the intervention or the objective go to counseling to learn improved coping skills the intervention to participate in group activities to develop coping skills so we want to look at motivation motivation is changeable you may be motivated to do something on Monday that you're not motivated to do on Tuesday when when I exercise you know some days I'll just be like I don't feel like going but if I get a new pair of running shoes I am chomping at the bit to get to the gym so motivation is changeable and it's variable depending on how you do things I mean you've only got so much energy and like today would I have like to go to the gym yeah but I have other things to do so I wasn't as motivated to get to the gym because I had other obligations the components of motivation emotional cognitive social physical and situational what about this is going to help me be happy what about this is the right thing or the logical thing to do what about this is going to help me get my social needs met or is going to help me meet what other people think I should do whether you think that's a good thing or not is sort of irrelevant we all do it we say what a society say we should do what is what are our parents or our loved ones say we should do physically how's it going to help me feel better have more energy sleep better be less stressed whatever it is and situationally is it going to improve the situation at all and sometimes you can put interventions in there that will improve motivation so for example socially that's one that's easy to do if I didn't want to go to the gym and or I didn't want to work out and I needed some social motivation then I would encourage a friend to go with me one thing I do now is I'll post on Facebook if I'm having difficulty getting motivated I'll start posting the results of my work out on Facebook in my work out group and I get a lot of feedback from that and then if I stop posting people start going where'd you go so social motivation can help keep you going cognitively you can make a list of all the reasons why it's something you need or want to do emotionally try to do things or try to do it in a way that's going to make you happy physically pay attention to how it's helping you feel better problem selection needs to be meaningful the reward must be worth the effort so create mutually beneficial goals with the person and make sure that those goals in their mind are worth the effort you know maybe losing weight really isn't that big of a deal to them but their doctor wants them to lose 30 pounds because they their blood pressure is too high okay so we need to look at what's the reward you know do you care why do you why should you or why do you care about your blood pressure you may not care about your weight but why do you care about your blood pressure and why does the doctor want you to lose that so creating mutually beneficial goals helping the client identify motivations and corresponding goals so if getting healthier and losing 30 pounds is the doctor's goal and the person's like you know I just want to get my blood pressure down well to get your blood pressure down you're probably gonna have to lose some weight so let's instead of focusing on 30 pounds let's focus on five let's see how you feel after that and start working at whittling down towards something that is seemingly more doable to the client and that there may be more motivated to do prioritizing goals somebody that is in pain exhausted malnourished and homeless is not gonna give a rat's patootie about developing self-esteem it's just the way it is so the foundation of our treatment plan we need to look and make sure they're getting their biological physiological needs met we need to make sure that they're getting medications that they need we need to make sure that they have safety and security both physically as well as mentally they need to be secure and safe from that internal critic and a lot of my clients that's kind of where I start is safety and security because they have a really wicked internal critic and once they're safe in their own head then we can often move to love and belonging once they silence that internal critic and quit hating on themselves they can start to like themself then love themself and then develop healthy relationships so writing the plan it is individualized it uses positive language you can't just eliminate stuff if you have kids and you're working with them and you're constantly telling little Johnny that's bad don't do that that's bad don't do that that's bad don't do that eventually Johnny's just gonna sit there and go well what can I do I can't do anything so we need to put in positive behaviors to replace unpleasant behaviors and so thinking with kids for example when a child gets angry and starts throwing a temper tantrum and wants to hit obviously that's not appropriate so what else could the child do when they're feeling angry my son when he was about 23-24 months old maybe a little bit older than that you know initially he had started out he developed a little aggression and he didn't want to go to the grocery store with me and he was sitting in the in the buggy he just hauled off and punched me in the shoulder and I looked at him and I'm like I know you didn't just do that but you know okay you know he didn't he was clearly agitated for some reason and didn't have the emotional vocabulary so we talked about it and you know long story short he learned how to when he started to get angry to communicate to me that he was angry and he was getting ready to get you know fired up and I remember taking him to work one day and we were doing something and he's walking down the halls with me just kind of toddling along and he goes I so angry and he just clenched his fists and his face turned beet red and I was like okay well that's much better than punching me so helping them figure out what to do and for him you know we taught him he needed to tell us how he felt he would also do the same thing when he got overstimulated he was a micro-premie and had some stuff you know ADHD type things and he'd get overstimulated and start just feeling really anxious and you know true kid of a therapist I remember him walking up to me again about three years old right around that age he was still had a pacifier and walked up to me and he said mommy I'm overstimulated and went to his room sat down on his bunk on his bunk and we had one wall in his room that was just pure white and he just sucked on his binky and stared at his white wall for a few minutes and when he was better he came out and told me he was fine you know helping people figure out okay when I feel this way when I want to do this what can I do instead so develop positive coping skills to deal with stress instead of eliminate drinking for example goals am smart they're assessment based we need to look at when we're setting our goals we need to look at what did we see that might be triggering this problem and these are the goals these are the things that we're going to work to correct it's actually the problem statement but it has to be meaningful to the person so I can talk until I'm blue in the face about interventions for depression and needing to get enough sleep and proper nutrition and if that's not meaningful to them they're just going to be like when can you refer me to a doctor and give me a workbook to work in so you need to focus on what's meaningful they need to be specific written in the KSA progression measurable so anybody can look at it and go yes he did it no he didn't achieve given skills and resources they need to be achievable given their skills and resources so you know for me you know if I had the goal of becoming an astronaut that is not achievable I am too old to go back and get another PhD and something that would get me up into the space program and I don't have the resources available to it it's just it's never going to be achievable so I need to look at a different goal so we want to make sure it's something that's achievable if we have a client that has three felony convictions for you know aggravated type persons crimes if they want to get into becoming a lawyer or join the CIA that's not going to happen once you have that there's no wiping that away so helping people realize what's achievable it needs to be results focused we want them to Jim Bob to be happier you know a three to a five six out of seven days of the week on the Likert scale when he's finished with treatment now whether that means he completes every single activity on his treatment plan is kind of irrelevant we want to see the results and sometimes the activities are less important and it needs to be time limited we need to have reinforcement and our behaviors need to be reinforced periodically we want to make sure that clients are getting those behaviors reinforced at least weekly preferably with some sort of small accomplishment and then the goals that they're working towards no longer than six months preferably three months and once they accomplish those goals okay we can set more goals that build on those so maybe the first goal is getting a bachelor's degree alright once you accomplish that and that's obviously not six months but once you accomplish that then working on figuring out you know what graduate school you want to go to that's another goal we want to define the problem is how is evidenced in the client how is affecting their overall functioning the client's perception of the problem and the client's strengths that will be used to mitigate the problem and that's a lot I can tell you treatment plans I've written I don't usually include all four of these things you should in best practices but goal development we want to look at the broad goal for the resolution of the problem start by asking what's the absence of the problem if you wake up tomorrow and you're not depressed what's that going to look like how are you going to know that you're not depressed what's going to feel like what's your energy level going to be like etc and that is the goal the goal is to wake up six out of every seven mornings and have the desire to get out of bed the goal is to have energy for at least 12 hours a day every day or however the client defines it so your objectives are steps toward the goal they're smart specific because Rome wasn't built in a day measurable attainable results focused and time limited pitfalls in goal setting failing to consider why we do or do not engage in certain behaviors if you don't go to the gym you know why don't you go to the gym you know if you don't consider the reasons why you know you have other things to do you've got children to toad around you've got this or that it's expensive whatever the reasons are that you don't do it you need to address those because just saying why you should do it doesn't make those go away so we need to address the reasons why you don't do it setting goals that are too big if you set this huge goal of you know I'm going to be CEO of a company well that's great however that's going to be a while unless you just start your own company and you're like I'm a CEO but if you want to advance in a company that's a huge undertaking so it's important to have smaller goals in there so you can get a sense of accomplishment and forward movement setting goals that are too hard you know and I think we've all done that occasionally we've kind of cut the time a little shorter than we should have setting goals without sufficient rewards and I know it sounds silly but we do need rewards we need to be able to look in the mirror and go I did that so make sure that clients are thinking about how can they reward themselves when they accomplish X goal when they do Y and you know if they're in treatment we can offer certain rewards we can give social feedback we can also maybe cut some of their time down and reduce the number of hours they're coming to treatment or something but we need to make sure there's sufficient rewards and setting goals that are too specific can also backfire on you like saying I want to be CEO at XYZ company that's my goal well I may be able to be CEO at some other company eventually but I may never be able to be CEO at XYZ company because that CEO is not going to retire you know he's going to stay in there until he dies so make sure that goals are broad enough that it gives people a little bit of wiggle room common issues so anxiety and depression and we're just going to talk about applying stuff now identifying the sub goals looking at specific measurable achievable results oriented and time limited ask the person what would it be like if you weren't anxious or depressed anymore the statement you know as I have been talking about instead of saying Sally won't be anxious we're going to say Sally will be calmer or happier resulting in improved concentration increased energy improved sleep and reduced headaches so that's the goal statement and you can put numbers in there it would be ideal if you did like you know having no more than one headache a month but the knowledge and skills okay this is what she wants to do this is where she's going so how do we help her get there well first she needs to learn develop the knowledge about her anxiety and about anxiety in general what causes it and then look at her life and look at what's going on in her world and say what's causing anxiety for me then Sally needs to look at her skills and she needs to say what have I done in the past that's helped me deal with my anxiety or my depression well let's build on those those are the skills you have what resources does Sally have that she's used to deal with her anxiety or depression or that she's willing to use maybe she's got a new friend that you know she could reach out and call on when she's feeling bad so identify what skills and resources she has and then identify what skills she needs to learn you know what else does she need given her skills what she's always done and her resources you know how can we bolster that to help her deal with her anxiety or depression and she may need to learn some stuff from scratch but she may only need to learn a little bit about other things teach, discuss, role play, practice and report so you want to make sure that you get her the information you help her manipulate and process it you practice it through role plays you have her practice it in the outside world and bring it back and talk about it in session okay couple things about goal statements and then we'll wrap this up we'll refrain from all substance use now and in the future well that's great but it can't be accomplished by program discharge it's not time limited it's time unlimited now and in the future and it doesn't identify other alternatives so a better goal statement would be we'll develop alternate skills and tools to deal with stress and peer pressure in order to remain substance free for the next 30 days so she can remain in compliance with her performance improvement plan and keep her job so we're identifying what she's going to do why she's going to do it and why it matters to her that is a good goal statement the objective statement is your smaller goals here steps to get to your big goal but a lot of times I see Sally will participate in an outpatient program why to what end that's an intervention Sally will learn about coping skills to deal with distress that's the objective by participating in an IOP program that's the intervention and which will help her reduce the desire to drink that's why she cares so by working with clients to develop goals they're going to determine how they learn best how to identify appropriate sub goals and how to create an effective change plan for themselves use coupon code COUNSELOR TOOLBOX to get a 20% discount off your order this month