Running head: TREATMENT PLANS 1
Treatment planning is crucial to the effective and ethical application of counseling
services (Gehart & Tuttle, 2003). They are created with the intention to convey the counselor’s
proposed strategies, client’s concern/goals, and experienced symptoms by way of an organized
and systematic document (Gehart & Tuttle, 2003). Treatment plans can take many forms and are
to be continuously updated and revised throughout the three phases of counseling: early, middle,
and closing/termination (Gladding, 2015). Though flexible in format, there are two basic
classifications of treatment plans: Symptom-based and Theory-based (Gehart & Tuttle, 2003).
Herein, Symptom-based plans are developed from a medical perspective where by symptoms are
identified, measurable goals are set, and therapeutic interventions are detailed (Gerhart & Tuttle,
2003). It is important to note that symptoms in this context are strictly defined in a psychiatric
sense. The second form of treatment planning is Theory-based. These plans are derived within
the context of a therapeutic model and incorporate a broad range of information including a
greater overview of the problem, socio-cultural influences, client perspective, and the
counselor’s theory (Gerhart & Tuttle, 2003). Using the perspectives of Bowenian and Structural
Family Therapy, the following are simulated Theory-based treatment plans written on behalf of
the volunteer family Adrian, Judy, and Pam.
Bowenian Family Therapy Treatment Plan
Problem: Pam is an adult woman living with her aging parents, Adrian and Judy.
Pam experiences an undefined developmental disability and struggles with
openly and clearly communicating- predominately related to emotions and
feelings. According to Adrian and Judy, Pam will often exhibit aggressive
behaviors and thus it is believed that she experiences a great deal of
Commented [LS1]: Excellent introduction – just be sure to cite any media used.
Commented [LS2]: Use APA heading format
unresolved anger/resentment towards her parents. There is a clear
maladaptive triangle wherein Adrian and Judy’s marital relationship is
neglected because their focus remains heavily rooted in the anxieties of
their daughter’s behaviors and symptoms (Gurman, Lebow, & Snyder,
2015). Pam lacks a meaningful social support network. The family at large
lacks general insight around Pam’s behaviors, including Pam herself. All
three individuals express anxiety, sadness, fear, and confusion around the
relationship patterns; there is love and a desire to be better connected
amongst all three members.
Early Phase Goals:
1. Create a therapeutic environment and a genuine connection with the family.
a. Open the closed-system family dynamic.
b. Identify transgenerational dysfunction.
c. Identify structure, configuration, and connectedness.
2. Reduce anxiety around the stated problems, by raising Pam’s differentiation.
a. Obtain internet to allow Pam a meaningful activity.
b. Increase Pam’s access to socialization opportunities and friend base.
Middle Phase Goals:
1. Neutralize the dysfunctional triangle.
a. Improve Pam’s and Judy’s relationship.
i. Reframe how family view’s Jessie and Pam’s relationship.
ii. Set a time for Pam and Judy to spend time with one another.
1. On Pam’s time table / using Jessie’s formula.
Commented [LS3]: Excellent application of the theory in defining the problem.
Commented [LS4]: What might a Bowenian theorist call these stages?
b. Continue to address Pam’s need to increase differentiation.
i. Increase her overall independence in order to decrease her
reliance on parents.
ii. Decrease anxiety around parent’s dying.
2. Address multigenerational family dynamics.
a. Address loss of family members.
b. Address son’s suicide and associated feelings.
Closing Phase Goals:
1. Confront Pam’s fears (Guerin, 1:11:1).
a. Improved social life
b. Improved communication.
2. Confront “strong-will and strong-head” personality traits (Guerin, 1:13:56).
Theoretical Interventions & Proposed Outcomes:
1. Genogram: a graphic chart utilized to map the familial relationships and
lifecycles of a three-generational system (Gladding, 2015). Herein, the
dynamics, rules, associations, boundaries, and structural patterns within a
family are highlighted and organized (Gladding, 2015).
a. A genogram will offer a succinct and pictorial account of Adrian,
Judy, and Pam’s closed family system. It will abridge the sizable
amount of demographics and historical data that will shed light on the
intricate patterns which drive the family dysfunctions and maladaptive
behaviors (Gladding, 2015). This intervention provides an organized
Commented [LS5]: Review APA for correct way to cite – great attempt though!
tracking system and offers the counselor an opportunity to engage and
connect with the family.
2. Relationship Experiments: tasks assigned, by the counselor, to each individual
family member in order toto initiate the process by which dysfunctional
patterns are reframed and diluted (Gladding, 2015).
a. After a counselor has successfully identified the maladaptive life
cycles and patters that cause distress within the family system, targeted
tasks can be ascribed with the intention of rebuilding new and
Structural Family Therapy Treatment Plan
Problem: Adrian and Judy are generally frustrated by the therapeutic process. Their
goals have not been met within their previous sessions and not enough
improvement has been made. The parents of Pam, their adult daughter, do
not feel that Pam communicates in a positive and healthy manner. Pam has
a tendency totends to react violently out of pent up anger but is unable to
appropriately express her emotions and their inception. It is believed by
tThe family believes, that Pam is more aggressive and more easily angered
by Judy rather than Adrian. Judy expresses frustration by this disparity.
Pam relies heavily on her parents to provide her basic Activities of Daily
Living such as meal preparation. This is an area of contention between
Pam and Judy. It is a collective belief that Pam is spoiled by her parents.
When she does not get her way, Pam will experience a tantrum-like
behavior. Commented [LS6]: Good work applying the theory.
Early Phase Goals:
1. Joining and Accommodating: establish the counselor as the leader while
adapting to the family’s patterns and worldview.
2. Mapping Family Structure: identify primary systemic patterns of interaction.
a. Focus on day-today interactions in order to shed light on family’
underlining conflicts- primarily between Pam and Judy
b. Compare these transactional patterns to those of Pam and others: such
as co-worker, supervisor, friends, etc.
Middle Phase Goals:
1. Highlight appropriate boundaries.
a. Redistribute power and alter the hierarchical relationship between Pam
b. Improve problem solving skills.
i. Provide psychoeducational training on conflict management
2. Identify the family subsystems.
a. Covert coalition
Closing Phase Goals:
a. Improve communication between all members of the family.
b. Repetition of message.
i. Do not allow Pam to dictate transactional patterns.
Commented [LS7]: How might a structural family theorist label the stages?
2. Reestablish appropriate and healthy boundaries.
a. Pam will ask her parents to maintain boundaries and to not give into
her spoiled tendencies.
b. Start with small day-today tasks such as making breakfast on Sunday
Theoretical Interventions & Proposed Outcomes:
1. Spontaneous behavioral sequences: an intervention wherein a counselor hones
in on unprompted interactions between family members. These scenarios
provide a glimpse into the natural mannerisms and interactions between
family members (Gerhart & Tuttle, 2003).
a. When a spontaneous interaction occurs, a counselor focuses on the
relational process and assists the family in understanding their
behavioral sequences (Gerhart & Tuttle, 2003). A counselor will direct
these interactional patterns towards a healthier and mutually beneficial
2. Enactments: similar tolike spontaneous behavioral sequences, enactment is a
technique wherein the counselor directly tasks the family with reenacting
natural behavior/interactions in order to observe their genuine and unaltered
exchanges (Gerhart & Tuttle, 2003). Enactments provide the counselor with
the opportunity to make assessments regarding the familial structure,
subsystems, and transactional patterns (Gerhart & Tuttle, 2003).
a. The use of enactments presents an opportunity for counselor
observation, assessment, and confrontation as well as client reflection,
and response (Gerhart & Tuttle, 2003). This intervention is also useful
in allowing the counselor an opportunity to provide the family with
alternative behaviors, communication patterns, and interactions.
Treatment plans should consist of two components: goals and interventions (Gerhart &
Tuttle, 2003). While traditionally following basic outlines and formats; they are also individually
tailored to the client’s needs and the counselor’s theoretical approach. In addition to the
theoretical model, presenting problem, and proposed interventions/goals, treatment plans should
also provide contextual information such as separating a parent’s needs from that of their child’s
(Gerhart & Tuttle, 2003). In general, a treatment plan that is well structured and written
irrespective of third-party mandates for reimbursement, creates opportunity for organized and
coordinated efforts as well as effective treatment probabilities (Gerhart & Tuttle, 2003).
Commented [LS8]: Excellent work.
Gehart, D. R., & Tuttle, A. R. (2003). Theory-based treatment planning for marriage and family
therapists. Belmont, CA: Brooks/Cole.
Gladding, S. T. (2015). Family therapy: history, theory, and practice (6th ed.). Boston: Pearson.
Gurman, A. S., Lebow, J. L., & Snyder, D. (2015). Clinical handbook of couple therapy (5th
ed.). New York, NY: Guilford Press.
Psychotherapy.net. (Producer). (n.d.). Bowenian family therapy [Motion picture]. [With Philip
Guerin, MD]. United States: Psychotherapy.net. Retrieved from the Walden Library
Psychotherapy.net. (Producer). (n.d.). Structural family therapy [Motion picture]. [With Harry
Aponte, LCSW]. United States: Psychotherapy.net. Retrieved from the Walden Library
Excellent application. I could clearly see how you were applying the theories and that
you could differentiate the theories as well. Well done.
Commented [LS9]: Remember that citations and references must match. Also, in APA, when two citations are the same, you must distinguish which citation represents which reference by using
a lowercase letter in the year. See APA manual for when and how to do th