ABSTRACT
One of the characteristics of a highly effective case conceptualization is coherence among its components. In my experience, if a lack of coherence or consistency is noted in a case conceptualization, it is most likely to be between the clinical formulation and the treatment formulation components. One of the fortunate and unfortunate effects of managed care is the standardization of treatment plans (Jongsma, 2006). The fortunate effect is that treatment plans today are likely to specify particular treatment targets with particular interventions and sometimes even a plan to monitor progress. The unfortunate effect is the extent to which many trainees and practicing therapists have uncritically adopted this standardized treatment mind-set. The result is there is a remarkable similarity in treatment plans. It is not unusual to review several charts of clients in the same clinical setting and find that most of the treatment plans are surprisingly similar. In my role as a consultant to various mental health clinics , I might pull and review 20 charts in a particular clinic. Among those charts there might be 12 clients with the DSM diagnosis of major depression. In reviewing the clinical case reports, sometimes called initial evaluation reports, I would turn to the treatment plan section and often would find an almost identical treatment plan for at least 10 of the cases. The plan
would usually include medication evaluation and monitoring combined with Cognitive-Behavioral Therapy keyed to the treatment objectives of symptom reduction, behavioral activation, and return to baseline functioning. Needless to say, therapists may have to undergo some unlearning to become reasonably effective with treatment and intervention planning.
