ABSTRACT
Based on a realistic and appropriate treatment formulation, the clinician’s next task is to implement the intervention plan. Presumably, this process is guided by an implementation strategy reecting the treatment focus. This chapter addresses establishing and maintaining the treatment focus and handling treatment-interfering factors that impede the process of implementation. Basically, a treatment focus is the clinician’s central therapeutic emphasis within and across sessions. Guided by the clinician’s conceptual map, the treatment focus is analogous to utilizing a spotlight, which illuminates a circumscribed area, rather than a oodlight, which illuminates a broad area. This focus and a therapeutic strategy (i.e., an action plan) guide and give direction in achieving treatment goals. Not surprisingly, focused treatment fosters the therapeutic change process and is associated with positive treatment outcomes (Goldfried, Raue, & Castonguay, 1998). Although establishing such a focus is relatively easy, maintaining it can be quite challenging. Because clients’ lives are complex and changing, they will want to discuss and process recent issues and concerns unrelated to the treatment focus. The challenge is for the therapist to “track” the treatment focus and “stay the course” despite digressions from the initial focus. “There is now a convincing body of empirical evidence indicating that therapist ability to track a problem focus consistently is associated with positive treatment outcomes” (Binder, 2004, p. 23). Needless to say, highly competent and effective therapists are considerably better at “staying on track” than are trainees and less effective therapists.
