TREATMENT GUIDELINES
1. The treatment approach used should be appropriate for the individual diagnoses and assessment. Co-morbid conditions should be considered in the development of the overall treatment plan.
2. Within the limits of the resources of the client and the center, the treatment should be provided at the level of intensity indicated by the client's condition and acuity. The treatment setting should represent the level of care that is both the least restrictive setting, and that can provide treatment intensive enough to optimally treat the client's condition. Outpatient visits should vary in frequency and duration, ranging from intensive outpatient treatment (multiple visits per week) to maintenance schedules (monthly, quarterly, or PRN visits). The treatment schedule should be part of the treatment plan.
3. The therapeutic relationship is the foundation of all effective interventions. The therapeutic relationship should be facilitated through the use of empathic methods in addition to structured therapeutic interventions. Therapeutic alliance should be considered in client placement and transfer decisions. When therapeutic alliance is threatened, the therapist should consider clinical supervision. Transfer to another therapist may be indicated.
4. The primary therapist should be aware of the psychiatric medications the client is taking and should communicate problems to the medical staff.
5. The practitioner should practice only in areas in which he/she possesses proper credentialing and/or training, or is developing skills with appropriate supervision.
6. Consideration of individual needs should be primary in selecting the model of intervention to be utilized. This selection should be made in a thoughtful manner taking into consideration the individual assessment. Some psychiatric conditions respond best to specific therapeutic interventions, and efforts should be made to provide those interventions.
7. Treatment should be provided in a manner that is appropriate to the cultural background of the client. When indicated, this may include referral to, or consultation with a practitioner with specific knowledge of the culture of the client.
8. Therapeutic boundaries are the bedrock of effective therapeutic relationships.
8.1 The therapist should establish boundaries which include the following:
- empathy for the client
- clear and articulated roles and expectations
- confidentiality of treatment
- advocacy for the client
- supervision by third party when indicated
8.2 The therapist should work to establish boundaries that exclude the following:
- any behavior that meets the therapist's needs at the expense of the client
- exploitation
- punishing/withholding behaviors of therapist which derive from counter- transference issues
- any romantic or sexual behavior
8.3 In these instances, clinical consultation should be sought to insure that clients are not exploited in any way or that the relationship continues to be therapeutic:
- romantic attraction
- countertransference conditions (intense emotional reactions)
- over-involvement
- social relationships
- client regression/dependency
- excessive therapist care-taking
9. The treatment plan should be developed in collaboration with the client in terms easily understood by the client. When appropriate, families and partnering agencies should be included in the treatment planning process. Families should be given the number of the local chapter of the National Alliance for the Mentally ill for information and support.
10. Access to services should be addressed in the treatment planning. The treating agency and clinician should work to remove all barriers possible. Examples may include scheduling accommodations, or provision of transportation or child care.
11. The treatment should work actively towards goal resolution. Goals should be completed or revised actively. Termination from treatment should be worked towards when appropriate, and should be discussed during therapy sessions.
12. In addition to goals for symptom change, the treatment should address environmental interventions that would benefit the client's quality of life. Examples include communicating with landlords, facilitating a change in housing, or working for family accommodations with the client. The therapist should possess a working knowledge of community resources. The therapist should refer the client to case management, as appropriate.
13. When appropriate, psychosocial rehabilitation, which works towards the restoration of social and occupational functioning, should be part of the treatment plan of persons with serious and persistent mental illness.
14. Clinical supervision by colleagues or formal supervisors is always optimal. Clinicians working towards licensure should seek supervision in all aspects of a case. Any therapist should seek supervision in the following instances:
HESE GUIDELINES
HAVE BEEN DEVELOPED BY:
THE UTAH PREFERRED PRACTICE CONSENSUS PANEL
UNDER THE AUSPICES OF THE UTAH
DIVISION OF MENTAL HEALTH
APPROVED AUGUST 15, 1997