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Treatment Planning in Psychotherapy


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Table of Contents

1. The PACC Approach to Treatment Planning PACC: Going beyond Randomized Clinical Trials PACC: Enhancing Accountability Guiding Principles of Our Approach
Overview of the Model
What Are the Benefits of the PACC Approach?
What the PACC Approach Is Not
Time and Cost
2. Developing a Problem List
Why Formalize the Problem List?
Domains of Functioning: A Biopsychosocial Perspective
An Outline for Biopsychosocial Assessment
Case Formulation and the Problem List
Prioritizing Problems
Reexamining the Problem List
Shortcuts for the Busy Clinician
3. Treatment Planning Using a Phase Approach From Problem Identification to Problem Solving Treatment Planning as the Therapist's Map
Treatment Phases
Effectiveness of Phase Models of Psychotherapy
Phases in the PACC Approach
Outlining Expectations for Progress within Phases
Treatment Aims
Treatment Strategies
Choosing Aims and Strategies: Case Example
Challenges in Implementing the Treatment Plan
Shortcuts for the Busy Clinician
4. Ongoing Measurement
Benefits of Ongoing Measurement
Obstacles to Routine Measurement
Completing the Measures Section of the Treatment Phase Form
Establishing a Measurement Plan
Case Study: Group Treatment for Social Phobia
Shortcuts for the Busy Clinician
5. Illustrating Progress through Graphing
Why Graph?: Rationale for Visual Inspection of the Data
Creating Graphs
Graphing Progress with Microsoft Excel
Reviewing Progress and Moving across Phases
Case Example
Research Implications
Shortcuts for the Busy Clinician
6. Review of Progress
Strategies for Implementing a Progress Review
Cultural Considerations in Conducting the Progress Review
Conducting Progress Reviews with Clients with Personality Disorders
Readiness to Change and the Progress Review
Reasons to Move to a New Treatment Phase
Seeking Consultation to Improve Treatment Delivery
When a Lapse Has Occurred
Case Example
Troubleshooting: Anticipating Barriers to Conducting Progress Reviews
Shortcuts for the Busy Clinician
7. Iterative Treatment Planning and Its Applications
The Decision Tree
Case Study: Using the Decision Tree
Ethical Implications of Using PACC
Applications of PACC
Final Comments
Appendix: Measures for Tracking Clients' Progress
Description of the Measures
Brief Psychiatric Rating Scale
Bulimia Test-Revised
Center for Epidemiological Studies-Depression Scale (CES-D)
Daily Spiritual Experiences Scale
Kansas Marital Satisfaction Scale
Psychotic Symptoms Rating Scales
Rosenberg Self-Esteem Scale
Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
Sources for Other Measures

About the Author

Sheila R. Woody, PhD, is Associate Professor of Psychology at the University of British Columbia and a registered psychologist in British Columbia, Canada. Jerusha Detweiler-Bedell, PhD, is Assistant Professor of Psychology at Lewis and Clark College in Portland, Oregon. Bethany A. Teachman, PhD, is Assistant Professor of Psychology at the University of Virginia. Todd O'Hearn, PhD, was previously Director of the Yale Psychological Services Clinic and served on the teaching faculty in Yale's Department of Psychology. Currently he is developing a private practice in the Santa Barbara area.


"This book is a marvelous contribution to the evidence-based practice movement in mental health. The authors' Planning and Assessment in Clinical Care (PACC) system helps the empirically oriented practitioner operationalize the steps necessary to identify and prioritize client problems, establish mutually agreed-upon treatment goals, and measure the outcomes of psychotherapy. PACC breathes new life into the long-advocated but little-implemented practice of integrating single-client evaluation designs into routine clinical practice. The case studies exemplify the best of evidence-based care in psychotherapy. This will make a superb primary practice textbook for graduate students in professional psychology, social work, psychiatry, counseling, and nursing."--Bruce A. Thyer, PhD, LCSW, School of Social Work, Florida State University

"This book is a boon for the practicing clinician as well as the graduate student beginning psychotherapy training or taking a course in behavioral assessment. Step by step, Woody et al. coach the reader in the use of an empirically oriented but idiographic approach to psychotherapy. Readers interested in problem-oriented psychotherapy, regardless of their specific theoretical orientation, will find much of value in this user-friendly work replete with examples of the complex cases encountered in real practice."--Dianne L. Chambless, PhD, Department of Psychology, University of North Carolina at Chapel Hill

"Woody et al. have provided a highly useful guide for clinicians of all levels of experience, regardless of theoretical orientation. The PACC model provides general strategies and concrete plans for tailoring treatment to each patient. Clinicians will find specific ideas on planning the different phases of treatment, harnessing client motivation, and overcoming pitfalls, as well as tools for assessment and progress evaluation. The Appendix includes a full range of widely studied self-report instruments that will prove invaluable."--Robert L. Leahy, PhD, Department of Psychiatry, Weill-Cornell University Medical College; Director, American Institute for Cognitive Therapy

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