Do YOU Hate Treatment Plans? You Aren't Alone (Progress Notes Survey Results, Part 5)

Do YOU Hate Treatment Plans? You Aren’t Alone (Progress Notes Survey Results, Part 5)

By Barbara Griswold, LMFT (October 9, 2019)

Thanks to the 499 of you who took my Progress Notes Survey! This is the fifth in a series of articles reporting on the survey results (if you missed the first four articles, click here).

One of the questions I asked in my Progress Notes Survey was whether or not respondents wrote treatment plans. If not, why not? If so, did they write them for all clients or just some of them, and how good did they feel about the plans they wrote?

40% of respondents said they did NOT routinely write treatment plans, while 23% said they wrote plans for SOME of their clients. This would suggest only 37% of respondents wrote treatment plans for ALL clients. Of the 257 respondents who gave a reason for not writing them, almost 50% said “I don’t see them as helpful;” the remaining 50% were divided equally between “I don’t have time” and “I don’t know how to write them.” (if you are in the latter category, check out my webinar on Progress Notes and Treatment Plans).

So, how did respondents feel about the plans they wrote? 25% of respondents said while they DID write treatment plans for some or most of their clients, they did NOT feel confident about them. Only 18% of all respondents said they wrote treatment plans and felt confident about them.

In the comments section, therapists left literally hundreds of comments, venting their feelings about (continued below graph)

(continued from above) treatment plans. Most seemed to feel plans were an unpleasant obligation, a waste of time, and not something they would write if they didn’t feel it was somehow required. Some therapists stated that they only wrote treatment plans for insurance clients, or only wrote one when an insurance form required one or when facing an insurance plan treatment review:

“I would, of course, write one up if/when it is needed by client or audit. Is that wrong?”

Many respondents said they didn’t write a formal plan, but included goals and objectives in the intake note, and/or throughout the progress notes:

“I take notes every session and document goals and interventions. It’s just not a formal stereotypical treatment plan but could easily be reformatted into a formal treatment plan because all the content is there.”
“I don’t write a treatment plan. But in my process notes, I often write what to explore or work on in the next session.”
“I’m not sure exactly what qualifies as a tx plan (ie. how much detail, how many goals/objectives, what specific format is best) so I can’t say I don’t write one. I put my brief goals in the “P” of the initial DAP note…so maybe I don’t write tx plans?”

A large number of respondents questioned the usefulness of treatment plans:

“I know insurance companies want treatment plans so they can monitor whether the treatment is effective, but I find them artificial. My clients are the ones who set the agenda for a session, not me. I may plan an intervention, but the client has other ideas…. I am a good therapist and do what I feel is best for my clients. I don’t like having a list of things I’m “supposed” to be doing with them.”
“I know this is what insurance wants, but it can be so cumbersome and I don’t find them very helpful in the end. I know what I want to do with a client but it can also change quickly depending on how their lives change.”
“I make myself write treatment plans but then I usually ignore them in favor of my sense of what the client is needing and/or willing to work on for that particular day.”
“I find therapy to be so fluid, as each session teaches me more about the client, that a treatment plan is a literal work in progress. I’m very experienced, and am comfortable adjusting my unwritten treatment plan as we proceed.”
“Sometimes my patients just want to have a safe place to open up and talk about anything they need, without judgment. They don’t have a goal, per se, except maybe to clone the type of relationship.”

Others stated that while they do write treatment plans, they weren’t sure they would meet with outside approval:

“I am confident about my plans in that that they address what my client needs. I don’t feel confident at all that insurance would accept them.”
“I’ve had United Behavioral Health argue [my treatment plans] don’t demonstrate medical necessity.”

Some lamented difficulties writing them or keeping up with them:

“I get more behind on treatment plans than on notes. Right now I have 6 that should have been written.”
“Every few months I’ll try to catch up on some treatment plans. I rarely update treatment plans once written.”
“I always write a one-sentence treatment plan in the EHR [Electronic Health Record], but only sometimes do I do a more specific treatment plan with goals and objectives and signed by the client. That one I find very difficult to do.”
“I make [treatment plans], but I don’t refer back to them like I should.”
“It’s a bad habit I’ve gotten into of not writing them nor updating them. I’ve recently begun writing them but need to do for all. I’ve made my own template on Word. I’ve printed them as templates to hand write into as I sit with each client.”

But yes, some respondents seem to either like treatment plans or have figured out how to utilize them and/or make peace with them:

“I have a habit of of renewing my treatment plan at the beginning of each calendar year. I review our work with the client, note major progresses, and clarify what needs to get done. Also, at anytime if I run into a needed change I take a note of it as being part of the treatment plan.”
“Therapy Notes [Electronic Health Records program] reminds me to update [my plan] every 3 months. I have a template that I copy and paste from to make it a 2-3 minute job for most things.”
“Therapy Notes requires writing a treatment plan in order to write future session notes. Without this I probably would fall behind. The program makes it very easy to do. I use a treatment planning book to assist me with wording and goals and objectives.”
“I use the Wiley Treatment planner that Simple Practice [Electronic Health Records program] just integrated.”
I use a form of my own devising that I THINK covers the bases. I print it on colored paper so I can see at a glance if its time to do a revision. I often do a revision because my diagnosis is changed or if we’ve moved on to new goals or therapeutic approaches or as mentioned, it’s just been, say, 5-6 months.”
“Barbara — I feel confident because I took your class on treatment plans!”

And this comment seemed to sum up the sentiments of many respondents:

“I like the idea of treatment plans and even the idea of sharing them with clients so we can stay on the same page and promote collaboration. However, to some degree they feel canned because I basically see the same type of clients and do the some subset of same predictable set of things, in a different order depending on the clients needs, so treatment plans seem partially like a waste of time. Also, I never learned the finer points of treatment planning, such as how to notate when goals change or are added, in a way that is organized and easily trackable.”

Conclusion: It would appear from this survey that treatment planning is an obligation that we therapists have trouble seeing the purpose for, or finding time for, and an area where we lack adequate training. But treatment plans are important, in that they are required by many state laws and professional ethics codes, as well as most insurance plans. If written properly and updated routinely — ideally with the client, your treatment plan can even serve as a useful therapeutic tool. To learn to write 5 minute treatment plans that can fulfill professional obligations and aid therapy, check out my pre-recorded webinar, “What Should be In Your Client Charts — But Probably Isn’t: Writing Great Progress Notes and Treatment Plans.“