3.B.3
Building the plan with the client and others
ASPPB's competency statement 3.B.3: Appropriately integrate client or stakeholder (e.g., family, justice systems, school) opinions, preferences, readiness to change, intervention history, and improvement potential into the treatment/intervention plan
A good plan reflects what the client wants and can do, not only what the evidence favors. Psychologists weigh the client's opinions and preferences, readiness to change, past treatment and how it went, and realistic potential for improvement. They take account of stakeholders such as family, schools or courts while keeping clear who the client is and what will be shared. Accommodating preferences is linked to fewer dropouts and somewhat better outcomes.
Key ideas
- Preferences
- Across 53 studies, clients given a preferred treatment or condition dropped out less (odds ratio 1.79) and did somewhat better (d = 0.28); the effect did not vary with client age, gender, ethnicity or education (Swift and colleagues, 2018).
- Readiness
- Match the opening of treatment to the stage of change. When a client is ambivalent, motivational interviewing draws out the client's own reasons for change before planning action (Miller and Rollnick, 2013).
- Intervention history
- Ask what was tried, for how long, how it was delivered and why it ended. A treatment that 'failed' may have been incomplete or poorly matched, which is part of the patient characteristics evidence-based practice weighs (APA Presidential Task Force, 2006).
- Improvement potential
- Set goals that are ambitious but reachable by weighing what bears on prognosis, such as severity, supports, prior response and readiness, which related to outcome across 76 studies (Krebs and colleagues, 2018).
- Stakeholders
- When a third party requests services, clarify at the outset the psychologist's role, who the client is, the probable uses of the services or information, and possible limits to confidentiality (APA Ethics Code, Standard 3.07).
Worked example
A 45-year-old accountant with social anxiety disorder asks for individual therapy. Two years ago she left a CBT group after two sessions because speaking in front of strangers felt overwhelming. She wants to speak up in meetings before a promotion review in six months, and her husband asks to join the sessions 'to help her open up.'
- History: explore why the group ended. Leaving after two sessions means she never reached the core of treatment, so CBT itself has not been tried and failed.
- Preference: offer individual CBT as she asks; accommodating preference is linked to fewer dropouts, which matters given how her last treatment ended.
- Readiness and potential: a concrete goal and a deadline suggest she is preparing for action, so build the plan around practice in meetings, aimed at the review.
- Stakeholder: ask her privately whether and how she wants her husband involved, and agree what would be shared, rather than adopting his plan by default.
Preferences, history, readiness and others' wishes shape how an evidence-based treatment is delivered, with the client's own goals at the center.
Check yourself
Which finding best supports offering a client the therapy format she prefers when the evidence-based options are otherwise similar?
Sources
- Swift, Callahan, Cooper and Parkin (2018), The impact of accommodating client preference in psychotherapy: A meta-analysis, Journal of Clinical Psychology (PMID 30091140), Abstract; effects and moderators
- Miller and Rollnick (2013), Motivational Interviewing: Helping People Change, Third Edition, Part I, ambivalence and evoking change talk
- APA Presidential Task Force on Evidence-Based Practice (2006), Evidence-based practice in psychology, American Psychologist (PMID 16719673), Patient characteristics, culture and preferences
- Krebs, Norcross, Nicholson and Prochaska (2018), Stages of change and psychotherapy outcomes: A review and meta-analysis, Journal of Clinical Psychology (PMID 30335193), Abstract; readiness and outcome
- American Psychological Association (2017), Ethical Principles of Psychologists and Code of Conduct (2002, amended 2010 and 2016), Standard 3.07, Third-Party Requests for Services