3.C.3
Explaining a change of plan and deciding together
Énoncé de compétence 3.C.3 d’ASPPB : Explain the rationale for adapting or changing treatment/intervention plan with clients or stakeholders and integrate their input into the updated plan
When a plan needs to change, the client should understand why and help shape what comes next. The psychologist shares what monitoring or new information shows, explains the options and their evidence, hears the client's concerns and preferences, and agrees on the revised plan. When others have a stake, such as parents, a school, an employer or a funder, the psychologist decides with the client, within consent and law, what they are told. Consent continues through treatment.
Notions clés
- Consent as the course changes
- Consent to therapy covers its nature and anticipated course (APA Ethics Code, Standard 10.01a), so a change of course is the moment to explain the new direction and seek the client's agreement to it.
- Shared decision making
- The three-talk model: team talk offers support and elicits goals, option talk compares alternatives using risk communication principles, and decision talk reaches a decision reflecting informed preferences (Elwyn and colleagues, 2017).
- Repairing strain
- A proposed change can strain the alliance. Inviting the client's reactions and resolving ruptures relates to better outcomes (Eubanks and colleagues, 2018).
- Stakeholders and disclosure
- Disclose to others with the client's consent unless law mandates or permits otherwise (Standard 4.05), and include only information germane to the purpose (Standard 4.04a).
- Changing to a referral
- If the client needs services the psychologist cannot provide, psychologists provide pretermination counseling and suggest alternative service providers as appropriate (Standard 10.10c).
Exemple commenté
A 29-year-old graphic designer is seen through her employer's assistance program, which funds six sessions of counseling for work stress. In session 3 she discloses months of cutting when overwhelmed and intense swings of emotion, and the psychologist judges that she needs a longer, specialized program.
- Share the reason: explain what she has described, why it calls for more than six sessions of stress counseling, and what a specialized program would offer, such as skills for managing emotions and urges.
- Use option talk: describe the programs available, their evidence, waiting times and costs, and ask what matters to her, such as privacy from her employer.
- Decide together, including a safety plan for the weeks before the new program starts and a direct introduction to the new provider.
- Agree on what the assistance program will be told: with her consent, perhaps only that a referral was made, and nothing about the self-harm.
Explain why the plan is changing, decide the change with the client, and share with others only what the client has agreed to and the purpose needs.
Vérifiez vos acquis
In the three-talk model of shared decision making, what is the task of 'option talk'?
Sources
- American Psychological Association (2017), Ethical Principles of Psychologists and Code of Conduct (2002, amended 2010 and 2016), Standards 4.04(a), 4.05, 10.01(a) and 10.10(c)
- Elwyn, Durand, Song and colleagues (2017), A three-talk model for shared decision making: multistage consultation process, BMJ (PMID 29109079), Results; team, option and decision talk
- Eubanks, Muran and Safran (2018), Alliance rupture repair: A meta-analysis, Psychotherapy (PMID 30335462), Abstract