Treatment tracking is important because it gives you a baseline, and therapists can use repeated assessment to track progress and re-plot the course when things get off track.

The Client

Imagine walking into a therapist’s office seeking services to deal with a so-called problem or issue you have. You walk in with immense nervousness and torpidity, you feel you want it to be over before it even begins. You find yourself sitting on a sofa across from a stranger and all you’re thinking about is what you’re supposed to say or do.

But then, the stranger across from you starts to speak and describes an entire process of how therapy generally unveils. You hear about confidentiality, possible therapeutic styles and interventions, and length of treatment. You begin to feel a bit comfortable and start to relax. This information starts to ease your discomfort and the picture begins to appear clearer about what you’ve gotten yourself into.

The Psychotherapist

Now, as a therapist, your view of the client is different from where you may be sitting. You may see a person walking in holding 2,500 pieces of a puzzle that needs sorting out. After you have given your speech about confidentiality and what they can expect from therapy, you put on your listening hat to see what’s going on and come up with a method that would work best for this particular client.

Why tracking progress is so important

There are many ways you can approach a client and assist with putting the puzzle pieces together. For instance, some folks like to start with collecting all the sides and corners then begin putting it together. Others prefer selecting a specific part of the puzzle and commencing with that or just simply starting in the middle and working your way out to the sides.

Any method you choose as a therapist will depend on the client, what they are most comfortable with, and your preferred method of working. Over time you may want to check in with the client to see if a method you’re using is continuing to benefit their progression in putting the puzzle pieces together.

Many times, you both begin with an outcome in mind, like the completed image on the puzzle box. However, how do you get there, and how do you show evidence of getting closer to your destination?

Sometimes, the process slows down. What if you can’t find a piece of the puzzle? How could you keep moving ahead? What if you get stuck and become unclear about which methods to implement next?

Well, maybe with a tracking device or tool you could detect where you are and where to go from there. Having a symptom analysis system could help prevent you and your client from feeling stuck, and it could substantially reduce ambiguity.

Using a checklist of symptoms associated with client complaints that is inclusive of rating scales can give tangible evidence about areas in which the client continues to suffer. Once identified, the therapist can adjust and target areas that would alleviate or reduce those specific symptoms.

Although you started with a particular way of working that was helping, there may be a point you reach where things appear immobile. If it comes to this point, you may need to switch your method.

What worked beautifully in the beginning may not be the method for the present. As you recognize this, you can apply other methods to further move your client along. With tangible evidence of progress (e.g., utilizing symptom checklists), both client and therapist can remain on track for successful outcomes.

What methods work best?

Now that you have an idea of why tracking progress could be crucial to successful treatment outcomes, let’s look at methods you can use.

There are a multitude of ways to track progress. The one that works best is largely dependent on the types of symptoms that clients present with. The most standard approach for years has been a written treatment or service plan with goals and objectives identified by clients.

Psychotherapists may determine progress based on achievement of goals with quarterly updates to the goals. Another approach in the most recent years has been a combination of treatment plans and the use of rating scales and other short standardized assessments to track symptoms over time.

Today, psychotherapists can also incorporate mobile apps as symptom tracking devices for daily use by the client. Self reports, along with standardized assessments and apps, can make for a powerful combination in tracking treatment progress.

Think about the population you treat and symptoms most relevant to your practice. For example, I generally work with children, adolescents, and adults with common complaints of anxiety, depression, and symptoms of post-traumatic stress disorder. I use the Revised Children’s Anxiety and Depression Scale (RCADS) to track treatment progress.

At the start of treatment, I provide the child and parent with the assessment. Once completed, I use the computerized scoring system which gives scores for each cluster of symptoms along with identifying whether or not the child’s symptoms meet borderline or clinical ranges. I share results with parents and the child to provide a baseline for symptoms and use it as a starting point to provide psychoeducation. Within approximately 6-8 weeks, I have the family complete another set of RCADS and review to see if treatment is working as evidenced by a reduction in scores, deteriorating as evidenced by an increase in scores or remains the same.

Self reports and observations by others close to the client can also be useful tools when tracking treatment. With this method, if a client is not showing progress, I would change my method of intervention, update the treatment plan and make adjustments on my end in order to see different results. Other scales I prefer to use include UCLA PTSD Index, CAPS-5 (to track PTSD symptoms), Beck’s Depression Inventory (BDI), and Beck’s Anxiety Inventory (BAI).

At times, I will also use the Child’s and Adolescent’s Needs and Strengths Assessment (CANS) as well as the Ohio Scales for behavioral and conduct concerns. I also incorporate the Stigma app for those dealing with mood related issues. Most clients will share results of the app during sessions and feel more in control of their own progress in treatment.

Over time, you and your clients will start to see the puzzle coming together, beautifully eliminating any sense of ambiguity and empowering clients to move forward feeling good about their successes in treatment. You can also move ahead with a sense of knowing whether treatment is working based on the evidence you collect over time, and by being aware of when to make adjustments to get better results. Austerity and design are two valuable skills that therapists use to embark on successful and fulfilling journeys with their clients.

In the long term, you’ll figure out an individualized way to help others find relief from daunting symptoms, and with careful planning, you’ll be successful at providing tools to individuals who seek your services.

The secret to tracking treatment progress is planning. Keep in mind the population with which you work and common types of complaints you hear when choosing your intervention methods. Incorporate a clear, solid treatment plan, choose a couple of standardized assessments that are user-friendly with strong reliability and validity factors, and set a time frame for when you repeat assessment to track treatment progress.

Remember to always provide an assessment and rationale in the beginning to formulate a baseline, then track and share results with your clients on their journey. With your help, the client will move toward recovery.

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Dr. Nazo Shamal

Dr. Nazo Shamal

What shapes and defines us depends on where we’ve been, where we are, and where we’re headed. I started out my early years of life escaping with my family from a war-torn country and making it out alive. A country with little educational opportunities for young girls let alone stable living conditions. Today, I hold a doctorate in psychology, a master’s in social work, and bachelors of arts in science; licensed to practice in the state of Hawaii and Virginia. There is no ocean left unconquered by the brilliance of resiliency in human nature. This belief I carry led me to work with children and adolescents experiencing complex trauma and ongoing unstable life conditions. It led me to work with families new to the country experiencing issues with adjustment and acculturation. Fourteen plus years of clinical practice gave me an opportunity to supervise and manage therapeutic programs, continue to practice psychotherapy and build my own mental health consulting services. Today, I continue to work in the private and non-profit sectors continuing to provide services to children and families, adolescents and adults with varying backgrounds.
Dr. Nazo Shamal

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