The treatment process for therapy involves a number of stages. As you know, treatment begins when the social worker first meets the client and it continues through assessment, treatment planning and ends at the termination stage. The following information will assist you in understanding each stage of the treatment process.
Intake and Engagement Stage:
Identifying the client’s presenting concern or problem. The goal of the initial engagement is to establish rapport and obtain information from the client about their problems or concerns. During this stage, the social worker must consider the client’s feelings as the client is maybe ambivalent, skeptic, distrust, have concerns about the cost, etc. Consider mandated or involuntary clients who are referred to treatment against their will. Most often, these clients may demonstrate feelings of anger and resentfulness. Never ignore these feelings. Instead, acknowledge their feelings. You may ask the client about their feeling regarding receiving treatment/services that they don’t want to do or deemed unnecessary. Inform consent form is provided and the client is aware of their rights to confidentiality and the exceptions. Inform consent reinforces ethical principles of self-determination, autonomy, and respect.
Information is gathered to better understand the client’s situation, their unique strength, and challenges. During the assessment stage, the social worker is gathering information relating to all the areas of the person’s life. There must be an understanding of who the client is and their presenting concerns/issues. The assessment process may include social worker’s observation, speaking with collaterals, reading the client’s records, and using assessment instruments. The assessment process is ongoing as progress is monitored to determine if the intervention has been effective and whether the desired goals are being achieved.
Planning and Contracting Stage:
Social worker and client collaboratively work to formulate the goals and objectives which are generally based on what has been determined by the assessment. The collaborative work will allow the client to be included in identifying and agreeing on their goals. Client’s goals may vary based on the nature of the problem. Clients may have various concerns or issues, that they are expecting to be addressed. In this case, the social worker must assist the client with prioritizing (partializing) their needs. Inquiring what is most important to the client promotes the principle, of self-determination. The social worker may also offer to assist the client with concerns needing attention while providing an explanation.
Termination is the conclusion of the social worker-client relationship. If goals are achieved, the client can be terminated. The social worker and therapist review what was accomplished. Termination can be initiated by the social worker, clients or the agency and it can occur for a variety of reasons such as:
- The client has achieved all goals
- The client is no longer interested in services
- When the client’s problem is beyond the social worker’s expertise
- Due to personal reasons such as relocation, retirement, illness, changing practice, impairment, or death.
- A client who is non-compliant with treatment
- When threatened or endangered by the client
- The client has not made progress towards treatment goal
- Conflict of interest has been identified
- The client has not made payments
- Before terminating clients for nonpayment, the social worker must ensure that the client has been made aware/ reminded of the financial contractual agreement that was discussed during the inform consent process. The client does not pose harm to self or others and that the client has been informed of the consequences of non-payment such as disruption of treatment or interruption of services. (Review the NASW Code of Ethics 1.16c). If the client is in crisis, the social worker must postpone the termination until appropriate steps are taken to address the crisis.