Staff Perspective: The Treatment Rationale - Blueprints of Psychotherapy

Staff Perspective: The Treatment Rationale - Blueprints of Psychotherapy

Imagine that you want to build a house -- or better yet, that you NEED to build a house to get respite from the elements and to feel safe and comfortable. Unsure where to begin, you seek out a builder to help guide you in this process. You might feel a sense of trepidation. What if this builder doesn’t understand your needs or the kind of house you’re hoping for? Worse yet, what if the houses they build aren’t solid, long-lasting, and sound? Now imagine meeting with that builder and getting vague and confusing details about the building plan with no glimpse of a blueprint, but having to consent to the project. Oh... and you also are required to put down a significant deposit.

Would you move forward with the project? How confident would you be in this builder? How motivated would you be to work with them?

Now imagine that you are a Service member or Veteran seeking therapy -- hoping to get respite from the symptoms and suffering that you are experiencing. Unsure of where to start, you seek out a therapist with a sense of trepidation. What if this provider doesn’t understand what you are going through? What if they don’t know how to effectively treat the symptoms you are experiencing? What if they don’t provide details about what treatment will entail and the reasons behind the strategies used?

Would you engage in treatment? How confident would you be in this therapist? How motivated would you be to work with them?

As mental health providers we are the builders and it is incumbent upon us (not to mention ethical) to use evidence-based psychotherapies (EBPs) and to educate our patients regarding how an EBP specifically targets the symptoms and presenting problems that they are experiencing. This can be especially critical for military-connected patients who may be hesitant to initiate psychotherapy to begin with and might align with better with a provider who is able to articulate the “mission” within a treatment protocol. The good news is that every EBP includes a very clear and detailed “blueprint” that we can share and discuss with our military-connected patients to ensure that they fully understand and consent to our “building” process. This blueprint is also known as the treatment rationale.

Delivering an effective treatment rationale sets the foundation for therapy and allows the client to:

  • Provide informed consent as an educated consumer  
  • Understand how the mechanisms of treatment correspond to the perceived etiology of their symptoms​
  • Evaluate the credibility and value of a treatment approach and determine if it is consistent with his/her treatment goals/mission
  • Consider the costs and benefits of the treatment

In addition, engaging in a discussion about the treatment rationale allows us as therapists to gain a better understanding of a client’s beliefs about and expectations for treatment.

Despite the importance of delivering an effective treatment rationale, therapists -- especially those just learning an EBP -- describe this as a challenging task. We often hear in consultation that delivering the treatment rationale the first few times can feel inauthentic because it doesn’t use the language or style typical of that provider. Additionally, new EBP therapists can feel insecure about their skills and abilities to deliver the treatment contributing to a feeling of awkwardness. These feelings can be amplified if the provider is new to working with Service members and Veterans and is still learning about military culture.

What we do know is that both practice and experience ameliorate these perceived challenges and enable therapists to see the value of the rationale in setting a strong foundation for treatment. Below is a list of Dos and Don’ts to consider as you continue to hone this skill.

DO: 

  • Spend time to truly understand the rationale yourself
  • Express confidence in the treatment and your ability to deliver it effectively (even if you have to “fake it until you make it”)
  • Keep it simple
  • Find the right “dosage” -- don’t short shrift or belabor
  • Remember that providing the treatment rationale is a process
  • Incorporate your own therapeutic style and personality
  • Check your client’s understanding (asking your client to repeat the rationale back to you is highly recommended)
  • Use analogies (military-connected patients often have a wealth of experiences from their service that you can draw on where appropriate)
  • Share rationale with spouse or other member of support system (when appropriate)
  • Share rationale with other members of the treatment team to ensure all are on the same page with treatment goals and processes

DON’T

  • Lecture (find a balance between didactic and discussion)
  • Give up if your first attempt feels imperfect

So remember, reviewing the treatment rationale with your military-connected patient is a critical step in your therapy process but also take heart in knowing that you can pull out those blueprints again at any time and go over them room by room if needed. Happy building!

Jenna Ermold, Ph.D., is a clinical psychologist working as the Lead, e-Learning Strategies for the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.