The Behavioral Medicine Treatment Planner
Claiborn, James Phd, Abpp, Journal of Cognitive Psychotherapy
The Behavioral Medicine Treatment Planner Douglas DeGood, Angela Crawford, and Arthur Jongsma. New York: John Wiley & Sons, Inc. (www.wiley.com). 1999, 225 pp., $175 (softcover).
The Behavioral Medicine Treatment Planner by Douglas DeGood, Angela Crawford and Arthur Jongsma is the latest in a series of treatment planning guides from Wiley. The series began with The Complete Adult Psychotherapy Treatment Planner. This newest volume is intended to serve practitioners in behavioral medicine. The publisher has responded to what is perceived as a change in the practice of psychotherapy and related work including a rise in demand for accountability. Practitioners must justify their planned interventions to managed care reviewers or other overseers of our work. This book is designed to be a tool for the behavioral medicine practitioner to use in developing the treatment plans and justification needed to get authorization or payment for services provided. One might expect it might also aid in conceptualizing the problem and goals of treatment. The authors note that the application of cognitive behavioral interventions has been rapidly expanding into the area of health care, creating the field of behavioral medicine or health psychology.
When I set out to review this book I was faced with a bit of a problem in my own conceptualization process. Typically, if I am going to review a book I will begin by reading through it. However, this treatment planner is not a book one would sit and read. It is meant to be a desk reference to be consulted when developing treatment plans and the result is that to review it, I need to describe how that consultation process would work.
The book consists of an introductory chapter, which lays out the authors' recommended approach to treatment planning and use of the guide, followed by an alphabetical set of chapters focused on specific disorders. We are offered material ranging from Acute Pain to Sickle Cell Disease. Although the title refers to behavioral medicine and the preface mentions cognitive behavioral psychology, the authors seem to have a much more eclectic focus than I would have expected. They attempt to offer suggestions in treatment planning which would fit with approaches including cognitive, behavioral, psychodynamic, family systems, and solution-focused models. The book also contains bibliographical suggestions on the topics in the same alphabetical order as the chapters.
The authors have attempted to force clear thinking about outcomes required for the managed care world. They note that the vague agreement to talk honestly rather than to focus on significant goals will no longer serve. Those of us doing cognitive behavioral work have been trying to focus on definable goals all along, so while I am not adverse to someone offering help with this formulation, it seems to fall a little short of the mark. As I understand a cognitive behavioral approach, we need to begin with conceptualization of the person and the problem. This has been described eloquently in some of the important books on cognitive therapy (J. Beck, 1995; J. Persons, 1998). This treatment planner, however, doesn't offer the kind of conceptualization I was looking for.
Each chapter begins with "Behavioral definitions" of the problem. For example, in the chapter on chronic pain there are 11 definitions offered. They include:
1. Persistent pain of more than three months duration.
2. Reduction (or complete loss) in ability to engage in normal daily social, vocational, and recreational activities.
3. Erroneous beliefs about the causes and treatments for pain.
Next we are presented with a selection of long-term goals. In the chronic pain chapter this list of 10 goals includes: