TPC-Journal-V3-Issue3

143 The Professional Counselor \Volume 3, Issue 3 Psychotherapy Effectiveness (2012) states the following: In contrast to large differences in outcome between those treated with psychotherapy and those not treated, different forms of psychotherapy typically produce relatively similar outcomes. This research also identifies ways of improving different forms of psychotherapy by attending to how to fit interven- tions to the particular patient’s needs. (p. 1) In other words, treatment fit is a more powerful predictor of client outcome than therapeutic modality. Perhaps Beutler et al. (2003) sums it up best: “The addition of patient-treatment fit leads to the conclusion that ‘fit’ of patient and treatment should not be ignored either in studies of treatment effects or in studies of therapeutic alli- ance” (p. 84). Despite evidence indicating the importance of treatment fit, there is a dearth of literature explaining how to conduct a brief, functional and collaborative treatment fit protocol in the first counseling session. And, although it is recognized that developing a treatment plan is advisable (Heinssen et al., 1995; Sexton et al., 1997), there is little information describing how to create treatment fit in a brief and practical format that can be used in clinical settings. Early initiation of treatment fit is especially important considering the evidence indicating that clients expect counseling to be brief (Klein, Stone, Hicks, & Pritchard, 2003), and on average attend only 3.5 sessions (Miller et al., 2006). Finally, it is recognized that counselor educators and supervisors need to develop systematic methods for teaching counselors how to build therapeutic alliance and ensure treatment fit (Budd & Hughes, 2009). The Treatment Fit Model Before describing the model, it is important for counselors to understand that either before or at the outset of the first counseling session, the client should complete an intake questionnaire that addresses a range of topics including but not limited to presenting symptoms, social support/stressors, legal, trauma, medical, illicit sub- stances, employment and educational history. Thus, when beginning the treatment fit process the counselor is interested in the client’s intrapersonal responses to the aforementioned issues gleaned during intake. Once the intake is completed, the treatment fit process can begin. This treatment fit model (TFM) is a modified version of several existing models (Boffey, 1993; Fong, 1993; Heinssen et al., 1995; Meichenbaum, 2002), but redesigned and enhanced to accomplish several tasks: (a) gather information about the client’s concerns, goals and treat- ment options, (b) determine how the client’s concerns form multiple intrapersonal perspectives, (c) provide the client with a written summary of concerns, goals and treatment plan, and (d) use the model as a psychoeduca- tional tool to help the client see how emotions, thoughts, behaviors and physiology interact, which can help the client recognize symptoms and develop coping skills before issues become overwhelming. Facilitation of Treatment Fit Model All three of the components, referred to as steps in the treatment fit process, can be accomplished within one 50-minute counseling session using the model in Table 1. Within each of the three steps—assessment, goals, and treatment plan—information is gathered about the client’s intrapersonal domains of emotions, cognitions, behaviors and physiology (e.g., racing heart, cold hands) to ensure a comprehensive understanding of the cli- ent’s issues and goals so a tentative treatment plan can be co-created with the client. As seen in Table 1, several theories are integrated into and used with this model to facilitate each step. Although the theories and techniques described in this article have been used by the authors to effectively facili- tate the treatment fit process, they are not meant to be prescriptive. Instead, integrative theoretical approaches will vary depending upon the needs of the client and skill level of the counselor.