Treatment Planning and Interventions · Capstone

What the Stall Is Telling You

Six stalled treatments, read against the clinical indicators rather than against a label. Then one case where the protocol says advance and the formulation says something else, and you write what you would do.

What this exercise practises

Treating a plateau as clinical data, telling the six stall types apart from what has actually changed in the treatment, and holding the difference between fidelity to an intervention and adherence to its sequence.

Two of the six look alike until you ask what altered. In one the client's situation changed; in the other, what the clients were willing to tell you changed. One of the six was built into the treatment plan at session two.

Estimated time to complete this exercise: 30 minutes

1Six stalls
2The protocol
3Close

Before you begin

How this one works

Six stalled treatments. For each one, identify which of the six stall types it is from the clinical indicators.
The shelf gives you the indicators rather than the investigative question, so the reading is done against what has changed in the treatment rather than against a label.
Two of the six look alike until you ask what altered. In one of them the client's situation changed; in the other, what the clients were willing to tell you changed.
The last part asks you to write. It is required to continue, and it stays in your browser.

A stalled treatment is almost always information, not failure. When progress has plateaued or reversed, the appropriate clinical response is not to escalate the intervention, increase pressure on the client, or attribute the difficulty to insufficient motivation. It is to return to formulation and ask what the stall is telling you.

References

  1. Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press.
  2. Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.