Step 1 Problem Selection: Step 2 Problem De?nition: Step 3 Goal Development: Step 4 Objective Construction: Step 5 Intervention Creation: Step 6 Diagnosis Determination: Putting It in Practice 10.21. Gain the most complete understanding of client problem possible, given the limits of time; client expressive abilities; and client awareness. Use Lazarus’s BASIC ID or some other guide to remind you of the many complex aspects of a client in need of assistance. Often, we use a model that includes a review of social, cognitive, emotional, physical, behavioral, and cultural aspects of the individual’s functioning.
Gain the most complete understanding of your client’s goal that you can. Ask clients what their life would look like if things were better. What would be a tolerable outcome? What would be the best imaginable outcome? Sometimes, projective questions such as de Shazer’s “miracle question” help clients articulate their goals .
Do your homework, part one: Go over what you know about your clients and their problems. Ask yourself what you still need to know to ?ll in any crucial gaps and make every effort to obtain this information. If you have time limits regarding when you must have your treatment plan completed , you may need to ask clients to wait for a minute or two as you sort through the information they have given you. Then, moving back to a collaborative mode, summarize your thoughts about primary and secondary problems and establish a provisional treatment plan.
Do your homework, part two: After the session, review a short list of viable treatment options, given what you know from your problem conceptualization and client goal statements. If you are unable to identify clear and appropriate treatment interventions, read, consult, and, if needed, obtain supervision. At that point, you can rank order the intervention alternatives and present them to your client during session two.
Another good idea: a big pot of vegetable soup that can be divided into portions and kept in the refrigerator for a number of lunches. Vegetable soup combines the bouillon, vegetable, and starch (crackers) portions of lunch. Here is a recipe for a pot of delicious low protein vegetable soup, contributed by Professor Judith Green of William Paterson College in New Jersey:
Margaret Green’s Vegetable Soup
(makes about 8 cups) 4 cups bouillon (chicken or beef) 2 cups water 1 stalk of celery, sliced 1 small parsnip, peeled and sliced 3 carrots, peeled and sliced 2 cups coarsely shredded cabbage 1 small onion, diced 2 large cloves of garlic, minced (about 3 tablespoons) 1?8 teaspoon ground black pepper 1 cup sliced green beans 2 cups drained canned corn 1 tablespoon salad oil 1?2 teaspoon dried oregano 1?4 teaspoon dried marjoram 1?4 teaspoon dried thyme leaves 1?2 teaspoon salt, or salt to taste (if desired) 1 or 2 tablespoons cornstarch (if desired) 1?2 teaspoon lemon juice In a large pot, combine the bouillon, water, celery, parsnip, carrots, cabbage, onion, garlic, and pepper. Bring to a boil and then simmer for half an hour. Next, add the green beans, canned corn, oil, oregano, marjoram, thyme, and salt. Bring to a boil again and simmer for another half hour. (The soup can be thick ened by mixing a few tablespoons of cornstarch with a little cold water and stirring the mixture into the soup.) Just before turning off the heat, add the lemon juice and stir well. When dividing portions, mix the soup from the bottom of the pot to distribute the vegetables evenly. The entire pot of soup will contain about 14 grams of protein. If the pot is divided into seven equal portions, each portion will contain about 2 grams of protein.
One of the biggest problems for patients is developing confidence that they can banish this physical disorder with a learning program. That kind of thing is completely outside of people?s medical experience. It is my job to convince them that it can be done.The Treatment of TMS FOLLOW UP SURVEYS An important confidence builder is the fact that most people who have gone through the program have been successful. In 1982 we did a follow up survey on 177 patients who had been treated between 1978 and 1981. Seventy six percent were leading normal lives with little or no pain, 8 percent were improved and 16 percent were unchanged. Some of those patients had not had the benefit of lectures and in many other ways the program was not as sophisticated as it is now.
In 1987 a similar follow up study was done, this time on a group of patients who all had CT scan?documented herniated discs and had the TMS program between 1983 and 1986. This time percent (ninety six people) were successful, 10 percent were improved and only 2 percent were unchanged.
Still more recently the well known journalist writer Tony Schwartz, who was successfully treated in 1986, mentioned in an article he wrote for New York magazine on Dr. Bernie Siegel that he had referred the program to forty patients for treatment and thirty nine of them were free of pain. I call this Tony Schwartz?s miniseries.
