When asked what subjects they wished they would have covered more in college, some members in our Facebook group for community mental health professionals responded that they would have preferred more training in integrating theory into their practice when working in client’s homes. It’s not difficult to see how theory is one of the first parts of your practice to be thrown out of the window; When a toddler is climbing up your leg while you’re trying to engage a parent, it’s hard to remember how to conceptualize the case, what interventions to use from your theory, and even what to put in a treatment plan.
For this series on applying theory to practice, I thought we might want to start with the relatively simple exercise of writing a progress note. Progress notes are the perfect opportunity to practice organizing your thoughts and your interventions around a theoretical orientation. Be sure to check out the last article “Beginner’s Guide to Writing a SOAP Note” if you are new to writing progress notes or could use a refresher. I used the same sample case and progress note to inform this article and approached this made-up session from a solution-focused theoretical model.
Solution-focused therapists focus on the future and client goals; they work to empower the client to solve their own problems. Here is a list of solution-focused interventions, some of which I reference in the note. Find your theory below for more examples and keep reading to see a quick guide on how I integrated theory in this case note.
S : Client reported he had decided on moving into public housing since last speaking with counselor. Praised client for prioritizing his goal of finding safe housing. Client stated he still had concerns that were “taking a toll”. Reviewed client’s concerns which included affordability of new housing and the possibility of moving into a new neighborhood. Validated client’s concerns. Assessed client’s readiness to move into new housing on a scale from 1-10 with 10 representing maximum readiness. Client rated himself at a 9. Reviewed client’s long-term goal of finding permanent housing. Discussed possibility of client writing a list of experiences he was looking forward to upon moving into his new apartment. Client verbally agreed to homework.
O : Client dressed casually for session in jeans and t-shirt. Client’s mood anxious, affect normal and appropriate to context. Speech pressured. Client began tapping foot when discussing moving into new housing.
A : Client has gained insight into need for safe housing. Client experiencing continuing anxiety related to difficulty focusing on potentially positive future experiences.
P: Review homework and discuss how client has coped during previous life adjustments. Refer client to agency housing specialist for any additional questions specific to public housing.
- I validated the client’s concerns about moving into new housing; the client is the expert on his own feelings and already possesses the answer to his problems.
- I praise the client for working towards his housing goal. Genuine compliments are a core component of solution-focused therapy.
- I used a scaling question to assess readiness for change. Scaling questions help the client to view their issues on a continuum and help both the therapist and the client track progress.
- I remained goal-oriented by reviewing the client’s long term goal of finding permanent housing.
- I assigned homework that encouraged the client to hold space for positive experiences in the new apartment; I am looking for exceptions to client’s expressed negative feelings towards this change. This intervention also helps the client to focus on the future and his long-term goal.
- I note in my assessment that the client is experiencing anxiety because he is unable at this time to focus on potential positive experiences. This is my interpretation of using my theory to answer the assessment questions “What is the cause of the client’s issues?”.
- I planned to review homework related to focusing on positive outcomes and also planned to use the solution-focused intervention of asking coping questions.
What other tips do you have for writing progress notes or using theory in home-based therapy? Share your tips below and be sure to check out our Facebook group to connect with other professionals in the field!