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treatment_plans [2026/09/28 14:16] – Correct the link to the governing-principles evidence section andrewtaustintreatment_plans [2026/10/08 07:06] (current) – Add consent, suitability and outcome monitoring articles to related reading andrewtaustin
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 Use the [[adaptive_formulation|Adaptive Formulation and Outcome Review Sheet]] to make a concise record. The examples below illustrate how the same framework can support a decision to use IEMT or to prioritise other assistance. Use the [[adaptive_formulation|Adaptive Formulation and Outcome Review Sheet]] to make a concise record. The examples below illustrate how the same framework can support a decision to use IEMT or to prioritise other assistance.
 +
 +===== Use the framework across three stages =====
 +
 +  - **Assessment:** understand the response in context, identify strengths and needs, and agree one priority that matters to the client. Produce a provisional formulation and a starting point for comparison.
 +  - **Planning:** decide whether IEMT, practical changes, other support or a combination fits that priority. Record the action, who is responsible and how its usefulness will be reviewed.
 +  - **Review:** compare the agreed indicators, check the client's experience and any unwanted effects, and make an explicit decision about the next step.
 +
 +The [[adaptive_formulation#copyable_assessment_record|assessment record]], [[adaptive_formulation#copyable_action_plan|action plan]] and [[adaptive_formulation#repeatable_session_and_follow-up_record|session and follow-up record]] can be copied into secure practice notes. Use the brief worksheet for straightforward work and the fuller prompts where they help a decision. These are proposed documentation aids; they are not a scored adaptation test.
  
 ===== Contents of a Treatment Plan ===== ===== Contents of a Treatment Plan =====
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 Agree the reference situation, scale anchors if using a rating, and a review point. A range, a verbal description or "I cannot tell yet" may be more accurate than a precise number. Do not make a zero distress rating a universal requirement for success. Agree the reference situation, scale anchors if using a rating, and a review point. A range, a verbal description or "I cannot tell yet" may be more accurate than a precise number. Do not make a zero distress rating a universal requirement for success.
 +
 +**Make the outcome reviewable.** Agree these details before an intervention, using as few indicators as the decision requires:
 +
 +^ Record ^ Example agreed with Alex ^
 +| Life outcome and why it matters | Contribute an idea in a team meeting, so Alex can participate in a valued work role. |
 +| Everyday indicator and baseline | Whether Alex contributes when a suitable opportunity occurs; no contribution at the last three meetings, with the available opportunities clarified. |
 +| Experience indicator and anchors | Anticipatory distress about the next team meeting, currently about 7/10; 0 means no distress and 10 the most intense distress Alex can imagine. |
 +| What would be useful | One prepared contribution at each of the next two meetings where a suitable opportunity is available; discuss whether this felt worthwhile to Alex. |
 +| Review point and conditions | Review after those meetings, or sooner if the plan becomes unsuitable. Record cancelled meetings and changes in format or support. |
 +
 +These numbers illustrate an individual agreement, not a clinical cut-off or a required IEMT outcome. Compare like with like: a rating about an imagined meeting in the session and a rating during a real meeting describe different conditions. See [[measuring_therapeutic_change|Measuring Therapeutic Change]].
  
 ==== 2. Describe the response before explaining it ==== ==== 2. Describe the response before explaining it ====
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 "The client reports a racing heart before speaking" is a report. "The client paused for several seconds" is an observation. "The pause protects against criticism" is a hypothesis requiring exploration. An early memory offered during IEMT work does not, by appearing, establish the cause of the current problem. "The client reports a racing heart before speaking" is a report. "The client paused for several seconds" is an observation. "The pause protects against criticism" is a hypothesis requiring exploration. An early memory offered during IEMT work does not, by appearing, establish the cause of the current problem.
 +
 +Useful prompts are: "What happened just before this?", "What did you notice or do next?", "What happened afterwards?" and "When is it different?" Ask what would be lost if the response changed, without assuming it has a hidden benefit. A detailed account of traumatic events is not required simply to complete this planning record.
  
 Consider whether a response provides useful protection as well as creating difficulty. Do not assume every response has a discoverable protective purpose. The plan should preserve useful options and make room for alternatives. Consider whether a response provides useful protection as well as creating difficulty. Do not assume every response has a discoverable protective purpose. The plan should preserve useful options and make room for alternatives.
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 Record strengths as well as difficulties. Every mode need not become a treatment target. Bodily symptoms requiring assessment belong with an appropriately qualified professional, rather than being presumed to be emotional imprints. Record strengths as well as difficulties. Every mode need not become a treatment target. Bodily symptoms requiring assessment belong with an appropriately qualified professional, rather than being presumed to be emotional imprints.
 +
 +**Choose a priority together.** For each relevant mode, note a strength, a difficulty and whether action is wanted now. Ask which issue most limits the chosen outcome and which need must be addressed first. Do not add the four modes into a total score or infer a Roy adaptation level from a distress rating.
  
 ==== 5. Write a working formulation and choose an action ==== ==== 5. Write a working formulation and choose an action ====
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 Where needs exceed the practitioner's competence, seek suitable supervision, referral or coordinated care. Urgent medical, mental-health or safeguarding concerns require the appropriate local response. Neither the Roy framework nor this worksheet supplies validated IEMT triage thresholds. Where needs exceed the practitioner's competence, seek suitable supervision, referral or coordinated care. Urgent medical, mental-health or safeguarding concerns require the appropriate local response. Neither the Roy framework nor this worksheet supplies validated IEMT triage thresholds.
 +
 +**Turn the formulation into an action plan.** Each action needs an owner, an agreed time or trigger, and a way to check what happened. Keep actions within the person's control separate from responses that depend on someone else.
 +
 +^ Action ^ Responsibility and timing ^ What to review ^
 +| Consider the agreed IEMT target, if suitable and chosen. | Practitioner and client agree the target and procedure before proceeding, including how to pause or stop. | What was undertaken; the client's response; any modification or unwanted effect. |
 +| Prepare a short contribution and consider requesting speaking time. | In Alex's fictional plan, Alex chooses whether and when to prepare and approach the chair before the next meeting. | Whether preparation and the request occurred; whether a usable opportunity was provided. |
 +| Arrange other assessment, support or coordination where indicated. | Name the agreed person or service and the next contact or review date. Obtain permission for any sharing of information. | Whether contact and access occurred, and what remains unavailable or outside the practitioner's role. |
 +
 +An intended referral is not the same as care received. Record the agreed next step if access is delayed. This planning framework does not provide a reason to delay care the person needs. The client can revisit a decision before the scheduled review; shared decision making is ongoing. [[https://www.nice.org.uk/guidance/ng197/chapter/Recommendations|NICE NG197: making and reviewing decisions]].
  
 ==== 6. Record what was done and review what followed ==== ==== 6. Record what was done and review what followed ====
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 ^ Finding at review ^ Implication for the next decision ^ ^ Finding at review ^ Implication for the next decision ^
-| The agreed life outcome improves and the client finds the change useful. | Consider concluding or reducing the work, or agreeing a further goal if the client wants one. |+| The agreed life outcome improves and the client finds the change useful. | Consider concluding or reducing the work. Continue only for an agreed purpose, rather than assuming more sessions are required. | 
 +| Participation improves while some distress remains. | Check whether the outcome is valuable and sustainable for the client; do not impose zero distress as a condition of completion. |
 | The target feeling changes but the intended activity remains difficult. | Review skills, opportunities, resources, environmental barriers and whether the original formulation was adequate. | | The target feeling changes but the intended activity remains difficult. | Review skills, opportunities, resources, environmental barriers and whether the original formulation was adequate. |
-| There is no useful change. | Reconsider the target, intervention, explanation and suitability of IEMT; discuss alternatives or referral. | +| There is no useful change. | Reconsider the target, intervention, explanation and suitability of IEMT; discuss alternatives or referral rather than repeating the same plan automatically. | 
-| There are unwanted effects, deterioration or loss of consent. | Pause or stop the relevant procedure and assess what response or additional care is needed. |+| There are unwanted effects, deterioration or loss of consent. | Pause or stop the relevant procedure and assess what response or additional care is needed. Record the concern, action and responsibility for follow-up. | 
 +| The relevant situation has not occurred, or follow-up is missing. | Record what is unknown. Agree a proportionate review if wanted; do not count missing information as success or failure. | 
 +| A difficulty returns after improvement. | Establish what returned, in which setting and what changed. Preserve evidence of gains that remain while reassessing the current need. |
 | Circumstances or the client's priorities have changed. | Revise the plan and its indicators rather than treating the previous goal as compulsory. | | Circumstances or the client's priorities have changed. | Revise the plan and its indicators rather than treating the previous goal as compulsory. |
  
 Reporting no improvement, a remaining difficulty or a wish to stop is legitimate feedback. It does not by itself establish a [[iemt#patterns_of_chronicity|Pattern of Chronicity]]. Reporting no improvement, a remaining difficulty or a wish to stop is legitimate feedback. It does not by itself establish a [[iemt#patterns_of_chronicity|Pattern of Chronicity]].
 +
 +**Finish each review with a decision and a reason.** Record continue, revise, conclude, pause or refer; who will do what; and when the decision will next be revisited, if appropriate. The client may choose no further work. At completion, record the gain, remaining limits and how the client can seek appropriate further help if circumstances change. Follow-up timing should fit the agreed question, rather than a universal schedule. See [[maintenance_generalisation_return_symptoms|Maintenance, Generalisation and Return of Symptoms]].
  
 ===== Behavioural Observations ===== ===== Behavioural Observations =====
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 //Both examples are fictional planning illustrations. Their review scenarios are hypothetical, not treatment results or evidence of effectiveness.// //Both examples are fictional planning illustrations. Their review scenarios are hypothetical, not treatment results or evidence of effectiveness.//
 +
 +For completed assessment, action and review entries, see [[worked_examples|Worked Examples: Assessment, Planning and Review]]. That page develops Alex and Morgan into fictional records and adds Sam, whose follow-up outcome remains unknown. Every recorded outcome is invented for teaching.
  
 ==== Example 1: a possible IEMT target within a wider plan ==== ==== Example 1: a possible IEMT target within a wider plan ====
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 **Review scenarios.** Reduced distress together with useful participation would support discussing whether the agreed work is complete. Reduced distress without participation would prompt review of preparation, meeting conditions and remaining difficulty. No improvement would prompt reconsideration of the plan; it would not prove that Alex was resisting change. **Review scenarios.** Reduced distress together with useful participation would support discussing whether the agreed work is complete. Reduced distress without participation would prompt review of preparation, meeting conditions and remaining difficulty. No improvement would prompt reconsideration of the plan; it would not prove that Alex was resisting change.
 +
 +**What an incomplete review would mean.** Suppose the first planned meeting is cancelled and the second allows no contributions. Alex's ability to participate has not been tested by those meetings. Record "no suitable opportunity" rather than two failures or proof that avoidance has resolved. If Alex also reports less anticipatory distress, retain that observation with its reference situation, while leaving the everyday outcome open for a later agreed review.
  
 ==== Example 2: practical support takes priority ==== ==== Example 2: practical support takes priority ====
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   * [[governing_principles|Roy's Adaptation Model as Governing Principles for IEMT Practice]]   * [[governing_principles|Roy's Adaptation Model as Governing Principles for IEMT Practice]]
   * [[adaptive_formulation|Adaptive Formulation and Outcome Review Sheet]]   * [[adaptive_formulation|Adaptive Formulation and Outcome Review Sheet]]
 +  * [[worked_examples|Worked Examples: Assessment, Planning and Review]]
   * [[adapt|Integral Eye Movement Therapy (IEMT): An Adaptive Model]]   * [[adapt|Integral Eye Movement Therapy (IEMT): An Adaptive Model]]
   * [[model|The IEMT Model]]   * [[model|The IEMT Model]]
 +  * [[measuring_therapeutic_change|Measuring Therapeutic Change]]
 +  * [[maintenance_generalisation_return_symptoms|Maintenance, Generalisation and Return of Symptoms]]
 +
 +  * [[informed_consent_shared_decision_making|Informed Consent and Shared Decision-Making]]
 +  * [[assessment_suitability_referral|Assessment, Suitability and Referral]]
 +  * [[adverse_effects_deterioration_non_response|Adverse Effects, Deterioration and Non-Response]]
  
 {{tag>IEMT training diagnosis anxiety depression pain practice}} {{tag>IEMT training diagnosis anxiety depression pain practice}}
  
  • Last modified: 2026/09/28 14:16
  • by andrewtaustin