Social Workers and Bureaucracy

At my most recent internship, I was an in-home psychotherapist for older adults (55+) who for one reason or another are homebound. The program that I worked for receives the majority of its funding from the Department of Mental Health (DMH). Clients being seen through a DMH program needed to have all of their sessions documented in progress notes that show a clearly directed path towards change. I was required to complete something called a Client Care Coordination Plan (CCCP) for one of my psychotherapy clients. The CCCP form requires precise documentation of how interventions by me (the therapist) will assist the client in making behavioral changes that will return her to a socially acceptable level of functioning-i.e., resuming driving, returning to work, and socializing regularly. When I discussed the CCCP with my client, I explained that we needed to come up with some goals for her treatment, and that it was important that the goals be ones that were created by her. One of the "traditions" in social work is that of self-determination by the clients in their treatment. After my client thought about goal setting, she admitted that one of the most symptoms of her depression was emotional numbness. The client stated that she would like to set a goal of "being more aware of my feelings when I'm having them."

I was giddy with the client's manifestation of self-awareness and motivation for change, and impressed by how quickly she had picked up some of the tenets of the psychotherapy process. When I was reviewing the CCCP with my supervisor, she shook her head and stated with disappointment: "You can't use that. That's not a measurable goal." To conform to the method of goal-setting recommended by DMH, goals need to be S.M.A.R.T.: Specific, Measurable, Attainable, Realistic, and Timely. Awareness of feelings was not something that we could accurately measure, and therefore should be part of the treatment on paper, although it would be useful in the real treatment. DMH programs like mine follow these guidelines under threat that their funds may be recouped if their notes do not adhere to the proper format.