Setting Treatment Goals

by Christina Bruni Patient Expert

The information in this blog entry will be included in my second book, Life Will Tell You: on Living Well in Recovery.
Consider it a preview.
Here, I'll talk about setting treatment goals.

I've been solely on the Geodon for close to three months, and have begun to think of goals I want to achieve in my recovery.
When I saw Dr. Altman on Friday night I proclaimed, "I want to develop a three-year treatment plan, and evaluate and adjust every six months."

I had originally told him that I examined the events in my life at the time the Stelazine stopped working, and asked if there could've been a cause.
He responded, "I don't have an answer for that."
I valued his honesty.
He didn't pretend to know, nor did he brush me off.
Instead, Dr. Altman clarified, "The drug didn't stop working.
You didn't have a relapse, and weren't psychotic.
You presented anxiety that intensified.
It was time to make the switch."

That's the beauty of working with a trusted professional who prescribes your medication: she or he will pick up on things you might not notice yourself.
In April 2007, I had scheduled the emergency visit to Dr. Altman three weeks earlier than I was supposed to meet him because I knew something was wrong that I couldn't live with.

My classic analogy is that of a VU meter, the device on a disc jockey's mixing board that measures the level of sound intensity.
On the left, it is quiet, and if the needle rises into the red, on the right, the volume is too loud and has to be adjusted.
Everyone has insecurities, which give way to self-doubt, yet those of us with schizophrenia go from self-doubt to worry to anxiety to paranoia, and then symptoms.
The medication adjusts the volume, yet more than that, making healthy choices seals our recovery.

Dr. Altman said something which made my jaw drop: "It wasn't because of the Stelazine.
You recovered because of the actions you took."
He continued, "Total symptom relief is the only acceptable outcome for your treatment."
I was impressed that he wouldn't settle for less.

Here now, I want to give you some ideas about starting a dialogue with your psychiatrist to develop a treatment plan with goals and measurable outcomes.
Again, remember that any goals must be SMART: Specific, Measurable, Achievable, Realistic, and Tangible.
The following is the six-step process taken from my self-help book:

1. Think in terms of a three-year treatment plan. What do you want to get done in three years? Often, after a diagnosis of schizophrenia, we think our life is over and there's not much hope. Or when we do begin to plan for the future, we see the endpoint and get so overwhelmed thinking how are we going to get there. Break your life into three-year stages of recovery to focus on what you can do. If you automatically view things in terms of the big picture, now is the time to focus on one brush stroke at a time. You're painting a masterpiece: the image in your head of the kind of life you want to lead, so think of the details that will contribute to a beautiful portrait. "Compartmentalizing," in this sense, is good: focusing on only what you need to do at the moment you need to do it.

2. Pick three yearly goals that are imbricated upon each other. Completing the first goal should enable you to tackle the midway or bridge goal that leads to the final outcome.

3. Write down your treatment plan and list the payoff or benefits in accomplishing the end goal, which is the springboard for the next three-year stage in your recovery.

Folks, right now I will rave about a book that was the catalyst for developing a major goal in my recovery.
Out now is Julie Morgenstern's When Organizing Isn't Enough: Shed Your Stuff, Change Your Life.
It is stunning.
I finished reading it in a week, and have committed to taking action on my treatment goal: "Develop a new daily schedule to promote healthy sleep patterns."
The payoff in having better sleep hygiene will be consistent energy levels throughout the week, an end to falling asleep at work, and freeing up time at night to paint and read fiction, two new hobbies.
I recommend the organizing book because Morgenstern proposes something revolutionary: that clutter in the form of bad habits once served a useful purpose, and only by uncovering and understanding the benefit we obtained from the behavior, can we let go of it and replace it with a healthier habit that serves our new needs.

4. Plan at each doctor visit what you are going to accomplish before your next meeting. Pick one thing-just one thing. Each of these immediate sub-goals will power you through to the bigger objective, like strong links in a chain that circle around each other and connect. The visit is often short, so write down your "one thing" beforehand on an index card, and review it in the waiting area at the office. Be open to any suggestions your pdoc makes as well.

5. Honestly report your progress back to your doctor. If you haven't gotten any further or have slipped back, brainstorm coping techniques and healthier habits to replace the old ones. Evaluate and adjust your treatment options as needed.

6. Reward yourself each month for committing to your recovery, even if you've taken baby steps and the ultimate result is down the road. Splurge when you do achieve what you set out to.

Christina Bruni
Meet Our Writer
Christina Bruni

Christina Bruni wrote about schizophrenia for HealthCentral as a Patient Expert. She is a mental health activist and freelance journalist.