Treatment Plan (Marriage and Family Therapy)

Treatment Plan

Date Created: [Date]

Effective Period: [Through date or next scheduled review]

Clinician: [Name, credentials, license number]

Setting: [Outpatient / Private practice / Agency]

Service Delivery: [In-person / Telehealth]

Plan Status: [DRAFT / Final] (Mark as DRAFT until signed by required parties)

Client System & Roles

Client Configuration: [Individual therapy / Couple therapy / Family therapy / Group therapy]

Identified Client(s): [Name(s) and DOB(s) of person(s) whose diagnosis is being treated]

Participants:

• Name: [Name]; Relationship to Identified Client: [Relationship]; Treatment Role: [Client / Co-client / Collateral-support person / Caregiver-guardian]; Attendance Pattern: [Attendance frequency and format] (Repeat for each participant; use TBD with decision point if participant not yet determined)

Participation Expectations: [Expected involvement and between-session practice for each participant] (Do not infer roles from relationship; explicitly document each person's treatment role)

Referral & Presenting Concerns

Referral Source: [Self / PCP / EAP / Court / School / Prior therapist / Other] — [Reason for referral] (Use "Not provided" if unknown)

Presenting Concerns: [Client's words in quotes or close paraphrase] — [Clinician summary including onset, recent triggers, and current severity/impact]

Strengths & Protective Factors

• Individual Strengths: [Concrete personal strengths, coping skills, motivation, insight]
• Relational/System Strengths: [Supportive dynamics, commitments, community resources]
• Safety-Related Protective Factors: [Reasons for living, supportive others, future orientation, help-seeking] (Include if safety concerns are present)

Diagnostic Framework

Diagnoses:

• [Diagnosis name] — [DSM/ICD code] — Status: [Confirmed / Provisional / Rule-out] (If diagnosis is deferred, specify what will be assessed, by when, and with what tools)

Clinical Formulation: [Concise summary of predisposing, precipitating, and perpetuating factors; how relational patterns interact with symptoms]

Functional Impact / Medical Necessity:

• [Specific impairments in work, school, parenting, ADLs, or social functioning that justify treatment necessity]

Risk Assessment

(Include if risk identified or policy requires universal screening; if not assessed, state "Not assessed" with plan to assess at next contact)

Risk Factors Assessed: [Suicide risk including ideation, plan, intent, history, means access; violence/homicide risk; abuse/neglect concerns and any mandated reporting actions taken]

Protective Factors (Safety): [Supportive relationships, reasons for living, future goals, beliefs, responsibilities]

Current Risk Level: [Not assessed / Low / Moderate / High] — [Brief clinical justification]

Safety Plan: [Created / Reviewed / Existing] — [Location stored and who has copies]

Treatment Approach

Modality: [Individual / Couple / Family / Combination] — [Rationale linking modality to treatment of identified client's diagnosed condition] (For couple/family modality, explicitly state how involving others treats the patient's condition)

Therapeutic Orientation: [EFT / Gottman-informed / CBT / Structural / Strategic / Solution-focused / Narrative / Trauma-informed / Other]

Frequency & Duration: [Session frequency], [Session length], [Estimated episode of care with reassessment point]

Between-Session Expectations: [Homework, practice exercises, logs, or worksheets] (Omit if none assigned)

Treatment Goals

(Order problems by safety/clinical severity, then functional impairment, then quality-of-life; include 2–4 problem areas as clinically appropriate)

Problem 1

Problem Description: [Observable/reportable condition with frequency, severity, and impact]

Goal: [Desired end-state in client-friendly language; include client phrasing when available]

Objectives:

• [Specific behavior/skill] — Measure: [Scale/log/percent/frequency] — Baseline: [Current level] — Target: [Goal level] — Timeframe: [By date or number of sessions] (Use "Baseline pending" with plan if not yet collected; include 1–3 SMART objectives per goal)

Interventions:

• Therapist: [Specific in-session methods tied to objectives and therapeutic orientation]
• Client/Participants: [Between-session practice, tracking, and behavior change tasks]

Problem 2

Problem Description: [Observable/reportable condition with frequency, severity, and impact]

Goal: [Desired end-state]

Objectives:

• [Specific behavior/skill] — Measure: [Instrument/log] — Baseline: [Level] — Target: [Level] — Timeframe: [Time bound]

Interventions:

• Therapist: [Intervention linked to objective]
• Client/Participants: [Practice or behavior change task]

Additional Problems

(Repeat Problem structure for Problems 3–4 as clinically indicated)

Progress Monitoring

Measures:

• [Standardized measures, relationship/functioning scales, or alternate tracking methods such as conflict logs or session rating scales] — [Who completes] — [Frequency]

Decision Rules: [Criteria triggering plan modification, e.g., lack of improvement by specified session prompts reformulation, modality change, or referral]

Confidentiality & Records

Informed Consent: Obtained [Date]; [Storage location/reference]

Multi-Client Confidentiality: Confidentiality boundaries, record access, and authorization requirements for disclosures reviewed with all participants. [Reference to practice policy on multi-client ROI] (Include for couple/family therapy)

Plan Review & Continuation

Next Scheduled Review: [Date or session number per organizational/payer policy]

Revision Triggers:

• New or increased safety concerns
• Worsening symptoms or functional decline
• Change in participants or household composition
• Sustained lack of progress or engagement

Continuation Criteria: [Active goals with measurable progress, ongoing functional impairment, continued client engagement]

Discharge Criteria: [Goal attainment level and/or symptom reduction indicating readiness for termination or step-down]

Signatures

Clinician Signature: ____________________________ Date: ________
[Printed name, credentials]

Client Acknowledgment:

[Signature line(s) for identified client(s) and participants] Date: ________

(OR) Treatment plan reviewed with client(s) on [Date]; client agreement and feedback documented.