Treatment Plan (Sports Psychology)

Document Type: Treatment Plan – Sports Psychology

Effective Period: [Start date] to [Target review date]

Clinician: [Name], [Credentials], [Organization]

Setting: [Practice setting] | [Delivery mode: in-person / telehealth / hybrid]

Client: [Athlete name], [Age], [Sport/position or event], [Competitive level: youth / HS / collegiate / professional / masters], [Team/club affiliation]

Client of Record: [Athlete / Team or Organization]. [Referrer or payer]. [Third parties with written consent on file for communication: athletic trainer / coach / team physician / none]. (Identify who is the client of record and payer. List any third parties with whom information may be shared and authorization status.)

Plan Rationale and Scope

[Presenting focus and reasons for seeking services]. [Scope of service: clinical mental health treatment / performance and mental skills consultation / integrated model with specified boundaries]. [Medical necessity applicability: supports medical necessity documentation / performance-focused, non-diagnosis-driven plan]. [Diagnostic status: confirmed diagnosis / subclinical concerns / pending with assessment steps and timeline]. (Write 3–6 sentences. Clearly separate clinical treatment from performance consultation when integrated. Do not infer diagnoses.)

Problem List

(List problems in order of severity and urgency: safety concerns first, then functional impairment, then performance optimization. Write problem statements in behavioral/functional language, not single-word labels. Always include at least one problem.)

1. Problem 1: [Title capturing the core clinical or performance issue]

   • Statement: [Behavioral/functional description of the issue and its impact on sport functioning (training, competition, return-to-play) and life functioning (sleep, academics/work, relationships) as applicable]
   • Onset/Course: [Acute / chronic]. [Key triggers: injury, transition, selection pressure, role change, life stressors]
   • Severity: [Mild / moderate / severe]; [Stable / unstable]
   • Baseline: [Current symptom ratings, standardized scale scores with measure name and date, and/or sport-relevant metrics]. (If baseline not yet collected, state when and how it will be established.)
   • Long-Term Goal(s):
     • [Goal 1 with specific target behavior/state, metric, and timeframe]
     • [Goal 2 with specific target behavior/state, metric, and timeframe]
     (Include 1–3 goals. Each must include a specific metric and timeframe.)
   • Short-Term Objectives:
     • [Objective 1 achievable in 2–6 weeks with clear metric and target date]
     • [Objective 2 achievable in 2–6 weeks with clear metric and target date]
     (Include 2–6 objectives if plan spans more than 2 sessions; omit section if not applicable.)
   • Interventions:
     • [Intervention name/approach: e.g., CBT / ACT / MI / imagery / arousal regulation / biofeedback / self-talk training / attention control / pre-performance routine / graded exposure]
       • In-session: [Activities tailored to sport, position/event, training phase, and competition schedule]
       • Between-session practice: [Specific drills, frequency/duration, context, and tracking method]
       • Rationale: [Brief linkage between intervention mechanism and this problem's targets]
     (Add additional intervention blocks as needed. Individualize to the athlete's sport context and stated priorities.)
   • Outcome Measures: [Symptom scales, sport performance indicators, adherence logs, coach/AT feedback if consented] with [Monitoring schedule: per session / weekly / per competition / monthly]

2. Problem 2: [Title]

   • Statement: [Behavioral/functional impact on sport and life domains]
   • Onset/Course: [Acute / chronic]; [Key triggers]
   • Severity: [Mild / moderate / severe]; [Stable / unstable]
   • Baseline: [Current ratings/metrics or plan for collection]
   • Long-Term Goal(s):
     • [Goal with specific metric and timeframe]
   • Short-Term Objectives:
     • [Objective 1 with metric and target date]
     • [Objective 2 with metric and target date]
   • Interventions:
     • [Intervention name/approach]
       • In-session: [Tailored activities]
       • Between-session practice: [Practice plan and tracking method]
       • Rationale: [Link to problem/goal]
   • Outcome Measures: [Tools/metrics] with [Monitoring schedule]
   (Include additional problems only if identified. Repeat structure for each.)

Session Plan

• Frequency: [Weekly / biweekly / monthly / variable cadence tied to training and competition]
• Session length: [Duration in minutes]
• Anticipated duration: [Total sessions or timeframe estimate]. (If cannot be estimated, explain why and when it will be clarified.)
• Criteria to adjust frequency: [Increase if: safety concerns, acute crisis, upcoming major competition, nonresponse] | [Decrease if: sustained progress, maintenance phase, off-season, goal attainment]

Coordination and Referrals

• Internal coordination: [Providers involved, scope of information-sharing, and cadence]
• Information-sharing boundaries: [What may be shared, with whom, and under what consent limitations]. (Explicitly document confidentiality boundaries whenever team/organizational involvement exists.)
• Referral triggers: [Suicidality/self-harm / eating disorder concerns / substance use / sleep disorder / nonresponse after defined interval] with [specific thresholds and referral pathways]
• Third-party feedback plan: [Content, recipients, schedule, and consent status]

(If no coordination is indicated, state "None indicated at this time.")

Risk and Safety

• Risk domains assessed: [Self-harm / harm to others / severe disordered eating / substance misuse / other]
• Current risk level: [None / low / moderate / high] with [supporting factors and recent indicators]
• Protective factors: [Relevant supports, coping skills, reasons for living, team/family resources]
• Safety plan/crisis resources: [Safety steps, emergency contacts, crisis lines, means-restriction strategies]
• Coordination actions taken: [Notifications, warm handoffs, involvement of medical/team staff within consent boundaries]

(If no acute safety concerns, document "No acute safety concerns endorsed or observed." Do not leave this section blank.)

Completion and Transition Criteria

• Goal attainment criteria: [Objective thresholds tied to long-term goals and outcome measures]
• Maintenance plan: [Booster sessions / relapse prevention strategies / in-season check-ins / off-season review]
• Step-down triggers: [Sustained improvement duration / independent skill use / stable metrics across competitions]
• Re-entry to care: [How to initiate, expected availability, priority during high-stakes periods]

Client Involvement

• Plan review: [Date reviewed]. Athlete [agrees / partially agrees / disagrees]. [Notes on disagreements and resolutions].
• Parent/guardian involvement: [Names/roles, scope of participation, consent status]. (Include if client is a minor.)
• Consent for provider coordination: [On file / pending / declined] for [named providers/roles]
• Consent for coach/team staff communication: [On file / pending / declined]. [What may be shared and cadence].
• Digital tools: [Apps/wearables/logs used, data elements collected, sharing permissions]

Authentication

Clinician Signature: [Name, credentials]  |  Date: [Date signed]