To give our readers a better sense of what an effective mental health treatment plan looks like, I have been recreating a treatment plan here through a series of blog posts. To see other posts in the Mental Health Treatment Plan series, please click here.

As therapy progresses and as your therapist gets to know you better your treatment plan will almost definitely require minor amendments—and sometimes major changes. Recently, a British social work student, Adam, wrote with questions about this aspect of the treatment plan. He expressed reservations about doing a treatment plan as in his reading he learned that there could be patients/clients whose diagnosis wasn’t clear at the outset of therapy, and only later, during the course of therapy, was the real problem or issue uncovered.

Well, Adam, you are absolutely correct—more often than not, in fact, I would say virtually all the time, issues arise or are uncovered during the course of therapy that were not found during the initial evaluation. A well-trained and experienced clinician will be able to ask the right questions in order to get an accurate diagnosis. However, many issues can cloud an initial evaluation, something we will talk about in a later post. People are complicated and no matter how thorough a psychosocial evaluation is it simply cannot describe fully a living, breathing person. It is rather a sketch—a good sketch, perhaps—but nonetheless a sketch.On the one hand, the treatment plan must change as the individual improves—new objectives and goals and recommendations, etc. will have to address those improvements. On the other, there are problems that by their very nature often remain hidden or are difficult to diagnose—some problems mimic other problems or look like other problems over the short term. I cannot do justice to the number of times that patients are misdiagnosed especially in the case of serious mental illness or personality disorders, which sometimes can appear to be something else entirely.

Sometimes someone is diagnosed with major depression because the therapist has seen the person only during the course of the depression, and several months later it becomes apparent that the problem is bipolar disorder. A clinician must ask detailed and appropriate questions in the evaluation. However, occasionally even an excellent diagnostician and a thorough evaluation cannot forestall a misdiagnosis.

Of key importance: Each and every section of every written treatment plan is open to amendment and change. In fact, this doesn’t have to be presented as a separate section, the changes can simply be written in over top of the original text in each individual section. It is important to remember that a treatment plan is, after all, a plan, and a good plan has built into it the ability to cope with changes, discoveries—both internal and external.


In Alexis’s case, after only three months we decide to make some changes (we had made some amendments, earlier). We decrease her visits to twice a month since she has made so many improvements. The work we do is still detailed, and I give her plenty of therapy “homework” (something I will address in another blog entry), but she has been working hard at making important changes in her life and has been discovering deep insights that have helped her manage her symptoms (in her case, medication was not indicated).