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How to write a personality disorder treatment plan

Learn how to create a personality disorder treatment plan, including information on therapy types, medication, and strategies tailored to your client’s needs.

September 26, 2025 • Updated on September 11, 2026

By Savanah Harvey, AMFT

10 min read

By Savanah Harvey, AMFT

Personality disorders are complex mental health conditions that significantly influence the way a person experiences their emotions and how they connect with others. There is not one way to treat personality disorders, as each carries its own unique set of challenges. 

To help categorize and organize approach to treatment, the DSM-V-TR groups them into three cluster types: Cluster A (paranoid or schizoid), Cluster B (borderline, narcissistic, and antisocial personality), and Cluster C (avoidant, dependent, or obsessive compulsive personality disorder). Because of this complexity, tailoring a structured treatment plan can be difficult, but doing so provides consistency across sessions, creating a space where your client can feel supported, seen, and validated.

What to know

1

A detailed personality disorder treatment plan is a win-win: It creates a blueprint for your client’s care and meets a payer’s need for documented medical necessity.

2

A treatment plan that includes measurable objectives, a documented safety plan, and a regular review cadence ensures high-quality care and compliance.

3

Headway's protected note templates and AI-assisted notes are here to help you document complex cases without added administrative burden.

What a personality disorder treatment plan needs to accomplish

Effective treatment planning begins with understanding how to write a mental health treatment plan that prioritizes personalization, safety, and long-term support. By tailoring care to each client’s unique needs, goals, and circumstances, clinicians can provide structured guidance that promotes meaningful long-term growth and stability.

A treatment plan serves as a blueprint for your therapeutic relationship with a client. It should lay out their diagnosis, symptoms, and treatment goals, as well as the therapeutic techniques you’ll use to reach those goals. A personality disorder treatment plan typically includes a safety and crisis plan as well.

Writing a thorough treatment plan is, first and foremost, about defining the clinical care you’ll deliver. But it’s also important for compliance, as it reinforces your diagnosis and demonstrates to an insurer that the care you’re offering is medically necessary.

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Step 1: Complete a comprehensive assessment and confirm the diagnosis

A thorough assessment is the beginning of an effective treatment plan. Clinicians evaluate symptom severity, functional impact, and co-occurring conditions using structured interviews, psychological testing, and careful observation. An accurate diagnosis guides treatment selection while setting realistic goals, and it creates a clear roadmap for progress.

The DSM-V-TR groups the 10 types of personality disorders into three clusters, based on similar characteristics:

Cluster A: Characterized by an odd or eccentric appearance, includes the following:

  • Paranoid: Mistrust and suspicion
  • Schizoid: Disinterest in others
  • Schizotypal: Eccentric ideas and behavior

Cluster B: Characterized by appearing dramatic, emotional, or erratic, includes the following:

  • Antisocial: Social irresponsibility, disregard for others, deceitfulness, and manipulative behavior for others personal gain
  • Borderline: Inner emptiness, unstable relationships, and emotional dysregulation
  • Histrionic: Attention-seeking and excessive emotionality
  • Narcissistic: Self-grandiosity, needs for admiration, and lack of empathy for others

Cluster C: Characterized by appearing anxious of fearful, includes the following:

  • Avoidant: Avoidance of interpersonal contact due to rejection sensitivity
  • Dependency: Submissiveness and a need to be taken care of
  • Obsessive-compulsive: Perfectionism, rigidity, and obstinacy

Step 2: Build the safety and crisis plan into the treatment plan

People with personality disorders—particularly borderline personality disorder—are at increased risk for self-harm and suicidal behavior, research shows. That means safety planning should be a top priority as you develop your treatment plan. Starting therapy can be a stressful experience, so it’s vital to have a safety and crisis plan in place as you begin. Only once the client is safe and stable can you proceed to the deeper work of treatment.

A safety plan should generally include:

  • Warning signs that signal the client may be heading toward a mental health crisis
  • Reasons for living
  • Coping strategies the client can use on their own
  • Loved ones and professional services the client can call on if they need additional support
  • Concrete steps for removing risks from their environment

Crucially, a safety plan should be developed in collaboration with your client to ensure it serves their needs and feels accessible and realistic for them.

Step 3: Choose a treatment framework you can actually deliver

Defining the therapeutic modalities you’ll use is a core part of treatment planning. To decide which techniques to include, you’ll need to assess both your client and yourself. Which modalities are a match for your client’s diagnosis, symptoms, and goals? And which techniques do you feel qualified to deliver?

You may include evidence-backed treatment approaches such as:

  • Dialectical behavior therapy (DBT), which aims to build distress tolerance and acceptance while also improving interpersonal and emotional regulation skills
  • Cognitive behavioral therapy (CBT), which focuses on changing unhealthy thought patterns
  • Schema therapy, which is similarly focused on adjusting maladaptive thought patterns — often those that developed during childhood
  • Pharmacotherapy, which may be used to manage specific symptoms or co-occurring mental health diagnoses, even though no drug is approved specifically for the treatment of personality disorders

Step 4: Turn personality disorder symptom domains into measurable objectives

Whenever possible, a treatment plan should include opportunities for measurement. Monitoring is helpful for insurance purposes — you can demonstrate to payers that treatment is having a positive effect, and thus is medically necessary — but also clinically. Knowing what’s working and what isn’t can help you refine your approach moving forward.

Attaching metrics to common personality disorder symptoms helps with data collection. The below example uses affective instability to show how you might apply this principle to your treatment plan:

  • Establish a baseline: Use a diary or log to determine how many mood shifts your client experiences per week at the beginning of treatment.
  • Set a target: Define a treatment approach and goal — for example, after eight weeks of DBT, the client will experience at least three fewer mood shifts per week.
  • Review results: After those eight weeks are up, review the client’s diary to see if treatment has had its intended effect. If not, you may need to adjust your approach.

What to consider when creating a personality disorder treatment plan

Individualized approach

An effective treatment plan is personalized to the client’s personality, emotional regulation skills, and life context. This may involve selecting specific therapy approaches such as DBT and CBT, adjusting session frequency, and incorporating strength-based strategies like building coping skills, naming personal values, and practicing boundary setting.

Treatment goal setting

Setting collaborative goals is essential for client engagement, motivation, and accountability. Keep the SMART (specific, measurable, achievable, relevant, and time-bound) framework in mind to create goals that reflect the client’s priorities. Some goal examples include reducing self-harm behaviors, enhancing emotional regulation, improving coping skills, or strengthening interpersonal relationships.

Comprehensive treatment options

Effective treatment plans combine a variety of interventions to meet the complex needs of clients with personality disorders. This can include treatment approaches like DBT for emotional regulation, psychoeducation to enhance symptom awareness, family therapy for relational support, and lifestyle modifications to promote overall wellness and day to day life. Simple lifestyle changes like establishing consistent sleep routines, exercising daily, maintaining a balanced diet, practicing mindfulness or meditation, and staying committed to daily routines helps support emotional stability and reinforce progress made in therapy.

Monitoring and adjustment

Knowing when to review and revise your treatment plans is essential to an effective treatment plan. Providers should regularly track client progress, assess intervention effectiveness, and refine strategies as new challenges arise. These practices keep treatment responsive to the client’s evolving needs and support meaningful, measurable progress.

Co-occurring conditions

It’s common for clients with personality disorders to experience co-occurring conditions such as depression, anxiety, or substance use disorders. Effective treatment requires assessing these conditions and integrating tailored interventions alongside primary therapy. Addressing co-occurring challenges comprehensively not only improves overall functioning but also reduces the risk of relapse and supports long-term recovery.

Personality disorder treatment plan example

To illustrate how a structured, personalized approach can be implemented, here’s a sample treatment plan for paranoid personality disorder. As with any clinical documentation, it is important to know which ICD-10 codes are used for personality disorders.

Client name: Jane Doe

Provider name: Sarah White, LMFT

Date of birth: January 1, 1990

Date: August 1, 2025

Diagnosis: F60.0, Paranoid personality disorder


Treatment goals:

Goal 1: Improve trust and interpersonal relationships.

Objective 1.1: Pt to identify situations where mistrust or suspicion increases in interactions with others.

Intervention 1.1: Use CBT techniques to explore triggers for suspicious thoughts and challenge negative cognitions.


Objective 1.2: Pt to practice expressing concerns in a calm, clear, assertive manner.

Intervention 1.2: Pt to bring 3 common scenarios to session to role-play alternate communication strategies with their home, social, or workplace settings. 


Goal 2: Increase self-awareness of patterns of negative or harmful cognition.

Objective 2.1: Identify three recurring paranoid thoughts/assumptions in daily life

Intervention 2.1: Introduce thought records and journaling exercises to track triggers, thoughts, and conflicting emotions.


Objective 2.2: Pt will begin to recognize cognitive distortions in at least 50% of recorded triggers, thoughts, and conflicting emotions.

Intervention 2.2: Name restructuring techniques, explore and validate pt experience of recognition.


Goal 3: Strengthen social support and community engagement.

Objective 3.1: Pt to identify and reach out to at least one trusted person for ongoing social support.

Intervention 3.1: Discuss social networks, identify trusted people, create a plan for outreach to one person.


Objective 3.2: Pt to schedule and attend at least one supportive social or community activity per month to practice trust-building and interpersonal skills.

Intervention 3.2: Psychoeducate pt on the importance and benefits of human connection. Role-play social interactions.

FAQs about personality disorder treatment plans

How long should a personality disorder treatment plan cover?

Each treatment plan is as unique as the client it serves. In general, however, personality disorder treatment plans cover a relatively long period of time — sometimes a year or longer — with more frequent review periods built in.

What are the most common treatment goals for personality disorder?

You should always work with your client to determine their unique goals. However, many personality disorder treatment plans aim to reduce affective instability and urges to self-harm, improve emotional regulation, and strengthen interpersonal relationships.

Do you need to be DBT-certified to treat personality disorder?

Legally, no. However, some therapists may not feel comfortable treating complex personality disorders without advanced training in DBT and related modalities.

Which ICD-10/ICD-11 code applies?

Personality disorders fall under ICD-10 F60. There are many different codes for various symptoms and presentations, so be sure to complete a careful assessment before selecting one.

Should medication be part of the plan?

There is not a medication specifically approved to treat personality disorders. That said, some clients may benefit from psychiatric medications that target specific symptoms or co-occurring diagnoses.

How often should the plan be updated?

Your treatment plan should include regular opportunities to review how symptoms are changing in response to therapy — perhaps every one to three months. If symptoms are plateauing or worsening, or if your client’s goals or circumstances have changed, it may be time to update the plan.

Build your best practice with Headway

Creating and implementing effective personality disorder treatment plans can be complex, but Headway supports providers with practical resources, structured templates, and a network of experienced professionals. Headway helps you enhance your practice, allowing you to focus on what you do best: caring for your clients.

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This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

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