Insurance-Pleasing Couples Therapy Treatment Goals

 By Barbara Griswold, LMFT (July 13, 2024)

Writing treatment plans for couples can be a challenge. You know it is important to select appropriate treatment goals that would pass an insurance plan review or audit.  But what goals will plans approve for couples therapy?

First, a few points about couples treatments plans: 

• When billing insurance for couples therapy, one member of the couple must be named as the identified client,and this client must have a diagnosis (usually more than just a Z-code).
• You only need one treatment planfor this identified client.
• Treatment plans for all insurance clients must have goals that are considered “medically necessary.”Goals like improving self-esteem, better sex, career decision making, personal satisfaction, and better communication alone may be considered personal growth, and may not be covered by insurance.

So, how to choose couples therapy goals? Here is my advice:

1. Goal #1 should be aimed at the identified client’s diagnosis.This is the same as when working with an individual. An example could be “reduce symptoms of [diagnosis] and reduce related impairment.”
2. Now, choose at least onemeasurable objective for Goal #1. That is, how will you measure that Goal #1 is being achieved? Examples might be a target score on an objective quiz like the PHQ-9 or GAD-7. Or simply that the client will self-report a measurable decrease in the frequency and/or severity of certain symptoms (ex. “from daily to less than 3 times a week”). Perhaps the client will be doing one thing from his depression or anxiety self-care plan daily.
3. For couples therapy, now choose a Goal #2 that addresses relationship goals.  Some examples:

• • Address relationship issues contributing to client symptoms or lack of functioning
  • Reduce relationship conflict that is contributing to client’s symptoms
  • Improve communication in relationship to deescalate conflict or to enable client to gain necessary support
  • Reestablish trust to stabilize relationship and reduce client dysregulation
  • Assist partner to understand client’s symptoms, to respond more effectively

Tip: When choosing this goal, think of it as explaining to the health plan why there is a need for couples therapy instead of individual therapy.

4. Now, choose at least one measurable objective for Goal #2.Perhaps the couple will be reporting less than one conflict per week. Or the couple will learn and be practicing three communication techniques learned in therapy to deescalate conflicts. Maybe they will be taking time outs at least 70% of the time when anger flares.

Of course, you may need to add more goals, depending on the client’s situation.

If you work with couples, you know how complex and challenging this work can be! check out my webinar “Couples Therapy: Billing, Documentation, and Ethical Dilemmas.” For more practice writing Treatment Plans, check out my pre-recorded webinar “How to Write a 10-Minute Treatment Plan,” available here.