A borderline personality disorder (BPD) treatment plan sets short-term and long-term goals, mostly chosen by the client, and pairs each with a measurable objective, a named main clinician, a crisis plan and a review date. In Australia, write it as one phase of longer treatment, because a year of Medicare-funded sessions is shorter than the evidence base.

What should a BPD treatment plan include?

A practical Australian template is Table 8.3 of the NHMRC Clinical Practice Guideline for the Management of Borderline Personality Disorder (2012), itself adapted from the University of Wollongong's Project Air Strategy. One caution first: the NHMRC publication page now marks the guideline "Rescinded". Treat it as a structural reference rather than a current NHMRC-approved guideline, and check for a successor before you cite it in a report.

Table 8.3 says the plan should identify:

the diagnosis and any co-occurring mental health conditions
short-term and long-term treatment goals
situations that trigger distress or increase risk
self-management strategies that reduce stress and risk
strategies tried before that did not help or made things worse
who to contact in an emergency
every professional and service involved, and their roles
family, partners, carers or friends who help, and their roles
the planned review date
who holds a copy of the plan

The "did not help" line is the one a locum or emergency department most needs. The copy list matters because the guideline asks that a person have only one BPD management plan, shared with consent across everyone treating them.

For general plan structure, see how to write a therapy treatment plan. The depression and PTSD versions are its siblings.

Why does session length matter so much in a BPD plan?

Because the Australian funding model and the BPD evidence base assume different timeframes, and the plan has to say which one it is working to.

The NHMRC guideline recommends structured psychological therapies designed for BPD (recommendation 8) and says therapists should generally consider at least one session per week (recommendation 9). It notes that in the trials showing those therapies work, treatment ran from 13 weeks to several years. The UK's NICE guideline CG78 goes further: recommendation 1.3.4.4 says not to use brief psychological interventions of less than three months specifically for BPD, outside a structured service.

Now the funding. Through Better Access, a client can claim Medicare benefits for up to 10 individual and 10 group sessions per calendar year. Only 6 individual sessions are available on the initial referral, and a GP review of the Mental Health Treatment Plan is needed before the rest.

A weekly course of Medicare-funded individual therapy covers about 10 weeks. That is shorter than the shortest effective trial the NHMRC describes, and under the three-month floor NICE sets. That does not make 10 sessions worthless, but a plan implying they are a complete BPD treatment misleads the client and the referring GP.

Three practical consequences:

State the funding in the plan. Record which services are Medicare-funded, which are private fee, and what happens at session 6 and session 10. The guideline notes that people with BPD are sensitive to feeling rejected or abandoned, and asks that planning for the end of treatment begin well in advance.
Use the group allowance for skills. The 10 group services are a separate allowance. The MBS descriptors for Better Access group items (for example item 80120) require a group of 4 to 10 patients, in person, lasting at least 60 minutes. A skills group run on those terms extends contact without spending individual sessions.
Plan the step up before you need it. The guideline recommends stepped care (recommendation 39) and referral to a specialised BPD service for severe or enduring presentations (recommendation 37). Name the service and the trigger for referral in the plan.

For more on the referral mechanics, see Mental Health Treatment Plan referrals.

How do you write BPD goals the client will actually own?

The NHMRC guideline says treatment goals should be "relevant to the person and determined mainly by them", and realistic, because symptoms are likely to fluctuate markedly while gains come slowly over the long term.

So split goals into short-term and long-term, as Table 8.3 asks, and write objectives that survive bad weeks: a frequency across a month, not a single perfect week.

Examples of short-term goals in the client's words:

"I want to stop ending up in emergency."
"I want to get through a fight with my partner without hurting myself."
"I want to keep this job past the probation period."

Examples of long-term goals:

"I want relationships that don't blow up every few months."
"I want to feel like the same person from one week to the next."

Each is a direction, not a measure. The objective does the measuring.

What do measurable BPD objectives look like?

An objective has four parts: what is counted, the baseline, the target and the review date. BPD has countable behaviour, and a diary card makes most of it visible. Some examples:

Self-harm: "Reduce self-harm episodes from a baseline of 9 in the last four weeks to 4 or fewer in the four weeks before the session 6 review, tracked on a weekly diary card."
Crisis presentations: "Zero emergency department presentations in the eight weeks before review, against 3 in the previous eight weeks, with the crisis plan used at least once in place of presenting."
Skills use: "Use a named distress tolerance skill at least 4 times a week, recorded on the diary card, up from none."
Relationships: "Stay in the room through at least 3 of 4 planned conflict conversations with partner by review, up from leaving or escalating in all of them."
Functioning: "Attend 90% of rostered shifts over the review period, up from 65%."

None is "client will regulate emotions", which cannot be scored, and none sets zero self-harm as the first target. A target the client is likely to miss in week three invites the plan to be abandoned.

Which outcome measures belong in a BPD plan?

NICE recommendation 1.3.4.7 asks that psychological treatment for BPD be monitored across a broad range of outcomes: personal functioning, drug and alcohol use, self-harm, depression and BPD symptoms.

BPD symptoms: the Borderline Symptom List short form, the BSL-23 (Bohus and colleagues, 2009), is a 23-item self-report scale developed for this purpose.
Functioning: the WHODAS 2.0 covers disability across six domains and has 12-item and 36-item versions.
Alcohol use: the AUDIT screens for hazardous and harmful drinking.
Depression and distress: the DASS-21 or K10. If the GP's Mental Health Treatment Plan was built on one of these, re-administer the same one at review. Our DASS-21 scoring guide explains why.
Self-harm: counted on the diary card rather than inferred from a questionnaire.

Read scores against behaviour: a falling distress score during a month with three emergency presentations is not progress.

How should suicide and self-harm risk be written into the plan?

The NHMRC guideline makes a distinction that should appear in the plan itself: many people with BPD live with persistent suicidal thoughts, and some use self-harm to regulate emotion without being suicidal, while acute risk can rise on top of that chronic baseline. It asks clinicians to distinguish self-harm from suicidal behaviour where possible, and to separate high-lethality from low-lethality self-harm.

It also lists when a full risk assessment should be repeated: at first contact, at the start of structured therapy, during a crisis, if another mental illness develops, if psychosocial circumstances change, at transitions or discharge, and whenever the management plan changes.

Write the crisis plan as a short, separate section: known triggers, what the client will try first, who they will contact, and what services should do if they present. With consent, it goes to the GP and any service the client is likely to present to. For documentation detail, see how to document a suicide risk assessment.

Who should the plan name as the main clinician?

If more than one service is involved, the NHMRC guideline asks services to agree on one main clinician who coordinates care (recommendation 42), and every professional involved should know who that is (recommendation 43). Write the name down: at 2am, "psychologist and GP" does not tell a hospital who to call.

The same section should record the GP's role, any psychiatrist, and medication. The guideline recommends medicines should not be the primary therapy for BPD (recommendation 11), with time-limited use as an adjunct for specific symptoms. A psychology plan should not set medication goals, but it should note who prescribes, and flag any concern about medicines that are dangerous in overdose, which the guideline raises as a practice point.

When should a BPD treatment plan be reviewed?

The guideline says at least every six months, and also at first contact with a service, on entry to or discharge from a treatment program, after a clinically significant change, and after a significant change in the person's family or social network.

Under Better Access, the GP review after session 6 is a natural fixed point. Bring the objective data to it: diary card counts, measure scores against baseline, and a clear recommendation about the next step, including whether a specialised service is now indicated. Our guide to the psychologist letter to the referring GP covers the report itself.

Families belong in the review where the client agrees. The guideline recommends involving family, partners or carers in the management plan with consent, and Better Access allows up to 2 services per calendar year involving another person, such as a family member or carer, counted within the client's allowance.

PractaLuma is AI-native practice management software for Australian mental-health practices, and its plan management view shows the sessions a client has left and when a review is due, alongside a library of standardised assessments that includes the WHODAS 2.0, AUDIT, DASS-21 and K10. See pricing for plans.

Frequently asked questions

Can a psychologist treat BPD under a Mental Health Treatment Plan? Yes. Better Access is available to people assessed with a clinically diagnosed mental disorder, which includes BPD. The funded sessions are limited, so the plan should say what happens after them.

Is DBT the only evidence-based treatment for BPD? No. The NHMRC guideline lists several structured therapies that outperformed treatment as usual, including CBT, DBT, MBT, STEPPS and TFP. It recommends a comprehensive DBT program where reducing self-harm is a goal for women with BPD, which is where the trial evidence sits.

Should the client or the clinician set the goals? Mainly the client. The guideline says goals should be relevant to the person and determined mainly by them. The clinician's job is to turn those goals into objectives that can be measured.

How often should a BPD crisis plan be updated? Whenever the management plan is reviewed, and after any crisis. NICE CG78 asks that crisis plans be updated as soon as possible after a crisis resolves, recording which strategies helped.

This article is general information for clinicians, not clinical or legal advice. Check current MBS descriptors before relying on the funding details.

BPD Treatment Plan Goals and Objectives (Examples)