Trust is an essential component of a healthy relationship. Without trust, relationships can experience heightened jealousy and anger. Difficulties trusting others can be a maladaptive coping skill resulting from previous negative experiences. For some, this can stem back to unhealthy attachments with parents or caregivers during childhood. Difficulties establishing trust can affect various areas of a client’s life, including their work, romantic relationships, and more.
Clients who struggle with trust can experience a range of mental health disorders, like depression and anxiety. They can also be related to more serious disorders like schizophrenia, paranoid personality disorder, and borderline personality disorder. Severe mental illnesses may require more intensive care, including residential and psychiatric services.
When working with clients who struggle with trust, developing a safe environment is key. It can be challenging to build a therapeutic relationship, especially with a client who experiences these challenges. With attention and patience, you can take steps to demonstrate safety and consistency within the therapeutic relationship.
Setting Goals and Objectives With Clients in Your Trust Issues Treatment Plan
There are signs you may see early in the intake process that indicate potential trust concerns. This can include having little to no social support and having a history of unhealthy relationships. These indicators can help you narrow down what should be included in your treatment plan goals and objectives.
Before I start developing a treatment plan for trust issues, I review all relevant paperwork. This may include intake forms, a biopsychosocial evaluation, or self-assessments. The components of my treatment plan will depend on the individual client, including their presenting concern, mental health disorders, and the treatment program they’re receiving. I then consider professional resources that could enhance treatment effectiveness. This includes clinical worksheets available at TherapyByPro. These are my go-to because they are evidence-based and customizable. Examples of worksheets I would use for a treatment plan for trust issues include:
What to Include in a Treatment Plan for Trust Issues + Example
For the remainder of this page, we will walk through the development of a treatment plan for trust issues using the TherapyByPro customizable treatment plan. Stick with us for a hypothetical case for Jane.
Jane’s story:
Jane is a 23-year-old woman who is seeking support after struggling with depressive symptoms. She reported struggling with a low mood, sleep disturbances, and poor concentration. These symptoms have begun to affect her work, which prompted her initial contact.
Janes explained that her symptoms have been persistent for over a year, but were not as intense until recently. She has noticed a decrease in her appetite and unintended weight loss in the last 8 weeks. Jane indicated a recent breakup with her partner around the same time, and noted that she should have known he would leave. She reviewed her relationships in adulthood, which highlighted a pattern of ending when things got serious. Jane stated that her father left when she was young, and she has not known a relationship to last long-term.
She denied all suicidal concerns, a history of mental health treatment, and the use of drugs or alcohol. She was agreeable to weekly individual therapy, but noted skepticism.
Agencies Involved and Plans for Care Coordination
In this case, it does not appear that care coordination is necessary. She has no history of mental health or psychiatric care and would be receiving outpatient care for her symptoms.
Example for Jane:
Care coordination: None at this time
Clinical Diagnoses
The clinical diagnosis should be supported by the case conceptualization included in the presenting problem section of your treatment plan. For this case, Jane meets the criteria for major depressive disorder, moderate. This is supported by her depressed mood lasting over one year, sleep disturbances, decreased appetite, unintentional weight loss, and impairment at work. Symptoms appear to have intensified after an interpersonal stressor, or the ending of her relationship.
Example for Jane:
Clinical Diagnosis: Major Depressive Disorder, Moderate (F33.1)
Current Medications and Responses
Jane denied receiving psychiatric care and using medications at the time of her intake. If this changes during treatment, I would adjust her treatment plan accordingly.
Example for Jane:
Medications: None at this time
Presenting Problem and Related Symptoms
This is the section where I present my case conceptualization. The information included supports the earlier diagnosis and the treatment plan goals that will be discussed in the following section.
Example for Jane:
Jane is a 23-year-old woman seeking treatment for ongoing depressive symptoms, more specifically, persistently low mood, sleep disturbance, and impaired concentration. These symptoms have begun to interfere with her occupational functioning, leading her to look for support. She reported decreased appetite and unintentional weight loss over the past 8 weeks, suggesting a recent worsening.
Jane reported that her depressive symptoms began over one year ago, with a notable worsening following a recent relationship breakup. She expressed negative core beliefs related to abandonment, stating that she “should have known” the relationship would end. A review of her relational history suggests a consistent pattern: relationships end when emotional closeness and vulnerability arise. Jane identified early abandonment experiences when her father left and reported limited experience with long-term, stable relationships. She denied suicidal ideation, prior mental health treatment, and substance use. Jane expressed willingness to engage in weekly individual therapy, though she showed some skepticism about treatment effectiveness.
Goals and Objectives
This is one of the most important, if not the most important, section of my treatment plans. The goals and objectives should align with the details included in the presenting section. They should also be personalized, realistic, and meaningful to the client. Ideally, your goals and objectives would be grounded in evidence-based therapies proven to treat their symptoms effectively.
Example for Jane:
GOAL 1: Decrease Depressive Symptoms
Jane presents with persistent depressive symptoms that have intensified over the past several months and are now interfering with her occupational functioning. Addressing these symptoms is a primary focus of treatment to improve her daily functioning, mood stability, and overall quality of life. This goal emphasizes increasing awareness of depressive patterns while implementing evidence-based interventions to reduce symptom severity and duration.
- Objective: Identify and track depressive symptoms, including mood fluctuations, sleeping patterns, and thoughts
- Objective: Engage in behavioral activation
- Objective: Use cognitive restructuring to challenge negative automatic thoughts
- Objective: Develop a healthy and consistent sleep routine
GOAL 2: Improve interpersonal functioning
Jane’s relational history reveals longstanding trust difficulties rooted in early abandonment experiences and reinforced through repeated relationship endings. These patterns contribute to her depressive symptoms and negative core beliefs related to intimacy, vulnerability, and abandonment. Improving interpersonal functioning will help Jane increase insight into her relationship patterns, clarify her needs, and develop healthier ways of connecting with others.
- Objective: Identify core beliefs tied to trust concerns
- Objective: Review previous and current relationship patterns to increase awareness
- Objective: Use assertive communication skills to establish and maintain one new boundary
- Objective: Make a list of her needs within interpersonal relationships that have not been communicated to previous partners
GOAL 3: Implement new coping and emotion regulation skills
Jane currently has limited coping strategies to manage emotional distress, particularly during periods of low mood or interpersonal stress. Strengthening her coping and emotion regulation skills will support symptom reduction, increase resilience, and improve her ability to manage distress independently. This goal focuses on building practical, accessible tools that Jane can use consistently both inside and outside of therapy sessions.
- Objective: Use mindfulness practices, such as deep breathing or grounding exercises, three times per week.
- Objective: Create a list of coping skills that are easily accessible, such as in her phone, on a computer, or written down as a reference.
- Objective: Identify warning signs of low mood and coping skills that can be used when they arise
- Objective: Use journaling to track her confidence, mood, and thoughts daily to review in counseling sessions.
Specific Interventions to Be Used
This section can be a helpful reminder before sitting down with clients. Reviewing this helps me develop a tentative roadmap for my session that addresses the goals and objectives my client is working towards.
Example for Jane:
Intervention 1: Behavioral Activation
Behavioral activation will be used to help Jane increase engagement in meaningful and goal-directed activities that have decreased due to depressive symptoms. Sessions will focus on identifying avoidance patterns, scheduling activities that support mood improvement, and gradually increasing participation in pleasurable or mastery-based tasks. This intervention aims to improve mood, motivation, and daily functioning.
Person Responsible: Jane
Intervention 2: Cognitive Restructuring
Cognitive restructuring will be used to help Jane identify, evaluate, and challenge negative automatic thoughts and maladaptive core beliefs related to depression and abandonment. The clinician will support Jane in examining the evidence for and against these thoughts and developing more balanced alternatives. This intervention targets cognitive distortions that contribute to low mood and interpersonal difficulties.
Person Responsible: Jane
Intervention 3: Psychoeducation regarding mindfulness practices
The clinician will provide psychoeducation on mindfulness practices to increase Jane’s awareness of thoughts, emotions, and physical sensations without judgment. Education will include the purpose of mindfulness, how it supports emotion regulation, and instruction in basic techniques such as grounding and breathing exercises. This intervention supports skill development for managing distress and emotional reactivity.
Person Responsible: Clinician
Intervention 4: implementation of emotion regulation skills
Jane will practice emotion regulation skills to improve her ability to tolerate distress and respond effectively to emotional triggers, particularly during interpersonal stress. Skills may include grounding techniques, distress tolerance strategies, and identifying early emotional warning signs. The focus will be on increasing emotional awareness and reducing impulsive or avoidant responses.
Person responsible: Jane
Intervention 5: Symptoms tracking using journaling
Journaling will be used to track Jane’s mood, thoughts, behaviors, and emotional responses over time. This intervention will help increase insight into symptom patterns, triggers, and progress toward treatment goals. Journaling entries will be reviewed in session to inform treatment planning and reinforce skill use.
Person responsible: Jane
Family Involvement
In some cases, incorporating couples or family therapy sessions can be helpful. While this is not one of those cases, it is not something to rule out down the road if appropriate.
Example for Jane:
Family Involvement: None at this time
Additional Services and Interventions
Examples of additional services that may be helpful include group support and holistic treatments that promote self-exploration and communication. This could consist of art and music therapy. I would have a conversation with Jane about these options and see if she is open to any local options.
Example for Jane:
Additional Services: Group support for depression or art therapy
Estimation for Completion
Because her symptoms are moderate, there is a strong likelihood that Jane will experience noticeable improvement within 3 months. This section can be adjusted as needed during treatment plan reviews to reflect her progress.
Example for Jane:
Estimated Time for Completion: Twelve weeks of individual therapy
Aftercare Plans
The aftercare section of your treatment plan can have treatment referrals in case Jane decides to end treatment prematurely. For this case, it would be appropriate to refer her to her primary care physician and offer contact information for community-based mental health services.
Example for Jane:
Aftercare Plans: Refer to Primary Care Physician and Community Mental Health Treatment Center (123)456-7890
Final Thoughts On Creating a Treatment Plan for Trust Issues
Trust is a common concern among clients of varying demographics and backgrounds. You can begin by having a consistent, supportive, and understanding environment for your client each week. Clients may hesitate to fully engage in sessions until they feel safe and trust the therapeutic relationship.
If you would like to learn more about addressing trust issues with your clients, we encourage you to explore available continuing education and training opportunities in your niche. Supervision is another valuable tool that allows you to receive personalized feedback on how to support your clients.
TherapyByPro is a trusted resource for mental health professionals worldwide. Our therapy tools are designed with one mission in mind: to save you time and help you focus on what truly matters-your clients. Every worksheet, counseling script, and therapy poster in our shop is professionally crafted to simplify your workflow, enhance your sessions, reduce stress, and most of all, help your clients.
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Resources:
- Rodriguez LM, DiBello AM, Øverup CS, Neighbors C. The Price of Distrust: Trust, Anxious Attachment, Jealousy, and Partner Abuse. Partner Abuse. 2015 Jul;6(3):298-319. doi: 10.1891/1946-6560.6.3.298. PMID: 28386379; PMCID: PMC5380380.