Thanks everyone for your insights! I guess I do have a treatment plan, it's just not formal. I have shared my ultimate goal with my T, and we have agreed to work on past traumas that are making me stuck on a big issue in my life right now. Then when I'm able, move on to working on the big issue itself, which hopefully will be easier because I won't be so stuck anymore. How's that for a plan? Would the insurance companies like that one?

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I doubt that every patient is aware of their treatment plan, as it's mainly the creation of the therapist to help keep the patient on track solving the presenting problem

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Sky, I found your comment interesting that a T might keep a treatment plan hidden from a client. I think of the therapist-client as being a team, and it seems like it wouldn't benefit the client to be "in the dark" about the T's plan?

freewill, that system you describe with the plans every 3 months sounds very frustrating. I am glad you are past that. Since I'm paying for my therapy out of pocket, I would not stand for "my time" being wasted like that. Suzy, I tried to get two different insurance companies to reimburse for my T, but no luck. I am done with the fight, gave it my best, and it at least is good to have an official answer, even though it is "no." So I am using some of my savings to pay for therapy. At least for now, it is really worth it, as my T has helped me tremendously in a relatively short time. Pffft to insurance.