Why “write therapy down”? Many patients* keep a therapy journal (something I hope to be blogging about shortly)—it can help you understand and become more aware of the therapy process, it can help focus your objectives, it is simply a good way to share feelings that otherwise might not come to the fore, and so on.
Therapists, too “write therapy down”—generally, for each and every patient they see. I want to share with you why they do.
Briefly, there are several reasons why your therapist writes everything down including evaluations, treatment plans and many notes about what goes on during your sessions together. Of course, they could merely memorize this information—though that would be quite difficult.
But by writing notes, your therapist can really increase his or her awareness and knowledge and improve treatment. That is why your one-hour long may start on the quarter or half hour—your therapist is using time between sessions to write progress notes from the previous patient and is also using some of that time to review your previous session notes so he doesn’t forget important things about you or your situation. (Don’t be offended, your therapist may see between 20-30 patients a week–it’s hard to remember every detail).
By making a written evaluation your therapist will be able to review his or her notes throughout the treatment experience. He or she will be able to more clearly see improvements, inconsistencies, or even set backs, etc., and revise your treatment plan accordingly. In essence, every time your therapist meets with you, he or she is actually participating in a continuous, ongoing evaluation. If the “baseline” evaluation is written down t he or she can reference it.
If you are using health insurance to cover the costs of therapy, many insurance companies actually require a written evaluation (and written treatment plan) in order to reimburse payments and grant visits.
If your therapist is unable to meet with you, let’s say he or she is on vacation or has a bad cold, etc., a colleague can review the thorough and detailed notes and be able to jump in, at least somewhat, to help you.
If you have another professional involved in your care, such as a program, individual medical doctor, psychiatrist or other mental health provider you may be asked to sign a release for this written information to be passed along to them. It can help them coordinate your care better.
If you decide to go to another therapist, your evaluation, treatment plan, and progress notes can be forwarded to the next provider at your request.
Also, you are entitled to have written copies of your treatment records, including the evaluation, treatment plan, etc. for your own uses.
When you complete treatment your records can be sent to your after-care provider at your request.
There may be a few more reasons why it makes sense to write therapy down, but those are the basics.
Cup of Soup - Mini Blog Entry
*Patient vs. Client: For A.N. who emailed me and asked why I use the term “patient”–these are my thoughts.
My choice of “patient” is a personal preference—I believe you and your therapist should use the term that is most comfortable for you. To me personally, the term “client” feels impersonal and more business-like—it just doesn’t connote the same level of responsibility, connection, and care. “Patient” just feels like it fits in a helping-profession type of relationship. Many people disagree with me and there is room for a wide range of opinions. We all know that what may be politically-correct can and will change over time—patients, consumers, clients, and back again. Again, you and your therapist should use whatever is comfortable for both of you. If being referred to as a client or consumer or patient is helpful to you, then you should state your preference. I believe this a personal and not political decision that therapists and the people they care for must come to terms with.
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Sarah at 3:39 pm on
January 19th, 2010
Richard Zwolinksi, LMHC, CASAC at 4:30 pm on
January 19th, 2010Patients Requesting Copies of Their Notes
It’s YOUR therapy. I am not sure of the law in every state or country, but in NY State, for example you are entitled to view copies of your session notes and records. If you feel it will benefit you why not discuss this with your therapist directly? What I suggest is that if seeing your progress notes is important to you, say to your therapist: I would like to begin setting aside a portion of my sessions to review the notes from the previous session. Will you please have a copy of your session/progress notes from this session ready for me to see the next time I come in?
Unless there is an ongoing legal issue such as a domestic violence issue, etc. you most likely will able to see your notes and records. In fact, I outline what happens during the first and subsequent therapy sessions in my book and one of the things I recommend is that patients and therapists together craft and review a written treatment plan for at least a few minutes every session or so.
Very clear and good explanation of why we do note taking. Not only is it legally necessary but allows us to review our progress and think ahead.
Lisa Brookes Kift, MFT
The Toolbox at http://LisaKiftTherapy.com
TPG at 5:53 pm on
January 19th, 2010Actually, I’d prefer that there be the absolute minimal number of notes possible, and I’d prefer it for the same reason that I would never want any audiotape or videotape of any therapeutic work.
The fact is — and I wonder if it’s incumbent on therapists to make this clear to clients — despite all the confidentiality laws in place, these materials are discoverable in certain circumstances, and not just the really scary ones like a therapeutic client turned suspected murderer.
For examples, the following is from the website of a psychological training institute in North Carolina. I can’t vouch for the quality of the institute — neither EMDR nor transactional analysis is my chosen paradigm! — but I think the information mentioned here is sound:
***
Patients need to be aware that notes can be released in such circumstances as…
IV. Uses and Disclosures Neither Requiring Consent Nor Authorization: The law may require release of protected health information without your consent or authorization in the following circumstances:
* Child abuse;
* Suspected sexual abuse of a child;
* Adult and domestic abuse;
* Health oversight activities (i.e., the state licensing board in North Carolina);
* Judicial or administrative proceedings (i.e., if you are ordered here by the court for an independent child custody evaluation in a divorce);
* Serious threat to health or safety (i.e. our “duty to warn” law, national security threats);
* Workers Compensation Claims (If you seek to have your care reimbursed under Workers Compensation, all of your care is automatically subject to review by your employer and/or insurer(s)).
http://www.seinstitute.com/privacy_rights.html
Also, if a patient dies? I think next-of-kin can make same request for process notes under HIPPA that the patient can.
Richard Zwolinksi, LMHC, CASAC at 8:37 pm on
January 19th, 2010Hi TPG,
I am grateful for your continuing comments.
We have slightly divergent views on this issue. First, I want to point out as you do that the site you link to appears to be in North Carolina so is a good reminder that laws are often state-specific. But yes, HIPAA laws are HIPAA laws and they protect our privacy–but up to a point. In cases where a patient is potentially a cause of serious harm to self or others therapists may be required (depending on the laws where you live) or at least have an ethical or professional obligation to seek some intervention; when the harm might possibly come to a child, or has come to a child,or is life-threatening in general, then I imagine we are all in total agreement. Keeping people safe is very important. We must reach out to help people.
Here is the HIPAA page of the HHS website if you want to wade through the laws. Whew!
http://www.hhs.gov/ocr/privacy/
As for your written preference for fewer notes, TPG, as a patient, you are entitled to ask your therapist not to take more notes than is required by law or professional ethics.
But speaking as someone who has supervised and trained literally thousands of psychotherapists over the years, one common denominator (granted, among several), of the most effective psychotherapists is that they keep careful notes, review them regularly, almost as if they were going to study for a test. My experience isn’t alone in showing that intense focus/planning/therapy requires study, and study requires notes.
I think your comment gives us plenty of food for thought and future discussion.
Still want my advice? Find out the laws in your state if you are very concerned about privacy for any reason, but still ask for a written evaluation, treatment plan, and at least rough session notes.
TPG at 8:59 pm on
January 19th, 2010Great response, and points well taken.
This is the kind of thing — the detailed process notes thing — where it’s not a problem at all for the client…until it’s a problem for the client. That child-custody dispute arena could potentially be a real bear. Imagine if the client speaks frankly and primitively/emotionally — and highly negatively! — about his former spouse in session, and there are notes to that effect. Ugh. One could always argue that the therapist could be compelled to testify, but most any judge, lawyer and/or juror will tell you that documentary evidence has a much more powerful impact than verbal testimony.
On another related topic…
Maybe at some point in the future you could blog on the propriety/advisability/utility/importance/intrusiveness/helpfulness of audiotaping and videotaping therapy sessions? There’s such a divergence of opinion on this issue. Janet Malcolm has this to say about the practice 23 years ago in the New York Review of Books:
“Surely one day analysts will look back on today’s debate over whether to tape record or not as they now look back on the controversy that polarized the profession in the late Forties and early Fifties over whether to change from linen head-napkins to paper ones. (See the Brickman Report, 1975.)”
http://www.nybooks.com/articles/5549
On the other hand, some therapists just won’t do it, seeing the recorder as a third party in the room that inevitably skews the dynamic.
You saw what I think about it: I wouldn’t want that kind of record, either as therapist or as client. But I can so easily see many patients who’d CLAMOR for the chance to replay their sessions in the privacy of their own homes. I can see too how it could be hugely useful to therapists, and not just in their training or supervision. And without actual taped records, how can any evidence-based outcome research be done that won’t be skewed by biased reporting?
Anyway, think on it as a topic. Thanks! Yours has quickly become one of the most compelling blogs on this site.
BSS at 7:14 am on
January 21st, 2010Good points about note-taking. Those of us in other professions — teachers, lawyers, businesspeople — could take a leaf from your book and take notes of our meetings with students or clients. It might make us more attentive and better prepared.
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What do you think about patients requesting copies of their notes from previous therapy sessions while therapy is still ongoing?
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