Therapy notes are boring!

As many of you know, I work in mental health. That being said, and being a former case manager, I've seen all kinds of notes...except notes from a therapist. The individuals that I've historically worked with (I/DD and autism) do not benefit from traditional talk therapy.

I had discussed therapy notes with my T and she said she didn't know why I'd ever want to read them because they are very cut and dry and devoid of detail. Now I know.

One of my MI Supported Employment clients had notes from his therapist in his file. I have never seen such a boring note in my entire life...it went something like this (not actually from the file, I'm making it up, but similar):

Client stated he was having problem with _____. Clinician suggested to client that he try ______. Client explained why he didn't think _____ would help him with _____. In the past, client had problem with doing _____, which would make it difficult to do _____ now. Clinician suggested _____ as an alternative. Client stated that this might work for him. Client wanted to know more information about ______.

Even dietary notes for I/DD individuals in group homes are more thrilling than this! I think my T is right; I don't think I would gain anything from reading my own notes. When she described what she writes in her notes, is was exactly like what was written above. Considering how detailed the notes I used to write were, I thought she might have been downplaying it. She wasn't.

Yeah, my T has said he keeps his notes as sparse as possible after years of being called to testify -- he used to work with inmates. We have discussed his notes a couple of times when I was nervous about something I said appearing in them. He has offered to let me read them and shown me the pages in question. I didn't read them, but I did glance at them and saw there were only like three sentences written on each.

That was pretty much how T explained it. Very simple, very brief, no names, "client" and "counselor" (her word of choice for what she does). She told me her notes were never more than a paragraph long...4-5 sentences max. She told me that considering what I do for a living, if she ever showed me my notes, I couldn't judge her on them!

The client's T notes in the chart I was organizing were actually two whole paragraphs long! Still very boring.

I have read them for cases I have been in. They are quite tedious.
And some therapists are quite pompous.

I write all my notes with my clients so they know exactly what is going into their chart. More agencies are shifting to this set up, so that the client takes part in this and doesn't feel their chart is a mystery. My clients all love it, it gives us a chance to talk about what we did together. My notes aren't quite like that example, though...

Now I think this is great, Stormy. It is a more person-centered approach. When I was the case manager (QP) for the group homes at the company I'm now trying to expand to provide more services, any client could read anything they wanted in that 500 page chart or have someone read it to him/her. In our Supported Employment program, the client sees most of the info from VR and they are certainly not restricted from seeing notes.

What do you think of this? My T said that in her circle of therapist contacts and CE trainings that she has been through, it has been said that it is unethical for a client to see his/her own therapy notes. She said she didn't understand it, but it seemed to be the prevalent theory in our area. Most mental health providers I know in our area (although I can't speak much for therapists, psychologists, or psychiatrists in private practice) are trying to be more person-centered and transparent.

My T told me she used to write her notes giving her own opinion and the stated opinions of the client, but she was told, "Stick to the facts only." In fact, in a recent training I attended, we were told to go with Sgt. Joe Friday's phrase, "Just the facts, ma'am," when writing notes or PCP's.

The world of mental health is paradoxical and juxtaposed. I hope you are in private practice (but then you have to deal with insurance companies). There are pros and cons to everything! Thanks for your unique perspective as a therapist and a client!

I used to work in drug and alcohol and I used to find the client casenotes extremely interesting for some reason. But then again I think about it and if I were to read my OWN case file notes, I would be horrified! haha... but reading about someone else is really interesting.

i suppose i always imagine them being like my therapists diary or something. like it will have all his secret thoughts and feeligns about me. but of course that's not true and seeing an example in black and white definitely kills the curiosity for me.

i agree with kazzax though, i'd love to read some of the other patients' notes from my service.

Kazzax, Kiki, I find psychological evaluations to be much more interesting!

My file is 2-3 inches thick. Sometimes I wonder what she puts in there? And I think to myself, "it can't seriously be filled all with notes, can it?"

I think there are notes and then there are notes. If the therapist is in private practice and writes "personal" notes (the interesting ones :-) those probably would not be discussed with the client, or ever be shared, could be similar to if we were keeping a therapy journal ourselves and what we wrote about our T, etc. Think of Yalom's books based on his notes? I don't think his therapy notes on people were boring?

Clinic notes or those for insurance are bound to be dull/just the "facts" because they do have others reading them so have to be understandable by all those who do.

My T and I use to joke that my notes (I saw her twice, for 9 years each time) took up an entire file cabinet drawer (along with the poems, letters, "stuff" I sent her over time). I don't think therapy in depth, over time, can have he said/she said sorts of notes like CBT/DBT sorts of therapy might as there is no "plan" or agreed-upon goal that could be discussed and which might stay constant. "Client gave therapist poem, therapist thanked client for poem and asked what it was about. . ." just does not convey it?

My file is scattered all over his office! I've read some notes he sent to my insurance company and they were very detailed. Sometimes he takes notes while I'm talking and he will fill up 4 pages with stuff.
I think it depends on the therapist and what type of therapy they are doing. CBT is probably pretty straight forward. Depth therapy might have more interesting stuff in it.

I used to work with autistic adolescence and their books full of notes were very interesting.

I brought my journal in for the first time last session, I put it on the table and he was eying it up like he wanted to get his greedy little paws on it!

When I worked as a psych nurse and had to do a detailed intake assessment on new patients, I used the phrase "client states" a lot. I know it sounds boring, not very interesting, but it leaves no room for ambiguity. This way the chart has the client's exact words and feelings.

I interned at a program for DD clients and was really impressed by the notes the psychiatrist wrote. They were detailed and full of useful information. She wrote them in session and always printed off a copy for the client (or his/her guardian).

I work as an RN at a psych hospital now and have to write 6-8 patient notes each day. They are quite brief as I don't have time to write extensively. I include a section on what the patient tells me and use direct quotes. I also must include my clinical impressions, for example patient affect. I also report on intent to self harm, thoughts of death, hurting others, delusions, etc. And I report on patient behavior, ability to self soothe, coping suggestions made to patient, if patient is participating in the program, if patient was disruptive, cooperative, insightful, etc. I think the notes are indeed pretty boring but they can help the staff on the next shift or the next day get a more complete picture of the patient if need be. The therapist notes are based on a session rather than observations made continually throughout the day, so they can be different--more limited like a snapshot in time, but also deeper and longer. The MD notes are yet another creature. All the notes from the different staff help add up to a more complete picture. The notes may be reviewed by county social services if any issues are raised. I think if I were doing outpatient work, a big function of my notes would be something I could quickly review before seeing the client at the next session to remind me of where we were at.

I'd definitely be interested in my pdoc's files. My file for him is literally on volume 3 which I always find amusing when I see it. While I know most of it is our appointment notes and taxes for refilled to the pharmacy kind of stuff, he has also been my treating pdoc for all of my hospitalizations and ECT treatments. He has all of the summary records which probably would be interesting information.

I think I always thought that the T notes were like a diary as well!!! But to see that does kind of make me feel better, like all my private stuff isn't just out there in my file somewhere...
I think my T does short little notes too, she has a clipboard with one sheet of paper on it, and she doesn't write too often. Works for me, she is very engaged while I am working with her, which is what I want while I am in therapy anyway.
I think I would be more nervous if I knew she was writing a ton while i was talking anyway!

My T is in private practice. If I give T something (a card with a poem, she takes it home rather than filing it. She said she had a special place at home where she keeps cards from anyone (clients, friends, and family).

She doesn't keep personal notes on clients. What little she writes down in session gets copied over to an official form for the practice. That is the note the insurance company gets. And they are like the ones in the original post.

I've had two therapists.

My first therapist let me read the notes he kept on our sessions. The first set I got, I thought it was very helpful as I could see we were both on the same page.

In the second set, it was very very hurtful because I found out that he kept information from me and essentially lied about something. He also expressed his inability to help me or know HOW to help me. He ended up leaving his practice and I changed therapists. The second set of notes still haunts me.

If anyone ever is able to read their own session notes kept by your therapist, please heed my few suggestions....

a. Talk about what you've read and whether or not the facts are right and if you feel you're on the same page.

b. Make sure that there is time to discuss what is in the notes before therapy is over.

My therapist wrote some pretty shocking things (to me) in the notes that I never was able to question or work out with him because I got the second set of notes on my last day of therapy. I only had 4 weeks notice of my therapist leaving and then with this on top....well I'm sure you can imagine what that was like.

c. If you're worried how you're going to respond to reading the notes, try reading some in session before you go home.

d. Be prepared to be embarrassed and ashamed in reading the notes. Even if you know some particular things are the truth, it can be hard reading that truth.

I think there are benefits to reading our session notes, but there are also serious repercussions. My ability to trust my new therapist has been a long road because of my previous experience. I wanted to read my new therapist's notes to make sure he wasn't leaving things out with me and I didn't trust him to communicate with my Pdoc, so I would constantly be giving consent and taking it away.

My new T has not let me read his notes, as he fears it just makes the trust issue worse and says by the time that it would be okay to share them, it probably wouldn't be an issue for me anymore. (Nice way to get out of it, T...)

Anyway, I hope my experiences can help someone else.

......Oh, and my notes were far from boring.