Sunday, April 2, 2023

"May I See My Therapy Notes?" A Surprisingly Controversial Topic (And Yes, I Share – Or Take None At All If You Prefer)

Sharing therapy notes empowers clients
Empowerment is key

You're pouring your heart out and the therapist takes a note. Immediately you wonder what they've written down.

So, can you see your notes?

With me, yes. In the free 15 min chat, I ask if you want notes or not. If you say yes, I always share notes with you. We're working together, right?

I believe in empowerment and transparency. So, if I think it's important enough to note down, then we're talking it over, and you need to see it.

It's your life we're talking about.

I believe refusing to share notes damages trust and infantilises clients. However, sharing notes with clients is controversial. In fact, note taking itself is also a hot topic. 

If you prefer the listen, click on the podcast 

What Therapy Notes Are For

Mental health practitioners take notes in different ways. One common style is to note how a client acts, including emotions they show, plus the therapist's hypotheses of what is going on, action taken, progress over time, or thoughts about the session.

Notes are useful to track work and effective change. When therapists have dozens of clients, you can't expect us to remember every detail without a prompt.

Also, if staff move about, having notes mean clients don't have to start all over again with every therapist change.

In hospitals, NGOs, and companies where practitioners have bosses, several people will access and use notes. They use them to extract data, to check on how your therapist is working, and more. That's a problem, which I'll discuss in a second.

Not Sharing Notes Is Common

Hospitals and companies are typically defensive, and they're known for withholding records from their patients and clients. 

It's not just therapy notes; the fight for us to see our own medical notes has been ongoing for decades. It's why so many countries have had to actively legislate to allow us access. And even then, there are lots of arguments about it - like this piece discusses so nicely

As early mental health practitioners were typically also medical doctors, and many therapists work in clinics, I suspect that this issue has a strong historical legacy. Whether it is or not, many therapists refuse to share notes with clients, even although in a recent study 94% of 85 clients polled said they found it useful.

I'm hearing more colleagues talk about this, so hopefully the norm will switch to transparency and empowerment being the norm. 

And if I may suggest a hint to further the revolution: if clients refuse to work with therapist who won't share, that change will come sooner.  Money always talks 😊

When Therapy Notes Hurt Clients or Are Dangerous

Another issue is that notes can hurt clients - and I'm not thinking about my awful spelling and brute approach to grammar, either.

Seriously, notes can hurt and even kill if they are seen by a third party. Here are some simple examples I come across regularly.

  • Zul is from a poor family. He shares a laptop with three sibs. If they saw his notes and learned he was depressed, they would worry.  Worrying them would burden him and impact on his mental health.
  • Fiona is exiting a violent marriage, and her husband snoops. If he sees her therapy notes, he'll beat her into hospital or an early grave.
  • Shan is an atheist in a country where that is illegal. If people saw his therapy notes, he'd be fined, flogged and jailed as part of his 're-education'.
  • Jenn had a miscarriage and she's devastated. But if her evil ex finds out, he'll accuse her of having an abortion. As those are illegal in her country, Jenn would go to trial and if wrongfully convicted, jail.
  • Mandy and Ken are discussing an abortion in a country where that's illegal. Being discovered even thinking about it means being fired and ostracised. If they we're to decide to do it and travel to a safe place, being discovered would mean jail.
  • Rob is gay in a country where that is illegal. If anyone saw his notes, he would be executed.
  • Farah is having an affair. Adultery is illegal in her country. If she's discovered, it means flogging, fines and jail.
  • Dave likes his privacy. He simply doesn't want a record of his mental health journey.
  • Karen doesn't want anyone to know she's in therapy because her organisation believes seeing a therapist means you're unstable or weak. If people knew, she'd never be promoted. She might even be fired.

The world is a nasty place, and we can't be Pollyanas. Therapy is a safe space, and that comes with obligations.

Leaks, Data Selling and Other Privacy and Security Issues

While organisations typically document everything for many good reasons, it's also a massive problem because too many are lousy at keeping records safe. 

They are targets for hacking, and sometimes unhappy staff leak or sell patient data. Here are a few articles about recent issues - in the USAthe UK and Australia.

Organisations themselves also choose to make money by selling client data. There are a tonne of scandals, like this one where the NHS gave information to Google which wasn't the first time either, as the same issue came up in the USA in 2019.    

As for health apps that track exercise, periods, and mental health, they are built to extract, package, and sell information. It's a huge industry, as this piece and this piece explain. 

If you're okay with selling your information, that's great. But if you are private or think it may put you in danger, it pays to be careful.

I am a private practitioner. Therefore, I make my own guidelines. My primary focus is healing in a private setting. 

I do my own paperwork. Nobody knows who my clients are. I keep client notes offline, and not on a server. I have firewalls. I do everything I can to keep notes safe.

As many of my clients are vulnerable, I offer a No Notes option

I'll ask before we start if you want notes. You can say yes or no - and I don't need a reason. It's your session and your choice. And if you start off wanting notes and then change your mind, that's okay too.

My view is this: it's your session and your life, so you pick. 

I hope you found this interesting. Be safe and if you need a therapist, you know how to find me. Thank you for reading!

Image by John Hain from Pixabay