Should clients read their therapist’s session notes?

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The latest trend in some psychotherapy circles is to let clients read the session notes compiled by their therapist. Say what?

That’s right. According to a recent New York Times article titled What the Therapist Thinks About You, the Beth Israel Deaconess Medical Center in Boston, following the current trend towards increased transparency, is conducting an experiment with mental health patients that grants them access to their therapist’s notes shortly after a session. The rationale behind this? Session notes are part of a person’s medical records and, as such, should be made available to clients who wish to read them.

I take issue with that position. The content-driven medical model focuses on diagnosis, treatment, and–one hopes–cure, and is not necessarily de rigueur in a therapeutic setting. Relationship-building is what drives therapy. And while most patients might want their doctor to be warm and pleasant, as opposed to aloof and curt, the success of medical treatment is not predicated on a physician’s bedside manners. In therapy, the process-oriented treatment is intricately tied to the quality of the relationship between therapist and client. Therapists, exploring the psychological states of their clients, delve into somewhat mysterious territory. More often than not, what troubles clients is invisible. Shrunken heart? Oversize ego? There is no equivalent to the descriptive “enlarged prostate” in therapy, where nuance is key and grey areas abound.

Why do therapists write session notes? First, because it’s the law. Documenting what takes place in every session is the therapist’s legal and ethical obligation. The notes also help therapists keep track of both the client’s progress and their own trajectory in adhering to the treatment plan and meeting the goals set for therapy.

I see danger in granting clients access to their therapist’s session notes. The notes are written in the language of psychotherapy. Knowing that clients can read them, therapists might be tempted to edit them for clarity or to amend the content to avoid offending the very people they are trying to help. In such instances, the notes become futile, a perfunctory document instead of an authentic assessment. Furthermore, a client’s insistence on clarification regarding the notes could imperil the therapeutic process by shifting the focus away from therapy itself.

It is not surprising that psychotherapy notes have not been made as readily available to clients as medical records: mental illness is a subject rife with controversy, fueled by misconceptions about the role of psychotherapy in treating such ailments and the fact that people who suffer from them are still stigmatized by labels that may not fit, but stick. This, I believe, makes the need for maintaining the confidentiality of session notes all the more crucial.

I applaud motions to promote transparency in a variety of fields: government, finance, politics, education, the medical establishment. But I seriously doubt that letting clients read what their therapist wrote about them is going to enhance the therapeutic process.

 

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