As social media creeps into more and more previously private parts of our lives, it is understandable that even clinicians in the mental health field would be tempted to join in.
In “What the Therapist Thinks About You” (July 7, 2014) Jan Hoffman presents examples of taking the process of treatment out of the office and into the domain of the internet, including posting session notes and diagnoses. He refers to one study showing that patients reading their therapist’s comments “became more involved in their care.”
Considering that mental health patients fall within the very wide continuum from psychotic to neurotic illness, it is difficult to evaluate such experiments with a general conclusion.
The office is the sanctuary where the patient is free to reveal everything. Today’s technological wonders bring the understandable temptation of instantaneous gratification through communication outside of the office. But the slow and deliberate analytic process is jeopardized when the client moves from the session to an untutored reading of the therapist’s notes or diagnosis.
Posting the notes amounts to an analytic intervention and, like all interventions, should be aimed at moving the process of treatment to new and/or deeper places. If a sharing of communication outside the office is intended to resolve a resistance I am all for it, but it concerns me that in the sped up world too many are moving too fast.
Theodore Laquercia, PhD
NY State Licensed Psychoanalyst
President
Society of Modern Psychoanalysts
Emeritus of Boston Graduate School of Psychoanalysis
I had my first experience with the patient notes system at BIDMC within the past year. It’s main benefits, for me, were being able to see lab results immediately, rather than having to wait for a letter in the mail, and also being able to send and receive email messages to my physician.
Reading the visit notes had a dual effect; on one hand it made me more involved in the process, which I wanted to be, but it also exposed me to commentary on aspects of myself that I am sensitive about. For example, it was noted that I exhibited “linear thinking” during my initial primary care appointment, and I didn’t know what that meant and why it mattered. I would say that my experience as a psychotherapy patient prepared me for seeing this type of commentary, in knowing that those notes were there for the sake of The Record, without any personal judgement. One surprising benefit, however, was spotting a couple of errors in those records, which I had the opportunity to correct!
Thank you for sharing your experiences with us!
I think being able to view an electronic version of any medical notes can be beneficial to the patient as it gets them involved and more connected to their own health. However, I worry that these online databases could be hacked into by an outside source. It’s just my own paranoia but with the numerous hacking scandals this year that have hit Apple, Target, Google, News Corp, etc. I worry that eNotes could also be accessed by an outside source and that my personal medical information would no longer be between my insurance, my doctor, and myself.
I have never had first hand experience with this, but I think therapists can share their notes with their clients. However, it does depend on the therapist. If the therapist rights down their own immediate interpretations, it may not be what is true after looking in depth more. I think an altered or summarized version of the notes would be better suited for patients.
Patients that are unstable or even simply working to better themselves should not be placed in a situation (like their session notes being posted online) where they feel anxiety, nervousness and fear about reading the notes. I am not saying that they would always feel like this but for more vulnerable patients it seems that this new technology could be detrimental to some patients. I would suggest moving to a system whereby if the patient did want progress notes, maybe the therapist could find some way to give them a brief monthly synopsis on their positive improvements to aid the process and not detract from it if the patients read a note the wrong way and felt bad about themselves.
This reminds me of what we do as teachers with reports about our students. Confidentiality is absolutely key and safety comes first. Using “S” for Sarah or “T” for Tommy, we are free to communicate on the internet about a student, get advice about how to help them, and even get support for a difficult child. The child should not see these notes because they would not be able to understand most of the language and jargon of a teacher. We may communicate with them what we are doing to help them, how they are learning best, when they have had a bad few days, etc. In a clinical setting, this is very similar. Patients may not understand all of the psychological jargon used, and be offended by some of the notes. They may not be ready to read them or be able to understand what the doctors notes truly mean beyond the surface level.
I think it is risky for the health of the relationship between the therapist and the patient to have session notes completely accessible. While, personally not a therapist, I would imagine that a lot of the session notes have hypotheses or issues the therapist thinks might be present but is still contemplating. Session notes seem to me a way for the therapist to keep track of what is happening in each session while also being a space for the therapist to work through questions and treatment options. These things might be okay for some patients to see but others might be too unstable to rationally examine the notes. I think patients could misunderstand or become upset by things they read in the notes, in turn damaging the trusting relationship that is crucial between therapist and patient. Perhaps, a summary of the sessions could be provided or maybe at the end of treatment it would be okay for a patient to see the session notes, as they would hopefully be in a stable place at that point.
Because sharing therapy notes is such a recent concept, it is difficult to assume the outcome of such a step. It should depend not only on the therapist, but also the patient, and the kind of disorder they’re diagnosed with. While sharing notes might be beneficial to neurotic patients, it might be counterproductive for those with psychotic disorders. Because most things have pros and cons, it is important to weigh the advantages an disadvantages of such an approach. Also, every person is different. Individual differences are bound to occur in this type of approach. Therefore, it is crucial to take into account all the factors before assuming that sharing notes might aid in the treatment of a patient or have a negative impact.
I believe this new approach could be a double-edged sword. For some patients it might be beneficial to read about their therapists’ comments since they might make them feel better and they might also make them realize that they are actually getting better at it. However, for some other patients the fact that they are not able to clearly understand what therapists mean with their comments could cause them stress and anxiety and make their condition worse. I think it all depends on the patients and their condition. Generally, I consider the approach to be a good way of sharing with patients their improvements and in what areas they should keep working to improve. It will be a good idea for therapists to use a more casual language when writing down their notes in order for the patients to be able to understand them and benefit from them. Even though i have never gone to therapy myself, I think it is always good to know what your therapy really thinks about you and your progress.
I think when it comes to patient notes, there are few cases where a patient will benefit from reading their own. Healing, from whatever condition, is typically a slow process because facing ones fears and conflicts is very difficult. Trying to speed up this process while making life altering changes in thought and behavior would not likely be helpful. It is also worth noting that clients are seeing professionals for a reason – because they do not currently possess the necessary skills to help themselves. A wise therapist leads their client to see their self in a new light and to find on their own some of the roots of their problems. Each person poses a new delicate, unique situation that requires a stronger or gentler response, and their professional process may be hard for a client to understand. Often people just want quick answers and solutions given to them, which isn’t how therapy or counseling works. It could be uncomfortable or shocking for someone to read something in their file they are not mentally prepared for. While this article says some clients became more involved in their care, it should be considered that others may reject sudden information or subconsciously put up more self defensive barriers against hard to take information (such as a diagnosis of a psychotic or personality disorder). In the wide world of mental illness, I believe it is best to let the professionals divulge information as it is helpful for each case.
I do not think that it is necessary for clients to see notes a therapist has written about him or her. If a therapist hypothesizes that a client has a certain diagnosis but is later incorrect in his or her theory, then the notes become irrelevant and the client need not see them. While being able to see notes may allow a client to review the treatment goals in between sessions it is not necessary if a therapist reviews diagnoses, treatment goals, and progress. By allowing client’s to see notes, a therapist may change his or her writing and not be as transparent as he or she would have been initially and then the notes would not benefit either client or therapist. Likewise, if a client reads the notes, but does not fully understand psychological jargon, the client may become confused or hurt. Thus while the goal would be to read the notes to reinforce new skills, reading notes might only serve to set back the client and be further detrimental to their mental health.
I think the key to this is definitely patient based. Firstly, starting from the psychologist’s diagnosis of the patient and the stability of that patient. There needs to be more research in this and the effectiveness. This is not going to be a general conclusion of the population as a whole. It is going to involve patients with different disorders and different degrees of the disorder, with different personalities. Some patients are likely to use the therapists notes and become much more self aware and use them in a positive way. Other patients, less stable at baseline, may react to these notes and lose a trusting relationship and not understand the notes.
As someone who has personal counseling experience, I believe that there are some positives and negatives to sharing counselor notes with clients. The positive aspect of sharing these notes is that it may be helpful for the client to see the way the counselor thinks during a session. However, if these confidential notes are to be shared, they should be shared only with the client, and even better, only while in the presence of the counselor. I believe there would be negative consequences if counselors began posting session notes on the internet, whether in a private portal or for anyone to see, because you cannot guarantee how any individual client will react to these notes if they are viewing them on their own away from their counselor. Overall, it is my belief that the notes taken by a counselor during a counseling session should not be shared..
The first reservation I have about this idea is that there is nothing positive to be gained by making notes available electronically that can’t be gained in person, during a session. I think that our society relies too heavily on technology to make and maintain contact between people, and I believe it’s detrimental to our relationships, whether they be professional, casual, or intimate. For that reason alone, I think any interaction between doctor and patient for the purpose of discussing mental states and progress should be done in person. There are a lot of things that may be confusing or misinterpreted in an email, copied notes, or other electronic correspondence that can easily be explained in person.
Second, if it is clear from the beginning that notes will be shared in full with the patient, this may cause some bias in the notes themselves. This is similar to the idea that recommendation letters which an applicant has waived the right to see tend to be more candid and honest because there is no pressure of knowing that the subject (the applicant) will be reading the letter. The more candid a doctor can be in his/her own notes, the more accurate the history may be, and perhaps the better the treatment.
I do see the possible benefits of a patient having access to their notes. If it helps educate the patient further then I am all for it. A hang up I have however, is the chance that the therapist may not want to disclose everyone of their opinions in fear of upsetting or offending the patient. Someone in a comment above suggested an electronic summary of the session notes, and I agree that may be a good way to go about this.
I really don’t think this is a good idea for many reasons. To be clear, if a patient wants to share their personal experiences with people that is fine because it is voluntary. To be forced to share private documents is another story. A patient seeing their own notes about themselves could have a psychological backlash that could be negative to their improvement. The therapists’ notes are for their use and their use only, they shouldn’t be forced to display them for their patients to see. I’m going to assume people are posting their notes or whatnot to Facebook and if this starts to become a viral sensation, people are going to get bombarded with a lot of crap in their news feeds which the majority of the population does not want to see. It is going to turn into an annoying pop culture trend. When I go on Facebook, I don’t want to see that Deborah is “going through a dark place” or “is having some problems with Frank”, it’s depressing and there is already enough negativity out there as is. I’d rather spend my time watching videos of cute animals than read personal notes about someone’s problems.
Although patients should know the progression of their therapy sessions,being able to see exactly what was written about them is a bit extreme. Patients typically seek out a therapist because they are already in a fragile state, having access to these notes can be counter productive to the patients road back to normalcy. Also during the first initial sessions the theory the therapist has selected may not be accurate or the best selection for that particular patient. Being able to view this is detrimental since essentially the patient is seeing inaccurate information. After a few more sessions and getting to know the patient better the therapist can select a different approach, also select a theory that better applies and alter techniques to better suite the needs of the patients to provide an ideal outcome. Seeing the notes is unnecessary and may cause more bad than good in my opinion.
I believe that often times, when patients turn toward therapy, they are already in a certain state of mind that has resulted them to seek for professional help. They are there because they may be confused, hopeless, or in need of a more sensible explanation to their problems. If the patients were to have full access to the notes without the presence of the therapist, this might confuse them even more. The therapist may have jotted down these notes throughout the session from a certain thought process that was going through the therapist’s mind. The notes and terms will probably make sense to the therapist because he/she is the expert but it might do just the opposite to the patients and mistake them for negative comments. With words like notes, it is very easy to interpret them the wrong way because there is no tone present. Also, without the therapist there to explain what these notes mean, the patients will feel like they are being judged and will end up feeling uncomfortable. This may cause the patients to hold back during future sessions.
I understand that some therapists believe their notes can help their clients improve, and that some clients agree as well. There are people who benefit by reading how another person thinks of them through positive comments and constructive criticism. However, for those who have psychological disorders such as schizophrenia, anxiety or bipolar disorder to name a few, this could in fact prevent the client from improving their behavior, and instead make matters worse. Therapists write more than just positive comments and suggestions on their notes, they also think of possible diagnoses and causes for a client’s behavior. These thoughts could scare a client and make their disorder worse. I think a better alternative would be for the client and therapist to discuss at their first meeting whether or not the client wants a note home after each session with a “plus and a delta.” A plus would be how the client is doing well coping with what is going on in their life, and an delta would be a reminder of a coping strategy that was discussed in the therapy session. By doing this, the client will be more likely have an increased self-esteem because they are aware of what they are doing right. Also, since the “delta” is something that the client and therapist talked about during the session it would not be a surprise and therefore would not negatively affect their behavior.
I think it is an interesting situation to allow patients to view their therapist’s notes, but I am not sure it is the best idea. I think a big issue would be censoring on the part of the therapists, or modulating the language to be more accessible to patients. Notes were originally intended for therapist usage and I think perhaps there is a better avenue of providing patients with the same information. It seems that notes on the part of the patient are to provide feedback so couldn’t the therapist find another means to do so without sharing the more technical and personal side (i.e. their speculations about a disorder)? Providing therapist notes in their original form could be detrimental to some patients and could also provide a privacy risk so in order to address those problems and still receive the increased involvement in care that showing patients notes provides, I think perhaps a feedback form or discussion should be used instead.
I would agree that the use of technology poses a risk to the sanctity and privacy that is assumed in a therapeutic setting. While the instant gratification that technology provides can be rewarding, I think it a very thin line that therapists must tread in order to ensure that the treatment is not negatively affected by communication outside of the office. Also, the notes that a therapist takes are crucial to their analysis and treatment of their patient. It is then up to the therapist to use these notes and observations in a way that would be helpful for the patient. However, if the patient has unfiltered access to these notes, they can be misinterpreted causing the patient to feel judged or defensive, which could be counterproductive to the therapists intended analysis and treatment.
I think the idea of therapists sharing notes with their clients could go either way depending on how a system is set up. Transparency is important between a client and therapist to establish trust, and it could be a positive experience for patients such as Mr. Baldwin to see how far they’ve come since treatment started. On the other hand, not all session notes will be as positive as the ones Mr. Baldwin read, which can have a negative effect on the client and possibly hurt their relationship with the therapist or the progression of treatment. Also, it may not be such a good idea to publicize therapist notes on the internet. Once something is put on the internet, it is there forever and personal, private information has the possibility of being leaked. People also have a tendency to overshare their personal problems on social media, which can have negative consequences later on such as a loss of credibility or damage to one’s reputation. I like how the article mentioned giving the therapist the power to withhold notes if they felt it would be harmful for the patient to read them, but I think this idea requires a lot more research and consideration before the possibility of it being implemented can be discussed.
I think that the decision whether or not to allow a client to read the notes that the therapist has written about them should be left unto the therapist. The therapist is the trained individual in the counseling process and their judgement should be trusted. If the therapist is being trusted enough to handle counseling a patient, why should we not trust their judgment regarding keeping their notes a secret? The notes that they are taking aren’t to criticize the patient, but for the therapist to utilize in future sessions or look back on for recurring behaviors. If the therapist believes that revealing their notes would not have a negative effect on their therapy then there should be no problem releasing the notes to the client.
I can see how some therapists might find it easy to show their clients their notes with the insights they’ve made and the patterns they have seen develop. I can also see why clients may want to see the notes and see how the therapist really sees them. However, I think therapy, like learning, is only effective when the client comes to the answers on their own. If a client doesn’t truly believe in what the therapist is saying, and is only going along with these insights because of their professional opinion, then they don’t internalize it, or internalize it in an inauthentic way. This can cause relapse if they don’t fully comprehend their behaviors on a deep level. Therapy is all about learning about yourself and learning coping skills – if you cannot learn them on your own (or with the guidance of the therapist) and the answer is handed to you, you will not really learn anything or have the strong neural connections to retain the information. I don’t think a therapist should share their notes, but maybe can check in with the client and tell them about where they can improve or what they are doing well. This way a therapist and take the time to filter their responses in a way that the client will respond to.
I honestly don’t see the benefits of allowing patients to have access to their therapist’s notes. If anything, I think it might slow the patient’s recovery down. It’s possible the patient wouldn’t like what the therapist wrote down and may become offended, shocked, or hurt. They might even become so self-conscious during a session that they wouldn’t share a lot if they shared anything because they might feel like their therapist was judging them instead of trying to help them. Someone commented above that the therapists’ notes were for their use only, and I agree. The therapists would be taking notes in ways that would help them gather their thoughts on how to proceed with the therapy or if there was something their patient said that they wanted to come back to at a later date. I don’t see how that would help the patients recover any faster.
I have mixed feelings about sharing therapy notes. It is something that I’ve never considered before. Like anything else, sharing therapy notes can be beneficial to some patients and detrimental to others. While we might be curious to know what our therapist is scribbling down during our session, in actuality reading such notes could make one feel worse. Additionally, such notes guide and direct the therapist more than the patient. A patient can misunderstand or negatively respond to such notes. Patients can become fixated on behaving and acting in a particular way to influence what the therapist is writing down. For instance, a patient with Schizophrenia can potentially become more paranoid after reading therapy notes. Lastly, some patients might already have a hard time opening up and sharing details with their therapist, therefore reading therapy notes can further hinder rapport. Furthermore, there would need to be a system in place to determine if it’s too soon to share therapy notes. It might be more beneficial to share therapy notes after completion of all sessions so the patient can see his/her own personal growth.
I think this is an interesting idea, but I have a few key problems with clients being able to see their records. My first main issue is that some of the psychologist’s notes might be unsettling or even harmful to the client. If someone read in their file that their psychologist didn’t think they were making progress with their therapy, could that lead the client it give up on therapy completely? Additionally, with an online database where patients can access their notes, I would be highly concerned with the security of that database, as hacking is becoming more common and hackers are getting better at stealing information.
I definitely feel that most patients should not be permitted to read the therapist’s notes about them from sessions. However, it definitely depends on which condition the patient is diagnosed with. If a schizophrenic patient is allowed to read the notes, it may make them more paranoid, which would defeat the purpose of their treatment. If someone with an anxiety disorder is allowed to read the notes, it may make them more anxious. Yet if someone is diagnosed with something milder, they may benefit from reading of the notes. Basically, it should be determined on a case by case basis, but in most cases, I personally do not feel it is advantageous for patients to read the therapist’s notes because they are fundamentally the therapist’s private words.
I do not know that a universal answer to sharing patient notes exists. To me, this seems like a contextual question in which all of the details about the patient should be taken into consideration. I believe that the explanation for not sharing notes with the patient should never be to hide what the therapist is thinking during a session. A patients questions about where the therapist thinks they are in their treatment or how their progress is coming along should always be answered transparently in a constructive and digestible way for the patient. The most justifiable reason for not sharing notes in my opinion would be that the patient, assuming they are not trained in counseling, would be reading the notes “untutored” as Dr. Laquercia says. Few things are as intimate as our own personalities, behaviors and feelings and reading notes about those very things off hand could cause a negative reaction. Rather than looking at the notes for instant gratification or a quick fix, I think it is important that the patient and therapist move through treatment together over a period of time. A note from an early session may not stand true only a few sessions later. My worry is that if a patient reads a note that could become defining for them before they have allowed the natural course of treatment to take place.
With all due respect, this article didn’t seem to truly cover much of what is going on nor was it worded in a clear manner. As I understand it, this is a manifestation of clear violation of the therapist/client relationship. Can’t you lose your license for this? I don’t understand how this is not either 1) illegal, or 2) a loophole in the system. This would be a big problem to most people, I’d imagine, unless the client is somehow allowing for this to take place? If you want to read your therapist’s notes, why in the world would Twitter or Facebook be the chosen portal? I simply do not see how any of this has to connect; technology has made filing cabinets in the office obsolete, but that’s about all it should be doing…
I strongly feel the therapist should not be obligated to share their notes with their clients. Anything the therapist writes should be private because of how it could easily be misinterpreted by the client. I know personally, I would over-think every note the therapist might write about me, which would only distract me from progressing with treatment. Although I can only imagine how aggravating and unnerving it must be to see someone writing notes about you and not being able to read them, I still feel they should be for the therapist’s eyes only. If the therapist were obligated to share their notes, it would change the candidness and honesty of their notes possibly making their final conclusions, less authentic.
Notes are not always fully formed, articulate thoughts. The therapist might be jotting down whatever thoughts they have in the moment, but not until much more deliberation, and consideration will they have a better idea of what the patient needs to hear.
Being able to have access to the notes could go either way, depending on the therapist, the patient and the session that they had together. For certain people I feel that seeing the notes may put them at ease. If they are struggling with anxiety for example, and people’s unknown thoughts and opinions contribute to that anxiety than maybe seeing the notes and knowing atleast what the therapist thinks would help them. However, I think it couldget to a point where people are pre-occcupied with what the therapist thinks and that could cause problems on it’s own. Whether it be because the therapist writes notes they percieve as negative, or because they are so caught up in wonder and analyzing what the therapist thinks that they forget to analyze their own. EIther way, I do feel that if someone asks to see the notes that are taken regarding their sessions that they should be allowed to see them. But I think they should understand the effect it may have on the therapy (good or bad) before asking to see or reading the notes.
I feel that a therapist’s notes should not be shared unless there is considerable resistance. I think notes can be misinterpreted to be negative or aggressive, much like text messaging. This can affect the patient’s progress and transference towards the therapist. I think recording the talk would honestly be better than notes. I think that even observing the therapist write something that they cannot see can be anxiety provoking, tense, and distancing. If there is considerable resistance, maybe the notes can be shared or the therapist can be open about what they are writing down. Resistance will negatively affect the patient and if it continues can negatively affect their progress.
I strongly feel that a patient should not be able to read their therapist’s notes. If these notes are accessible, patients are able to read their therapist’s notes and feel anxiety from what they are reading or become defensive because they feel insulted. Therapists can also record possible but false hypotheses about their patients which can cause misinterpretation. Therapists also record their patients’ progress in their notes. Some patients may read these notes and assume that they can stop taking medication because of the progress they’ve made. Allow patients to read their therapists’ notes could potentially be detrimental since they would tend to judge their progress on how their therapist feels rather than on their self-evaluation. Therefore, making these notes accessible can have a negative effect on the patients and be counterproductive to the therapy they’ve gone through.
I can understand both sides of the argument, however I am biased in siding that patients should not be able to see their notes. To me, if feels as if a patient reading their therapists’ notes is almost like reading the answers to a test that they have yet to take. Sure they can see the answers, but if the patient didn’t come to that conclusion themselves, how much good does that too?
Another point to consider would be the degree of mental stability that each patient has. For example, a stable, neurotic, with a diagnosis of acute anxiety may be able to handle reading notes about their progress, when on the other hand, a psychotic bipolar patient may not be stable enough to take criticism in a constructive manner. I think if, notes were to be readily accessible to patients it would have to be approved on a case by case manner. If the patient were to read something that they did not agree with, or understand, it may create a level of mistrust and hostility between the therapist and patient. All in all, the therapists’ notes are the therapists’ notes, and not the “therapists’ AND patients’ notes” for a reason.
I can see how having access to therapists’ notes can be beneficial for certain patients. However, I believe that in general this is not a good idea. Anything patients hear about their progress or struggles should be addressed directly to them rather than risking them misinterpreting the notes of their therapist. It is easy to form quick judgments, and without the therapist there to directly explain what he/she means by what is stated in the notes, this could actually create more anxiety for the patients. I think it would be more beneficial for the therapists to write a thought-out report, on how they think the patient is doing, that the patient can read in session and they can talk about together. Therapists should not be obligated to share their personal notes, and I agree with others who have said that having these notes electronically would make me nervous about other people outside of the treatment team hacking and getting access to this confidential information.
While a therapist is always encouraged to have an objective view of matters discussed in session, it may not always be communicated in the best way using words, and even if it were there are numerous cases where there will still be misunderstandings/interpretations between patient and therapist so I don’t believe it is a good idea to let patients view their therapy notes. The first thought that occurred to me was ‘wouldn’t the patient want to discuss things from the notes?’, while this would probably be encouraged as to have the patient more involved, isn’t there always the point of wasting time discussing misinterpretations? and doesn’t this take time out of the actual session?. While the article gives a few examples of how viewing therapy notes was able to get the patient to be more proactive in treatment, this won’t be the case with patients who are not happy with their therapy or therapist as they may misinterpret the notes as more of a personal attack that is now more widely accessible, and should this lead to repeated confrontations, it may cause the therapist to lose his/her objective view while posting notes.
This is a fascinating discussion due to the fact that this is where the world is heading to and almost seems inevitable for the medical world to head this way. I believe that this can be a very useful tool for therapists. But this needs to be used very carefully with patients. Mostly when speaking about mental health. If you already know you are dealing with patients who are mentally unstable it might not be the best idea to reveal new information or reflections without giving them the emotional support they will need. Yet, for some patients it can be a great tool to read the notes and feel the support and advice of a professional. With this it is all about seeing it case by case. Another thing that stood out to me about this is how the closer we get to the internet the less privacy we have. It just scares me a little to think that in reality now a days we truly have no privacy.
I find this to be an extremely intriguing debate. There are some clear pros and cons to either side. On the one hand, if a patient is making progress, understands the diagnostic lingo, and is psychologically stable when he/she chooses to read his/her session notes, having that ability to see how well he/she is doing in the eyes of their therapist is priceless. An instantaneous self-esteem boost, and more inspiration to continue to move towards a healthier, happier life. On the other hand, if the patient isn’t stable, isn’t making progress, or misunderstands critical components of the notes, having access could lead to psychological disaster, or worse, death. Also, there’s the fact that the therapist will inevitably feel the unnecessary pressure to placate not only the insurance companies, his colleagues or supervisors, any other health professionals with access to the records, but now the patient as well in writing the notes. This can lead to countless conflicts down the road, and result in a lack of progress for the patient as well as the therapist trying to perform accurate analysis. However, I think that for certain patients and for certain therapists, allowing access to session notes could definitely be a useful tool to employ if the related factors align properly in the given scenario. For example, making note access a milestone to be achieved for the patient if he or she makes enough progress could be a great incentive to become more involved in one’s therapy. Using multiple sets of notes with respect to different readers (while being tedious) could mitigate conflicts in terms of the placation of the readers. Two things are for certain though. First off, access to notes should not be definitively universal, as some patients will inevitably be incapable of handling the information their notes may detail. And secondly, therapists that do choose to give their patients access to their session notes must also discuss the the contents of the notes with their patients on a regular basis, to avoid miscommunications and to help the patient understand what their therapist means, thinks, and believes. All this being said, this topic is undeniably interesting and worth researching.
I feel as though a patient should not be able to read their therapist’s notes. Therapists use their notes as a place to write down themes of what their patient is saying, hypotheses of issues they could be having, thoughts or activities that they think could help their patient, questions, etc. These help the expert guide their session and track the progress their patient has made between each meeting. Giving the patient access to this information could lead them to come to incorrect conclusions, intensify their symptoms, or encourage them to make unhealthy decisions. However, I understand how it could be distracting or nerve-wracking to have someone writing down the private thoughts and information you are telling them or how patients could misconstrue note-taking for not paying attention. I think this is something that has to be discussed on a case-by-case basis. It might be more important for certain patients that notes be taken in a certain way as to not disturb or agitate them, or that the therapist wait till after the session to record their thoughts if possible.
As a student in psychology with an interest in clinical practice and counseling services, I find the idea of a therapist sharing their notes with the patient intriguing, though I maintain an instinctual skepticism towards the approach.
Open access to one’s therapy notes can, and seems as though it is, encouraging and positive for some of the patients that utilise them. It cannot be denied that this feature will allow for an insight into the treatment that the patient might not otherwise receive, and, hopefully, encourage them towards greater progress.
However, the therapist’s notes are traditionally a place for the practitioner to reflect on the treatment, including private yet crucial insight about the patient and plans for future steps in the treatment process. The therapist may not be used to sharing this insight, and this shift can in fact change the method or technique of the practitioner in their practice.
In addition, the observation of individual medical patients having unique reactions to patient notes is significant. Not every person in therapy will react to feedback in the same way. I think it begins to change the nature of therapy when reviews, which could otherwise be discussed in person in a private session, become a removed and impersonal summary from behind a computer screen.
Moreover, I begin to be concerned about the privacy and security of online resources that allow for such sensitive, personal information to be entered into the fragile realm of the internet. If such information should be compromised, the result could be detrimental for the patient in question.
In conclusion, while I believe that greater transparency in therapeutic treatment can be a step in the right direction for some patients, I worry that the risk of varying patient reactions and unreliable internet security are greater than the potential benefits of expanding to an online platform in what is traditionally a very personal and private treatment.
I feel that patients should not be exposed to the notes of their therapists in order to protect the therapist-patient relationship. Although I understand the desire for instant access to results (that we’ve become so accustom to in todays society), I feel as though this access will interrupt the relationship between therapist and patient. Communication between therapist and patient is crucial, and it is important for a patient to feel heard and understood by their therapist in order to establish a healthy relationship. These notes however may hinder therapist and patient communication and may distract the patient from their progress. When reading these notes outside of therapy, a patient may feel less understood and perhaps criticized by their therapist. This isn’t to say that the therapist will be providing criticism in their notes or bashing the patient, however without explanation, these notes may come across in a different way than intended. I am guilty of misinterpreting notes that have been provided to me by my professors in the past, which may have negatively influenced my perception of the teacher and the class all together. Similarly I feel that this may happen if a therapist provides their notes to their patients. Notes can often be difficult to interpret because there is no tone, and no expressions involved, which can distract a patient from what the therapist is truly trying to convey. The misinterpretation of a therapists notes may be hurtful to a patient, and ultimately unhelpful in the therapy process.
I understand the desire that some patients may have to view their notes, for reasons such as looking for an objective evaluation from a professional to simply fulfilling curiosity. I believe that medical files should be open to the patient, given the right of the patient to be informed about their treatment and diagnoses. With that being said, I understand the issue of releasing this information online-a setting in which privacy can be violated and in which misunderstanding can occur if the therapist is not present to help explain notes, records, and observations to the patient. For this reason, I fully support patients having access to their notes, but I believe this access should be granted in the controlled setting of the therapist’s office, with the therapist present to communicate findings with the patient.
I understand the desire that some patients may have to view their notes, for reasons such as looking for an objective evaluation from a professional to simply fulfilling curiosity. I believe that medical files should be open to the patient, given the right of the patient to be informed about their treatment and diagnoses. With that being said, I understand the issue of releasing this information online-a setting in which privacy can be violated and in which misunderstanding can occur if the therapist is not present to help explain notes, records, and observations to the patient. For this reason, I fully support patients having access to their notes, but I believe this access should be granted in the controlled setting of the therapist’s office, with the therapist present to communicate findings with the patient.
If a therapist wants to give their notes to that patient should not be allowed because that’s the therapists personal notes. By having the therapists notes readily accessible, it can cause a harmful relationship between the therapist and the patient. That is a very close confidential bond that you want to keep. By reading their notes it could potentially lose that relationship and cause the patient to leave the therapist completely. Another reason this could be harmful to the therapist- patient relationship is misinterpretations. Misinterpretations happen all the time in classes and in the work place, so it could happen that the patient misinterprets the therapists notes. Yet again causing friction between the therapist and patient.This could potentially cause the patient to set themselves back in their treatment and be painful to get over.
Very interesting article. There are so many positive and negative aspects of allowing patients to view their medical/therapy records. I believe the ability to access your records online is something the health world needs to move towards but with caution. I believe all results and records should be discussed with the patient before they are posted online. The possibility that a patient can view their diagnoses or potential diagnoses is risky, the patient may interpret them wrong or even freak out about what they read or see. By forcing the patient and doctor/therapist to discuss and review the notes all concerns and questions can be answered. After the discussion happens, the results being posted shouldn’t have a major affect on the patients. I do think the doctor/therapist should use their professional reasoning to decide whether a patient is stable enough to read and discuss records. Overall, I believe patient/therapist transparency is something to be considered on a case by case system.
Like many technological advances we are experiencing in today’s day and age, there are numerous benefits to using the internet for sharing client notes with the patient. The issue is that technology is still at it’s very early stages and I fear that it is growing far to fast and that we do not understand all of the consequences yet. Sharing client records online holds countless risks with it. Clients are supposed to feel safe and comfortable sharing their feelings and thoughts in confidence with their therapist. Any time you put something into writing, especially in an electronic format, you are essentially creating a lifelong record of that information. There have been numerous data hacks from what are supposedly the biggest and most secure companies out there such as Target and Google. If somebody hacked into one of these systems and gained access to these personal records, people’s lives could potentially be destroyed. In addition, future potential patients might refrain from seeking help in fear that there personal information may be exposed to the world. In my opinion, the potential risks significantly outweight the benefits.
Sharing notes with a patient is an important component of therapy that should be decided on a situational basis. Patients may be inhibited during sessions when they are unaware of what is being written about them, causing them to not share or share things they don’t feel, rather share what they think will make the therapist satisfied. In this case, transparency with notes might be beneficial in opening up the therapist-patient relationship. Transparency with notes could also very aversively effect treatment, causing the opposite of the previous situation. A patient may begin to manipulate their words as to make notes that are ideal, however untrue. An alternative may be a therapist sending a rewritten summary of their notes to the patient, yet this may be time consuming for the therapist. A summarized version would be helpful in the sense that a therapists original notes from a session, which are most likely candid and blunt, would be protected. Full transparency may not always be the best choice.
I think that a patient reading notes electronically could be interesting and helpful. It depends on what type of person that patient is- whether he/she learns better socially, or having things written down. With the changing times, using the internet is definitely fitting and I believe that by reading medical notes, the patient and counselor could have a better relationship. However, the meaning behind what is written down in the notes could be taken to be positive or negative, so the counselor should use language that is straight forward.
The concept of providing electronic access to notes from therapists/doctors is a very forward thinking and modern way of connecting with clients. However, like most things in life there is an upside and a downside. I like the idea of being able to access notes from my primary care physician, for things like my weight, any health concerns or possible medication regimens. Yet I have some hesitation to therapists posting their notes for the client to read. This requires a great deal of discretion on behalf of the therapist to decided whether to share the notes or not. Some clients could benefit from this transparency, while it could set others back. Dr. Glen O. Glabbard noted that therapists might be reluctant to include something in their notes out of fear it could negatively effect their client. Additionally, in the midst of a session something might come to the therapists mind, yet might not be something worth exploring further. This could be interpreted the wrong way by the client, which could cause discomfort, or for the client to open up less. With all this being said, the research highlighted in this article indicates that it is in fact beneficial for the client and makes them a more active participant in their treatment. This could be very helpful for some, and yet could do damage to others therefore, as mentioned discretion is imperative.
I think being able to access session notes online would be useful to the patient. However, the therapist should discuss the notes with the patient first, because things often get lost in translation through written communication. It would also be a good idea to allow the patient to decide if he or she would like to use the internet as a tool for therapy. Even if the notes were shared privately with the patient, anything posted online always runs the risk of becoming public information. Therefore, allowing the patient to make this decision would give him or her more of a say.
I think whether or not the patient can access the therapist’s notes depends entirely on circumstances of the individuals and (potential) diagnosis. It could be helpful for the patient to have records of what they are working through and get the chance to see things through a more objective lens, however it is disconnected and potentially abrasive. I am also distrustful of having important information like this on the internet- there is always the chance that a third party could attain it, and once it has been uploaded it will always be there, regardless of whether or not it is deleted.
While I find this concept very interesting, I’m concerned by the potential for misapplication. If we examine this from the starting premise that therapist-to-patient communication should be intentional, adaptive, and of course, therapeutic, there are some immediate concerns with a system of electronic access to medical notes. The potential for confusion and misinterpretation is enourmous: the physician has no control to guide the conversation, explain context, correct misunderstandings, or observe the patient’s response to the communication. A note written specifically to the patient could meet some of those needed criteria (bar adaptability), but from an efficiency standpoint this does not help. A note to the patient would need to be crafted separately from clinical notes, reducing efficiency to a point where the therapist might as well communicate his or her thoughts in person.
Additionally, if a counselling services provider establishes this kind of system as the norm, there is the potential for communication decisions to be taken out of the therapist’s hands and placed at the whim of policy and/or market pressure.
Altogether, the use of IT technology as a means of communication can obviously be a useful tool to the therapist, but this should be a considered decision with regard to each patient rather than an aim for broad groups or providers.
It appears that we can all agree that no one can definitively say these tactics even work, and that alone is extremely concerning. It appears as though the CIA continued to work with ineffective tactics because they felt they did not have an alternative. Worse, it was orchestrated by psychologists who have a clear ethical guideline to do no harm. What I find interesting is that on US soil, in maximum security prisons, there has been clear evidence as to the torture that is solitary confinement. This is allowed on our own soil to people who no longer carry a threat to the safety of the United States. It causes true alarm as to the extent of the torture that occurs overseas to those who are considered a threat. These psychologists should be brought in to guide the interrogations away from torture, not towards it.
The idea of sharing notes with patients should be determined on a case by case basis depending on multiple factors, in my opinion. First, it greatly depends on the patient. While it will motivate some to stay involved, it could definitely discourage others. The time at which the patient has been seeing the therapist could also be a factor. It could become extremely difficult to build a report with the patient if the therapist is either censoring his notes or being completely honest to the point where it could be off putting to the patient. It could be worth exploring having some notes be visible while others not. For instance, medical test results, diagnosis, next steps, goals, etc., could all be so useful for a patient to be able to quickly revisit online. However, a psychologist’s notes with concerns or thoughts about the patient’s personality could easily cause a much more complicated relationship that causes more harm than good.
Given the growing popularity of electronic records systems in the medical profession, and the increased connections between patients and providers through systems such as online patient portals, I can see why people would feel the same type of transparency would be beneficial in psychiatric care. However, the notes a doctor makes when treating a patient with digestive pain are vastly different than a doctor’s notes from a session with a depressed patient. Notes made when discussing physical health concerns are much more objective and concrete; a patient is not likely to be surprised by the insights they read in notes such as these. Given the sensitive nature of psychiatric care, part of the responsibility of a therapist is to figure out how to convey their personal notes from a session to their patient in a more calculated and digestible manner. If patients are given access to these psychiatric notes in raw form, they will likely draw incorrect conclusions from the subjective thoughts of their therapist, both damaging the therapeutic relationship and hindering their own healing process.
I would like to begin by expressing that my attitude towards this article/study largely concurs with that of “Tess F”.
I am particularly concerned with the possibility (let alone, probability) of a therapist’s notes being misinterpreted by his/her patient(s). Therapists/Counselors are extensively trained to notice that which the patient does not directly disclose, but rather relays, and often accidentally. As Dr. William Sharp has mentioned before, “Therapy is what falls out of a person’s pocket when they are trying to show you what’s in their pocket”. The reason I feel this quote resonates so truthfully in this specific situation is as follows: imagine the potential damage that could be inflicted upon a patient who reads information about themselves that they may not yet be aware of, let alone agree with.
Many patients who suffer from mental illness are affected by symptoms which directly/indirectly affect their ability to perceive certain situations accurately. Call it psychoses, neuroses, or whichever term you’d like – patients suffering from mental illness do not perceive reality in the same way as those who do not. Thus, a common result of such maladaptive cognitive patterns is a warped perception (at varying degrees) of communication with others. Depending on the diagnosis, these patients could be exceptionally sensitive to criticism, unaware of common shortcomings, or exhibit an unwillingness to trust others altogether. By gaining access to their trained clinician’s notes, without assistance in properly interpreting said notes, what is left is a vast amount of room for the patient to over-analyze or misinterpret what was written.
Although this may seem a stretch for some, it is clearly visible in many daily scenarios for others. Even those who do not suffer from mental illness often make mistakes in interpreting black-and-white communications from others (i.e. over the internet, via text message, email, etc) that offer no intonation with which to properly decipher the purpose of said communication. How many times have normal couples fought over a text that was misinterpreted; or have colleagues fought over a poorly-worded email? As mentioned in the initial blog post, “Today’s technological wonders bring the understandable temptation of instantaneous gratification through communication”. This instantaneous gratification can be overwhelming for many, let alone for those with mental health struggles. This sort of interaction between patients and clinicians leaves much room to be desired for clear, effective, and well thought-out communication. By adding this easily misinterpreted medium to an already complex relationship, I just personally do not see any good that could come of it.
I feel that it’s hard to say whether or not the posting of these notes would be beneficial. It’s common practice for medical doctors to bring their patients’ symptoms to other doctors for any advice; however whether or not that should extend to mental health is pretty controversial. In one regard, other specialists may have good advice on how to address the symptoms and progress with treatment, but the patient also may feel self conscious if they were to read the notes from their sessions.
As a client I would have liked to be able to read my therapy note. I think it would enable a client to decide if he/she is understood by the therapist as well as to see their progress. I think being able to monitor your own progress through your therapist’s eye is a great way to look at your own improvements from an outsider’s perspective. Therefore, I think transparency with this method would improve therapeutic communication, but I am not sure if it would effect the therapist bias in writing the notes, since they are aware that their clients would read it. They might hinder some points just to not reveal it to their clients, which might effect their therapy sessions since these notes are what they are using for themselves too, as far as I see it. In addition having this as an option is great, if people are not comfortable they don’t have to read them, as the article also mentions it. Lastly even though one is offended by a comment, it might give them time to digest and work on the things that offended them with the therapist. This might pace up the therapy and reach to a resolution quicker. I definitely agree that this intervention should aim at moving the process of treatment.
I do not think it is ever ok to post sessions notes or specific diagnoses on the internet unless expressly asked by a client. As mentioned in the article, the office is often a safe space for clients where they are able to divulge private information to a sympathetic ear without fear of client-counselor patient confidentiality being violated. If reading a therapists comments help some clients become involved in their care, then by all means that should be incorporated into therapy. However this kind of incorporation can occur during a session or over private or encrypted email in the way some physicians tell patients of test results. I see no reason for it to be public in any way.
I worry more generally that online session information, treatment plans, diagnoses, etc. actually limits and shuts down the flow of communication. During the course of a therapy session, the counselor and patient can ask each other questions and can create more of a fluid conversation. Once these notes or comments are posted online, this fluid communication then takes on a one-sided approach involving only the information posted or back and forth online communication between the counselor and the patient may be delayed or misconstrued and may ultimately hinder the overall treatment process. Therefore I think treatment information online should be restricted so that only the information that has been discussed in the therapy session is posted and should not include new diagnoses or new comments. This will allow patients to return back to the notes to remember the session and next steps, yet this online information will not include new information that has not been previously discussed and/or explained.
While I agree that using electronic devices to have a look at the doctor’s notes is a great way for a patient to get more involved with the counseling process and improve their self-reflection, I am concerned that the information provided by the specialist might be incorrectly understood. For example, it has been proven that patients diagnosed with anxiety or/and depression tend to misinterpret information in a self-deprecating and negative way, so that the impression left from the counselor’s notes could retard patient’s improvement.
For certain patients, having access to a therapist’s notes may serve as a powerful motivator and spur progress in therapy. For others however, it may give patients a false sense of safety or improvement that can interfere with their treatment. As evidenced by the example of the schizophrenic who becomes so confident that he stops taking his medication, access to therapist’s notes should be a factor of treatment considered holistically, taking into consideration the diagnosis of the patient, their relationship with their therapist, and their desire to read their therapist’s notes. Ultimately however, the right should remain with the therapist to determine if he or she is comfortable sharing their notes with a patient; it is important to ensure that a situation does not develop in which a therapist feels uncomfortable being fully honest about a patients disabilities in their own notes.
I believe that in certain situations the transparent approach between a therapist and patients could be a good thing. Patients will be able to think about their therapy session and recount what was talked about. I think that a patient has the right to see their therapists notes about them. But, in some cases thus might not be helpful to the patient. For example, this approach might not be helpful if a therapist is working with s paranoid patient. The patient might take the therapists notes the wrong way and this could hinder the patient-therapist relationship.
I enjoyed the perspective this article has as it provides counterarguments to the notes situation. I think the concept of putting notes online can be very beneficial and even catalyze the treatment process for a patient. The direct impact of the written word can influence the patient to see his or her behavior in a different light and be extremely effective for the patient’s treatment. I would strongly caution against using this method for every patient, however, because it could be very detrimental and hindering depending on the mental health of the patient. I believe that the decision of whether or not to use open notes should be left to the therapists discretion as they know the patient best.
We use Shocoon as our parent theme, and we have a slight customization based on it.
If patients want to truly know something about their diagnosis or about their treatment it is important that they simply ask their therapist in person, just like it has always been done. If the patient were able to read over the therapists notes and obsess over every comment I think it could almost violate the sanctity of the relationship. The patient needs to feel as though they can say anything during their sessions and not as though it will one day be published information, even if it is still private. There is something sacred about the communication between a therapist and patient in an office, while online everything feels open and exposed, but anonymous. Any sort of online intervention between patient and therapist would make the relationship that between one of strangers and I do not think it would help anyone. The patient would lose valuable opportunities to learn and I do not think the therapist would be able to get quite as much necessary information from their patient if the relationship moved out of the office. For certain cases perhaps it could work, but just like the therapy itself I think it absolutely depends on the individual. Every person is different and perhaps for some people it could be very good for them to be able to read notes and have a digital relationship with their therapist, but I think this would also be rare. The current system of slow and steady growth is not broken, and this method would not provide quick fixes that many people are looking for, if anything it could just cause more problems.
If patients want to truly know something about their diagnosis or about their treatment it is important that they simply ask their therapist in person, just like it has always been done. If the patient were able to read over the therapists notes and obsess over every comment I think it could almost violate the sanctity of the relationship. The patient needs to feel as though they can say anything during their sessions and not as though it will one day be published information, even if it is still private. There is something sacred about the communication between a therapist and patient in an office, while online everything feels open and exposed, but anonymous. Any sort of online intervention between patient and therapist would make the relationship that between one of strangers and I do not think it would help anyone. The patient would lose valuable opportunities to learn and I do not think the therapist would be able to get quite as much necessary information from their patient if the relationship moved out of the office. For certain cases perhaps it could work, but just like the therapy itself I think it absolutely depends on the individual. Every person is different and perhaps for some people it could be very good for them to be able to read notes and have a digital relationship with their therapist, but I think this would also be rare. The current system of slow and steady learning is not broken, and even this new method would not provide quick fixes that many people are looking for, if anything it could just cause more problems.
As is currently the case with other therapeutic techniques, I think that the use of online notes should be at the discretion of the clinician. It is the clinicians responsibly to decide based on their knowledge and experiments which techniques they believe will produce the best outcomes when utilized during a session and/or after with a patient. I say after with a patient because it is not the case that all treatment ends as soon as the patient walks out of the office. The patient viewing session notes after the session has concluded is an example of this. If the clinician believes that this will help the patient then I think that it should be tried. However, I do not think that this technique is a revolutionary catch all that will be beneficial to all patients. With that being said, I do believe the use of these electronic notes could help some patients. Sheer curiosity of the patient would not be an acceptable reason to display these notes, but if the patient was at a high enough level of functioning where they would understand these notes and better understand their diagnosis and current state would be.
What does this say of the trust between counselors and their clients? I personally believe that therapists should be completely open with their clients; there should not necessarily be any new information in the notes. Mr. Baldwin, for example, should have been told in person by his therapist about what great progress he was making. I’m not saying that the notes shouldn’t be made available, but that it shouldn’t be necessary. It’s a problem to me if a client is finding something out from typed up notes rather than a counselor directly. Perhaps the highly accessible system is keeping therapists honest? Or is it making dishonest therapists even more so, completely leaving out information from all records, both verbal and electronic? The example of Peggy Kriss, in which she has clients write the notes with her so that they can serve as a sort of reminder of the session throughout the week, is a great use of the tool, but it is idealistic to assume that every therapist would use this method in that way. The electronic, public postings leave me with other concerns as well, such as their susceptibility to hackers or, as the article states, potentially abusive partners. It is difficult, probably impossible, to promise that only the client and therapist will see the notes online; there is a potential for huge breaches in confidentiality that may not only make the client uncomfortable, but may even put him at risk.
I think that its up to the psychologist or doctor to share their notes with the patient or not. If they see benefits in doing so and it has worked positively in other instances, then they have all the right to do so, and the patient all the right to see their notes. I think the patient could benefit from reading the doctors notes but that in some cases it may be detrimental to the patients progress if they read something that hurts their feelings or that they did not want to know. Sharing notes in private seems fine, but in my opinion sharing them online seems like a bad idea. Like someone in the comments said, the internet is a place where people can hack into and confidentiality can be breached.
I have never read the notes my therapists have taken in our sessions even though I have always wondered what they said. It is a practice I could see working for many people, but definitely not all. I think it should be an option to the patient if the therapist believes he or she is ready to or it would help him or her. If the patient has PTSD and only relives what he or she experienced when he or she chooses to, reading the notes could be triggering or painful. During the good times, it could very well help with progress especially if the patient does not feel like he or she is making progress. The studies discussed in the article show it is a very helpful method, I believe this could continue to be true. I mainly believe though it is something that should be an option at the right time agreed upon my the therapist and patient.
I’m very conflicted on the idea of therapists sharing their notes with their patients. While it might help to build trust and understanding, it could definitely be harmful if the patient reads anything they find hurtful or objectionable. For example, if the therapist puts in her notes that the patient is in denial about a past trauma, it might be detrimental for the patient to read what he sees as an accusation. This could lead to the therapist censoring herself in notes, which could impede her efficacy as a therapist. I think it would be a better idea to occasionally verbally discuss her thoughts with the patient, and perhaps share select parts of her notes when appropriate. It’s also something that should really happen depending on the patient, as some would handle the feedback better than others. It will be interesting to see if electronic communication such as this becomes more widespread, and how far it will go.
Similar to Dr. Clinton’s statement on diagnostic language I have concerns about language formality in this system. Language is fluid and I believe that it needs to adapt per the audience to be fully understood. With this belief, I understand Mr. O’Neill’s urge for therapists to use straightforward descriptions. However, I still do not fully support it. Diagnostic language is important to the medical field to scientifically describe mental and physical illnesses. This language and type of writing is utilized for a reason. A translation to “common” speech although helpful, has the potential to create misunderstanding. There are ways to mitigate this issue. If training is provided to mental health professionals under this system to practice diagnostic language along with patient understood diagnostic language, I believe this way may have more success. If counselors are accustomed to using diagnostic language, then requiring them to spend extra time creating more straightforward description may not be worth it just to give access to a patient.
I am ambivalent to whether, or not, I believe that a therapist’s notes should be accessible to mental health patients. There are multiple aspects of this debate which need to be highlighted. Specifically, the pros and cons surrounding the effect on the patient or client, the effect on the therapist, and the effect on confidentiality needs to be analyzed. Like with many changes in healthcare procedures, there is a population who will benefit from reading their therapist’s notes and a population who may be negatively affected. Without more concrete data to support that reading the notes increases the positive outcomes related to therapy, I would hesitate to support the notion of releasing notes to patients. There is also a large margin for misinterpretation of the therapist’s notes by the patient, as many mental health terms are misused in society and psychological theories are very complex. The diagnosing process in mental health is different from other healthcare professions. There is not a single test for bipolar disorder like there is for strep throat. I agree with Dr. Glen O. Gabbard in that mental health professionals may begin to censor what is written in their notes during sessions because patients or clients would be able to read them. This would influence the diagnostic process.
Aside from the ethical dilemma around patient care, there is also the concern of privacy. As technology advances and more information is stored electronically, there is an increasing need to keep patient records confidential. Hospitals, universities, even dating websites, have had private records stolen from them. I believe that the patient should be informed of the risks of posting notes to internet platforms, and, also, have the ability to request that notes not be made available to them. As this debate is controversial, my best suggestion to ameliorate both sides of the debate would be for therapists to not release their session notes. Instead, if the patient or client wishes to be more involved in their therapy, they should be able to privately discuss certain notes made during their appointment.
I am ambivalent to whether, or not, I believe that a therapist’s notes should be accessible to mental health patients. There are multiple aspects of this debate which need to be highlighted. Specifically, the pros and cons surrounding the effect on the patient or client, the effect on the therapist, and the effect on confidentiality needs to be analyzed. Like with many changes in healthcare procedures, there is a population who will benefit from reading their therapist’s notes and a population who may be negatively affected. Without more concrete data to support that reading the notes increases the positive outcomes related to therapy, I would hesitate to support the notion of releasing notes to patients. There is also a large margin for misinterpretation of the therapist’s notes by the patient, as many mental health terms are misused in society and psychological theories are very complex. The diagnosing process in mental health is different from other healthcare professions. There is not a single test for bipolar disorder like there is for strep throat. I agree with Dr. Glen O. Gabbard in that mental health professionals may begin to censor what is written in their notes during sessions because patients or clients would be able to read them. This would influence the diagnostic process.
I am ambivalent to whether, or not, I believe that a therapist’s notes should be accessible to mental health patients. There are multiple aspects of this debate which need to be highlighted. Specifically, the pros and cons surrounding the effect on the patient or client, the effect on the therapist, and the effect on confidentiality needs to be analyzed. Like with many changes in healthcare procedures, there is a population who will benefit from reading their therapist’s notes and a population who may be negatively affected. Without more concrete data to support that reading the notes increases the positive outcomes related to therapy, I would hesitate to support the notion of releasing notes to patients. There is also a large margin for misinterpretation of the therapist’s notes by the patient, as many mental health terms are misused in society and psychological theories are very complex. The diagnosing process in mental health is different from other healthcare professions. There is not a single test for bipolar disorder like there is for strep throat. I agree with Dr. Glen O. Gabbard in that mental health professionals may begin to censor what is written in their notes during sessions because patients or clients would be able to read them. This would influence the diagnostic process.
Aside from the ethical dilemma around patient care, there is also the concern of privacy. As technology advances and more information is stored electronically, there is an increasing need to keep patient records confidential. Hospitals, universities, even dating websites, have had private records stolen from them. I believe that the patient should be informed of the risks of posting notes to internet platforms, and, also, have the ability to request that notes not be made available to them. As this debate is controversial, my best suggestion to ameliorate both sides of the debate would be for therapists to not release their session notes. Instead, if the patient or client wishes to be more involved in their therapy, they should be able to privately discuss certain notes made during their appointment.
I am ambivalent to whether, or not, I believe that a therapist’s notes should be accessible to mental health patients. There are multiple aspects of this debate which need to be highlighted. Specifically, the pros and cons surrounding the effect on the patient or client, the effect on the therapist, and the effect on confidentiality needs to be analyzed. Like with many changes in healthcare procedures, there is a population who will benefit from reading their therapist’s notes and a population who may be negatively affected. Without more concrete data to support that reading the notes increases the positive outcomes related to therapy, I would hesitate to support the notion of releasing notes to patients. There is also a large margin for misinterpretation of the therapist’s notes by the patient, as many mental health terms are misused in society and psychological theories are very complex. The diagnosing process in mental health is different from other healthcare professions. There is not a single test for bipolar disorder like there is for strep throat. I agree with Dr. Glen O. Gabbard in that mental health professionals may begin to censor what is written in their notes during sessions because patients or clients would be able to read them. This would influence the diagnostic process.
Aside from the ethical dilemma around patient care, there is also the concern of privacy. As technology advances and more information is stored electronically, there is an increasing need to keep patient records confidential. Hospitals, universities, even dating websites, have had private records stolen from them. I believe that the patient should be informed of the risks of posting notes to internet platforms, and, also, have the ability to request that notes not be made available to them. As this debate is controversial, my best suggestion to ameliorate both sides of the debate would be for therapists to not release their session notes. Instead, if the patient or client wishes to be more involved in their therapy, they should be able to privately discuss certain notes made during their appointment.
Certain patients could greatly benefit from seeing session notes on an online database, but only if they could integrate the notes in a way that made them beneficial. However, given how unique every patient is, I do not believe that this should become a typical practice. If a patient is willing to hear it and curious about the therapist’s theories or hypotheses, it could be helpful for the therapist to disclose certain observations. However, many individuals would not know how to handle certain facts about their thought processes or mental states. This kind of information could detrimentally affect their progress, and I think therapists should use caution when disclosing their insights. If it is deemed acceptable and beneficial for a patient to know more about what is going on with their mind, they should have this information disclosed to them in the physical presence of their therapist so that any questions or feelings could be adequately dealt with. With an online portal, I just imagine a bunch of patients reading private and sensitive information about themselves and then not knowing how to comprehend or integrate it. It could also be weeks or many days before they are able to speak with their therapist, and a lot of harm could be done in that time if any of the information was misconstrued. While making therapy more interactive is a wonderful idea, I do not believe that an online portal is the way to do that.
The argument of sharing notes or medical records with patients is difficult to define as it depends on both the patient and the specific variables involved with a case. It is impossible to say that all individuals would benefit from being able to read the notes from their counselor just as it is impossible to say without a doubt that no individuals would benefit. As Dr. Delbanco explains in the “Project Puts Records in the Patients’ Hands” article, the shared medical record is a medicine, and “medicine is never perfect.” The idea of sharing notes definitely carries the potential to offer a positive opportunity for personal growth by the patient while also strengthening his or her relationship with a counselor, but there is also the potential for shared records to become an issue or miscommunication between the counselor. My first major reaction is that the sharing of session notes should be decided by the counselor on a case by case basis and definitely should not be shared until later sessions after trust is gained and the counselor-patient relationship is strong and established.
I definitely agree with Ms. Nina Douglass’s belief that one size does not fit all. I agree with the use of sharing medical records and notes with the patient as long as consideration for the safety and health of the patient is the top priority. I believe this sharing could be extremely helpful to many individuals, but it cannot yet be considered a “one size fits all” approach because all patients cannot be bucketed or grouped together in a way that protect their image of self and personal growth. I believe from personal experience that the counselor-patient relationship is strong enough from face-to-face sessions. Rather than posting notes online, I as a counselor would find it more effective to discuss the possibility of spending time explaining my written notes if I believe this is in the patient’s best interest.
The use of social media with counseling seems counter intuitive. Social media platforms allow individuals to hide behind a screen without having to encounter others face to face. The security of a screen allows people to write without second guessing the effect it may have on those who receive their words. It also allows the individual to prepare their words rather than being candid as they would be in person. The publishing of counseling notes online allows for clients to interpret the notes in their own way, without the ability to ask for clarification. This may cause a client to not want to see a counselor again. Also, with access to their counselor’s notes, a client has the opportunity to overanalyze the words in front of them and obsess over their intended meaning. I am not clear on the benefits of using social media to post counseling notes. Is it so that the client can have access to what was discussed? Will this serve as a refresher for goals outlined in session? If so, wouldn’t this also allow a client to see things that they discussed which lead to further distress or other negative feelings?
I think that it could potentially be very damaging to read comments from a therapist. While they may not be as intentionally cruel as a social media comment, reading the comments of a therapist without an accompanying explanation or face to face interaction could cause many unforeseen consequences. I think that it may also cause therapists to alter their notes. Ideally, therapists should be noting positive gains to their patients, but that may not be conducive to many types of therapies. However, we will not know all the possible outcomes without these types of studies. Those treating the patients must also be mindful, like those mentioned in the article, about who may be seeing the notes. While I do think that more collaboration between the therapist and the client is great, we should wait for the results of this and other similar studies before making this available to all.
I believe the notes should serve as a tool to aid counselors, not as a tool to inform patients. If patients are curious about their progress I think it is perfectly appropriate to share this curiosity with their counselor and allow counselors to determine what a patient might be ready to hear or not. Though I am not a practitioner myself, I can only imagine that counselors are actively managing every move they make in a counseling session, in hopes of best supporting their patient. Perhaps they have a thought and write in down and determine it is not relevant later on. This type of processing or filtering might be hindered if patients were given access to all notes. I feel the attention of the counselor should be on listening and processing what a patient is saying during a session, not on what the counselor should write that will be appropriate and productive for the patient to read following the session. I think making notes accessible to patients puts unnecessary pressure on practitioners and might ultimately distract from potentially successful and effective counseling.
I think that many people in therapy would learn a lot more about themselves if they had access to their session notes. But I also think there are some people who would not benefit from this. I think it should be to the doctors or therapists discretion which patient would benefit from reading their notes. I think seeing what immediate responses your therapist has to your own thoughts could be helpful. Like the article said, it could motivate a person to change their behavior, feel better about being in therapy, or give them a wake up call. I think it would be better for both the patient and the therapist if there was some explanation to the notes, if the therapist explained what they wrote and why they wrote that just so there are no misunderstandings between the therapist and the patient. I think adding this to the patient-therapist relationship would help strengthen the bond, add more trust into the mix. The patient may feel more at ease saying things knowing how the therapist responds to what they share in session. I agree with the statements made in the comments about not having the notes made available in an online portal. This definitely could cause privacy issues for both the patient and the therapist. I think note sharing is something that should be done in session.
There are a few things that worry me about posting session notes online. One is the chance that the therapist may alter the session notes or leave out bits of information that their client may find unpleasant. This would defeat the purpose of taking full session notes for the therapist because they might worry about how their client will interpret them. That brings me to another worry. Clients reading session notes outside of the office may lead to certain misunderstandings. A client may perceive a phrase to mean one thing (perhaps negative), while the therapist wrote it with a completely different meaning. This could lead to a lack of trust and openness between the therapist and client when back in session, as well as bring up new issues that could have been avoided had the notes not been posted online in the first place. I feel that part of what makes therapy effective is the safe space that is created during sessions between the therapist and the client. Adding an online forum opens that space to the outside world, which limits its effectiveness in promoting trust.
From what I read from the article, I don’t see how the benefits of sharing patient notes with the patient outweighs the possible negative consequences of the patient reading those notes. Due to the certain negative view on mental health issues held by most people, patients may feel hurt or misunderstand certain terms used in the notes that will only widen the gap between a patient and his or her therapist. It’s easy to misunderstand writing, especially notes because notes tend to have a unique meaning only to note-taker. To be perfectly honest and fair, this is the first time that I’ve heard of this practice being performed, so I may be completely wrong in understanding whether this practice will help or harm the relationship between the patient and his or her counselor. I personally would choose to avoid this. Ultimately, I feel that this type of discretion should be handled by each patient’s individual counselor due to possible ramifications of such a practice and certainly not a blanket overall policy.
I think that depersonalizing therapy isn’t always helpful to the patient. By posting things online or having the patient involved in care outside of the therapeutic environment can be a bit dangerous to the person’s thinking. If this person is already very self-conscious or preoccupied with the notion that someone is judging them, finding out what their therapist thinks during sessions might be hurtful and not helpful. I also think this would alter the psychologist’s ability to write freely about what they’re thinking and feeling during a session and maybe write towards an audience that is now bigger than just themselves. This may give the patient incorrect information or a bad or good “vibe” from their psychologists that may change their perspective on treatment.
I believe opening notes to patients switches the dynamic of patient centered counseling. I believe the patient should be coming to realizations, with help from an educated counselor, but shouldn’t be told what to the counselor thinks. Bringing in what the counselor thinks may start to guide the patient in a way that is the counselors choice, not the patients.
I understand what this approach is trying to do for its clients. By allowing the client to see what you (as their therapist/psychiatrist) see and interpret about their conversations and their behaviors, the clients may gain a different perspective of their situation. With this new perspective, clients will therefore be able to approach their presenting issues with new insight and knowledge. What I don’t understand is how this process can happen outside of the session. I applaud and appreciate clinicians who ask and allow clients if they’d like to see the session notes, especially if it seems that these notes are creating a conflict and more stress onto the client. With this discussion occurring during the session, it allows for dialogue and understanding, so that misinterpretation doesn’t occur. My fear with allowing clients access to session notes is that misinterpretation may occur, and conflict and tension could arise due to what was said (that could go unresolved if not brought up within the next session), and therefore clinicians altering their notes to not offend, scare or otherwise hinder the relationship that they’ve developed with their client. During sessions, clinicians are too processing and trying to understand the presenting issues and these are their process notes of your (the client’s) process–they aren’t fact, but merely the thoughts of your clinician. To look at these notes may take away from the process that should be going on naturally (and at your own pace) within the client and may be construed as a fact that could be completely off-base, but a fact that could stay with a client for a long while.
While it is interesting to see a new movement in the treatment of patients, I have some concerns with allowing patient to have access to their therapist’s notes about their sessions. Similar to what had already been mentioned in the article, I don’t agree with the use of layman’s term to describe mental illness. I understand that it is easier to use everyday speech to explain to a patient but, I think a therapist should still use diagnostic language as it is important to use correct terminology when it comes to the diagnosis of mental health. As for the issue of patients misunderstanding the notes because of the diagnostic language, to me, this actually seem like an argument against having open access to the therapist’s notes. If the notes end up breeding misunderstanding, I think it defeats one of the purpose of the practice, which is to increase trust between therapists and patients. A possible alternative will be for the therapist to go over the notes with the participant and answer any questions that a patient may have. This method will still consist the element of transparency but at the same time helps lessen the opportunity for misunderstanding.
I am also concern with the potential issue of confidentiality. When keeping records and notes online, it’s probable that these information about a patient can leak online. As of right now, there is no way of giving a hundred percent guarantee that the information will not be exposed to public. If this were to happen there will be the matter of a breach in confidentiality, which can lead to distrust in therapists and other legal issues. With all that being said, this practice is still very much in its early stages and therefore it is hard to judge the effectiveness. Just to reiterate the article, it should be note that patients come from different backgrounds, just because it works for some, it does not mean it will work for others.
While it is becoming fairly widespread and common for patients to have access to their physical health records (via online patient portals, etc.), I do not believe that the same should be done with mental health records, specifically therapists’ session notes. Physical medical records tend to be objective and factual, while mental health records can be more subjective and personal, to both the patient and their condition, and the therapist and their evaluation. Allowing patients to view session notes may expose them to ideas that, while accepted by the therapist, are not appropriate for the patient in their current stage of therapy. Therapists often have impressions and insights that are important in shaping their treatment and session approaches, but are not necessary, and may not be healthy, for the patient to view. Patients could become upset, offended, or violent in response to such personal statements about them. It is my belief that everything a patient needs to know can be communicated to them during the sessions themselves, face-to-face. I also think of the time away from the therapist as an opportunity for the patient to mull each session over for themselves, somewhat removed from the situation, so they have the opportunity to reach some conclusions and milestones on their own terms.