To Write or Not to Write | Taking Notes During Therapy Sessions

During my time in university, there were debates on many practice topics for social workers and therapists. One topic that brought some interestingly heated discussion was note taking during therapy sessions. Is this helpful or hurtful?

I’m currently practicing as a psychotherapist in an outpatient mental health clinic, and hold a caseload of about 45 clients per week. The challenge of remembering the many details to each client’s life is something many social workers and therapists, including myself, continue to battle with. An unsettling feeling arises however when I watch a show or movie that portrays a therapist in a chair across from the client, legs crossed, wearing glasses, and very seriously taking notes when the client says an “interesting” statement. How do we bridge the gap?

In terms of my personal practice, the sole session in which note taking is prevalent is during the intake biopsychosocial assessment. Because the client is providing their in-depth and detailed history, it is important to take notes during this time. Note taking can still add a non-personal touch to the sessions, especially when you want to begin building rapport immediately. When note taking is necessary in this first session, I like to preface the session with a disclaimer, and let the client know why I’m writing, what I’m writing, and let them review the notes at the end of the session to confirm it’s correct. This helps break down part of the wall of note-taking, and the discomfort it can add. In sessions past the intake session, I rarely take notes as I feel it takes away from the client’s experience and session time. In order to be fully present and hold space for the client and what they have brought into the room, it’s important the attention is not broken. In a clinical study conducted by L.P. Hickling, E.J. Hickling, G.F. Sison Jr., and S. Radetsky, it was found that notetaking has significant and detrimental effects on the therapeutic relationship and the effectiveness of sessions. Clients often viewed taking notes as distracting (Hickling et al., 1984), while the absence of note taking allowed for a more effective therapeutic style where clients felt heard and significantly more comfortable (Bernardi, 2015).

Pros of Notes
– Triggers memory for important details of client’s experience
– Helpful with high caseloads
– Helpful for tracking data
Pros of No Notes
– Builds better rapport and trust with clients
– Allows for better communication and openness
– Client feels fully heard and listened to
– Therapist is giving full attention to client and the session
Cons of Notes
– It can make the client feel distracted or uncomfortable
– It can take away from the session time and create an environment that feels too clinical
– The therapist’s attention is not fully on the client, and they could end up missing details anyways.
Cons of No Notes
– It can be difficult to remember important details
– Client’s lives can be complicated, and being without notes can make it difficult to keep track.

Given the research and real-life practice experience, it is apparent that conducting therapy sessions without notetaking is the most effective method for therapeutic practice. While notetaking may be necessary during the intake session, or to jot down a quick note, it is imperative the therapist seeks to be inclusive in the note-taking and ensure the client feels comfortable.

References

Bernardi, Francesco (2015). Note-taking during counselling sessions: A mixed methods research on the client’s perspective. (Unpublished Doctoral thesis, City University
London).

Hickling, L. P., Hickling, E. J., Sison, G. F., Jr, & Radetsky, S. (1984). The effect of note-taking on a simulated clinical interview. The Journal of psychology116(2d Half), 235–240. https://doi.org/10.1080/00223980.1984.9923641

2 thoughts on “To Write or Not to Write | Taking Notes During Therapy Sessions

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  1. Great Post! As someone in early stages of training to become a therapist, it’s not something I had given much thought to. Definitely will consider the pros and cons going forward so thank you! 😊

    -A.B

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