Can I Request My Therapy Notes?

Therapy notes are information recorded by a mental health professional used to aid in documenting and evaluating conversations that take place during therapy. These are the notes that a therapist writes down as you talk during your therapy session. They are the therapist's private thoughts, meant to help them document their impressions and develop a clearer picture of the problems and experiences you are dealing with. 

It's normal to be curious about what your therapist is writing. What are your rights when it comes to accessing these notes? 

This article discusses your rights with regards to therapy notes as well as the potential pros and cons of reading them. It also discusses what to do if you decide to request your therapist's notes. 

What Are Therapy Notes?

HIPAA defines psychotherapy notes as any note in any form used to document or analyze the contents of conversations that occur during individual, group, family, or joint counseling sessions.

These notes are not the same as progress notes. Progress notes serve to document the progress of treatment. They include information about the presenting symptoms, diagnosis, current functioning, treatment plan, and prognosis. They also include information about medications, treatment modalities, and results of psychological tests.

While they contain important information, progress notes are briefer and more limited in terms of their scope. This is because these notes' information might be shared with other service providers and insurance companies.

Therapy notes, on the other hand, are much more detailed. Their purpose is to help your therapist take down their impressions during sessions in order to get a fuller picture of your situation. They may contain more personal information that should not be shared with others outside of the therapeutic relationship. 

Reasons to Access Therapist Notes

Why would you want to look at your therapist's notes about your counseling sessions? There are a few different reasons you might want to access therapy notes.

• You're moving or changing therapists: If you are going to move to a new area, you'll likely need to find a new therapist. Your new therapist might benefit from looking over your previous therapist's notes.
• You're concerned about your therapist's actions: If you are concerned that your therapist has engaged in actions that are unprofessional or unethical, you might want to access their notes to demonstrate your case.
• You feel like these notes might provide insight: In some cases, you might feel like reading through your therapist's notes might provide insight into your experiences. It can also be a helpful way to see your progress and recognize how far you have come during your therapy sessions.
• You think it might improve treatment: You might want to read therapy notes because you think it might improve your relationship with your therapist and benefit your treatment. Seeing what your therapist has written during your sessions might help with therapeutic rapport and strengthen the therapeutic alliance.
• You're just curious: It's natural to wonder what your therapist might have jotted down during your sessions. If this is the reason why you want to read these notes, it is important to ask yourself if satisfying your curiosity will be helpful—or could it potentially lead to other problems.

Whatever the reason, you need to be clear in your explanation to your therapist. If your therapist refuses, there is no point in demanding access if the state and federal laws prohibit your access. Outline your reasons and discuss them with your therapist, but keep your expectations reasonable.

Patient's Rights

Under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, you have the legal right to see most, but not all, of your medical records. In fact, according to the Department of Health and Human Services, you do not have a right to any psychotherapy (process) notes taken during your sessions or treatment.

Under current federal law, process notes are considered separate from your medical records (the latter of which contains things like vaccination history and lab results). As opposed to diagnostic records, process notes are considered thoughts and impressions therapists have that are not unlike keeping notes in a journal. They may lead a therapist to a diagnosis, but they are not the diagnosis.

If the therapist believes that something in the process notes may harm you in any way, they have every right to withhold them. What a therapist cannot do is withhold them as a means to compel payment of a late bill. Any coercion of this sort is punishable under the law.

On November 20, 2020, new federal rules were enacted that require healthcare providers to offer patients access to their clinical notes. While people can access their process notes, psychotherapy notes are excluded from this mandate, and healthcare providers can block certain information if they believe that it poses a risk of harm.

Benefits of Seeing Therapy Notes

While therapy notes are meant to help your therapist keep track of your sessions and guide their thinking, there is evidence that allowing clients to read these notes can be beneficial.

Some of the potential benefits of reading therapy notes include:

• Being more involved in your treatment
• Feeling better heard or understood
• Feeling empowered
• Improving medication and treatment adherence
• Seeing and tracking your progress

A 2017 study of people who were being treated in an outpatient psychiatric clinic found that having access to therapy notes showed no evidence of harm. Having access to these notes was also perceived as beneficial for those who were being treated.

A 2019 study published in the Journal of Mental Health found that 94% of participants felt that having access to their therapy notes was a good idea, and 87% wanted to continue having access to them. The study also found that more than half of the participants felt that reading these notes increased their trust in their therapist and helped them feel more in control of their care.

Risks of Reading Notes

If you are interested in reading your therapy notes, it is important to consider some of the potential risks of doing so. While denying process notes may seem very unfair, there is a rationale for the law. Seeing these notes might satisfy your curiosity, but it's important to be aware of how reading your therapist's notes might negatively impact your well-being and your relationship with your therapist.

• Reading your therapist's thoughts might affect your relationship with them: During the course of a therapy session, the therapist needs to jot down thoughts and impressions in real-time. As such, the notes may be raw and contain words or statements that are meant to be relevant but end up hurting the therapist-client relationship.
• You might read things you didn't want to hear: While most participants in one study felt that they benefited from reading these notes, 11% felt either judged or offended by what they read.
• Therapy notes can be misinterpreted: To supporters of the HIPAA legislation, releasing notes is not unlike posting a diary on the internet. The meaning of the notes may be prone to misinterpretation and taken well out of context.
  

How to Request Notes From Your Therapist

Even if your state law adheres to the standards of HIPAA, it does not mean that you cannot request your notes or that a therapist is barred from releasing them. If you would like to access these notes, discuss it with your therapist.

Talking about your reasons for wanting to read these notes can help your therapist understand your request. It can also help you understand some of your therapist's concerns about releasing these confidential records.

If a therapist turns you down, ask for an explanation but avoid getting into an argument. If you have had a good relationship with the therapist, you may need to accept that they have your best interests in mind. Don’t let a disagreement over therapy notes destroy an otherwise valuable and productive relationship.