Reading Your Psychotherapist’s Mindby Richard Kensinger, MSW | July 27, 2014
I am a clinical social worker and faculty member in psychology and community counseling. I came across a provocative article in the New York Times, Wellness section, entitled “What the Therapist Thinks About You”. I am sharing my clinical experience of sharing my notes with the clients I treat.
Mental health patients do not have the ready access to office visit notes that, increasingly, other patients enjoy. But as discussed in the article, Mr. Baldwin is among about 700 patients at Beth Israel Deaconess Medical Center who are participating in a novel experiment.
Within days of a session, they can read their therapists’ notes on their computers or smartphones. The hope is that this transparency will improve therapeutic trust and communication.
The Department of Veterans Affairs, which began making medical and mental health records available online last year, is only just beginning to study the effect of this on mental health patients.
The Beth Israel project grew out of OpenNotes, a program by Dr. Delbanco and his colleagues that made physicians’ notes accessible to 22,000 patients at three institutions. A 2011 study showed that patients responded positively and became more involved in their care.
Mindful of any pitfalls, the Beth Israel psychiatrists have offered notes initially to only 10 percent of patients.
I have been sharing my clinical notes with clients for years now, with no discernible negative effects. However, I do so only at the next session as a review of our last session. I never post them in any electronic format, so as to preserve respect, confidentiality and privacy. I do not trust the safety of electronic information.
I have been doing this for a number of reasons, some I will discuss here.
For one, I believe that all healthcare recipients are entitled to an accurate recording of their care. Secondly, I believe that this approach also solidifies the therapeutic alliance, which is critical to effective care. Thirdly, it reinforces therapeutic momentum and keeps the client and clinician focused on the objectives and goals of the treatment.
So in my experience, the benefits outnumber the liabilities. I’m certain that some clinicians will disagree with the essential premise of this article; and I welcome robust discussion.
J. Hoffman (2014). What The Therapist Thinks About You. New York Times, July 7.
Leveille SG, Walker J, Ralston JD, Ross SE, Elmore JG, & Delbanco T (2012). Evaluating the impact of patients’ online access to doctors’ visit notes: designing and executing the OpenNotes project. BMC medical informatics and decision making, 12 PMID: 22500560
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