Should I Take Notes During Therapy: The Pros and Cons

Note-taking during psychotherapy and counseling sessions is a common practice that raises important questions about its impact on the therapeutic process. The decision to document therapy notes depends on various factors, including the therapy setting, the clinician's workflow, and the needs of both the therapist and the client. While taking notes is essential for accurate record-keeping and compliance, it also presents challenges in maintaining the emotional and relational aspects of therapy. This blog delves into the advantages and disadvantages of note-taking in therapy with a particular focus on how it affects the clinician-client dynamic and the overall effectiveness of treatment.

Before diving into the pros and cons, it’s essential to recognize some contextual factors that influence and limit note-taking practices:

 

Location and Autonomy: The work setting (e.g., hospital, private practice) and the level of independence given to clinicians.

Volume and Compliance: The workload and the need to meet regulatory requirements (e.g., HIPAA compliance, insurance documentation).

Modality and Resources: Different therapy approaches require varying levels of documentation, and available technology (such as EHR systems and AI-powered scribe tools) can either aid or complicate the process.

The Pros of Note-Taking During Therapy

While taking notes during therapy isn’t universally embraced, there are clear benefits to this practice. For therapists, especially in high-pressure environments, note-taking during sessions can streamline administrative tasks and enhance session quality.

1. Time Efficiency

Taking notes during a session can save valuable administrative time. Rather than scrambling to recall details after the session, therapists who document key points in real-time can avoid catching up later, leaving them more time to focus on session planning, self-care, or even a well-deserved break. This practice allows therapists to remain efficient and organized, without sacrificing time that could otherwise be spent on client care.

2. Accuracy and Clarity

When notes are written during the session, the documentation is more likely to be precise. Real-time note-taking helps ensure that what is documented aligns directly with the conversation, reducing the risk of errors or misinterpretations. This accuracy is critical for maintaining a clear record of treatment, ensuring continuity of care, and meeting compliance standards.

3. Sustained Memory

Notes can act as a powerful tool for reinforcing important themes in the client’s story. By jotting down critical names, events, or concerns as they arise, therapists can easily revisit these points during the session or in future sessions. This enhances the therapeutic process by providing a sense of continuity, helping both the therapist and client track progress over time. This practice not only benefits the therapeutic relationship but also shows the client that their narrative is valued.

4. Reduced Reliance on Memory

Therapists already juggle multiple clients and complex cases and relying on one’s memory too much would not be an ideal practice. Attempting to retain every detail from a session solely through memory can be unreliable. By taking notes, therapists reduce the mental load and ensure that no important information is overlooked. This is particularly useful for complex cases where clarity is paramount. Memory-based documentation risks mixing up clients’ stories, which can lead to confusion or mistakes and can sometimes cause embarrassment when reviewing notes with clients later. 

5. Ensuring Compliance

Documenting during therapy helps clinicians adhere to essential regulatory requirements, such as HIPAA. Real-time notes allow therapists to quickly capture any critical information needed for compliance, including diagnoses or treatment updates, while avoiding errors like placing sensitive data in the wrong chart. This helps protect both the therapist and client, minimizing the risk of audit issues or legal complications.

 

The Cons of Note-Taking During Therapy

While there are undeniable advantages to taking notes during therapy, this practice isn’t without its drawbacks. The following challenges often arise when clinicians choose to document during sessions.

1. Distraction from Active Engagement

One of the biggest concerns about taking notes in therapy is that it can distract the therapist from fully engaging with the client. Therapy is a deeply relational process, and when the therapist is focused on writing, it may feel as though the therapeutic presence is diminished. Clients may sense this shift and feel that they are not being fully heard or understood, which can impact the trust and openness 

2. Client Discomfort

Clients often feel uneasy when their therapist is writing during a session. The simple logic here is that if I’m busy with note-taking, then I’m not clinician-ing or at least clinician-ing as I should be. This can create a sense of being judged or evaluated, as though the therapist is assigning importance to certain topics over others. This dynamic can inadvertently shift the focus away from the client's experience and onto the therapist's process. For some clients, this might even hinder their ability to share openly, as they may wonder what’s being noted or how it may be interpreted later.

 

3. Questionable Effectiveness

In some cases, note-taking may not be as beneficial as it seems. Not all clinicians find it useful to document while speaking with clients. For some, the act of taking notes may lead to disjointed or incomplete documentation that doesn’t capture the nuances of the session. If the notes end up being vague or not serving a clear purpose, it might be more efficient to reserve note-taking for after the session, when the details are fresher and the therapist can focus entirely on documentation.

4. Less Therapy, More Compliance 

Excessive note-taking can also make therapy feel less personal. If the focus shifts too much toward meeting documentation standards or satisfying audit requirements, the client may feel like they are participating in a mechanical process rather than an emotionally supportive conversation. Some clients may even express that they feel their therapy is being “interrupted” or “shortened” by note-taking, prompting therapists to reconsider the balance between documentation and therapeutic engagement.

5. Avoidance of Emotional Intensity

Note-taking can sometimes serve as a barrier to fully engaging with the emotional intensity of a session. For therapists who feel uncomfortable with certain discussions or who struggle with maintaining a neutral and attentive presence, writing can provide a temporary distraction from the emotional work. While this may offer a sense of control or distance, it may also reduce the depth of the therapeutic relationship and hinder progress. Therapists who find themselves relying on notes to avoid emotional discomfort should seek supervision or self-reflection to address the underlying issues.

 

Conclusion

We can conclude that note-taking during therapy depends on the individual clinician’s preferences, the therapeutic approach being used, and the unique needs of each client. There is no question that note-taking can be a helpful tool for accuracy, efficiency, and compliance, but it is important to balance these advantages with the need for client engagement and therapeutic presence. The rise of AI-powered medical scribes is also transforming how therapy notes are managed, allowing clinicians to spend less time writing and more time focusing on the client.

At the end of the day, the best approach is one that supports both the clinician’s workflow and the therapeutic process. Whether you’re a proponent of note-taking or prefer to document after the session, the key is ensuring that the process enhances the work being done and doesn’t interfere with the client’s journey.

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