Good practice in the treatment of mental illness | Letters

A lack of note-taking is not always a red flag in therapy, writes Dr Helen Damon, and Ruth Medhurst says that the terminology around illness is totally outdated

Your article (‘It was devastating’: what happens when therapy makes things worse?, 17 July) lists several “red flags” that indicate a therapist is unprofessional, including never taking notes in session. I am a counselling psychologist – a profession regulated by the Health and Care Professions Council and the British Psychological Society. I am also a lecturer on a professional doctorate in counselling psychology and I see clients in private practice. I have previously worked in the NHS and in the education and charity sectors. I would like to clarify that it is not a red flag per se if a therapist does not write notes in session.

Maintaining accurate and up-to-date session notes is central to therapeutic practice, but many therapists, myself included, write notes (as soon as possible) after each session. Indeed, one rationale for therapy sessions typically lasting for 50 minutes rather than an hour is that this enables therapists to write notes on their previous session in the space before their next one. Given that there are more than 400 forms of psychological therapy, it is unsurprising that therapists practise in different ways; there are therapeutic rationales for writing and for not writing notes in session.

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