Sharing Psychotherapy Notes with Patients: Therapists’ Attitudes and Experiences

Abstract

Evidence suggests that the practice of sharing clinicians’ notes with patients via online patient portals may increase patient engagement and improve patient–clinician relationships while requiring little change in providers’ workflow. Authors examined clinical social workers’ experiences and attitudes related to open psychotherapy notes using focus groups and telephone interviews. Twenty-four of 29 eligible therapists agreed to open their notes to patients, and nine participated in this study. Participants were generally positive about their experiences and reported few disruptions to their workload or practice. However, they were hesitant to bring up notes to patients during sessions, and they discussed the benefits of open therapy notes mostly hypothetically. The five therapists who did not share notes worried that open notes would be detrimental to therapeutic relationships, patient well-being, and workflow. However, the concern they discussed most often related to the electronic health record rather than to open notes, because therapy notes are visible to all authorized clinicians as part of the general medical record. Future research is needed to deepen our understanding of the risks and benefits of open psychotherapy notes and to inform development of training programs to support therapists in opening notes.

Sharing Clinical Notes in Psychotherapy: A New Tool to Strengthen Patient Autonomy

“…Although fewer health organizations have chosen to share mental health notes (7), all patients have the right to understand their care (8). While many clinicians anticipate workflow problems from sharing notes (9, 10), studies suggest that clinicians do not experience major burdens to documentation practices (11)(12)(13).…”

“Let's Talk About Your Note”: Using Open Notes as an Acceptance and Commitment Therapy Based Intervention in Mental Health Care

“…Prior studies have reported clinician concerns about detrimental effects to the therapeutic relationship, patient well-being and workflow as a result of using open notes (6,(10)(11)(12). However, early data has found that patients who have access to their mental health notes requested information less often, attended more appointments and reported greater activation and recovery scores (13).…”

“…Advocates have framed open notes as a tool to increase patient autonomy, reduce stigma, empower patients to manage their mental health and strengthen the patient-clinician relationship ( 8 , 12 , 14 ). Use of open notes in practice has varied, with some providers using a passive approach (e.g., waiting for patients to ask about their notes), and others using a more active approach (e.g., encouraging feedback from patients) ( 12 , 15 ).…”

Healthcare in the new age of transparency

“…This concern about documenting sensitive information was and continues to be, a particular issue for notes prepared by mental health specialists. However, all electronic health record systems that offer the option of sharing notes with patients allow for “hiding” individual notes hesitation by mental health professionals continues 33‐36 . Experiments in the Veterans Administration by psychiatrists offer lessons for how to document difficult conversations 37,38 .…”

“…However, all electronic health record systems that offer the option of sharing notes with patients allow for "hiding" individual notes hesitation by mental health professionals continues. [33][34][35][36] Experiments in the Veterans Administration by psychiatrists offer lessons for how to document difficult conversations. 37,38 While psychotherapy notes are not included in the documentation that must be shared with patients beginning November 2, 2020; we are seeing slow progress in sharing mental health notes.…”