Progress Notes and Online Text Therapy Platforms: Doing It Right

These days therapy isn’t necessarily hour-long sessions with a client in your office.

That’s SO 2014. Now we have video therapy and text therapy through apps, which are an amazing tool for you and your clients, and introduce a few new considerations for therapists, particularly around progress notes.

First of all, let’s define ‘text therapy.’ It’s a pretty simple definition but we always want to be clear when we’re talking documentation, right?

Text therapy is providing therapy through any format where texting or online chatting are your main form of communication. This can happen through apps like TalkSpace, BetterHelp, and more. Sometimes you’ll combine video, phone, and texting, and the same considerations would apply to those combos.

Personally I LOVE these formats!

Still, there are a few big points to think through when you’re either considering offering counseling through these platforms or already are offering services through these platforms.

Assessment, support, and information

First, you want to assess your level of risk and figure out how comfortable you are with it. Some people love trying new things and find it easy to think through all the issues and come to a decision. Some have a harder time, and might not love the idea of being dependent on someone else (the app) for record-keeping, etc.

Second, you want to make sure you have a solid support network of other therapists to consult. If you don’t have that network in place, please get working on that before you engage in these new platforms. If you’ve already started, get that network together now.

Third, you’ll need to be aware that you probably won’t have a lot of access to the client information you’re used to seeing. These platforms are great for anonymity, which can be a really awesome tool for your clients. Some clients will feel more comfortable sharing and being honest because they know you have limited info. Some clients may never have considered therapy without the choice to remain anonymous.

Anonymity can be excellent for the therapy process, but it does come with some issues for you to be thinking about:

  1. You want and need basic client information, like name, phone number, and address.
    Why? Because sometimes you get cut-off mid phone call, or the app might stop working, and you’ll need to be able to communicate with your clients if that happens. A client might start exhibiting suicidal ideation or you may realize they’re in danger, and you’ll need an address. Now plenty of your clients will be happy to give you the basics, so just ask them.
And then, if needed, keep asking. 

    I’m not saying harass them about it, but as the information is relevant, make a point to ask them again if they’ll share those three things.

  2. Who keeps the records?
    You’ll get to the root of the problem and get the answer you need by simply asking your platform provider what happens in case of a records request. For your own peace of mind and for your clients’ sake, you’ll need to know whose responsibility it is get the clients their records and what is revealed in the process. 
If the app says, ‘Well we don’t have anything to give them,” then you know they aren’t keeping records at all, and you’ll need to keep a full record to CYA. On the other hand, if they say they can hand over entire transcripts of conversations, then you know that what’s being said isn’t completely private, and you need to pass that information on to clients.

And then there’s the notes question.
Where do you write progress notes? How?

Well, you’ll need to know where to access the data you do have on clients. Maybe you’ll keep your own record on the side, or maybe you’ll feel more comfortable keeping a full record. It depends what you have access to through the app.

Either way, keep your notes wherever you have access to the rest of a client’s info. You’ll need access to them in order to protect your clients and yourself, to write reports if a client requests them, etc.

And of course, you need to write notes for EVERY session. If you have specific sessions by chat where you are 100% focused on the client for an hour, write your progress notes as usual after each session.

If you’re texting back and forth all the time, instead you’ll want to do daily or weekly summary notes. So maybe you spend ten minutes talking on Monday, and five on Wednesday, and then a few minutes Thursday, Friday, and Saturday, and you write a weekly progress note.

Maybe you spend lots of time on texting in between video sessions, in which case you’ll need a regular note for the video session and a summary of what’s going on in the texts. This way you’ll be able to refer back to what you’re working through, what techniques you’ve used, and what progress a client is making, even if it’s not happening in a traditional way.

There you have it: If you’re considering starting text therapy, think all of this through ahead of time. If you’re already doing it, make sure the processes you have in place cover everything.

Looking for more information on notes? Check out my Therapy Notes FAQ or the Comprehensive Note Writing Guide for Therapists

And if you want something that covers mental health paperwork in general, sign up for the Private Practice Paperwork Crash Course.