Comprehensive session notes should include:

  • Date and Time of the Session: Record when the session took place.
  • Client Identifiers: Include the client’s name or ID number (while maintaining confidentiality).
  • Session Goals and Objectives: Document the goals for the session and any specific objectives that were addressed.
  • Content Summary: Provide a summary of what was discussed, including key themes, client responses, and significant events.
  • Interventions Used: Note any therapeutic techniques or interventions implemented during the session.
  • Client Progress: Include observations about the client’s progress toward their goals, noting any changes in behaviour or mood.
  • Plan for Next Session: Outline any plans or objectives for the next session, including homework or tasks assigned to the client.