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Dear Dr Robert, 


I write with two questions. 


The first is regarding client access to psychotherapy notes. I am in the process of a predicted, managed handover from one psychotherapist in a practice (who is leaving) to another. My first therapist took plentiful notes in sessions, and wrote them up after each session, and these are now being handed over to the new therapist. I have never asked for access to these notes, and it was never offered. Now I am between the therapists, and it feels very strange that someone I don't know is reading the interpretations of another person on a great deal of very personal information about me. I wonder if the new therapist will 'inherit' ideas about me that I might question, yet I have no control over that.



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I wonder what contexts are lost, what filters are added, and what decisions about treatment will be maintained  or overturned. I feel like there is a kind of 'magic curtain' operating here that I am not supposed to disturb - like perhaps my treatment depends on my remaining in this state of not knowing, of blind trust - because the therapists are trained, after all, and I'm not. The dangers of a little knowledge, etc. I feel like this 'default' position makes me just an incidental site of my conditions and my treatment. At the same time I'm obviously questioning that situation. Why should the new therapist know more than I do about this information? Why should I be a passive partner in this regard? My question is - is it 'done' for a client to read their notes? What would you do if a client asked for access to these? Given that treatment often seems to involve careful negotiation (by both therapist and client) of the process of bringing forth awareness, are there problems with sharing the notes? And if so, doesn't that put the client in an inherently 'babied' position, while protecting/elevating the therapist's clinical judgement? As you can no doubt see, this is an emotional dilemma for me, but it's also one that I'm interested in intellectually. 





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My second question is about the intense green on your website pages. Reading questions on your website often leaves me feeling a bit disoriented, and it's because the extreme background colour creates a very immersive experience that is often a good match for the intensity of the questions. It's hard to move on to other sites or activities, because when I look away, my colour perception is drained. Is this a deliberate choice and effect, and if so, why?


Thanks,
Jen






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Hello, Jen--

The notes made by the first therapist are likely to prove valuable to the second therapist, not so much as a set of judgments or conclusions about you, but as a starting point for the beginning of your therapy with her (or him). Reading the notes of your first therapist probably will save the new therapist a great deal of time and effort which now will be available to be used in other ways. Since this is your therapy, and since you are paying for it, I would imagine that you would see that this efficient use of therapy time is to your advantage. Personally, I am always pleased to receive help from the previous therapist of a client, and I do not take any of it as gospel, but just, as I say, a starting point.

Apparently, however, you are troubled both by the idea that the notes contain secrets which you must not be allowed to know, as well as by the idea that the notes will somehow be "incorrect," leading the second therapist to believe things about you which she (or he) might never have believed if she had simply met you and gotten to know you purely by means of your own words and behavior.



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You seem also to resent having a dependent status vis-a-vis your treatment, which you call "an inherently 'babied' position."

Since I imagine that you raised those issues, which you say constitute an "emotional dilemma," intending indirectly to elicit my opinion on your dilemma, I will address your concerns, but first let me get right to your direct question: "Is it 'done' for a client to read [a therapist's] notes?" I would say no. The therapist's notes are her private property and she is not obligated to share them with anyone unless ordered by a court in a legal proceeding. Of course, that would not prevent her from sharing the notes with you if you asked to see them. However, I think you did well to have avoided asking to see the notes, and your therapist certainly did well by not offering to show them to you. In fact, if you had asked, she probably would have declined to share them, and that probably would have been for the best. I have never shared my notes with a client, and probably never will.





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This is not because a therapy client is a "passive partner" in the therapy—far from it—but because the role of the therapy client is not the same as the role of the therapist. The client seeks help because something in that person's life is at least unsatisfactory if not completely unworkable. Presumably, the client has tried other ways of handling the difficulties, and those ways have failed. Now the client is putting his (or her) trust in the process of psychotherapy as a treatment for his problems. Since much of the effectiveness of psychotherapy depends upon the skill and sensitivity of the therapist, the client really must trust both the good intentions and the abilities of the therapist. If he cannot do this, the therapy will never succeed, and the client should seek a new therapist whom he can trust. This seems obvious to me, and I hope it is to you as well.

If you do see this, then you will understand that although you and the therapist are partners in the work, the partnership is not one of equality at all. You are the one with the troubles, and the therapist is charged with helping you to deal with them or to overcome them. This does not make you a "baby," but it does mean that you require help with your life, which is, in a sense, a dependent position, and one that does have some of the emotional feel of being a child. The therapist may have problems of her own, but you do not know what they are, and the therapist—if she is any good at all--will not share them with you unless she does so for a specific therapeutic purpose. Again, this does not make you a "baby," but it does smack of an adult-child relationship: the adult decides what to tell the child, and what to withhold until, in the judgement of the adult, the child is ready and prepared to hear and accept it.



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Of course, in one sense psychotherapy is simply about two human beings sitting in a room conversing, but good psychotherapy is far from an ordinary conversation. In this kind of encounter, the conversation is being managed carefully by the therapist who should not say or do anything which she believes might impede the process of healing. Part of that kind of therapy management involves deciding which ideas and insights should not be shared with the client, either because the therapist feels that it would be better for the client to discover those insights for himself, or because the therapist believes that certain thoughts about the client might be discouraging or otherwise harmful to the client at that particular time in the therapy.

To speak personally, I often develop theories or insights about a particular person in therapy which I choose to keep to myself, either temporarily or sometimes permanently. If I choose to share them, I want to decide when and how. Particularly in the case of insights likely to be perceived as painful or frightening, I would not want my client to read them in my notes, but to hear them from me directly so that I can choose the best words to express them (which is unimportant in making notes), and so that I can carefully monitor the conversation with a view towards responding in real time to doubts, fears, anger, or whatever reaction the client might have.

Please try to understand. If your therapist is any good, you should let her manage the therapy as she sees fit. If you have questions, ask them, but don't expect the therapist to be an open book. The therapist should be authentic and honest, but not ingenuously. If you feel a bit infantilized by such an approach to your treatment, that may be one of the costs of psychotherapy, just as losing control of certain personal choices and freedoms might be one of the costs of a surgical operation and subsequent hospitalization.

As for the green background of my web pages: I receive a lot of comment on that, both pro and con. I chose the color because that particular shade of green has, in my opinion (and I could be mistaken), a beneficial effect on the mind—simple as that.

Be well.







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Dear Dr Robert -

Thank you kindly for your thorough and thoughtful response. You might be interested to know that I had a first meeting with my new therapist yesterday, and when I raised this issue with her she gave me a response almost opposite to yours in some regards. She said that the notes were mine in that they were about me, and that I was welcome to book an appointment to read through them at any time. She told me that she had herself decided to read only the summary and geneogram, as it felt intrusive to her to read material that I had not explicitly chosen to share with her. She said she found it more useful to encounter me on the basis of our own interactions.

I don't see either approach as invalidating the other (though they obviously can't both be applied at once), and I appreciate you sharing your thinking. While my therapist's approach has gone a long way towards quickly establishing an initial basis of trust between us, your response has given me some things to chew on: specifically, how much of what kind of information do I need in order to trust from this 'childlike' position? 'Childlike' obviously doesn't need to mean utterly blind or foolish, but when one's own modes of being are already in question, it can be hard to find reliable bearings.

Thank you again for taking the time.

Best wishes,
Jen




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