Ahhhh, the comfort of paper notes.

A lot, lot, lot of counselors have not moved past the paper note. It is okay if you haven’t and it works for you. If you have a new counselor under your wing make extra sure they know how to handle anything, ANYTHING they write down on paper.

The actual risk of a stranger finding a clinical note and feeling the need to read it and then bothering to do anything with it is slim to none.

A supervisors concern should be the perception the client has around the privacy of their notes. The client needs to know that those notes on their private life moments are locked up and kept from prying eyes.

Seems simple, right? Should be.

Imagine this: Your supervisee just finishes up session. The whole time the therapist had a noe pad in their lap, jotting now relevant information to the session. There is no name on the paper, no identifying details so the therapist tosses the note pad in their bag before ending session. The client sees this and says nothing. After that the client and clinician walk out together. Seems innocent enough.

Now, for some reason the client is upset by the therapist. Who knows why, it really doesn’t matter. Now they have a HIPAA complaint they can file and WILL win. I can’t give you legal advice and seems like a stretch, but its an easy 25k lawsuit.

What went wrong?

First of all, the new therapist did not have the notes locked in any way.

Secondly, the client’s perception is that their private information which they hold deep feelings about is out there, who knows where, maybe anyone could read it at any time. They feel so much distrust, in fact, they file a lawsuit.

How do you avoid this?

Our practice has gone extreme. We do not take notes on paper at all. We record notes directly into the file as the client sits there or we pull from memory. It is too risky, in my mind, to do it any other way. If you think that is outlandish, simply teach your supervisees to have a manilla folder with their client notes in it. How the notes appear and get put away needs to communicate official business. Clients should see where the notes are locked up. Amazon sells lock bags like what the banks give some businesses for transporting cash for the day. There are also small lock boxes and, of course, large file cabinets. The point is that clients must feel confident in the confidentiality of their information storage. Walking out the door with a notebook shoved in a backpack creates concern. Casually walking out of the office with a client is also a no-no.

Don’t ever leave a doubt in a counseling client’s mind around the safety of their information.

Ahhhh, the things you never dreamt you’d have to teach.