What Is Your Therapist Really Thinking? And Do You Even Want to Know?

Have you ever sat in a therapy session, divulging detail after intimate detail about yourself, and wondered What does my therapist think of me?, Do I sound like a terrible person?, or What the f*** is she scribbling in that little notebook?

Well, 700 patients at the Beth Israel Deaconness Medical Centre in Boston are about to find out. As the (lucky?) participants in a novel experiment, they are being given access to their therapists notes from counseling sessions, just days after each meeting. The hope is that this will improve the transparency and trust of the process.

It’s an intriguing idea and a great way to dispel the stigma and silence surrounding mental illness, but it raises a few massive questions. Do patients really want to know what their therapists think? And, moreover, will this approach even be helpful?

On the one hand, I can certainly see this method making patients feel more involved in and committed to therapy. Certainly, this was the result of an OpenNotes program that allowed 22,000 patients access to their physicians' notes, and it’s reasonable to think that this effect could translate to treatment of mental illness as well. As rough as it might be to read your own words, it could make you more reflective and considerate.

On the other hand, it’s possible that patient access to therapy notes might hinder the entire process. For one, think of all the misinterpretation! It’s not hard to see a patient misunderstanding medical jargon (not to mention misreading their doctor’s hieroglyphs) and becoming offended or even ceasing therapy entirely. A particularly horrifying negative outcome would be for the wrong person to get their hands on these notes, such as an untrustworthy family member or abusive partner. (Picture the upsetting scene in Harriet the Spy where Harriet loses her closest friends when her enemies find her notebooks and read her unfiltered personal reflections to her best mates).

And then there’s the therapist. Therapists might adopt the school-teacher report-writing approach and become self-censorious or entirely euphemistic. (She’s not “completely daft” she just “needs praise and encouragement.” He’s not “foul-mouthed,” he simply “expresses himself clearly”). This could also stop them from writing down any potential diagnoses or thoughts in their nascent stages.

As long as you don't read "She has no hope," "Wish this session were over," or "Remember that anecdote for the next cocktail party" on your therapist's notepad, it could be an eye-opening experience. 

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