Well, given that I worked as a therapist for about 15 years, I found this article interesting reading because what it means to therapists professionally. I have a few brief thoughts. I mean, I teach and have supervised and have always said that you should always write as if someone else is going to read it because clients always have access to your records. I mean, you can be audited and as much as you think it is private, it really isn't. I've had people get a hold of reports and spend hours pouring over it and then come back to me so I've had to take responsibility for what I've written. Edited to add: I once had someone take a report of mine and use it in a custody fight which drove me nuts because of how it was being used. But it does really remind you how high the stakes can be for everything you write.

And that knowledge that someone else can read your articles isn't terrible—you are never as opaque as a clinician as you imagine you are. One of the earliest pieces of useful advice I had is that "Any client can tell if you are full of shit." So you can't really sit in front of someone, act like you care and are compassionate and then talk shit about them among your colleagues which a lot of clinicians do. And frankly, that's hurts people's practice. I mean,it's not like I haven't had negative feelings but you handle it differently and have more insight into what you are doing and what the dynamics are. I don't know how many times I've had people complain about getting into power struggles with their clients, then they berate and denigrate them and then don't seem to understand why the negative feelings continue. They don't see how they are contributing to it. You are supposed to understand the power struggle—not get mired in it.

I agree with the ideas espoused in the article that reading notes aren't as exciting or revealing or necessary to many clients as people think they might be. I've offered to show people who have asked explicitly myself and most aren't interested in what I write—they are interested in the therapeutic relationship. Those who do see it are underwhelmed. What is most difficult is when people get a formulation or a diagnosis that is upsetting but that should be discussed with clients anyway—it's just that some clinicians avoid talking to people about how they see them.


Anyway, open communication is generally a good thing even though, most of the time, the revelations are not major surprises even if they aren't explicitly shared.