Quill generated this note with AI from the summary that was provided. The therapist can then copy-and-paste the note into their current EHR platform.
Behavior:
Client logged into the virtual session appearing stressed. They reported worsening anxiety related to their work as a therapist. Client stated, "I'm constantly terrified I'm going to mess up and hurt someone or get reported." They described obsessive behaviors, including rereading documentation multiple times, lying awake at night replaying sessions, and worrying about saying the wrong thing or not properly assessing risk. Client acknowledged that their performance is objectively good, with no complaints and positive feedback from their supervisor, but expressed difficulty stopping the worry.
Intervention:
The session lasted 45 minutes and was conducted virtually. The therapist provided psychoeducation on how reassurance-seeking behaviors, such as rereading notes, checking in with colleagues, and googling ethics questions, maintain anxiety rather than reduce it. The therapist collaborated with the client to create a plan to reduce reassurance-seeking behaviors and build confidence. Specific interventions included setting a limit on documentation review, identifying reassurance-seeking behaviors and alternatives, and introducing cognitive reframing techniques, such as creating a list of evidence supporting their competence.
Response:
Client engaged actively in the session and demonstrated insight into the connection between their anxiety and reassurance-seeking behaviors. They appeared hesitant about implementing some of the suggested strategies, such as creating an evidence list, but expressed willingness to try. Client's responses indicated a readiness to begin addressing their perfectionism and anxiety, aligning with their treatment goals of reducing work-related distress and improving self-trust.
Plan:
Client was assigned homework to practice limiting documentation review to one check and to start compiling an evidence list of their competence. The next session is scheduled for next week to review progress on these tasks and continue building strategies to enhance self-trust and reduce anxiety.
We had a 45-minute virtual session today. Dr. Patel logged in looking stressed and said the anxiety about their work has been getting worse. They're a therapist, and they said quote 'I'm constantly terrified I'm going to mess up and hurt someone or get reported' unquote. They described how they obsess over documentation, rereading their notes over and over to make sure they didn't miss anything. They'll lie awake at night replaying sessions, worrying they said the wrong thing or didn't assess risk properly. They said they know their performance is actually good, they've never had a complaint, their supervisor gives positive feedback, but they can't stop the worry.
We talked about how this is less about actual risk and more about anxiety and perfectionism. The obsessive rumination and the constant reassurance-seeking, checking in with colleagues, rereading notes, googling ethics questions late at night, those are actually maintaining the anxiety, not reducing it. I explained that every time they seek reassurance, it gives short-term relief but reinforces the belief that they can't trust their own judgment.
We started building a plan to reduce the reassurance-seeking and improve their confidence. First, we set a limit, they can check their documentation once after writing it, and that's it. No rereading later. Second, we identified their most common reassurance-seeking behaviors and came up with alternatives. Instead of texting a colleague for reassurance, they'll sit with the uncertainty for 30 minutes and see if the urge passes. Third, we worked on some cognitive reframing. I asked them to write down evidence that they're competent, feedback they've gotten, clients who've improved, times they handled tough situations well. They seemed hesitant but agreed to try.
Their homework is to practice the documentation limit this week and to start that evidence list. We'll meet again next week to see how it's going and keep working on building their self-trust.
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