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.
Data:
Session duration was 45 minutes and conducted virtually. Client appeared stressed and 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 such as rereading documentation repeatedly, lying awake at night replaying sessions, and worrying about assessing risk properly. Despite receiving positive feedback from their supervisor and having no complaints, client reported difficulty stopping the worry. Discussion focused on how anxiety and perfectionism, rather than actual risk, are driving these behaviors. Client identified reassurance-seeking behaviors, such as checking in with colleagues and googling ethics questions late at night, as maintaining their anxiety.
Assessment:
Client demonstrates insight into their anxiety and perfectionism but struggles to break the cycle of reassurance-seeking and obsessive rumination. These behaviors are interfering with their ability to trust their professional judgment, despite evidence of competence. Client responded well to psychoeducation on how reassurance-seeking reinforces anxiety and engaged in developing a plan to reduce these behaviors. Hesitation was noted regarding cognitive reframing tasks, but client agreed to attempt them.
Plan:
Client will practice limiting documentation review to one check after writing and will avoid rereading later. They will also identify reassurance-seeking behaviors and replace them with alternatives, such as sitting with uncertainty for 30 minutes before acting on urges. Client will begin creating a written list of evidence supporting their competence, including positive feedback and successful outcomes. Homework includes practicing these strategies and starting the evidence list. Follow-up session is scheduled for next week to review progress and continue building self-trust.
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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