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.
Problem:
Client logged into the virtual session appearing 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 rumination, including replaying sessions at night, worrying about saying the wrong thing or not assessing risk properly, and rereading documentation repeatedly to ensure nothing was missed. Client acknowledged receiving positive feedback from their supervisor and having no complaints but reported being unable to stop the worry. They identified behaviors such as reassurance-seeking, checking in with colleagues, and googling ethics questions late at night as part of their struggle with anxiety and perfectionism.
Intervention:
The session lasted 45 minutes and was conducted virtually. Therapist discussed how the client's behaviors, such as reassurance-seeking and obsessive rumination, maintain rather than reduce anxiety. Therapist explained the reinforcing cycle of seeking reassurance and its impact on the client's ability to trust their own judgment. Therapist collaborated with the client to develop a plan to reduce reassurance-seeking behaviors, including setting a limit of checking documentation only once after writing, identifying alternative behaviors to reassurance-seeking, and engaging in cognitive reframing by listing evidence of their competence.
Response:
Client appeared hesitant but agreed to try the proposed strategies, including limiting documentation checks and starting an evidence list of their competence. They engaged in the discussion and demonstrated insight into how their behaviors are contributing to their anxiety. Client's willingness to attempt the interventions suggests progress toward building self-trust and reducing perfectionistic tendencies.
Plan:
Client was assigned homework to practice the documentation limit and begin creating an evidence list of their competence. The next session is scheduled for next week to review progress and continue working on strategies to improve self-trust and reduce anxiety. Future sessions may focus on further cognitive restructuring and refining strategies to manage perfectionism.
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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