The session lasted 45 minutes and was conducted virtually. Client appeared stressed and reported worsening anxiety related to their work as a therapist. Client expressed fear, stating, "I'm constantly terrified I'm going to mess up and hurt someone or get reported." They described obsessive rumination, including rereading notes multiple times, lying awake replaying sessions, and worrying about saying the wrong thing or improperly assessing risk. Client acknowledged their performance is objectively good, citing positive feedback from their supervisor and a lack of complaints, but reported being unable to stop the worry. Therapist identified the client's behaviors, such as reassurance-seeking, obsessive checking, and googling ethics questions, as maintaining the anxiety. Therapist explained that reassurance-seeking provides short-term relief but reinforces the belief that the client cannot trust their judgment. Together, a plan was developed to reduce reassurance-seeking and build confidence, including limiting documentation review to one check after writing, delaying reassurance-seeking behaviors by sitting with uncertainty for 30 minutes, and creating an evidence list of their competence, including positive feedback and successful experiences. Client agreed to try these strategies despite initial hesitation. Homework assigned includes practicing the documentation limit and beginning the evidence list. The next session is scheduled for next week to evaluate progress and continue working on building self-trust.
SIMPLE Note Example
Ethics and Risk Management Anxiety
Therapist/clinician client addressed perfectionism, obsessive worry about mistakes, and developed strategies to reduce reassurance-seeking.
Generated SIMPLE Note:
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.
Client Session Summary:
Here's the summary of this client session. Remember, Quill does not record the client session. A therapist would provide a summary (like the one below) after the session is over, and then Quill would generate a note similar to the one above.
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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