What Therapists Write in Notes: Privacy, Mandated Reporting, and the Minimum Necessary
In times like these, when trust in systems feels shaky and privacy feels fragile, it’s natural to wonder: what exactly does my therapist write down about me?
Therapy is a place to speak freely. My documentation is designed to meet professional standards while also protecting your privacy. Here’s how I approach it.
Progress Notes: What They Are
Progress notes are brief, clinical notes that reflect medical necessity. This meaning they connect symptoms you’re experiencing to their impact on your daily life, work, or relationships. These notes are part of your medical record, but they’re not a transcript of our conversations.
Most progress notes exist to meet insurance requirements, which focus on showing medical necessity.
Mandated Reporting: What It Actually Covers
In New York, there are only a few situations where I am legally required to make a report, and those reports go only to the appropriate protective agencies — such as Child Protective Services, Adult Protective Services, the county Director of Community Services under the SAFE Act, or 911 in acute emergencies. Immigration status is never documented, and ICE is not a reporting outlet.
It’s also important to know that reporting is not always the proper first step. Whenever possible, I pursue other approaches first — such as safety planning, crisis supports, or working with you to create protective measures before making a mandated report. Reporting is reserved for situations where there is no other way to address imminent risk.
The mandated categories in New York are:
Child abuse or neglect
Elder abuse
Abuse or neglect of vulnerable adults
Imminent danger to self (actively planning to end your life right now, not just experiencing suicidal thoughts)
Imminent danger to others (when, in my professional judgment, someone is likely to engage in conduct that would result in serious harm, which may require a report under the SAFE Act)
That’s it.
What’s not reportable? Attending a protest. Talking about your political beliefs. Processing fear, grief, or anger about current events. Those, and any other, conversations remain private.
*Disclaimer: Mandated reporting laws vary by state. New York is my home state, so I use it here for ease of writing. I am also licensed to practice in other states, and I’m happy to discuss how these requirements may differ during a consultation or intake session if you have questions.
How Sensitive Topics Are Documented (Or Not)
If you share about political stress, protest activity, or other sensitive issues, they may show up in my notes only in very broad terms such as:
“Client processing current climate”
“Client discussing stressors related to world events”
That’s as specific as it gets.
A few things I will never document:
Political beliefs or affiliations
Immigration status
Medical procedures (including abortion)
Do Therapists Write Down Everything You Say?
I practice a “minimum necessary” approach, which is the professional standard for documentation. That means I don’t record the full story you share, only what’s required to reflect your mental health symptoms and their impact.
For example, if you’re experiencing family conflict tied to political beliefs, I would document it like this:
“Experiencing distress around familial relationships and ruptures that are causing significant distress and mental health symptoms related to depression such as feelings of hopelessness and isolation.”
That’s the extent of what I would write. No specifics about the politics, no details about who said what. Just the symptoms and their impact.
This approach is rooted in my graduate training, where I learned to document the minimum in order to safeguard clients if records are ever subpoenaed. Life holds many unknowns, and sparse, symptom-focused notes are one way of protecting your privacy.
Closing
My priority is always to protect your privacy and dignity while meeting professional standards. Therapy is not about surveillance, it’s about care, reflection, and growth.