Psychotherapy Notes vs Progress Notes: What Belongs Where (and Why It Matters)

Many clinicians use the phrase “process notes” casually to refer to their own private thoughts about a session. But HIPAA uses a very specific legal term—psychotherapy notes—and it treats them differently from the rest of the clinical record (the progress notes).

Knowing the difference isn’t just academic; it shapes privacy, client access rights, and how you design your documentation system. If you mix them up, you might accidentally release your private musings to an insurance company, or worse, withhold a client's legal medical record when they request it.

This distinction is one of the most powerful privacy tools a therapist has, yet it is often misunderstood.

Who this is for

This guide is for therapists and small group owners who want clean documentation habits and want to avoid accidentally mixing private process notes into the official medical record in ways that create unnecessary exposure.

What you’ll walk away with

You’ll get a plain-English definition of psychotherapy notes versus progress notes, a clear list of what does not count as a psychotherapy note, and a simple "what goes where" workflow to keep your records compliant and secure.

Educational note: This is informational guidance based on HIPAA regulations, not legal advice.

The Two Types of Notes

In the eyes of HIPAA, your notes are split into two buckets. One bucket is the official medical record. The other bucket is your private workspace.

Bucket 1: Progress Notes (The Medical Record)

This is part of the "Designated Record Set." This is what insurance companies, other doctors, and courts (usually) see. It is what the client has a legal right to access.

What goes here: Session start and stop times, modality and frequency of treatment, results of clinical tests, and a summary of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress. It also includes the specific interventions used during the session. Think of this as the "receipt" for the service. It proves the service happened, that it was medically necessary, and that the standard of care was met. It should be factual, objective, and readable by another professional.

Bucket 2: Psychotherapy Notes (The Private Zone)

HIPAA’s Privacy Rule (45 CFR 164.501) defines psychotherapy notes as notes recorded by a mental health professional documenting or analyzing the contents of conversation during a counseling session, that are separated from the rest of the individual’s medical record.

What goes here: Your hypotheses and hunches, impressions of transference/counter-transference, specific details of dreams or fantasies, sensitive information about third parties, and notes for your own supervision. Think of this as your "scratch pad." It is for your eyes only. It allows you to process your own reactions and formulate complex clinical ideas without worrying about how they would look in a court record or insurance audit.

What does NOT count as a psychotherapy note?

This is where therapists get in trouble. You cannot just label everything "Psychotherapy Notes" to hide it. HHS is very clear:

“Psychotherapy notes do not include: medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.”

If it describes the "what, when, and how" of treatment, it is a Progress Note. If it describes the "why and I wonder," it might be a Psychotherapy Note. If you put a diagnosis or a safety plan in your psychotherapy notes, it doesn't count as being in the record—which can be a huge liability.

Why it matters: Privacy and Access

The reason to keep them separate is Access Rights.

Under HIPAA, clients have a right to inspect and obtain a copy of their Protected Health Information (PHI) in their designated record set. However, psychotherapy notes are generally excluded from this right of access.

• Progress Notes: The client (and often their insurer) has a right to see them. This transparency is generally good for treatment.
• Psychotherapy Notes: The client generally does not have a right to see them (unless you choose to share them). Insurers cannot demand them for payment purposes.

This separation protects the therapeutic relationship. It allows you to write honestly about your clinical impressions without worrying that the client will read a raw, unfiltered hypothesis before you have processed it with them. It creates a safe space for the therapist's mind to work.

Storage and workflow: What “Separate” actually means

To qualify as psychotherapy notes, they must be kept separate. If you staple them to the progress note, they lose their special protection.

In the Digital World (EHRs): Most modern EHRs (like Soli, SimplePractice, TherapyNotes) handle this by having a specific field called "Psychotherapy Note" or "Process Note" that is distinct from the "Progress Note." When you print the record for a client request, the system automatically excludes the Psychotherapy Note field. The best practice is to use the dedicated field; do not just write "Psychotherapy Note" at the top of the Progress Note field, as that may not technically separate the data in the database structure.

In the Physical World: If you keep paper notes (which is rare now but happens), progress notes go in the main client file folder. Psychotherapy notes must go in a separate, locked file cabinet or a separate secure envelope to maintain their status. If they are in the same folder, they are considered part of the record.

Common Mistakes

One common mistake is the "Diary Entry" Progress Note, where a therapist writes pages of narrative detail in the Progress Note. This over-shares information with insurers and creates liability. Keep Progress Notes succinct and factual. Another mistake is "Hidden" Medical Info, putting critical safety info (like suicidal ideation or a medication change) only in the Psychotherapy Note. If it is relevant to patient safety or treatment history, it must be in the official Progress Note. Finally, "Lazy Separation"—storing them in the same folder and just hoping no one looks—is risky. If they are not technically separated, a judge or auditor may rule that they are part of the main record.

Practical Next Steps

Start by auditing your current notes. Look at your last 5 notes; did you include raw impressions in the main text? If so, start separating them. Next, check your software. Find the "Psychotherapy Note" field in your EHR and test exporting a record to ensure that field is not included in the PDF. Finally, define your boundary. Decide what you need to write to do good therapy. If you don't need to write down the details of the client's dream, don't write it at all. "Less is more" is a valid documentation strategy.

The bottom line

When you separate what belongs in the clinical record from what belongs in private reflection, you reduce risk, improve clarity, and protect client trust. The Progress Note is for the world; the Psychotherapy Note is for the work.

Sources

• HHS: Definition of Psychotherapy Notes (45 CFR 164.501)
• HHS: HIPAA Privacy Rule and Mental Health Information
• HHS: Individuals’ Right under HIPAA to Access their Health Information