Why doesn't Dr. Crew take notes during sessions?

Yesterday I saw a new patient for the first time. He had been in to see many therapists over the course of his life. He asked me a question that I have been asked numerous times over the past almost 27 years doing therapy. He asked me, "Why don't you take notes during the session?" I thought since this is a common question asked of me by patients and colleagues alike I would address this in the blog.

Like most graduate students I was taught that taking notes during treatment sessions was protocol. I worked at clinics and other treatment centers and did just that. I had a number of patients find it difficult to engage in therapy while I was taking notes about what they were telling me. I found it to be very difficult to really listen to what I was hearing and take notes at the same time. Perhaps it was due to my dyslexia that this was more problematic for me than for for other therapists.

I, like many therapists, have always been involved in my own therapy and have been to a number of clinicians over the years. I always found it annoying and irritating when I am telling a therapist how I feel or describing a situation and they are writing as I speak. I can tell when they are really "half listening" to me as they write down their notes.

I am a student of mindfulness and a true believer that one cannot do an excellent job at more than one thing at a time. (Sorry to you believers in the myth of multi-tasking being effective, at best it's just adequate.) I decided then that I would no longer take notes during a treatment session with a patient. I came to feel that meeting with a therapist is no different than any other relationship between two people. No one takes notes when meeting a person for the first time and refers to them as they meet each subsequent time! Doing therapy, to me, is about the relationship that develops over time between a patient and myself. The relationship often fuels our work together based on our mutual care for each other, respect for each other, mutual trust, and the agreement on what we are desiring and intending to accomplish together. Taking notes during a session inhibits me from truly hearing what someone is telling me; not just with their words, but with their eyes, their body language, and the connection we share together. These important observations cannot be communicated effectively when I am writing. Moreover, I cannot use these same communication skills aforementioned when I am writing.

Sometimes, because I do not take notes during a treatment session, I may not recall exactly what someone had said during a session. Again, I feel this is a natural thing that occurs between two people when they interact. If I forget something or become a bit confused about a particular fact, then so be it. It happens. After a while, I tend to recall almost every detail of what a patient has told me just from being very present and truly listening to what they are communicating to me. I get much more from truly listening rather than to take notes and miss a portion of what they say. I write notes from each session after the patient leaves the office and review them prior to our next session. (Again, I can be fully present as I write the notes as well.)

A therapeutic relationship is an organic and living thing that occurs when one feels understood and cared for by one's therapist. It does not feel organic in any way for me to be writing as someone is sharing often difficult or intimate details or feelings with me. If any of you know me well, you are well aware that if I don't feel natural doing something I will stop doing it. And, I have.