The terms "psychotherapy note" and "progress note" are often used interchangeably by clinicians, students, and even some supervisors — but they refer to legally and clinically distinct document types. Under HIPAA, these two categories are defined separately, with different privacy protections and different rules governing their disclosure.
Understanding the difference matters for how you structure your documentation, how you respond to records requests, and how you handle client rights under HIPAA. This article explains both document types clearly, outlines the key differences, and offers practical guidance for therapists navigating these distinctions in everyday practice.
A progress note — also called a clinical note or session note — is a clinical document written after each therapy session. It is part of the client's official medical record. Progress notes document session content at a clinical summary level: what the client reported about their current status and concerns, how they presented during the session, what interventions the therapist used, how the client responded, progress toward treatment goals, and what is planned for the next session.
Because progress notes are part of the medical record, they may be shared with other treating providers with appropriate authorization, reviewed by insurance payers as part of utilization review or audit, and disclosed in response to a standard records request — including a client's own request for their records. Therapists write progress notes after every session as a matter of standard clinical and legal practice.
For examples of what progress notes look like across common formats, see Therapy Progress Note Example.
Under HIPAA (specifically 45 CFR § 164.501), a psychotherapy note is defined as notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session. This is a technical, legal definition — not the everyday use of the word "note."
What goes into a psychotherapy note is process-level material that is too detailed or personal for the medical record: the therapist's raw impressions and hypotheses about the client's psychological dynamics, countertransference observations, the therapist's personal clinical reflections, verbatim or near-verbatim session content, and similar material that serves the therapist's own clinical thinking rather than the medical record's documentation function.
Psychotherapy notes must be kept separately from the rest of the medical record. This is not just a best practice — it is a condition of their receiving the heightened HIPAA privacy protections. Notes that are stored together with progress notes in the general medical record are not considered psychotherapy notes for HIPAA purposes.
It is a common misconception that all notes a therapist takes during or about a session are psychotherapy notes. They are not. Progress notes — which document session content at the clinical summary level — are not psychotherapy notes under HIPAA, even though they document therapy.
The following comparison highlights the most clinically and legally significant distinctions between these two document types:
Part of the official medical record
May be shared with other providers and payers with appropriate authorization
Required for insurance billing
Subject to standard records requests
Contains: clinical summary, interventions used, clinical assessment, plan
NOT part of the official medical record — kept separately
Stronger HIPAA privacy protections; standard authorization is not sufficient for disclosure
Not required for billing
Cannot be compelled by a standard records authorization
Contains: process observations, raw impressions, hypotheses, countertransference notes, verbatim content
Under HIPAA, psychotherapy notes receive heightened privacy protections compared to other protected health information. Covered entities generally cannot use or disclose psychotherapy notes without an authorization that specifically identifies those notes — a standard authorization for the release of medical records is not sufficient. Additionally, covered entities are generally not permitted to condition treatment, payment, enrollment, or benefits eligibility on a client providing authorization to disclose their psychotherapy notes.
Progress notes, as part of the general medical record, are subject to the standard HIPAA authorization and records request process. A client who submits a standard records request will receive their progress notes. They will not, under HIPAA, receive psychotherapy notes through that same standard request.
State laws frequently add requirements on top of HIPAA — and some states provide additional protections for mental health records broadly, not just psychotherapy notes in the HIPAA-defined sense. The content above is general educational information, not legal advice. For guidance specific to your state, your practice type, and any situation involving actual records requests or disclosure decisions, consult your state licensing board and qualified legal counsel.
Understanding these distinctions is not just a compliance exercise — it has direct implications for how you set up your documentation systems and how you respond to records-related situations. Key practical steps:
Keep progress notes in the client's official clinical record — they are part of the medical record and subject to standard records requests and payer audits
Keep psychotherapy notes separately from the medical record, in a secure location with stricter access controls than the clinical record
Understand what would be released in a standard records request — progress notes yes, psychotherapy notes no (absent specific authorization)
Know how your EHR handles these document types — not all electronic health records have a separate, protected field for psychotherapy notes
When in doubt about a specific situation, consult your malpractice carrier, state licensing board, or legal counsel — requirements vary by state and practice context
No. Progress notes are required — they are part of the medical record, necessary for billing, and standard clinical practice. Psychotherapy notes are not required. They are optional. Many therapists never keep separate psychotherapy notes at all and practice in full compliance by maintaining thorough, well-written progress notes.
Some clinicians do keep personal clinical notes as part of their reflective process — jotting hypotheses, countertransference reactions, or questions they want to hold between sessions. Whether to do so is a personal and practice-specific decision. If you do keep such notes and want them to receive HIPAA psychotherapy note protections, they must be maintained separately from the medical record and meet the definitional requirements under 45 CFR § 164.501. Speak with your licensing board or legal counsel if you have questions about how to structure that in your specific practice context.
If you use any AI-assisted documentation tool, understand clearly what document type it produces and how it handles that content. Progress notes and psychotherapy notes should not be mixed in the same system or stored interchangeably. Tools like AfterSession are designed to support progress note documentation — SOAP, DAP, BIRP, and similar clinical record formats. AfterSession does not have a psychotherapy notes function; it produces structured clinical progress notes that the therapist reviews and finalizes. As with any documentation tool, the therapist remains responsible for the content, accuracy, and appropriate handling of all records.
Yes, psychotherapy notes have heightened privacy protections under HIPAA compared to other protected health information. Under 45 CFR § 164.501 and related regulations, psychotherapy notes are defined as a separate document category, and covered entities generally cannot disclose them based on a standard authorization form alone. The specific requirements for authorizing disclosure of psychotherapy notes are more stringent than for other medical records. State laws may add additional protections on top of HIPAA — check your state licensing board guidance for specifics in your jurisdiction.
Under HIPAA, clients generally do not have the right to access their psychotherapy notes through the standard right of access that applies to the rest of their medical record. A covered entity is permitted (but not required) to deny access to psychotherapy notes. This is one of the key distinctions between psychotherapy notes and progress notes — clients can typically request and receive progress notes as part of their medical record, but psychotherapy notes have additional protections. State law may modify these rules, so check your state's regulations and consult your licensing board if you have questions about a specific situation.
Not all EHRs do. Some EHR systems have a dedicated, separately secured field for psychotherapy notes; others treat all session documentation as a single record type. If you intend to keep psychotherapy notes, it is important to understand how your EHR handles this distinction. Notes that are stored alongside progress notes in the main medical record may not receive the additional privacy protections that HIPAA reserves for properly maintained psychotherapy notes. Review your EHR documentation or contact your vendor if you are unsure.
A progress note (clinical note) contains a clinical summary of the session: what the client reported, how they presented, what interventions the therapist used, the client's response, progress toward treatment goals, and the plan. It is written at a summary level — not verbatim content. A psychotherapy note, by contrast, contains the therapist's personal process observations — raw impressions, hypotheses about the client's dynamics, countertransference reactions, verbatim exchanges, or other material the therapist records for their own clinical reflection. This is material that would not typically appear in the official medical record. Not all therapists keep separate psychotherapy notes; they are optional, not required.
The key distinction is straightforward once you know it: progress notes are part of the medical record, subject to standard privacy rules and disclosure processes. Psychotherapy notes are a separate legal category under HIPAA — kept apart from the medical record, with stronger privacy protections, and not required for clinical practice or billing.
Every therapist should know which document type they are working with at any given moment. Progress notes — the clinical summaries you write after each session — are where the vast majority of routine documentation work happens. Understanding their legal status, what they may contain, and how they differ from psychotherapy notes is foundational knowledge for any licensed clinician in private or group practice.
A realistic therapy progress note example with a reusable template, format comparisons (SOAP, DAP, BIRP), common documentation mistakes, and tips for writing session notes faster.
A realistic SOAP note example from a therapy session, with a reusable template, common documentation mistakes to avoid, and tips for writing notes faster.
A realistic DAP note example from a therapy session, with a reusable template, common documentation mistakes to avoid, and tips for writing notes faster.
Describe your session in your own words. AfterSession generates a structured SOAP, DAP, or BIRP progress note that you review and save. No recordings, no verbatim content.
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