How Long Should a Therapy Progress Note Be?
This might be one of the most common documentation questions I get:
How long does my progress note need to be?
And therapists are always hoping I'm going to give them some magical answer like:
Exactly 347 words. Insurance companies fucking LOVE 347 words.
😂
Unfortunately, that's not how this works.
Your progress note needs to be long enough to document the clinically necessary information.
And not a whole lot longer than that.
Because a longer note is not automatically a more compliant note.
Sometimes it's just...a longer note.
There Is No Prize for the Longest Progress Note
I think a lot of therapists learned documentation in settings where more documentation felt safer.
So we documented EVERYTHING.
The client's entire week.
Every topic discussed.
Every detail of every conflict.
Every intervention.
Every response.
Every thought we had.
And suddenly we're spending 25 minutes writing a note for a 53-minute session.
Absolutely the fuck not.
The goal is not:
How much information can I possibly put into this record?
The goal is:
Have I documented enough clinically relevant information to support the service I provided?
Those are very different questions.
A Short Note Can Still Be a Strong Note
Let's say your progress note says:
Client reports continued anxiety characterized by excessive worry and difficulty concentrating, resulting in impairment in occupational functioning. Therapist utilized cognitive restructuring to support the client in identifying catastrophic thoughts contributing to anxiety. Client successfully identified two cognitive distortions and developed an alternative thought with therapist support. Client demonstrates partial progress toward reducing anxiety-related impairment but continues to experience clinically significant symptoms affecting occupational functioning. Continue weekly psychotherapy focused on increasing independent implementation of CBT skills.
That's not very fucking long.
But look at what we have.
Symptoms.
Functional impairment.
Skilled intervention.
Client response.
Progress.
Continued clinical need.
Plan.
What else are we trying to prove here?
A Long Note Can Still Be a Terrible Note
Now imagine a three-page progress note documenting:
What the client's spouse said.
What the client said back.
What happened at work Tuesday.
What their mom thinks about the situation.
What their friend told them.
What they ate for lunch.
Six paragraphs about their childhood.
And then:
Therapist provided support and validation.
That note is substantially longer.
Is it substantially better?
No.
It's actually giving me significantly less information about the skilled clinical service you provided.
Length does not equal quality.
Stop Measuring Documentation by Word Count
I don't care whether your note is 150 words or 500 words nearly as much as I care whether the clinical information is there.
Ask:
Did I document the client's current clinical presentation?
Did I establish symptoms or functional impairment?
Did I document the skilled intervention I provided?
Did I document how the client responded?
Did I evaluate progress?
Does the record support continued treatment when applicable?
Did I document the plan?
If yes?
Great.
Move the fuck on.
Your Note Should Be Long Enough to Explain Your Clinical Decisions
There are obviously situations where a note needs more detail.
Maybe symptoms significantly worsened.
Maybe you changed the treatment approach.
Maybe there was a safety concern.
Maybe you completed a risk assessment.
Maybe you coordinated care.
Maybe there was an unusual clinical event.
Maybe you're recommending a different level of care.
In those situations, more documentation may be clinically necessary because there is more clinical information to document.
That's different from making every routine progress note unnecessarily long because you're afraid short notes are inherently noncompliant.
Routine Sessions Usually Don't Need Novels
Sometimes the session was incredibly straightforward.
The client continues to experience anxiety.
You worked on cognitive restructuring.
They demonstrated some improvement.
Symptoms and impairment remain.
You're continuing treatment.
That note can be straightforward too.
You don't need to make the documentation more complicated than the therapy was.
If the clinical story can be accurately documented in a concise note, write the concise fucking note.
Stop Documenting Every Topic Discussed
This is probably one of the easiest ways to shorten your notes.
Your client may have discussed:
Work.
Their partner.
Their mom.
Their upcoming vacation.
A conflict with a friend.
A weird interaction at Target.
And something their sister said in 2017.
You do not necessarily need seven paragraphs documenting seven topics.
Maybe clinically:
Client processed multiple current stressors contributing to increased anxiety and difficulty regulating emotions.
Then document what you did clinically.
Your progress note is not the session agenda.
Document More Therapy and Less Story
If your note is long because you're documenting a lot of therapy, that's one thing.
If your note is long because you're documenting a lot of story, that's where I want you to start cutting.
Instead of three paragraphs describing the interpersonal conflict:
Client reports increased emotional distress related to an interpersonal stressor, contributing to rumination and sleep disturbance.
Then give me the clinical work:
Therapist utilized cognitive restructuring to support the client in identifying interpretations contributing to continued distress. Client demonstrated increased insight and developed an alternative interpretation with therapist support.
That tells me substantially more about the service you provided.
And it took four fucking sentences.
Templates Should Make Your Notes Shorter
A good documentation template should reduce the amount of thinking and writing required.
It gives you the structure.
Then you customize the relevant pieces.
Clinical presentation.
Intervention.
Response.
Progress.
Plan.
Done.
A template should not give you 14 giant text boxes that make you feel obligated to write a dissertation in every single one.
If your documentation template is making documentation harder...
I have some fucking questions about the template. 😂
Don't Confuse Concise With Vague
This is important.
I am advocating for concise clinical documentation.
Not:
Client anxious. Did CBT. Client receptive. Continue therapy.
😂
That's short.
It's also not particularly useful.
Compare:
Client reports increased anxiety resulting in difficulty concentrating at work. Therapist utilized cognitive restructuring to address catastrophic thinking contributing to occupational anxiety. Client identified two distorted thoughts and developed alternative interpretations with therapist support. Client continues to demonstrate partial progress but experiences clinically significant anxiety-related occupational impairment. Continue weekly CBT-focused psychotherapy.
Still concise.
But clinically meaningful.
That's what we're going for.
Your Note Length Can Change From Session to Session
Every progress note does not need to be approximately the same length.
Routine session?
Maybe the note is short.
Major clinical change?
Maybe it's longer.
Risk assessment?
Probably longer.
Significant treatment modification?
Maybe longer.
Straightforward follow-up where you're continuing the same clinical work?
Probably shorter.
The amount of documentation should reflect what clinically happened.
Not some arbitrary minimum number of paragraphs you decided insurance wants.
More Documentation Can Mean More Unnecessary Information in the Record
There is another reason I'm not interested in documenting more for the sake of documenting more.
Everything you put in the progress note becomes part of the medical record.
So if the information isn't clinically necessary, why are we permanently documenting it?
Your client's most vulnerable moments do not need to become a five-page narrative because you were worried that a shorter note wouldn't look "clinical enough."
We can demonstrate medical necessity and skilled treatment without documenting every detail of someone's life.
A Better Question Than "How Long Should My Note Be?"
Instead of asking:
How long should my progress note be?
Ask:
Does my progress note tell the clinical story?
Can I understand:
Why the client needed treatment?
What skilled treatment was provided?
How the client responded?
Whether they're progressing?
Why treatment continues, when applicable?
What happens next?
If yes, your note has done its fucking job.
There Is No Gold Star for Documentation Suffering
I need therapists to stop treating spending their entire evening on documentation like it's evidence that they're responsible clinicians.
You can be thorough and efficient.
You can be compliant and concise.
You can protect your client's privacy and support medical necessity.
You can write a clinically strong progress note without spending twenty minutes recounting every single thing that happened during the session.
The goal is not to document the most.
The goal is to document what matters.
And then I desperately want you to close your laptop and go live your fucking life.
Want Me to Just Give You the Progress Note Template?
Naturally. 😂
My Documentation Templates for Compliance include a customizable individual therapy progress note template designed to help you document the clinically relevant pieces of the session without writing a fucking novel every time.
The bundle also includes diagnosis-based treatment plan goals, modality-based objectives and interventions, client strengths, medical justification language, safety documentation, and diagnostic justification.