Good practice in the treatment of mental illness | Letters

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Your article (‘It was devastating’: what happens when therapy makes things worse?, 17 July) lists several “red flags” that indicate a therapist is unprofessional, including never taking notes in session. I am a counselling psychologist – a profession regulated by the Health and Care Professions Council and the British Psychological Society. I am also a lecturer on a professional doctorate in counselling psychology and I see clients in private practice. I have previously worked in the NHS and in the education and charity sectors. I would like to clarify that it is not a red flag per se if a therapist does not write notes in session.

Maintaining accurate and up-to-date session notes is central to therapeutic practice, but many therapists, myself included, write notes (as soon as possible) after each session. Indeed, one rationale for therapy sessions typically lasting for 50 minutes rather than an hour is that this enables therapists to write notes on their previous session in the space before their next one. Given that there are more than 400 forms of psychological therapy, it is unsurprising that therapists practise in different ways; there are therapeutic rationales for writing and for not writing notes in session.

I concur with the article in advising people to offer feedback to their therapist if they feel able to, and to raise any concerns they have about their professionalism with the relevant regulatory bodies. So while not taking notes is not necessarily a therapeutic red flag, welcoming and responding constructively to clients’ feedback is certainly a therapeutic green flag.
Dr Helen Damon
London

I read Rebecca Lawrence’s article (Mental illness is a reality – so why does ‘mental health’ get all the attention?, 14 July) with relief, after seeing our daughter Rachael struggle for many years with her mental health. Dr Peter Ord (Letters, 19 July) appears to also agree with Lawrence in the first part of his letter, but then goes on to disagree. I find the terminology around illness totally outdated, leading to stigma and loss of funding for research and treatment for what we term mental health. We are physical beings and our brains are part of that physicality; as Lawrence says, they can “go wrong”, as can any other part of the body. Don’t stigmatise disorders of the brain just because we know so little about them.
Ruth Medhurst (née Newton)
Hinckley, Leicestershire

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