Can Patients Access Their Psychotherapy Notes?
Differences in access to clinical records versus psychotherapy notes
Posted May 6, 2026 | Reviewed by Davia Sills
When patients receive services from mental health professionals (MHPs), they have a right to informed consent (Barsky, 2023). Informed consent includes the right to understand what kinds of records their MHPs keep, and whether they have the right to access their progress notes, psychosocial assessments, or other documentation provided by their MHPs. Professional ethics for MHPs all recognize the importance of informed consent, privacy, and access to information about services provided ( ACA, 2014 ; APA, 2017 ; NASW, 2021 ).
Under the federal Health Insurance Portability and Accountability Act ( HIPAA ), patients generally have a right to see their “protected health information,” which includes clinical records maintained by MHPs (U.S. Department of Health and Human Services, 2024). Under this same law, however, there is an exclusion for “ psychotherapy notes.” The purpose of this article is to distinguish between clinical records (which patients have a right to access) and psychotherapy notes (which HIPAA excludes from the access rule). The distinction can be confusing, particularly for people who are not familiar with the different types of records that mental health professionals may keep. State laws may also offer patients the right to access their records; however, state laws cannot override federal laws, such as the exception for psychotherapy notes (Barsky, 2024).
What Are Psychotherapy Notes?
Under HIPAA , “Psychotherapy notes means 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 or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record.” For MHPs to maintain control over access to their psychotherapy notes, these notes must be kept separately from the patients’ other clinical records (e.g., in separate paper folders or separate electronic files). If an MHP combines these notes, then patients have a right to access all the notes in the combined clinical file.
While psychotherapy notes are excluded from patient access rules, patients are entitled to access their clinical records, such as information about their diagnosis, risk assessments, functional status, treatment plans, symptoms, prognosis, and progress to date.
Why Would MHPs Keep Psychotherapy Notes?
MHPs maintain clinical records for many reasons, including treatment coordination, continuity of care, billing, insurance review, legal compliance, or general clinical documentation. Psychotherapy notes serve different purposes. They are generally kept for an MPS’s own professional use. Psychotherapy notes are not intended to be shared with the patient, health insurance companies, or others. Rather, MHPs keep psychotherapy notes to support their clinical thinking, reflections, and decision-making .
Psychotherapy notes may include MHPs’ theories or hypotheses about what the patient is experiencing. They may include MHPs’ reflections on what they have observed or what patients have shared with them. For instance, an MHP might note how a patient’s current concerns may reflect early childhood trauma , or how the MHP may need to further explore a patient’s reluctance to share certain types of personal information.
Keeping psychotherapy notes separate can help MHPs protect patient privacy. Some clinical reflections may be sensitive or deeply personal information. Since such information is not needed for billing, treatment planning, care coordination, program evaluation, or administrative review, MHPs can limit the ability of third parties to access these notes.
MHPs may also want to guard against certain notes being shared with patients themselves because they contain tentative impressions and assessments. MHPs might use notes to ponder whether a patient is minimizing substance abuse problems or avoiding a painful topic. While such impressions may be clinically important for MHPs to note for themselves, they may not be appropriate to share with the patient unless and until doing so would serve the patient’s treatment goals and interests.
What Records Can Patients Request?
Patients are free to request any and all records, including psychotherapy notes. Patients should understand, however, that while MHPs have discretion to share psychotherapy notes, they are generally not legally required to share them. Ideally, when patients request records from MHPs, it is often helpful to discuss why the patient wants the records, as well as any risks or concerns related to sharing the records.
In managing specific requests for psychotherapy notes, MHPs might explain how they are using psychotherapy notes, as well as how the accessible clinical records may have the types of information that the patient is seeking (e.g., diagnosis, treatment goals, recommendations). Most often, when patients request records, they are seeking information from their MHP’s clinical records, not from their psychotherapy notes.
Rather than asking an MHP for their psychotherapy notes, a patient might ask questions that relate to particular concerns. For instance:
Frank discussions about the MHP’s thoughts and clinical impressions may be much more valuable to patients than simply reviewing an MHP’s psychotherapy notes.
While patients generally have a right to access their clinical records, MHPs may keep a separate set of psychotherapy notes that they do not intend to share with their patients. For MHPs, it is important to explain recordkeeping practices clearly at the outset of treatment, maintain appropriate separation between clinical records and psychotherapy notes, and use documentation practices that support both patient privacy and effective care.
For patients who wish to review their records, it is helpful to clarify what information they are seeking and to discuss their questions openly with their MHPs. Most concerns about accessing records can be determined through friendly discussions between MHPs and their patients (Barsky, 2017).
American Counseling Association [ACA]. (2014). Code of ethics. https://www.counseling.org/docs/default-source/default-document-library/ethics/2014-aca-code-of-ethics.pdf?sfvrsn=55ab73d0_1
American Psychological Association [APA]. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code
Barsky, A. E. (2024). Clinicians in court: A guide to subpoenas, depositions, testifying, and everything else you need to know . Guilford Press .
Barsky, A. E. (2023). Essential ethics for social work practice . Oxford University Press .
Barsky, A. E. (2017). Conflict resolution for the helping professions. Oxford University Press .
National Association of Social Workers [NASW]. (2021). Code of ethics. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
U.S. Department of Health and Human Services. (2024). Health Insurance Portability and Accountability Act of 1996 privacy rule: 45 C.F.R. §§ 160 and 164 . Electronic Code of Federal Regulations. https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164
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Allan E. Barsky is a professor with the Phyllis and Harvey Sandler School of Social Work at Florida Atlantic University (FAU) in Boca Raton, FL, USA. The views expressed in Dr. Barsky’s blogs do not necessarily reflect the views of any organization to which he belongs.
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