Good practice in the treatment of mental illness | Letters

A lack of note-taking is not always a red flag in therapy, writes Dr Helen Damon, and Ruth Medhurst says that the terminology around illness is totally outdated

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 I find the terminology around illness totally outdated, leading to stigma and loss of funding for research and treatment for what we term mental health.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

Have an opinion on anything you’ve read in the Guardian today? Please email us your letter and it will be considered for publication.

Letters

The GuardianTramp

Related Content

Article image
Ensuring a good standard of therapy | Letters
Letters: The three leading regulatory bodies for the counselling and psychotherapy profession have created a new competence framework as a response to the mental health crisis

Letters

30, Nov, 2018 @4:08 PM

Article image
Low mood or clinical depression? Taking a critical approach to psychology | Letters
Letters: Readers respond to Lucy Foulkes’ article on what we are getting wrong in the conversation around mental health

Letters

31, Mar, 2021 @3:04 PM

Article image
The Guardian view on mental health: saving lives requires money and monitoring | Editorial
Editorial: Lessons are not being learned from the deaths of hundreds of mental health patients, despite the warnings of coroners

Editorial

06, Mar, 2018 @5:27 PM

Article image
Mentoring and networks are crucial for student mental health | Letters
Letters: It is very important to emphasise the importance of prevention, writes former mentor Constantine Louis. And get rid of freshers’ week, writes Jackie Sherman

Letters

23, Sep, 2019 @5:15 PM

Article image
Understanding depression and developing empathy | Letters
Letters: Dr Annie Hickox advocates for the powerful combination of medication plus talking therapy. And Laurel Farrington highlights how empathy reduces when we are anxious and stressed

Letters

08, Mar, 2021 @5:25 PM

Article image
Myriad challenges of mental illness | Letters
Letters: It is morally wrong to deny mentally ill patients treatment and to resist the efforts of well-meaning research scientists trying to understand the origins of the disease

18, Dec, 2014 @7:35 PM

Article image
Dog-eat-dog culture is bad for students’ mental health | Lettesr
Letters: Former LSE student counsellor Robert Harris on the psychological horrors suffered by millennials, and Dr Max Davie on worrying cuts to student counselling services

Letters

19, Jul, 2018 @5:24 PM

Article image
Hope, resilience and mental health support | Letters
Letters: Mark Winstanley describes the quiet revolution that is transforming care for those with mental illness, while Dr Patrick Roycroft and Dr Sarajane Aris call for more compassion-based psychological help

Letters

13, Apr, 2021 @4:53 PM

Article image
Why we are sceptical of antidepressant analysis | Letters
Letters: Academics dispute the claims made for these drugs in a recent analysis, while one long-term user recounts how they have worked for her and other readers point to the usefulness of meditation and community in fending off depression

Letters

23, Feb, 2018 @4:33 PM

Article image
How can every mind matter in a broken mental health system? | Letters
Letters: Readers respond to the launch of the NHS Every Mind Matters campaign and share their thoughts on other mental health issues

Letters

09, Oct, 2019 @4:29 PM