Help! My Client Requested a Copy of Their Therapy Records (and Progress Notes!)

 Welcome to the first installment in my series designed to help therapists navigate challenging documentation situations. Today, I'm tackling one of the most common concerns I hear from therapists: what to do when a client requests a copy of their therapy records, including progress notes.

Let's face it—when a client asks for their records, your stomach might do a little flip. That's completely normal! As a mental health professional, receiving a records request can feel intimidating, but I'm here to assure you that this is a routine part of practice. While my video on this topic covers the common issues that arise, this article will go more in depth on the legal requirements, professional considerations, and exactly what steps to take when handling these requests. I've got your back!

Understanding Client Requests and Rights

Why Clients Request Therapy Records

There are several reasons a client might request a copy of their therapy records or progress notes:

• Court Cases: They may need information for legal proceedings or to share with legal counsel

• Third-Party Sharing: They might want to provide information to entities such as workman's comp, an employer, or insurance companies

• Care Coordination: They might want to share records with another licensed health care professional

• Progress Review: Sometimes, clients simply want to review their progress notes to track their therapeutic journey

• Personal Records: Some clients want a copy for their own personal health records

• Disagreements: In some cases, a client might request therapy records as part of a dispute with you

That last scenario? Yeah, it's definitely the most scary. When a client is upset with you and requesting therapy notes, it can trigger all sorts of anxieties about what they might find or how information could be misinterpreted. But don't worry—I'll walk you through exactly how to handle even this nerve-wracking situation.

Note: While clients may want records to share with third parties, such as insurance companies, this article and my video primarily focus on direct requests from clients for their own records.

Requests coming directly from third parties involve different procedures and considerations that I'll cover in future content. Understanding these motivations can help you approach the request with appropriate context and compassion.

Legal Framework for Client Access

Under the Health Insurance Portability and Accountability Act (HIPAA), and under almost every state law, individuals have a fundamental right to access their mental health records. This includes therapy records maintained by covered entities like therapists and other mental health professionals.

The HIPAA Privacy Rule establishes that:

• Clients have a right to inspect and obtain a copy of their protected health information in a designated record set.

• This right to access applies to all records, including both electronic health records and paper records.

• Progress notes, clinical notes, and other documentation in the client's medical record must be provided.

• Fees for copies may include only the cost of labor, supplies, and postage (and this is typically outlined in your state's law).

• Covered entities must respond to requests within 30 days (state laws often require faster response times).

The Psychotherapy Notes Exception

HIPAA makes an important distinction between regular progress notes and psychotherapy notes:

• Psychotherapy notes (sometimes called process notes or personal notes) are defined as notes recorded by a mental health professional documenting or analyzing the contents of conversation during private counseling sessions.

• These notes must be kept separate from the rest of the medical record.

• Psychotherapy notes are specifically exempt from the right of access that applies to other health records, but this exemption is part of HIPAA and may not be part of your state's law.

• To qualify as psychotherapy notes under HIPAA, they must be:

  • Kept separate from the client's medical record

  • Used solely by the therapist who created them

  • Not required for treatment, payment, or healthcare operations

It's crucial to understand that many therapists don't maintain separate psychotherapy notes as strictly defined by HIPAA. If your notes are part of the client's medical record, they are likely considered progress notes, not psychotherapy notes, regardless of what you call them.

Most importantly - your state law may override HIPAA in this way, providing access to all records, including psychotherapy notes. More on that below!

Legal Requirements

What you're legally required to do in this situation varies based on your state, but in general:

• You must provide access to all mental health records that don't qualify as psychotherapy notes (and in many states, even to psychotherapy notes).

• If the request is for copies, you must provide them in the electronic or paper form requested by the client, if readily producible in that form.

• You must respond within 30 days of receiving the request (some states require faster response).

• You can only charge reasonable, cost-based fees for copies (no, you can't charge $500 to make it go away!).

• You must confirm the identity of the person requesting access, and

• If a covered entity denies access to any part of the record, you must provide a written explanation of why access is being denied, and provide the opportunity for another licensed mental healthcare provider to review the records and reason for denial.

Here's the bottom line: Unless you can prove that giving your client access to their records would cause significant harm (usually to the point of endangering their physical safety), you have to provide the records. You can almost never say "No."

Professional Responsibilities

Beyond the legal requirements, you also have professional responsibilities. Approach the situation with clinical sensitivity, recognizing that reviewing records can be emotionally significant for clients, and they are often requesting access to records because of stressful situations (e.g. a court case).

Be prepared to discuss the content of therapy notes with the client, and explain clinical terminology that might be confusing or misinterpreted. If you are nervous about this process, seek consultation. You do not want your own anxiety about releasing records to have a negative impact on your client.

Review the client's file ahead of time and make sure the mental health records are accurate, complete, and up-to-date. Clearly document all requests for records and your responses.

When a client requests their mental health records, here's your step-by-step game plan:

	Take a deep breath Then take another. You've got this. These things happen, this is a normal process, and your licensing board knows it.
	Acknowledge Receipt Let the client know you've received their request and outline what happens next. Be kind and professional, even if you're nervous. If you are unsure about something, it's okay to say, "Let me look into that and get back to you with an update tomorrow."
	Clarify the Request Figure out exactly which records they want and in what format. Ask what they are seeking to achieve by accessing their mental health records, and present alternate options, if that applies. Sometimes clients don't actually want everything, but they're not sure what they need.
	Prepare Recoreds Review and compile the requested records, potentially excluding any legitimate psychotherapy notes. (More on those in a bit!)
	Determine Fees Calculate any applicable fees (limited to only the cost of copying and delivering—be reasonable here).
	Provide Access Deliver the records within the required timeframe (30 days under HIPAA, likely shorter under the client's state law).

Don't forget to seek support if you need it! Consider consulting with your liability insurance, professional association, or a trusted colleague for guidance. I also offer consultation sessions where we review the therapist's notes and any concerns about releasing records.

Handling Psychotherapy Notes

What Qualifies as Psychotherapy Notes?

Under HIPAA, psychotherapy notes (commonly called "process notes") are narrowly defined as:

"Notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of 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."

Importantly, psychotherapy notes DO NOT include information related to:

• Medication prescription and monitoring

• Counseling session start and stop times

• Modalities and frequencies of treatment

• Results of clinical tests

• Diagnosis, functional status, treatment plan, symptoms, prognosis, and progress notes

For your notes to qualify as protected psychotherapy notes, you must write them separately from the regular medical record and not share them in the ordinary course of business.

Can clients access psychotherapy notes?

This is where HIPAA and state laws sometimes differ. When HIPAA and state laws differ on this issue, the default is to defer to state law.

So yes, in many states, client can access psychotherapy notes, because these are still considered part of the client's treatment record.

You can deny clients access to psychotherapy notes when:

• You keep them entirely separate from the rest of your client's records.

• They contain your personal observations, impressions, and analyses that aren't necessary for treatment.

• Releasing them could cause psychological or emotional harm or present unacceptable security risks to the client or others.

• Your state does not have a law about restricting client access to psychotherapy notes.

Remember, if your notes don't meet the strict definition of psychotherapy notes under HIPAA, you likely cannot deny access to them, even if you label them as "process notes" or "psychotherapy notes."

Consider whether maintaining separate psychotherapy notes is necessary for your practice. Since all information necessary for treatment needs to be in progress notes anyway, separate psychotherapy notes might actually be more of a burden than useful.

Managing Client Concerns and Upset

Let's talk about the scenario that keeps many therapists up at night—when you get a mental health record request because they're upset with you. Here's how to handle it:

1. Stay Calm: I know it's hard, but approach the situation professionally and avoid defensiveness. Your anxiety might be screaming, but your response needs to be measured. If necessary, let the client know you have received their request, then take a day or two to consult and calm down.

2. Listen Intently: If appopriate, ask the client about their concerns and what they hope to achieve by reading their records. Sometimes they just want to be heard. It's okay to acknowledge the client's emotions without necessarily agreeing with their assessment.

3. Explain Professionally: Discuss any paramaters around access to documentation and be clear about timelines. Identify when and how you will follow up.

4. Offer Collaborative Review: In some cases, it may be useful to review the records with the client. Clarify clinical terminology without being condescending, and explain any circumstances in which you may have written therapy notes in a certain way. For example, it is common to identify "impairments" in order to meed medical necessity criteria for insurance companies.

Here's something that may feel extreme: Offer to review records with clients before they submit the request.

Regardless of the circumstances, and often through no fault of the therapist, clients can become unhappy with treatment. In these circumstances, it is rare that a therapist is shocked by receiving a records request from a disgruntled client.

You may be able to circumvent such a scenario by offering access to your client at the beginning of a conflict, as a way to, quite literally, make sure you are on the same page. Use your professional judgment and remember that sometimes, clients are searching for anything to validate their feelings and it genuinely has nothing to do with you or your documentation. Try not to take it personally.

Addressing Record Content Concerns

If a client expresses concerns about specific content in their therapy records:

• Review for Errors: Check for any factual inaccuracies that should be corrected.

• Add Context: Consider adding an addendum that provides additional context without altering original notes.

• Clarify Terminology: Explain clinical terms or professional shorthand that may be misinterpreted.

• Document Disagreements: If you and the client disagree about something in the record, document both perspectives.

• Maintain Boundaries: Recognize the difference between correcting errors and changing professional assessments.

Handling Potential Complaints

In some cases, an upset client might file a complaint with your licensing board or with the Office for Civil Rights. If this happens:

• Don't panic! I mean it. Regulatory bodies know these aren't always legitimate complaints. They investigate everything, but they understand the nature of these situations.

• Your board will ask for your records and do their own review to determine if there's any merit to the complaint.

• They'll likely interview you and the client separately, and prepare a report.

• This process can take a long time and yes, it's stressful. But you will have the support of your liability insurance attorney.

• Focus on demonstrating that you followed proper procedures and professional standards.

• Remember you're not alone! Reach out to close colleagues for emotional support (without violating confidentiality, of course).

I've seen many therapists weather this storm successfully. Your documentation is your best defense, which is one reason I'm so passionate about helping therapists maintain excellent records from the start.

The Release of Information Process

Once the client requested their therapy records, and you've reviewed the above professional and legal protocols, here's how to actually deliver protected health information in a secure way that protects confidentiality:

• In-Person Pickup: Have the client come in and sign for the records

• Secure Electronic Delivery: Use a HIPAA-compliant secure web portal or encrypted email

• Certified Mail: For paper records, consider certified mail with return receipt

• Secure File Transfer: For electronic records, use encrypted file transfer protocols

Third-Party Requests for Therapy Notes

If a client wants records released to a third party, such as another healthcare provider, or an attorney:

• Discuss with them the purpose of the request, and other potential options, such as a treatment summary.

• Require a signed Authorization to Release Information specifying exactly what records can be released and to whom.

• Ensure the authorization includes the name of the recipient, an expiration date, and the purpose for obtaining access.

• Inform the client of their right to revoke the authorization at any time.

• Only release the specific information authorized by the client.

Client Requests for Records and Special Situations

In certain clinical situations, records requests become a bit more complicated. The key to handling these situations well is to focus on informed consent, both at intake and throughout treatment.

• For Couples/Family Therapy: Be very clear about who is the client, how you handle documentation, and who can access joint and/or individual records.

• Minors: Be aware of state laws regarding when minors have access to records, when minors have the ability to deny access to records, and the level of access for parents/guardians. Seek legal documentation regarding custody, but always assume both parents have access when documenting discussions.

• Legal Proceedings: When clients are in the middle of legal proceedings, there is more likelihood they will request access to records. Review with them their options early on, and assume your documentation may be requested.

Conclusion and Next Steps

When your client requests a copy of their therapy records, it doesn't have to be a heart-stopping moment of panic. With the right preparation and understanding of the legal requirements, you can handle these requests professionally and confidently.

Remember these key points:

• Most therapy records must be provided to clients upon request—it's their legal right to access their protected health information.

• True psychotherapy notes (commonly called process notes) may be protected from disclosure via HIPAA, but many states override this exemption.

• Clear documentation practices from the beginning, including a clear review of informed consent, make handling record requests so much easier.

• Proper security procedures, such as using a client portal and having clients sign a Release of Information, protect both you and your clients.

• Use your professional judgment and when in doubt, reach out for professional consultation. Your liability insurance company likely offers free consultation with an attorney.

I always remind therapists that transparency can actually strengthen the therapeutic relationship. By approaching record requests as an opportunity to practice openness rather than as a threat, you can transform what feels scary into something that builds trust.

Remember, you're not alone in this.

Reach out to close colleagues, your liability insurance, and seek consultation. I offer individual consultation sessions if you want someone to review your progress notes and talk through potential challenges. Click here to book a consultation any time. 

This series will continue to address common documentation challenges therapists face. Subscribe to the YouTube channel and get regular updates.