Psychotherapy notes vs progress notes
Short answer: Psychotherapy notes are a clinician's separate notes that analyze what was said in a session. HIPAA gives them extra protection: they fall outside the client's right of access and most disclosures need specific authorization. Progress notes sit in the regular record, cover the date, interventions, risk and plan, and can be shared for treatment and payment.
Under HIPAA, psychotherapy notes are a narrow category with extra protection. Most therapists keep progress notes in the regular record and a small set of separate process notes. Pair this with the HIPAA checklist for therapists and the guide on texting clients: HIPAA rules and consent.
What are psychotherapy notes?
Definition: HIPAA defines psychotherapy notes as notes a mental health professional records or keeps separate from the rest of the record that document or analyze the contents of a counseling session.
They only qualify if they are kept apart from the medical record. Notes mixed into the EHR chart are not psychotherapy notes under HIPAA, even if they feel private.
What do psychotherapy notes not include?
These belong in the regular record, not in psychotherapy notes:
- Medication prescribing and monitoring
- Session start and stop times
- Modalities and frequencies of treatment
- Results of clinical tests
- Summaries of diagnosis, functional status, treatment plan, symptoms, prognosis and progress
What are progress notes?
Definition: Progress notes document the session in the client's record: the date, interventions, client response, risk assessment and plan. Payers and other providers may need to see them.
How do access and disclosure differ?
| Area | Psychotherapy notes | Progress notes |
|---|---|---|
| Where kept | Separate from the record | In the record |
| Client access | Not included in the right of access | Generally included |
| Disclosure | Usually requires specific authorization | Can be disclosed for treatment, payment and operations as HIPAA permits |
| Payers | Cannot require them as a condition of payment | May request |
What should you do in practice?
- Keep psychotherapy notes physically or electronically separate.
- Do not put information you need for care or billing in them.
- Document your policy about when you keep them.
- If you do not keep them, you do not need to address them.
Frequently asked questions
Do I have to keep psychotherapy notes?
No. Many clinicians do not.
Can clients see progress notes?
Generally yes, with limited exceptions.
Can a payer demand psychotherapy notes?
HIPAA says a health plan may not condition payment on providing psychotherapy notes.
How Sealed helps
Sealed gives therapists a HIPAA program built for behavioral health, including note and disclosure policies. Start your risk analysis.
Sources and check date
Checked October 11, 2026.
- 45 CFR 164.501 (opens in a new tab) (definition of psychotherapy notes)
- 45 CFR 164.508 (opens in a new tab) and 164.524 (opens in a new tab) (authorization and individual access)
- HHS OCR guidance on mental health information, including psychotherapy notes (opens in a new tab)
This is general information, not legal advice.