Session notes are clear. But what happens between sessions?
A client texts that something went wrong. Ten minutes after a session ends, you realize the question you forgot to ask. A colleague passes along information that shifts the clinical picture. You’re left with a heavy feeling after a difficult session — something you want to bring to supervision before it fades.
All of this is between-session material. Most therapists document none of it. It simply disappears.
This guide covers what to document between sessions, how to structure it, where it lives in the client record, and how this material makes your actual clinical work better.
Why between-session notes matter
Clinical continuity. Memory is unreliable. A thought that came to you after a session and wasn’t written down is gone by the following week — along with whatever clinical value it carried. A client contact that wasn’t documented is a clinical event that, effectively, didn’t happen.
Risk management. If a client texts about a crisis and you respond — but don’t document it — you have no record of your clinical decision-making. If the situation escalates later, or if there’s ever a complaint, the absence of documentation is its own problem.
Informed sessions. Reviewing between-session notes before an appointment takes two minutes. It means you walk in knowing what happened since you last met, what the client reached out about, and what threads to pick up — rather than relying on your recall of a session from a week ago.
Two types of between-session notes
These are different enough that they should be kept separately in the client record.
Type 1: Your own clinical notes
Your personal observations, thoughts, hypotheses — what comes up after a session or in the days between appointments. This is part of your clinical thinking, not official client documentation in the strict sense.
Type 2: Documentation of client contact
Any actual contact with the client between sessions: a text, a call, an email, a crisis outreach. This is part of the official client record — the same as a session note.
Each type has its own logic for when and how to write it.
Type 1: Your own clinical notes
Delayed insight after a session
It happens to every therapist: you’re driving home and realize — “what he said about his brother, and what came up last month about his father — it’s the same pattern.” Or you notice a countertransference reaction you weren’t aware of during the session.
This is clinically valuable — if you capture it. If not, it’s gone before the next appointment.
Example note:
After session with A.: when she says “I’m fine” — I’m now noticing that’s consistently a marker that something important is being kept outside the session. Track this phrase next time. Possibly a way of closing topics that feel unsafe.
Preparation for the next session
While the session is still fresh, this is the right time to capture what you want to bring back to the client next time. Not just the formal homework you assigned — your own questions, hypotheses, directions you want to explore.
Example note:
Before next session with K.: ask about the conversation with his mother — he mentioned it in passing and we didn’t have time to follow it. Intuition: something important there around shame.
Countertransference and your own reactions
Especially important in trauma work, high-acuity cases, or clients who touch something personal. One or two sentences about what you’re carrying after a session — this is material for self-reflection and supervision.
Example note:
After session with V. — sense of heaviness and helplessness. Possible secondary traumatic stress response. Bring to supervision: how not to carry his hopelessness home.
Clinical hypotheses
Understanding sometimes arrives not during a session but at 2am or a few days later. If you don’t write it down, it’s gone.
Example note:
Thinking about P.: his need to “control” everything in every story — possibly the only way he’s ever known to keep anxiety manageable, going back to childhood. Test this hypothesis next session.
Where and how to keep your own notes
These live in the client record, but in a separate section — “Between-session observations” or “Notes for next session.” They don’t go into the official session note, but they’re linked to the specific client.
Practical format: date + two or three sentences. Not an essay — just enough to capture the idea.
05/23/2026
After session with A. — she never says "I want."
Always "it would be nice," "I probably should," "maybe I could try."
This isn't accidental. Next session: track her language around choice and agency.Type 2: Documenting client contact between sessions
This is the part of between-session documentation most therapists handle worst — or skip entirely.
Client sends a text or message
A client texts between sessions. What do you document?
Minimum:
- Date and time of the message
- Brief content summary (verbatim only necessary for crisis or high-risk content)
- Your response or clinical decision
- Whether there’s anything to bring back to the next session
Example note:
05/21/2026, 10:22 PM. Client texted: “Had a really hard conversation with my parents tonight. Almost lost it.” Responded: validated, asked about distress level (7/10), agreed to process in detail at session 05/23. No suicidal ideation — checked directly in the exchange.
Why this matters: if the client doesn’t bring it up at the next session — and clients often don’t — you’ve lost a clinically significant event. And if anything goes wrong later, you have a record of what happened and what you did.
Client calls
A call gets documented the same way as a session — just shorter.
What to capture:
- Date, time, duration
- Reason for the call
- What was discussed
- Your clinical decision
- Risk assessment if relevant
Example note:
05/19/2026, 11:30 AM, ~8 minutes. Client called: panic after watching the news, “can’t stop the thoughts.” Did brief phone grounding (4-7-8 breathing). Distress reduced by end of call. Agreed: if it happens again, call rather than sit with it alone. No suicidal ideation. Bring up the topic of news triggers at 05/22 session.
Crisis contact
If a client reaches out in acute crisis, documentation needs to be thorough.
What to document for a crisis contact:
- Exact start and end time
- How the client made contact
- The client’s specific words about suicidal thoughts, verbatim or as close as possible
- Your risk assessment: plan, intent, means access
- What you did: what you said, what resources you provided, what you agreed to
- Client’s state at the end of the contact
- Your plan: next contact timing, adjusted session frequency if needed
Example crisis contact note:
05/17/2026, 11:40 PM – 12:10 AM. Client texted: “I can’t do this anymore. What’s the point.” Responded immediately, moved to phone call (11:45 PM). Client said: “I keep thinking it would be easier if I wasn’t here” — passive SI, no plan, no intent. Means access: has medications at home. Agreed: client will give medications to a neighbor tonight. I’m reachable until morning. By end of call (12:10 AM) distress had decreased; client agreed to call if anything changed. Next session moved up to tomorrow at noon. Risk: moderate, contained. Monitoring.
In a week, you won’t remember these details. In a year, you definitely won’t.
Information from third parties
If a family member, another provider, a school, or a physician contacts you — this also gets documented.
What to capture:
- Who contacted you, when, by what method
- Whether you have written client authorization to receive third-party information
- Brief content summary
- Your decision: whether you’ll bring this up with the client
Example note:
05/20/2026. Client’s mother called (client is 14). Said her daughter “hasn’t been eating for a week” and has become withdrawn. Consent for parental contact is on file (signed 03/03/2026). Thanked her, did not confirm or deny any session content. At next session 05/22 — address this directly with the client. Clinical concern: possible somatic anxiety response or early restrictive behavior.
When to write between-session notes
Immediately — if:
- A client reached out in crisis
- Something clinically significant happened between sessions
- You made a clinical decision based on a between-session contact
Same day — if:
- A client sent a non-urgent message
- You received information from a third party
Within 24 hours — if:
- You had a clinical thought or hypothesis after a session
- You want to capture a countertransference reaction for supervision
No later than the day before the next session:
- Check that all between-session contacts are documented
- Add “for next session” notes if you hadn’t had time earlier
Why messaging apps are not clinical documentation
Text messages, WhatsApp, and standard SMS are not HIPAA-compliant. They’re not linked to the client’s record, not searchable alongside session notes, and not guaranteed to persist — messages get deleted, phones get lost, accounts get suspended.
The standard practice: document the fact and content of the contact in your clinical records. The original messages can remain as a reference, but they are not the documentation.
What must exist in the clinical record:
- Date and time
- Brief content of the contact
- Your response and clinical decision
- Risk assessment, if applicable
Between-session documentation checklist
After every session:
- Any delayed insight worth capturing?
- Questions or hypotheses to bring back next time?
- Countertransference reaction worth noting for supervision?
For any client contact between sessions:
- Date and time documented
- Brief content documented
- Risk assessment — if it came up
- Decisions and agreements documented
- What to revisit at next session
Before every session:
- Reviewed all between-session notes since last appointment
- Between-session contacts factored into session plan
Common mistakes
“Client texted, I responded, I moved on.” An undocumented between-session contact is a clinical event that effectively didn’t happen. In a month, you won’t remember what was said or what you decided.
Incomplete documentation of crisis contacts. “Client reached out, doing okay” is not documentation of a crisis contact. You need specifics: what the client said, what you assessed, what you did.
Treating messenger apps as clinical records. They aren’t. The contact and its clinical content need to live in your practice documentation — not only in a chat thread.
Not capturing delayed insight. A thought that came after a session and wasn’t written down is a lost thought. Sometimes it’s the one that would have unlocked the next session.
Mixing personal notes with official documentation. Your hypotheses and countertransference are your clinical tools — not part of the formal record. They belong in the client record, but in a separate section.
TheraMemory keeps the full client timeline in one place — session notes, between-session contacts, and your own observations. Before the next appointment, open the record: everything that happened since the last session is already there.
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