What should a therapist review before each session?

Before each session, review in this order: (1) last session note — what was the focus, what did you agree on, what homework was assigned; (2) any risk flags from the last session — SI/SH level, safety plan status, any between-session contact that occurred; (3) current treatment goals — which goal is active, where in the treatment sequence you are; (4) any logistical notes — cancellations pattern, billing, administrative items. You do not need to re-read the entire case history. The goal is to walk into the session knowing: what happened last time, what was the plan, and whether there are any elevated risk concerns. This takes 2 minutes with a good documentation system.

Why does pre-session review matter clinically?

Pre-session review is a clinical skill, not an administrative task. Clients notice immediately whether their therapist remembers them — if you have to ask 'what were we working on last time?', trust erodes. More importantly, you may miss risk escalation: a client who reported passive SI last session and arrives today in crisis needs a different opening than a client who left last session feeling stable. Pre-session review catches the difference. It also reduces the 'fresh start' phenomenon in sessions — starting cold means the first 10-15 minutes of the session are spent reconstructing context that should have been reconstructed before the client arrived.

What is the biggest pre-session review mistake therapists make?

The biggest mistake is not doing it at all — starting the session from scratch and using session time to reconstruct context. The second biggest is going too deep: reading the full intake, reviewing every prior note, spending 10-15 minutes preparing. Neither approach is sustainable at high caseload. The 2-minute review targets exactly what you need for this specific session: the last note, the active risk level, the current goal. Everything else can be retrieved during the session if needed. The aim is to have enough context to open the session with continuity rather than confusion.

How does a good documentation system change pre-session prep?

A good documentation system makes 2-minute prep possible. The key features: (1) session chronology — previous note visible without navigating to a separate file; (2) client context card — intake information, active goals, important background, risk history stored separately from session notes so they're always one tap away; (3) risk flag visibility — any active SI, safety plan, or clinical concern visible before you open the session note. Without these features, pre-session review takes 10+ minutes or doesn't happen. The documentation system is not just for records — it's a clinical tool that affects what happens in the room.

Pre-Session Review for Therapists: 2-Minute Checklist Before Every Session

Most therapists either skip pre-session review entirely or spend 10 minutes rereading case notes they already know. Neither is right. Two minutes — with the right information in the right order — is enough to walk into every session with continuity.

Short answer: before each session, check in this order: (1) last session note — focus, agreements, homework; (2) risk level at last contact; (3) current treatment goal. That’s it. Two minutes. The goal is to open the session knowing what happened last time and whether there’s anything elevated to address first.

Why It Matters Clinically

Pre-session review is not administration — it’s the transition from one client’s world to another’s. Without it:

You ask clients to remind you what you discussed last time (trust cost)
You miss risk escalation between sessions
You start sessions in reconstruction mode instead of therapeutic mode
You lose the first 10-15 minutes of the session to context-setting that should have happened in the 2 minutes before

At high caseload (8-10 clients/day), the cognitive load of carrying every client’s clinical context in working memory is not sustainable. The pre-session review is how you offload that to your documentation system and retrieve only what you need, when you need it.

The 2-Minute Pre-Session Review: In Order

Step 1 — Last session note (60 seconds)

Read the Plan section of your last note first, not the Data. The Plan tells you:

What you agreed to focus on next
What homework was assigned
Any actions you were supposed to take (referral follow-up, between-session contact)

Then scan the Assessment for any risk notation and the session’s overall clinical picture.

What you’re looking for:

□ What was the focus last session?
□ What homework / between-session task was assigned?
□ What was the plan for this session?
□ Was there anything flagged for follow-up?

Step 2 — Risk level (20 seconds)

Scan specifically for the risk assessment from last session:

□ Was SI/SH present at last contact? At what level?
□ Is there an active safety plan?
□ Was any between-session contact agreed to?
□ Did between-session contact occur? (check if documented)

If SI was elevated last session, your session opening changes. If there was a safety plan agreement, you need to check in on it in the first few minutes.

Step 3 — Client context (20 seconds)

A glance at the client card (not the session notes):

□ Current active treatment goal
□ Any important background that's relevant today
  (upcoming event, anniversary, recent life stressor noted in prior sessions)
□ Any logistical note
  (billing, cancellation pattern, consent to contact)

Step 4 — Reset (20 seconds)

Before the client walks in: close the notes. Take a breath. The review is done — you’re not reading while they talk.

The Full 2-Minute Checklist

PRE-SESSION REVIEW — 2 MINUTES

LAST SESSION (from previous note — read Plan first)
□ Session focus: _________________________________________
□ Homework assigned: ______________________________________
□ Plan for today: _________________________________________
□ Anything flagged for follow-up: _________________________

RISK
□ SI/SH at last contact: □ None  □ Passive  □ Active
□ Safety plan active: □ No  □ Yes — review status at session start
□ Between-session contact: □ None agreed  □ Agreed — occurred: □ Y □ N

CLIENT CONTEXT (from client card)
□ Current active goal: ____________________________________
□ Relevant background for today: __________________________
□ Any logistical note: ____________________________________

READY: □ Notes closed  □ Present

What the Review Catches That You’d Otherwise Miss

Without review	With 2-minute review
”What were we working on last time?”	Opens with: “Last time you were going to try the breathing exercise — how did that go?”
Missing that SI was passive last week but client arrives activated today	Notices elevated risk immediately, adjusts opening
Forgetting referral you said you’d follow up on	Checks: “I was going to send you that resource — did you get it?”
Starting at session 7 like it’s session 1	Knows exactly where in the treatment sequence you are
Asking for an update on the family situation you already know	References it directly, showing continuity

What Not to Review Before a Session

Don’t re-read the full intake. You did that when you first saw the client. If there’s something specific in the intake you need to reference, it belongs in the client card’s «Important Information» section — accessible in seconds, not buried in a long document.

Don’t review more than 1-2 prior notes. If you feel you need to read back 5 sessions before you know where you are, the problem is in the treatment plan, not the review process. The active treatment goal should tell you where you are.

Don’t review while the client is talking. This is a before-session activity. Reading notes during session sends the message that your documentation system is more important than the person in the room.

What the Pre-Session Review Looks Like in Practice

Client A: session 8 of CBT for OCD

Pre-session scan (90 seconds):

Plan from last note: “Introduce ERP for ‘checking’ compulsion — develop hierarchy. Client will attempt one item from the hierarchy before next session.”

Risk: None flagged.

Client card: Goal = reduce checking compulsions in home context. Recent note: moved in with partner last month — new context for compulsions emerging.

Walk-in opener: “Last time we put together a first step for the checking hierarchy — how did it go when you tried it at home?”

Client B: session 12 of trauma processing, SI was passive last session

Pre-session scan (2 minutes, slightly longer because of risk):

Plan from last note: “Continue trauma processing if client stable at start of session. Check in on SI at session open — was passive (2/10) related to trauma content in session, client denied plan or intent.”

Risk: SI passive 2/10 last session. Safety plan in place since Session 3. No between-session contact agreed to.

Client card: PTSD, car accident. Currently in Phase 4 of EMDR, Target 2.

Walk-in: brief check-in first. “How has your week been? I want to check in with you before we dive in today.” (Then: safety check before proceeding to trauma work.)

Client C: new session, administrative flag

Pre-session scan (60 seconds):

Plan: “Explore grief avoidance pattern — behavioral activation.”

Risk: None.

Client card flag: Missed last 2 sessions (1 cancellation, 1 no-show). Note to address attendance pattern.

Walk-in opener stays warm, but you know to address the gap: “I’m glad you’re here today — we’ve had a couple of missed weeks. How are you doing?”

Building a Pre-Session Habit

The review only works if it’s consistent. Three practical conditions:

1. Buffer between clients. 10-15 minutes between sessions is not “free time” — it’s: write previous session note (5-8 min) + pre-session review for next client (2 min) + transition (2 min). Schedule it.

2. Documentation system that supports it. If reviewing the last note requires opening 3 different files, the review won’t happen consistently. The previous note should be visible in 1 click.

3. Client card as a living document. The client card is not a completed intake form — it’s a running summary of what’s currently important. Update it when something changes (new stressor, updated risk level, new goal), not just at intake.

TheraMemory is built around this workflow: the previous session note is visible before you write the new one, and the client card’s «Important Information» section stores context that matters between sessions — current goal, risk history, important background. Two-minute prep is a design goal, not a workaround.

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Previous session note visible before every session. Client context, goals, and risk history in the client card — one tap, not three files. Pre-session review in 2 minutes by design.

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Pre-Session Review: What to Check in 2 Minutes Before Every Client

TheraMemory helps therapists stop carrying every session detail in memory