Hypnotherapy session notes: template, outline and example

A hypnotherapy session note is the short, dated written account of each hypnosis session. It keeps the client's request, the technique used, the suggestions given and what the client says about them afterwards.

What a hypnotherapy session note is for

A few weeks after a session, your memory of what you said fades. The note keeps what matters.

• Finding the right words again. The images and phrasing that moved the client matter a great deal. If you write them down, you can use them again next time, or avoid them if they bothered the client.
• Following the goal. Each note says where the client stands compared with what they came for. You can see whether the work is moving forward or whether to change approach.
• Keeping a trace of the framework. The note shows what you offered and the advice you gave, such as seeing a doctor.

The French framework

The practice of hypnosis is not regulated

In France, no text regulates the practice of hypnosis as such, nor the title of hypnotherapist. No specific training is required. The 2015 Inserm report on the effectiveness of hypnosis makes this point. It notes that this unregulated status covers practitioners with very different qualifications, and that training courses vary widely.

A ministerial answer published in the Journal officiel on 11 December 2018 explains why a hypnotherapist certification was not added to the national register of professional certifications (RNCP). According to the answer, the word "hypnotherapist" may lead the public to think a diagnosis is being made, and some requests are usually handled by medicine. The same answer adds that hypnosis has its full place in care, particularly in hospitals.

The title of psychotherapist is regulated

Use of the title of psychotherapist is governed by article 52 of the law of 9 August 2004 and by decree no. 2010-534 of 20 May 2010. To use the title, you need at least 400 hours of training in clinical psychopathology and a practical placement of at least five months. This training is open to holders of a doctorate that allows them to practise medicine in France, or of a master's degree in psychology or psychoanalysis. The decree provides full or partial exemptions for some professionals, including doctors and psychologists.

The professional must then be entered on the list kept by the regional health agency (ARS) for their main place of practice, before using the title at all. Together, these lists form the national register of psychotherapists. According to the ARS Nouvelle-Aquitaine, using the title without registration can lead to penalties under article 433-17 of the French Criminal Code, which punishes the unauthorised use of a regulated title. If you are not on this register, do not use the title of psychotherapist. This does not stop you practising hypnosis.

The limits of the practice

Making a diagnosis and treating an illness are matters for a doctor. The 2018 ministerial answer cites a ruling of the Cour de cassation of 9 March 2010. In that case, a person who was not a doctor practised manipulations, acupuncture and hypnosis, among other things, with the aim of curing people. They were convicted of the illegal practice of medicine. The judges held that hypnosis used "for curative purposes" falls within medical treatment.

What is targeted, then, is hypnosis that claims to treat an illness or takes the place of a doctor. In practice, do not make a diagnosis, do not promise a cure, and refer anything that calls for medical care to a doctor.

The Inserm report finds the safety studies reassuring. It does, however, call for vigilance about the ethical abuses that suggestion techniques can lead to. It also finds the data insufficient for several uses. So write the goal without promising a result.

When to refer to a doctor

Some situations fall outside the scope of a hypnosis session. In that case, advise the client to see a doctor, then note that advice in the file, with the date and the client's response.

• A physical symptom that has not been seen by a doctor.
• A client who is thinking of stopping or reducing a treatment. That choice belongs in a discussion with their doctor.
• Depression, chronic pain or stopping a medication. The 2018 ministerial answer lists this kind of request among those usually treated by medicine. Check that the client has medical follow-up, or advise them to talk to their doctor.
• Severe distress or suicidal thoughts. In a life-threatening emergency, call 15. The 3114, the French national suicide prevention line, is available 24 hours a day, 7 days a week, free of charge, across France.

Your notes are health data

According to the CNIL, the French data protection authority, health data are data relating to a person's physical or mental health, past, present or future. Your hypnotherapy notes fall into this category, whatever your title. If you use online software, check where it hosts the data. Our article on HDS-certified hosting explains what to look for.

The client can ask to access the data that concern them. According to the CNIL, you must reply within one month at the latest, and this right is free. If you are also a health professional, further rules apply, covered in our article on patient access to therapy notes. So write factual notes that the client could read without being hurt.

This article describes the French framework. In Belgium and Switzerland, the rules on titles and on client files are different.

The note outline, section by section

Keep the same outline from one session to the next so you can compare sessions at a glance. Each section takes one to three lines.

1. Identification and context

Client's name, date, session number, length, in the practice or by video. Also note any medical care for the same issue.

2. The client's request

Write it in their words, in quotation marks. In the first session, this is the starting request. In later sessions, note what has changed since last time.

3. The goal of the session

Agree it with the client, in concrete terms. For example, "to feel able to walk into the meeting room without wanting to leave". If you use a 0 to 10 scale, note the question asked and the answer.

4. State at the start of the session

What the client says about the past few days, their score on the scale and what you observe. Describe rather than judge.

5. Induction and technique

The type of induction, for example eye fixation or breathing, then the deepening and the rough length of the hypnosis phase.

6. Suggestions and images

The main suggestions, the metaphors used and the client's safe place if they have one. Use their exact words where you can.

7. How the client felt afterwards

What the client says on coming out of hypnosis, the images that stay with them, any discomfort and their score on the scale.

8. Task between sessions

Self-hypnosis, a breathing exercise or a cue to use in a specific situation. State how often you agreed the client would do it.

9. Next steps

When the next session will be, what you plan to repeat or change, and any referral you advised, to a doctor or another professional, with the client's response.

A completed example

The example below concerns a fictional client. It shows the level of detail expected, not how to run the session.

• Identification. Ms Lefèvre, 41. Session 2, in the practice, 50 minutes. No ongoing medical care for this issue, according to the client.
• Request. "Before every presentation in a meeting, my hands shake and I go to pieces." Since session 1, one presentation, "a bit better than usual".
• Goal of the session. To feel calm enough to start her presentation on Thursday. Nerves at 8 out of 10 when she thinks about it.
• State at the start. Smiling, talks fast. Says she did the breathing exercise four times during the week.
• Induction and technique. Eye fixation, then slow breathing. Deepening with a staircase of ten steps. Hypnosis phase of about 20 minutes.
• Suggestions and images. Return to the safe place chosen in session 1, a beach in Brittany. Image of a "thermostat" the client turns down herself. Mental rehearsal of Thursday's presentation, seen from the beach.
• How she felt afterwards. "My hands felt heavy, it was pleasant." Found the staircase too long. Nerves at 5 out of 10 when thinking about Thursday.
• Task. Five minutes of self-hypnosis each day until Thursday, using the thermostat. Slow breathing just before walking into the room.
• Next steps. Next session in two weeks. Shorten the deepening. Review how Thursday's presentation went.

Following progress from one session to the next

It is the series of notes that shows whether the work is moving forward.

• Reread the previous note before the session. You find again the images that helped, those that bothered the client and the task you agreed.
• Take stock. After a few sessions, reread all the notes. If nothing is changing, discuss it with the client and consider another approach or a referral. Keep the same scale, asked at the same point, so the numbers can be compared.

Common mistakes

• Noting the technique without the words. "Induction, deepening, suggestions" will not help you next time. The client's images and phrasing will.
• Not noting a referral. If you advised the client to see a doctor, write it down, with the date and the client's response.
• Interpreting rather than describing. "Unconscious resistance" reads badly if the client asks for their file. "Did not wish to continue the exercise" is more accurate.

Taking your notes with Delta

Delta is the clinical assistant for mental health and allied health professionals. You have two ways to take your notes. During the session, Delta transcribes what is said. After the session, you dictate your observations. You can also add written notes.

Delta then generates the session report, with a short summary, a detailed summary and topics for the next session. It takes your profession into account. It also updates the client's file, with a summary of the work so far and the goals being followed. You can find the whole history of the work and how it has evolved in one place. Delta also drafts letters, certificates and assessment reports, adapted to your profession.

Data are hosted in France by an HDS-certified provider, and AI processing takes place in France. The client's name and identifying details are pseudonymised before they reach the AI. No audio file is kept. The audio is used only during the session, to produce the transcript. The data are never used to train a model and are encrypted in transit and at rest.

Delta works in the browser, with a Mac and Windows app recommended for sessions. Before using transcription during a session, inform the client and obtain their agreement. Our article on consent to AI note-taking explains how. The trial lasts 14 days, with no credit card required. After that, the subscription costs €29 a month including VAT when billed annually, or €35 a month including VAT billed monthly, with no commitment.

Further reading

• Systemic family therapy note, template and example
• AI for therapists, useful uses and limits
• All our clinical document templates
• Delta for therapists

Frequently asked questions

Sources

• Décret n° 2010-534 du 20 mai 2010 relatif à l’usage du titre de psychothérapeute (consolidated version, copy hosted by ARS Pays de la Loire)
• ARS Nouvelle-Aquitaine, Psychologues, psychothérapeutes et ostéopathes
• Inserm, Évaluation de l’efficacité de la pratique de l’hypnose, report, June 2015
• Assemblée nationale, written question no. 14617, Certification professionnelle en hypnothérapie, answer published on 11 December 2018
• CNIL, Le droit d’accès, connaître les données qu’un organisme détient sur vous