An EHR for the Therapeutic Alliance

Updated: Nov 23, 2021

Introduction

Before I co-founded Sessions Health, an EHR for improving efficiency and the therapeutic alliance, I wrote my graduate school integration paper on how to develop expertise as a psychotherapist. This was critically important for me since I wanted to make the most out of my career as a psychotherapist. What I learned was that cultivating deep relationships with clients was critically important. This is also known as the therapeutic alliance.


Sessions Health, An EHR for Improving Efficiency and the Therapeutic Alliance
Sessions Health, An EHR for Improving Efficiency and the Therapeutic Alliance

With my background in software, I sought to create a software system to help therapists develop expertise. What I discovered though, is that many therapists are overworked and burnt-out and don't have time to work with an entirely different system devoted to improving their expertise. However, as fate would have it, I ended up meeting some people who were working on building an improved electronic health records (EHR) software management system for psychotherapists and mental health professionals. This proved to be the perfect opportunity for applying my research in a way that better aligns with how therapists in mental health are already working--that is, within whatever EHR they are using.


I was brought on to provide the perspective of a working psychotherapist so that the mental health practice management software aligned as closely as possible with how therapists actually work. In addition, as a psychotherapist in private practice, I also knew about the business side of a mental health clinic. From CPT code 90837 to CPT code 90791, from submitting claims to insurers to doing monthly billing, understanding the nuts and bolts of psychotherapy practice management was a key piece of the puzzle that led to me becoming a co-founder.


Sessions Health - the best electronic health records software for improving the client relationship

One year later, Sessions Health is a reality and we are providing psychotherapists the tools to become more expert psychotherapists by enhancing the therapeutic alliance with the people they work with. Sessions Health is based in Minneapolis, the healthcare capital of the country. We are committed to constantly improving the system so that psychotherapists and mental health professionals always have the best mental health practice management software to help them focus on the people they work with. This is a major distinction between us and other practice management systems that only focus on the business and administrative aspects of being a mental health counselor in private practice or in a mental health clinic.


Features for deepening the therapeutic alliance

While the features in Sessions Health are always evolving, we initially focused on two major areas based upon research.

- Soliciting client feedback

- Significant anniversaries for clients


Session bridging and client feedback

Session bridging lets you get valuable feedback from your clients. The concept behind session bridging is to help the psychotherapist bridge the time between sessions so that clients are thinking about the work being done outside of therapy sessions. We built this directly into the scheduling feature of Sessions Health so that therapists can quickly and easily start engaging more deeply with the people they work with when the session is over.


We built a default questionnaire that can be used for session bridging, but it can be customized so that each therapist can deliver any sort of feedback form that they want to. Therapists can have multiple session bridging forms so that they can deliver different questionnaires to different patients. They can be assigned as one-off questionnaires, or to be delivered after each session within the context of recurring appointments.


Session bridging is dynamic and allows for infinite creative designs so that you can make it work for however you do therapy. For CBT therapists, maybe they want to assign homework. For a narrative therapist or humanistic therapists, maybe they want to create a session bridging form to help the client reflect on their story. A strengths-based therapist might want to help the client think about what strengths they used in the session. There's no limit to how the therapist can tailor session bridging for their approach to psychotherapy.


When clients return session bridging, the therapist can easily view the responses from within the EHR system. The user interface is designed so that the results can be viewed at the session level or from a grid that shows a list of all of the session bridging feedback that has been emailed. Clients don't need an account to log-in. They simply click a link and are taken directly to the form to respond to the questionnaire.


Sample client feedback questionnaire

The following is a sample questionnaire that can be given to people after their psychotherapy session to help the therapist understand more about the therapeutic alliance and how treatment is going.



Session bridging client feedback questionnaire
Session bridging client feedback questionnaire


1. Please select the statement that most closely aligns with your experience.

2. I felt heard, listened to, and respected today. (Strongly Disagree Disagree Agree Strongly Agree)

3. My therapist and I worked on the concerns that were most important to me today. (Strongly Disagree Disagree Agree Strongly Agree)

4. Overall, did this session feel like it was right for you? (Yes / No)

5. Please provide any additional or clarifying information you want to share about this session.


With this type of client feedback form used as session bridging, therapists can get a better understanding of how treatment is going. Do they feel a strong connection to the work? Do they feel like a particular session is the type of session that works for them? While some therapists might use client feedback for every session, others might only want to get client feedback occasionally. It is likely far more important to get client feedback during the first ten psychotherapy sessions since this is when the therapeutic alliance is most fragile.


Important anniversaries for psychotherapy clients

Most people want to feel like they are special people to their therapists. One way of deepening the therapeutic alliance is by remembering key dates for the people we work with as mental health professionals. Sessions Health builds this directly into the EHR so that therapists can easily access this information during the course of their day-to-day work.


When setting up a client in the EHR system, the software will ask the therapist if they want to create a birthday reminder for the client. If this is set up, seven days before the client's birthday, the reminder will show up in the psychotherapist's home screen. The goal of this is to help the therapist be proactive in mentioning the client's birthday and avoid awkward and guilt-inducing moments when clients come in and talk about how it was their birthday last week while the therapist sits guilty thinking about how they wish they would have known during the previous week's session.


Reminders aren't limited to birthdays. Clinicians can also set up other client anniversaries. For example, if working with a client who is suffering from intense grief or depression, it can be helpful to be reminded of critical anniversaries that preceded the grief or depression, such as the death of a spouse or parent. These reminders will also show up in the clinician's home screen seven days before the event so that they have time to prepare for the upcoming session when the client will almost be certainly be affected by the anniversary of the traumatic event. These types of reminders, if in place, will make the therapist more skilled and mindful about the current state of their patients and demonstrate to the client how much care and consideration the clinician has for them.


The future of private practice management software

I'm convinced that the approach that Sessions Health is using will become the leading way of thinking about developing mental health clinic and private practice management systems. For decades, these tools have languished in the cold, clunky realm of being purely functional without a heart and divorced from the mindset of the professionals who must use these tools to get their work done. I predict that once Sessions Health captures the market of EHR systems, that others will follow along and try to replicate the thinking and spirit of what Sessions Health has brought forth.


Conclusion

The EHR & EMR market is saturated with products that have been designed only for the nuts and bolts of running the administrative side of private practice. Many of these systems were also not designed by the people who actually use them--mental health professionals and clinicians. Very few EHR software systems have been thoughtful about what is important to psychotherapists, namely the focus on the relationship with the people they help. Sessions Health is leading the way in becoming the mental health practice management system that is deeply focused on helping psychotherapists to become more expert by giving them the tools to gather feedback from patients and improve the therapeutic alliance.


Visit Sessions Health at https://www.sessionshealth.com/.

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