Note: three different scenarios’ AND look the examples
DAP Notes
DAP notes are the kind of case notes you will use for your record-keeping of the counseling sessions that you conduct for our class. Remember, you need to treat these records like you would any counseling records—they are private, confidential records whose confidentiality you are ethically and professionally required to protect. You will complete one note per session with your practice “client.”
What is a DAP note?
DAP notes are comprised of single-spaced text and should be no longer than one page (most will be about a half page). There are three sections to a DAP note. The “D” stands for “Data,” and this is the section where you write the what of your session: what happened, what did the client say or do that seemed important to record, what did you say or do as the therapist that is important to call attention to. Typically ranging between 1 and 3 paragraphs, this section should be written using precise language such as “the client said” and “the client indicated.”
The “A” stands for “Assessment,” and this is the section where you write more about the underlying content of the session, the salient hypotheses you have about the client, or the progress or pitfalls you see the client currently experiencing. This section ranges from two to four sentences, and should be written using tentative language such as “it seems the client” and “it appears.” Only the most likely and evidenced of your conceptualizations should be written here.
The “P” section is the “Plan” section, and this is where you write about your thoughts on what is to come in your therapy with the client. In other words, as a mindful therapist you are putting to paper your thoughts about what you will be working on with the client in the next session. This section is typically about 1 to 3 sentences long; you want to be realistic about what can be accomplished in the next session, so writing more than 3 sentences is probably holding yourself and your client to unrealistic expectations. This section should be written using tentative, forward-looking language. (See Example of a DAP Note, this document.)
When writing DAP notes, keep in mind that the language you use to describe your session is incredibly important. You are creating a document of your session, and this document could conceivably be used in a court of law or other arena where you would want your professionalism and ethics to shine through. This document reflects you as a professional, so make sure it is your best work!! This means that spelling, grammar, punctuation, and appropriate use of language are things you should attend to in writing these notes. Your language should be objective (rather than subjective or judgmental), should be precise (make it clear who the comments are coming from by using firm language when something is coming from the client ,“client said”, or by using tentative language, “it appears”, when it is coming from you, the counselor), should communicate respect for the client, and should have a collaborative tone (rather than having a tone of competitiveness or adversity—unless your relationship with the client does seem to have adversarial components to it; if this is the case, make sure you document this observation about your relationship using tentative language and citing evidence that supports your observation as appropriate in the “D” and “A” sections).
Termination Session Notes
When you terminate with your client, you need to write your notes a little differently for that particular (termination) session. First, you need to note in your “D” section that this was the last session with the client (you may also want to include here any important events in terminating, like the client’s feelings about terminating or any feedback the client had for you about her therapy, as these could be important things to take into account in any future therapy with the client). Second, you need to write your “P” section differently; namely, you will say something along the lines of this: “Given that this was our last session, there is no plan for a next session. However, it appears that it could be beneficial to continue working on ____ with the client should she return to counseling in the future.”
Storage of DAP Notes
You will store your DAP notes in the secure storage area in the Lassen Training Clinic when the notes are not in use. DAP notes should be written the SAME DAY as your session, and should be written in private surroundings. DO NOT take them home with you!! The only reason the notes should leave the Clinic is for you to turn them into your supervisor, this instructor.
Example of a DAP Note
Client: D. A. (use initials to further safeguard client privacy)
Therapist: Alvin
Session #: 3
D: This session, client talked more about her feelings towards her father and her thoughts about her father’s relationship with client’s stepmother. Client said that she loves her father yet wishes he would spend more time with her as opposed to focusing on her stepmother. Client said that she has felt more distanced from her dad in the past few years since her parents’ divorce. She described her sadness about feeling this distance even though she has been living primarily with her father since the divorce, and explained that she has had difficulties connecting with her stepmother. Client stated that she sees her current relationship struggles in establishing her own long-term, committed romantic relationship as a result of her own mixed feelings about her parents’ ultimately unsuccessful relationship. Client said that she feels “unlovable” by her father and mother, and that she is afraid that her future partner would not be able to truly love her, either. Client was quite tearful as she shared this fear about the future.
A: It appears that the client’s core belief about herself is that she is unlovable as evidenced by the client’s statement in session. It seems that her self-esteem needs may not have been adequately addressed as a child and she may not have received enough feelings of love and genuine affection from her parents while growing up. As a result, it appears that she doubts anyone’s ability to love and value her deeply, and may be struggling with the ability to value herself as well. Therefore, it appears the client may opt out of potential relationships out of a sense that she does not deserve them because she does not deserve love.
P: Continue exploring with client her feelings of being “unlovable.” Process with the client the reasoning behind her feeling that she is unlovable. Also, explore with client the hypothesis that she may not feel she is deserving of love in her future relationships.
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