Quill generated this note with AI from the summary that was provided. The therapist can then copy-and-paste the note into their current EHR platform.
Subjective:
Client discussed self-harm behaviors and feelings of hopelessness. Client stated, "I don’t know how else to cope with my emotions."
Objective:
50-minute session focused on DBT interventions targeting distress tolerance and emotional regulation. Client seemed open and hopeful about using the techniques discussed.
Assessment:
Client is in the early stages of learning to manage distress without self-harm. Demonstrated willingness to explore alternative coping strategies.
Plan:
Client's homework is to create a crisis plan and identify alternative coping strategies. Progress will be evaluated in the next session scheduled for two weeks from today.
During today’s 50-minute session, client discussed her self-harm behaviors and feelings of hopelessness. She said, "I don’t know how else to cope with my emotions." We used DBT to focus on distress tolerance and emotional regulation skills. Client’s homework is to create a crisis plan and identify alternative coping strategies. She seemed open to trying these new techniques and hopeful for improvement. We’ll check in on her progress in our next session in two weeks.
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