NHS Talking Therapies Session Note (Step 3)
Session Note Template:
Summarises a high-intensity (Step 3) treatment session in an NHS Talking Therapies for anxiety and depression service, formerly known as IAPT. This NovoNote template is built around the service’s session-by-session outcome monitoring — PHQ-9, GAD-7, WSAS and the anxiety disorder specific measure — recording the scores collected, alongside the formulation, interventions and between-session tasks.
Note: In order to bring in psychometric scores use this template via the “Create Document” pathway, and ensure psychometrics are selected.
Template Structure
Example Output
Template Structure
Session Details:
- Date of session
- Session number within the treatment episode, and planned total if stated
- Modality — face-to-face, video, or telephone
- Duration, including start/finish times if stated
- Therapist name and role, if stated
Routine Outcome Measures:
- Scores completed this session (e.g. PHQ-9, GAD-7, WSAS, and any anxiety-disorder-specific measure), recorded exactly as stated
- How scores were discussed with the patient, their account of any discrepancy between scores and how they feel, and any effect on session focus
Problem Descriptor and Goals:
- Problem descriptor and ICD-10 code in use, and any change agreed this session with the reason
- Patient’s problem statement in their own words, and any revision agreed this session
- Goals, including the patient’s rating this session and their account of what has changed
Since the Last Session:
- Review of the between-session task: what was set, what the patient did, what they noticed or learned, and any obstacles — record the patient’s account of obstacles rather than simply noting non-completion
- Significant events, life stressors, or changes in circumstances since the last session
- Changes to medication or other treatment, other services involved, or contact with primary care
Session Focus:
- Agenda agreed at the start of the session and who contributed each item
- Focus of the work and how it relates to the formulation and agreed goals
Formulation:
- Maintenance formulation used or developed this session, naming the disorder-specific model where one was used, and the specific maintaining processes identified — thoughts, appraisals, behaviours, attentional or physiological processes and their relationships
- Any revision to the formulation made this session and what prompted it
- How the formulation was shared with the patient and their response
Interventions:
- For each intervention: the specific technique, the protocol or model it comes from, what it targeted in the formulation, how it was delivered, and the patient’s response, including any shift in belief, affect or behaviour — with enough detail for another therapist to continue the work
- Any in-session measurement taken (belief ratings before/after, distress ratings during exposure, behavioural experiment predictions and outcomes) with the actual figures
Within-Session Outcome:
- What the patient took from the session — new learning, a revised appraisal, a disconfirmed prediction, or an unresolved difficulty, with before/after ratings if a belief or distress rating changed across the session
Between-Session Task:
- Task agreed for before the next session, specific enough to check — what, when, how often, and how it will be recorded
- Rationale, link to the formulation, anticipated obstacles and how they were problem-solved
- Patient’s stated confidence rating, if given
Risk:
(Include only if explicitly mentioned)
- Risk indicators from the measures and how they were followed up
- Suicidal ideation — ideation, intent, plan, means, protective factors
- Self-harm — current or recent
- Risk to or from others, and safeguarding concerns, and the action taken
- Action taken — safety planning, means restriction, crisis contacts given, escalation, discussion with supervisor/duty worker, contact with GP or other services, and the agreed review point
Progress and Clinical Decision Making:
- Progress against the problem statement and goals, drawing together the outcome measure trajectory and patient report, and how any divergence between measures and self-report was accounted for
- Obstacles to progress — engagement, attendance, life circumstances, comorbidity, unresolved maintaining processes
- Stepping and treatment length — stepping up/down, extending/concluding treatment, sessions used and planned, and reasoning
- Supervision — intention to take the case to supervision and the specific question to raise
Employment and Wider Support:
- Discussion of work, study, sick leave, return to work, benefits, employment adviser referral, or other signposting/onward referral
Next Steps:
- Date, time and modality of the next session, and any agreed agenda item to carry forward
- Actions for the therapist before the next session — sending a resource, liaising with the GP, arranging an interpreter, checking a referral
Session Summary:
- Short paragraph covering the outcome measure position and direction of travel, the focus of the session, the interventions delivered and the patient’s response, any risk and the action taken, and the plan for the next session
Example Output
Session Details:
- Date of session: 14 May 2026
- Session number: Session 4 of 6 planned
- Modality: Telephone
- Duration: 45 minutes
- Therapist: Sarah Green, PWP
Routine Outcome Measures:
- Scores this session: PHQ-9: 8 (mild), GAD-7: 14 (moderate), WSAS: 12 (significant functional impairment)
- Discussion of the scores with the patient: James noted the GAD-7 score “feels about right” but was surprised the PHQ-9 had dropped, saying he’d “been getting out more.” Discussion confirmed low mood has improved faster than worry, which shaped today’s focus on worry-specific work
Problem Descriptor and Goals:
- Problem descriptor: Generalised Anxiety Disorder (ICD-10 F41.1); no change agreed this session
- Problem statement: “I worry constantly about things going wrong at work and can’t switch off, even when there’s no real problem”
- Goals: (1) Reduce time spent worrying each day — rated 4/10 this session, up from 2/10 at baseline; (2) Get through a full workday without checking emails after hours — rated 5/10, James reporting two email-free evenings this week
Since the Last Session:
- Between-session task review: James was set worry postponement practice (deferring worries to a fixed 15-minute slot). He completed this on 4 of 7 days; on the days he didn’t, he reported “the worry felt too urgent to put off.” He noticed that on the days he did use it, evenings felt calmer
- Events and changes: A performance review at work has been brought forward to next week, which James identified as a current trigger for increased worry
- Medication and other treatment: No change; James remains on sertraline 50mg, prescribed by his GP
Session Focus:
- Agenda: James raised the upcoming performance review as the priority item; therapist added a brief review of the worry postponement technique
- Focus of the work: Session focused on testing the worry “if I stop worrying, I’ll be unprepared and it’ll go badly,” using the upcoming review as a live example
Formulation:
- Generalised Anxiety Disorder model (Intolerance of Uncertainty framework) used. Maintaining processes identified: positive beliefs about worry (“worrying keeps me prepared”), intolerance of uncertainty about the review outcome, and reassurance-seeking via repeated checking of work emails. No revision to the formulation this session
- The link between the belief “worrying prevents bad outcomes” and James’s reluctance to fully engage with worry postponement was shared with James, who agreed this fit his experience
Interventions:
- Behavioural experiment: Tested the prediction “if I don’t worry about the review, I’ll be unprepared.” James rated belief in this prediction at 75% before the experiment. Plan was to prepare using a structured 20-minute review the evening before rather than ongoing worry, and observe the outcome
- Worry postponement (worry time) reviewed and refined: fixed slot moved to 6pm to avoid clashing with dinner, identified by James as a barrier last week
- In-session measurement: Belief in “worrying prevents bad outcomes” rated 75% before the behavioural experiment discussion, 50% after considering the counter-evidence from the past two email-free evenings
Within-Session Outcome:
- James identified that the two evenings he didn’t check emails “nothing went wrong,” which challenged the belief that constant vigilance is necessary. Belief in the worry moved from 75% to 50% within the session; James described this as “a bit of a lightbulb moment”
Between-Session Task:
- James to complete a 20-minute structured preparation session the evening before the performance review, in place of ongoing worry, and to use the 6pm worry postponement slot daily. He is to record the outcome of the review against his 75% prediction. James rated his confidence in completing this at 7/10, noting the review date itself as the main obstacle if anxiety spikes beforehand
Risk:
- Risk indicators from the measures: GAD-7 item 7 and PHQ-9 item 9 both scored 0; no risk indicators flagged
- Suicidal ideation: James denied any thoughts of suicide or self-harm when asked directly
- Self-harm: None reported
- Risk to or from others, and safeguarding: None identified
- Action taken: No action required; standard safety net information reiterated (GP and out-of-hours crisis line details confirmed as held by James)
Progress and Clinical Decision Making:
- Progress this episode: PHQ-9 has fallen from 14 (moderate) at baseline to 8 (mild) today; GAD-7 has remained relatively static (16, moderate, at baseline; 14, moderate, today), consistent with James’s own report that low mood has improved ahead of worry. Goal ratings show incremental movement (worry time 2/10 to 4/10; email boundary 3/10 to 5/10)
- Obstacles to progress: The upcoming performance review is a time-limited stressor likely to temporarily increase worry frequency
- Stepping and treatment length: No change discussed; 4 of 6 planned sessions used, on track for review at session 6
Next Steps:
- Next session: 21 May 2026, telephone, to review the outcome of the performance review against James’s prediction
- Actions for the therapist: None outstanding
Session Summary:
James’s PHQ-9 continues to trend downward (8, mild — from a baseline of 14, moderate) while GAD-7 remains largely unchanged (14, moderate — from 16, moderate), consistent with his own account that mood has improved ahead of worry. Today’s session used a live trigger — an upcoming performance review — to test the belief that worrying prevents poor outcomes, with belief ratings shifting from 75% to 50% within session. No risk was identified. James was set a structured preparation task and a shifted worry postponement slot to test the belief further before the next session on 21 May 2026.
- Template Type
- Session Note
Author:
Dr Ben Buchanan
NovoPsych CEO & Clinical Psychologist
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