Session Note Template:
For use by a clinician using an Mentalization Based Treatment (MBT) framework, this template provides a detailed summary of a session with a client on NovoNote.
Session Content:
Describe the content of the session, covering the main focus areas, the client’s responses and insights, and key discussions and explorations.
Mental Status Examination:
- Mood: Describe the client’s reported mood and clinician’s observations.
- Thoughts: Describe the content and process of the client’s thoughts.
- Affect: Describe the client’s emotional state and range of expressed emotions.
- Behaviour: Describe observed behaviours of the client during the session.
- Insight: Describe the client’s level of awareness about their condition.
- Judgement: Describe the client’s decision-making capacity.
Mentalizing:
Describe the client’s ability to understand their own mental states and those of others, including: Any impairments in mentalizing; impact on social interactions and self-perception; and coping mechanisms related to mentalizing difficulties.
Self-Other Differentiation:
Describe the client’s ability to distinguish between self and others, including: Any blurred boundaries; impact on interpersonal relationships; and self-perception in relation to others.
Mentalizing Poles:
Describe the client’s imbalances in the different dimensions of mentalizing, including: If the patient is more focused on the self or other dimension of mentalizing; if the client is more focused on the affective or cognitive dimension of mentalizing; if the client is more focused on the internal or external dimension of mentalizing; and if the client is more focused on the implicit or explicit dimension of mentalizing.
Non-Mentalizing Modes:
Identify and describe the client’s non-mentalizing modes (e.g., teleological mode, psychic equivalence, or pretend mode), and their significance.
Interventions:
- Describe the therapeutic mentalizing interventions used during the session, including specific mentalizing techniques or approaches, such as the not knowing stance, empathic validation, contrary moves, stop and rewind, increased focus on personal interactions between the therapist and the client, marked affect, and gentle challenges.
- Describe the goals and rationale of the interventions used, and the client’s response to the interventions used.
Metaphors Used:
List the metaphors used and describe their significance and relationship to the client.
Next Steps:
Outline the plan for future sessions as agreed between the clinician and the client, including: Date and time of next appointment, focus areas for upcoming sessions, and the therapeutic modality.
Session Content:
Mary discussed a weekend conflict with her partner, initially presenting it in absolute terms as evidence he “doesn’t care.” Through exploration, she began recognising multiple perspectives and the complexity of her partner’s motivations. Focus was on developing capacity to maintain mentalizing during emotional activation.
Mental Status Examination:
- Mood: Reported as “calmer but still stirred up”
- Thoughts: Initially rigid thinking about relationship conflict, became more flexible
- Affect: Variable range from anger to sadness, regulated as session progressed
- Behaviour: Initially agitated, became more relaxed and engaged
- Insight: Moderate awareness of emotional dysregulation patterns
- Judgement: Good when mentalizing effectively, impaired when emotionally activated
Mentalizing:
Variable capacity throughout session. Appeared compromised when emotionally activated, particularly difficulty mentalizing partner’s perspective when feeling abandoned. Good recovery when arousal decreased with therapeutic support.
Self-Other Differentiation:
Difficulty maintaining boundaries between own emotional experience and assumptions about partner’s intentions when distressed. Tendency to conflate internal feelings with certainty about others’ motivations.
Mentalizing Poles:
Imbalanced toward other-focused mentalizing when distressed. Predominance of affective over cognitive mentalizing. Focus on external behaviours rather than internal states.
Non-Mentalizing Modes:
Clear psychic equivalence mode when describing conflict, presenting emotional reality as objective fact about partner’s intentions.
Interventions:
- Used not-knowing stance and empathic validation.
- Applied “stop and rewind” technique when assumptions made.
- Mary responded well with increased mentalizing capacity.
Metaphors Used:
“Emotional storms” metaphor to explain how intense feelings cloud perspective. Mary reported finding this helpful for understanding conflict experiences.
Next Steps:
- Next session 29/05/2025 at 2:00 PM.
- Continue developing mentalizing during emotional activation.
- Explore attachment experiences contributing to abandonment sensitivity.
- Template Type
- Session Note
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