Family/Caregiver Session Note (Dance/Movement Therapy)

Date of Service: [Date of Service]

Start Time: [Start Time] / End Time: [End Time] / Duration: [Duration]

Location/Modality: [in-person / telehealth] (Include site if relevant)

Clinician: [Name, credentials]

Participants Present:

• [Participant name] — [Relationship to identified client]; [attended full session / attended partial session]
• (Repeat as needed for each participant)

(If identified client was not present, explicitly state this and include clinical rationale for caregiver-only session.)

Session Focus & Consent

[Reason for today's session and treatment plan goals addressed]

(If this is an initial session, participants changed, or new intervention types were introduced, document consent status. For family sessions, note whether confidentiality expectations and limits were reviewed.)

(If therapeutic touch, physical prompting, or close-proximity interventions occurred, document that touch was used, consent obtained, purpose, and participant response. Omit if touch was not used unless site policy requires explicit documentation.)

Subjective

[Caregiver and/or client reports since last session] (Summarize functional changes, relational dynamics, behavioral concerns, and somatic factors affecting movement participation. Attribute statements clearly, e.g., "Caregiver reports…", "Client states…". If subjective data was not obtained, briefly state why.)

Objective

[Observable movement and relational data] (Document in neutral clinical language. Include pertinent observations such as arousal/regulation cues, posture and movement qualities, spatial relationship patterns, affect range and congruence, engagement level, caregiver responsiveness and co-regulation attempts, and escalation/de-escalation patterns as relevant. Focus on what was directly observed; avoid inferences.)

Interventions

[Movement-based and verbal/systemic interventions provided] (For each intervention, note the technique, clinical target, and brief context. Include adaptations or safety considerations as relevant. Examples: mirroring, rhythmic entrainment, grounding sequences, dyadic attunement exercises, psychoeducation, communication coaching, caregiver skills training.)

Response & Progress

[Participant responses to interventions] (Describe behavioral, affective, and movement indicators of change. Note caregiver uptake of coaching and shifts in interaction. Link responses explicitly to treatment plan goals, indicating [progress / no change / regression]. If response could not be assessed, document the limitation.)

Risk & Safety

(Include this section only when risk content was discussed, assessed, or observed during the session.)

[Risk content identified and clinical response] (Document specific concerns such as suicide/self-harm, risk to others, abuse/neglect, or physical safety during movement. Include actions taken, safety steps, and any mandated reporting. Do not imply assessment of domains that were not evaluated.)

Assessment & Plan

Clinical Impression: [Synthesis of system dynamics, regulation capacity, and how movement data informed formulation; progress relative to treatment phase] (Distinguish observed facts from clinical interpretation. For caregiver-only sessions, note how caregiver factors affect the identified client's treatment trajectory.)

Plan: [Next session date and focus; home practice assignments; coordination of care; referrals] (Note if consent or boundary issues need to be revisited.)

Clinician Signature/Credentials/Date: [Signature block]