Group Psychotherapy Note (Athletes)

Date of Service: [Date]

Start/Stop Time: [Start time]–[Stop time]; [Total duration] minutes

Location/Modality: [in-person / telehealth] (If telehealth: include patient's state, privacy confirmation, and consent verification.)

Provider: [Provider name, credentials] [; Co-facilitator: Name, credentials (if applicable)]

Group: [Non-identifying group program name]

Diagnosis/Treatment Plan: [Active diagnoses]; [Treatment plan goals addressed this session]

(Each participant's note must be individualized. Refer to other group members only with non-identifying descriptors. Label source of information as patient report, clinician observation, or collateral.)

Group Session (Shared Content)

Theme/Objectives: [Session topic]; [2–3 learning objectives]

Interventions Delivered: [2–4 clinician-delivered interventions as actions, e.g., cognitive restructuring, mindfulness practice, values clarification, distress tolerance skills, role-play, facilitated peer feedback]

Group Process: [Brief non-identifying note on overall engagement/dynamics] (Optional; include only if clinically meaningful. Use terms like "another member" or "a participant.")

Individual Participant

Attendance/Participation: [present / late / early departure] (Include reason if known.) [Participation level: active / moderate / minimal] with [1–2 behaviorally specific examples] (Do not reference other members by name.)

Interval Update: [Patient-reported updates since last session relevant to treatment goals: mood/anxiety changes, stressors, sleep, coping strategies used, athlete-specific context if clinically relevant] (Omit if no significant changes.)

Clinical Observations: [Pertinent observations: appearance, affect, engagement, thought content as relevant] (Omit if unremarkable and no clinical concerns.)

Response to Interventions/Progress: [Skill(s) practiced]; [Patient's response]; [Clinician assessment of progress toward specific treatment plan goal(s)]; [Barriers if applicable]

Risk Assessment

• Suicidal ideation: [denied / passive / active] (If active: include intent, plan, means, immediacy.)
• Homicidal ideation: [denied / present] (If present: include intent/plan; do not identify target.)
• Self-harm urges: [denied / endorsed] (Include if relevant to this patient; note frequency/intensity and actions taken.)
• Protective factors: [Relevant supports, reasons for living, coping skills] (Include when risk is non-zero.)
• Actions taken: [none indicated / safety plan reviewed / crisis resources provided / other] (Specify if any intervention required.)

(If safety not assessed, explicitly state reason and document follow-up attempts. Never leave blank or infer safety from silence.)

Plan

Disposition: [Continue group / modify frequency / discharge] with [brief rationale]

Coordination/Referrals: [Referrals or coordination as indicated] (Omit if none.)

Between-Session Plan: [Individualized homework or skill practice with specific target]

Next Session: [Date/time if scheduled]

Clinician Signature: [Signature]

Credentials: [Credentials]

Date/Time Signed: [Date/time]