Hypnotherapy Session Note (Smoking Cessation)

Session Information

Date of Service: [Date]

Patient: [Patient name or identifier]

Provider: [Provider name and credentials]

Session Duration: [Total face-to-face counseling time in minutes]

Modality: [in-person / telehealth]

Tobacco Use Status

(Summarize changes since last visit. Include only information explicitly documented.)

• Current status: [abstinent / reduced / unchanged / increased / relapse] (If abstinent, label as patient-reported unless biochemically verified.)
• Products used: [Products and delivery methods] (Include only if used since last visit.)
• Quantity/pattern: [Amount and frequency] (If unable to quantify, document best estimate and label as approximate.)
• Quit attempts or slips since last session: [Number, context, duration, recovery] (Include only if occurred.)
• Quit date: [Actual or target date, or not set]
• Stage of change: [contemplating / preparing / active quit / early abstinence / maintenance / relapse recovery]
• Medication/NRT status: [Current regimen, changes, side effects, or none] (Include only if applicable.)

Triggers & Cravings

(Capture intensity and context. Use numeric scales where specified.)

• Craving intensity (0-10): [Current] / [Peak since last visit]
• Key triggers - internal: [Stress, boredom, fatigue, emotions as reported]
• Key triggers - external: [Meals, coffee, social settings, environmental cues as reported]
• Withdrawal symptoms: [Symptoms reported, or none]
• Motivation (0-10): [Rating] / Confidence (0-10): [Rating]
• Primary barriers: [Key obstacles identified]
• Upcoming high-risk situations: [Situations identified, or none] (Include only if discussed.)

Interventions

(Document only counseling and techniques provided this session. Do not include interventions not performed.)

• Behavioral counseling provided: [Trigger management, coping skills taught, stimulus control recommendations, relapse prevention, motivational enhancement as delivered]
• Hypnosis: [performed / not performed] (If not performed, briefly state reason.)
• Induction method: [progressive relaxation / focused attention / imagery-based / other] (Include only if hypnosis performed.)
• Suggestion themes/targets: [Craving reduction, non-smoker identity, stress response, trigger management, post-hypnotic coping cues as addressed] (Include only if hypnosis performed.)
• Patient response during hypnosis: [Observable indicators of engagement, depth, comfort] (Include only if hypnosis performed.)
• Self-reported experience: [Patient's description of sensations, imagery, perceived effectiveness] (Include only if hypnosis performed.)
• Reorientation confirmed: [yes / not applicable]

Assessment

(Clinician synthesis only; do not introduce new patient-reported data here.)

[improved / stable / worsened] — [Summary of trend in tobacco use, craving control, coping skill effectiveness, and adherence to home practice]. [Key maintaining factors]. [Prognosis: good / fair / guarded]. [Patient alert and able to participate, or concerns noted].

Plan

• Quit plan next steps: [Specific targets and timeframes]
• Home practice: [Self-hypnosis or audio recording instructions; coping skills to practice; troubleshooting guidance] (If declined, document rationale and alternate plan.)
• Medication/NRT: [Initiate, continue, adjust, or coordinate with prescriber] (Include only if applicable.)
• Follow-up: [Next session date or timeframe]
• Contingency plan: [Instructions for escalating cravings or relapse]