Should I keep one chart or two charts for a couple?

This depends on your setting, your state's laws, and your agency's policies. There are two common approaches: (1) A single couple/relational chart where the 'client' is the relationship, with one shared record. This is the most common approach in private practice couples therapy. (2) Two individual charts, each with separate documentation. This is more common when one or both partners also receive individual therapy from you or when your EHR requires individual records. Whichever approach you use, establish it at the outset of treatment and be consistent. If using a single chart, clarify in your informed consent that both partners have equal access to the record.

What CPT code should I use for couples therapy?

The primary CPT code for couples therapy is 90847 (family psychotherapy with patient present, 50 minutes). This code is used when both partners are present and the focus is on the relational dynamic. If you see one partner individually to address their own clinical issues in the context of the relationship, use 90834 (individual psychotherapy, 45 minutes) or 90837 (individual psychotherapy, 53+ minutes). Do not bill 90847 and an individual code for the same session. Note that 90847 requires a diagnosed client — the relationship itself is not a billable diagnosis under most payers.

What if one partner tells me something in confidence?

This is one of the most common ethical dilemmas in couples therapy. The best practice is to establish a clear 'no secrets' policy at the outset of treatment and include it in your informed consent. Under a no-secrets policy, you inform both partners that any information shared individually (including in individual sessions, phone calls, or emails) may be brought into couples sessions if clinically relevant. If you learn of information that you cannot ethically keep secret (e.g., an undisclosed affair), but the disclosing partner refuses to share it in session, you may need to terminate couples therapy. Document your confidentiality policy in the intake paperwork and reference it in your notes when relevant.

How do I document couples therapy without taking sides?

Use balanced, observational language that describes both partners' behavior and contributions to the dynamic without assigning blame. Instead of 'Partner A was hostile and dismissive,' write 'Partner A's communication style during the session included raised voice and interrupting, which Partner B responded to with withdrawal and silence.' Document patterns and dynamics rather than labeling one partner as the problem. When quoting, include statements from both partners. Your assessment should focus on relational patterns, not individual pathology, unless you are treating a diagnosed condition in one partner.

Can both partners request copies of the couples therapy record?

Generally, yes — both partners have a right to access the shared couples therapy record. This is why it is critical to write notes with the awareness that both individuals may read them. Avoid language that could be perceived as biased toward one partner. If your state has specific laws about access to psychotherapy records in the context of divorce or custody proceedings, consult your state licensing board or a healthcare attorney. Document your records access policy in the informed consent at the start of treatment.

Couples Therapy Notes: How to Document Dual-Client Sessions

Progress Notes|10 min read|Updated 2026-03-19|Clinically reviewed

What Are Couples Therapy Notes?

Couples therapy notes document clinical services provided to two individuals who are in a romantic or committed relationship and are being treated together to address relational concerns. These notes carry unique documentation challenges that do not arise in individual therapy: two clients with potentially different perspectives, confidentiality boundaries that span two people, billing codes specific to relational treatment, and the need to document dyadic patterns without appearing to favor one partner over the other.

The fundamental tension in couples therapy documentation is that you are treating a relationship — an entity that does not have its own diagnosis code, its own chart, or its own insurance card. Yet most billing systems, EHRs, and legal frameworks are built around the individual. This means couples therapists must navigate a documentation landscape that was not designed for their work, making thoughtful record-keeping especially important.

Whether you practice Gottman Method, Emotionally Focused Therapy (EFT), the Developmental Model, or an integrative approach, your notes must accomplish the same core objectives: demonstrate medical necessity, document interventions and response, track progress toward treatment goals, protect both clients' rights, and create a legally defensible record.

When You Need It

After every couples therapy session, whether both partners or one partner is present
When billing CPT 90847 (family psychotherapy with patient present)
When one or both partners are also in individual therapy with you or another provider, and you need to maintain clear boundaries between records
When couples are involved in legal proceedings (divorce, custody) where therapy records may be subpoenaed
When treatment involves sensitive disclosures (affairs, substance use, domestic violence) that require careful documentation
When transitioning a couple from couples therapy to individual therapy or vice versa

Key Components

Identifying Information and Session Structure

Date, duration, and CPT code (90847 for conjoint sessions)
Both partners identified (by initials or first names, per your practice's convention)
Whether both partners were present for the entire session
If an individual session occurred within the context of couples treatment, note this clearly

Relational Presentation

Unlike individual notes that document one person's affect and behavior, couples notes must capture the relational dynamic — how the partners interact with each other in session.

Include:

Each partner's affect and presentation
Communication patterns observed (pursuer-withdrawer, escalation, stonewalling, etc.)
Quality of interaction (collaborative, hostile, disengaged, mixed)
Significant shifts in the dynamic during the session
Both partners' reports of the relationship since the last session

Interventions and Relational Response

Include:

Specific couples therapy techniques used (Gottman interventions, EFT tango, communication skills training, etc.)
How each partner responded to the intervention
Shifts in the relational dynamic during or after the intervention
Psychoeducation provided and its relevance to the couple's treatment goals
Any individual-level interventions used within the couples context

Assessment — Relational Focus

Include:

Progress toward relational treatment goals
Patterns identified or reinforced during the session
Changes in relational functioning since treatment began
Risk factors (domestic violence screening, safety concerns)
Diagnosis for the identified patient (if billing requires one)

Billing Considerations: 90847 vs 90834

CPT 90847 — Family psychotherapy, conjoint, with patient present (50 min):

Used when both partners are present and the focus is on relational dynamics
Requires a diagnosed "identified patient" for most payers — the relationship itself is not a billable diagnosis
Common diagnoses: Adjustment Disorder (F43.2x), Major Depressive Disorder, Generalized Anxiety Disorder, or other conditions exacerbated by relational distress
Some payers do not cover 90847 — verify benefits before beginning treatment

CPT 90834/90837 — Individual psychotherapy (45 or 53+ min):

Used when you see one partner alone to address their individual clinical issues
Must be documented as an individual session in that partner's record
Cannot be billed on the same day as 90847 for the same client

Important: Never bill 90847 as two units of 90834. Couples therapy is one service delivered to two people — not two individual sessions happening in the same room.

Filled-In Couples Therapy Note Example

Couples Therapy Note — Gottman Method Session

Presenting Concerns This Session: Couple reports a "difficult week" following a conflict about division of household responsibilities. R.S. states, "I feel like I'm doing everything and it doesn't matter how many times I bring it up." L.S. states, "Every time I try to help, I get told I'm doing it wrong, so I just stop trying." Both partners report decreased positive interactions over the past week. No positive rituals of connection (date nights, check-ins) were completed from the previous session's homework.

Relational Presentation: R.S. presented with frustrated affect, arms crossed, speaking rapidly and directing complaints to the therapist rather than to L.S. L.S. presented with flat affect, leaning away from R.S., providing brief responses, and intermittently checking phone until asked to put it away. Communication pattern observed: R.S. in a critical-pursuer role, leading with complaints and "you always/you never" statements. L.S. in a stonewalling-withdrawer role, disengaging through silence and device use. The Gottman "Four Horsemen" pattern was evident — criticism (R.S.) and stonewalling (L.S.) were the dominant negative patterns, consistent with previous sessions. No contempt or defensiveness escalation observed today.

Interventions:

Four Horsemen psychoeducation (review): Revisited the criticism-stonewalling cycle with the couple, using today's in-session interaction as a live example. Both partners were able to identify their respective roles in the pattern when prompted.
Softened startup training: Coached R.S. in converting the critical statement "You never help with anything around the house" into a softened startup using the Gottman formula (I feel ___ about ___ and I need ___). R.S. practiced: "I feel overwhelmed when I'm handling the household tasks alone, and I need us to create a plan together."
Physiological self-soothing: Noted L.S.'s elevated autonomic arousal (shallow breathing, gaze aversion) during the conflict discussion. Introduced a brief self-soothing pause — guided both partners through 2 minutes of paced breathing before continuing the conversation. L.S. reported feeling "less like I need to shut down" after the exercise.
Dreams within conflict exploration: Explored the underlying meanings each partner attached to the household responsibilities conflict. R.S. connected the issue to a core need for partnership and equity rooted in family-of-origin experiences. L.S. connected their withdrawal to a childhood pattern of being criticized by a parent regardless of effort.

Response: R.S. was initially resistant to the softened startup exercise ("But I am upset — why do I have to sugarcoat it?") but engaged after psychoeducation about the difference between expressing legitimate needs and leading with criticism. After practicing, R.S. stated, "That actually feels less exhausting than being angry about it." L.S. visibly relaxed during the self-soothing exercise and made more eye contact with R.S. in the second half of the session. During the dreams within conflict exploration, both partners demonstrated increased empathy — L.S. stated, "I didn't know it was about feeling like you're in this alone. That's not what I want." R.S. responded with softened affect: "And I didn't realize I was doing the same thing your mom did." This was the most emotionally connected moment observed in treatment to date.

Assessment: The couple continues to default to the criticism-stonewalling cycle under stress, consistent with treatment plan goals. However, today's session demonstrated meaningful progress: both partners were able to identify their roles in the negative cycle, R.S. practiced and endorsed the softened startup technique, and the dreams within conflict exploration produced the first observed moment of genuine empathy and emotional connection in treatment. The couple's homework non-completion suggests that between-session skill application remains a barrier. Identified patient R.S. continues to meet criteria for Adjustment Disorder with mixed anxiety and depressed mood — relational distress is the primary stressor. No domestic violence indicators observed. Both partners denied safety concerns.

Plan:

Continue weekly conjoint couples therapy (Gottman Method)
Homework: R.S. to practice one softened startup per day when expressing a need (written formula card provided)
Homework: L.S. to practice self-soothing pause when noticing the urge to withdraw — use the paced breathing technique before disengaging
Both partners to complete one daily stress-reducing conversation (Gottman "How was your day?" ritual) for at least 20 minutes
Next session will continue dreams within conflict work and introduce the Gottman compromise exercise for the household responsibilities issue
Next session: 03/20/2026 at 4:00 PM

This is a sample for educational purposes only — not real patient data.

How to Write Couples Therapy Notes Step by Step

Step 1: Document both partners' perspectives. Start by recording what each partner reported about the week and the presenting issue. Use balanced language and give roughly equal space to each person's experience. If one partner dominated the session, note that as a clinical observation rather than simply reflecting their perspective more heavily.

Step 2: Describe the relational dynamic, not just individual behavior. Instead of listing each partner's behavior separately, describe the interactional pattern. "R.S. expressed frustration through criticism, which L.S. responded to with withdrawal, creating an escalating pursue-withdraw cycle" is more clinically useful than separate behavioral descriptions.

Step 3: Document interventions with specificity. Name the couples therapy techniques you used. "Gottman softened startup training" or "EFT Stage 1 de-escalation" communicates more than "communication skills work." Connect each intervention to the relational pattern you were targeting.

Step 4: Capture both partners' responses. Note how each partner responded to your interventions — individually and in relation to each other. The most clinically significant moments in couples therapy are often shifts in the relational dynamic, so document those explicitly.

Step 5: Write your assessment about the relationship. Your clinical assessment should focus on relational patterns, progress toward relational goals, and the couple's functioning — not an evaluation of which partner is doing better. If you are treating an identified patient's diagnosis, connect the relational dynamics to that individual's clinical presentation.

Step 6: Review for bias before finalizing. Read your note as if each partner were reading it. Would either person feel that you took the other's side? If so, revise. Both partners may access this record, and perceived bias can damage the therapeutic alliance and create legal complications.

Common Mistakes

Taking sides in the documentation. Notes that consistently frame one partner as the problem and the other as the victim will damage trust if read by either party and may be used against you in legal proceedings. Document patterns and dynamics, not blame.
Using the wrong billing code. Billing two units of 90834 for a conjoint session is incorrect and may constitute fraud. Use 90847 for conjoint sessions where the relational dynamic is the focus. If you see one partner individually, bill and document it as an individual session.
Not establishing a confidentiality policy upfront. If you have not clarified your no-secrets policy in writing before treatment begins, you may find yourself in an impossible ethical position when one partner discloses information privately. Document your confidentiality policy in the informed consent and reference it in your notes when relevant.
Documenting session content as a he-said-she-said transcript. Your note is not a play-by-play of the argument. Document clinically relevant themes, patterns, and interventions — not who said what to whom in chronological order. Focus on the clinical significance of the interaction, not the narrative.
Neglecting domestic violence screening. Couples therapy is contraindicated when active domestic violence is present. Document your ongoing assessment for safety, including any indicators you screen for and any direct questions asked. If DV indicators emerge, document your clinical decision-making about whether to continue, modify, or terminate couples treatment.