Session Mode and MSE
Learn how to use Session Mode and Mental State Examination (MSE) to document clinical observations for each session.
What are Session Mode and MSE?
Session Mode and MSE (Mental State Examination) are clinical documentation tools that help therapists track the nature of each session and the client's observable mental state. This data supports treatment planning, progress monitoring, and clinical reporting.
Where Can You Use Them?
Session Detail
Open any session to find Session Mode and MSE cards. Click to select options.
Client Flow
In the client detail page, use the client flow timeline to quickly update modes and states for multiple sessions.
Session Mode
Session Mode categorizes your therapy session from multiple therapeutic perspectives. You can select up to 3 modes per session.
Process-Oriented
Describes how the session unfolded.
Productive
Session goals were met, concrete progress was made, and the flow was smooth.
Challenging
Difficult topics were addressed, or resistance/intense emotional challenges were encountered, but these were an important part of the process.
Routine
A standard follow-up, assessment, or progress review session that was calmer in nature.
Structuring
The session was focused on setting goals, creating a treatment plan, or structuring future steps.
Termination
The session focused on the closure process, reviewing overall progress, and preparing for the end of therapy.
Content & Emotion
Describes what was discussed and experienced.
Breakthrough
A significant insight, awareness, or 'aha!' moment occurred for the client or therapist that could change the direction of the therapy process.
Emotional
The session involved intense emotional release, catharsis, or moments where the client was very emotionally open.
Exploratory
The session was focused on exploring new themes, hypotheses, and possibilities rather than reaching a specific conclusion.
Psychoeducation
The session was focused on providing information to the client about a specific topic, model, or theory.
Skill Building
The session was focused on actively practicing coping strategies, techniques, or behavioral exercises.
Crisis
The session was focused on intervening in an urgent crisis situation or creating a safety plan.
Therapeutic Alliance
Describes the nature of the client-therapist relationship.
Collaborative
There was a strong collaboration and harmony between the client and therapist. The therapeutic alliance felt strong.
Resistant
The client showed resistance in the process, had difficulty exploring topics, or was distant towards the therapeutic work.
Alliance Repair
The session focused on addressing ruptures, conflicts, or meta-communication about the therapeutic relationship itself.
Mental State (MSE)
Mental State captures the client's observable mental and emotional state during the session. Unlike session modes, you can select multiple mental states without limit.
Primary State
Dominant emotional mood observed
Euthymic (Calm, Balanced)
LowMood in the normal range; calm, balanced. Neither depressed nor elevated.
Dysphoric (Sad, Depressed)
CriticalAppearance of being sad, gloomy, depressed, mournful, tearful, or hopeless.
Anxious (Worried, Tense)
HighWorried, tense, anxious, fearful, or in a state of panic.
Irritable (Tense, Hostile)
HighTense, easily annoyed, impatient, agitated, or hostile.
Elevated (Euphoric)
MediumOverly cheerful, euphoric, with a noticeably increased energy level (inappropriate for the situation).
Quality of Affect
Nature of emotional expression
Restricted (Flat Affect)
MediumSignificant reduction in the intensity or variety of emotional expression. Responses are diminished or expressionless.
Labile (Rapid Shifts)
HighSudden, rapid, and intense shifts in affect (e.g., quickly starting to cry, sudden anger).
Incongruent (Mismatched)
HighThe observed emotional expression does not match the content being discussed.
Interactive Demo
Click on the options below to see how selection works. Session modes are limited to 3, mental states have no limit.
Session Mode
2 of 3Mental State (MSE)
1 SelectedBest Practices
Document After Each Session
Update session mode and MSE immediately after the session while observations are fresh.
Be Consistent
Use the same criteria for selecting modes and states across all sessions for reliable tracking.
Use Client Flow for Review
The client flow timeline provides a quick overview of patterns across multiple sessions.
Consider Treatment Goals
Session modes should align with your treatment plan objectives.