I am a counselor by trade
My raw notes (not progress notes, but like the actual notes I take when talking to someone) are overwhelmingly like this:
Doing well, week was okay - recording response to “hey, how’s it going, how’s your week, how’s your mood?”
Then immediately something like:
Actually doing terribly. Work is stressful. Conflict with family. Experiencing insomnia. GI issues. Procrastinating a lot and doomscrolling instead of doing work. Etc
There’s this social pragmatic language we go through. The script of what we say to everyone that is completely dishonest but we say it as a colloquial greeting. Even if you are actually doing great you don’t generally expand on why. You just say the same thing you always do because no one actually wants to hear about it. Once that’s out of the way then we can get to the actual thing because therapy and doctors visits are some of the contexts where someone is actually there to hear you out (for money, to be fair)