A Therapist's #1 Secret Productivity Killer

I talk with a lot of therapists who have trouble keeping up with notes. Yet, when we actually sit down to write notes together it only takes about five minutes to write one note (on average). 

Even if you see 20 clients a week, that's only an hour and 40 minutes every week to keep up with notes. If we assume a 40 hour work week, that still leaves more than 18 hours each week for all the extra administrative stuff you do (answering phone calls, marketing, billing, networking, etc.). This makes paperwork, and particularly notes, seem like a really small portion of the weekly workload, right? Especially when we consider how important your notes are for your business. 

So if it's not the time it takes to write notes themselves that's causing the problem, what is?

I've seen one problem come up over and over again... Not ending your sessions on time

Yup, this one thing is so easy to do but it eats up hours worth of productivity. Don't believe me? Let me count the ways, my friend...

Ending sessions late eats into the time you need to care for yourself. When you have clients scheduled back to back and you're not able to take some time to center yourself in between you feel more exhausted at the end of your day. It's go, go, go until the last client leaves. By the end of a day like that, the last thing you want to do is stay in your office and finish notes before heading home.

Even more practically, you may simply be hungry or tired and need to head home because it's dinner time, bedtime, take the kids to swimming lessons time, etc. 

One solution to this problem? Schedule yourself a 30 minute break in the middle of back to back sessions. Decide how best to use this time, whether it's for a walk around the block, taking a nap, grabbing a bite to eat or even catching up on a few notes. 

Now let me say that I do think it's okay to write your notes the next day. If I see clients until 8pm at night, that's what I'm doing! But the moment we put off that task we increase the likelihood that it will get pushed back even further (woops, forgot about that appointment tomorrow morning and then the kid's school thing!) and also that it will be of poorer quality whenever it does get done.

And guess what? It takes longer to write notes when you have to try and recall what actually happened in the session. I know I'm not the only one who has sat in front of a computer screen trying to remember what in the heck was that big thing I talked about in my session at 4pm two days ago. Now, a task that could take five minutes is taking fifteen minutes. And there are 10 more notes to do. 

Ending sessions late also eats into time you could spend on small tasks. One good thing about all of us being on our phones all the time is that you can actually be productive while doing things like waiting in line or sitting in the waiting room at a doctor's office.

Let's say you feel great in between sessions and don't really feel the need to center yourself, go to the bathroom or grab a quick snack. If you see 4 clients in a row and do 50 minute sessions, that's 30 minutes in between you can use to call someone back, confirm an appointment, briefly answer an email... Or even write a progress note!

By contrast, those extra 5-10 minutes you're providing your clients by going over in session aren't likely making a huge overall impact. Of course, there are always exceptions and the occasional session will go over but when this becomes a regular practice, it really takes up your time.

My whole point with using the phrase "meaningful documentation" over and over again is that your paperwork needs to suit your (and ultimately, your client's) needs. Same with your policies and procedures.

If you know you won't be ending sessions on time and don't want the stress, then own it. Plan around it. Use the 30 minute break strategy above. Schedule chunks of time to write your notes when you won't feel stressed about other things. Do what works for you to get the work done well. 

And if you feel like a little help with the technical part of writing is what you need to save yourself some time, check out my free Private Practice Paperwork Crash Course. In that course, I share strategies for simplifying your documentation and identifying templates that work best for you... another great time-saver. 

Like the tips in this blog post? This blog is part of the compiled tips in the ebook Workflow Therapy: Time Management and Simple Systems for Counselors. 

Feeling Stuck With a Client? 3 Ways Your Documentation Can Save the Day

We've all been there. That moment in session where you realize you've had this same discussion with your client before and it ended up nowhere. That moment you see a family or couple bringing up exactly what they seemed to have already worked through. That moment you find yourself searching in your mental toolbox but come up empty-handed.

That moment where you have nothing to say and are having difficulty finding hope in the situation yourself.

While these situations are uncomfortable and often disconcerting, they hold huge potential for growth and change. But as with most obstacles that seem like a 12 foot wall, these situations usually require a different strategy in order to overcome.

What's the awesome strategy I have for you in these difficult clinical situations?

Do a review of your client's file.

Before you stop reading, let me explain!

Usually when you come across these clinical scenarios it's after you've done some work with your client. These situations don't typically pop up in week one or two because you're getting to know your clients, they're motivated to change and your plethora of clinical tools are at your disposal. 

But for those times when it's months later and your toolbox hasn't proved as helpful as it normally is, this little trick can be a game changer. 

Because now you are looking at your client with different, more experienced eyes. 

Have you ever had a situation happen where things weren't making sense and then someone offered you some insight... and when you looked back on things you realized all the signs were there early on but you just couldn't see them yet? That's what your documentation can do for you, offer that critical insight.

1. Go back to the very beginning.

Look at your client's intake paperwork. How did they present when they first came in? What did they identify as their main problem? Did they identify goals? 

Also notice if anything seems missing. Perhaps their original paperwork denied substance abuse but you discovered otherwise later on. Perhaps they noted a happy family situation but have talked about nothing but being unhappy in their marriage for the last three months.

Is there anything that pops out at you as unusual or noteworthy now that you know client more? If so, perhaps there is something you can bring up in your next session to change the cycle of repetition or feeling stuck.

2. Evaluate your treatment plan.

Do you have a treatment plan with your client? If not, this is a great time to start one! Talk about their goals, ways in which they feel they have progressed and what they would like to see happen in the future. 

And whether or not you already have a treatment plan, this is a great time to ask about how counseling is going. Do your clients feel things are going well? Does it feel like anything is missing?

If you've already got a treatment plan going, bring that out in session to check in. Are you both on track? Does this plan still make sense? Are there things either of you could be doing differently to help achieve these goals?

Make it a conversation but don't be scared to actually have a treatment plan written out and share it with your clients. This is where the paperwork can be a great catalyst for insight.

3. Review your notes from day one.

Lastly, start with the very first note in your client's file and read through chronologically. What stands out to you? What progress has been made? 

Any topics you find coming up again and again? What were the plans related to those topics? Was there follow through on any homework or plans?

Try to be as open in this process as possible. There may be something that jumps out at you right away that you've never noticed before. There may also be behavior you realize you're enabling or something clinical you realize you've missed and should address.

Really focus on conceptualizing your client's case and how to best meet their needs. This will certainly bring up questions or ideas you can address with them in the next session.

"But Maelisa, I did this and realize my notes are so minimal they don't really give me much information."

That's okay! First, take that as valuable information and adjust your note writing a bit (from now on) to include a tad more detail. Second, ask your client to help you fill in any gaps! Not literally on paper, but start your next session with an overview.

Ask your client about any sessions they found particularly meaningful or any times they felt resistant to things you discussed. Perhaps you can create a "best of" list or a "most helpful" and "least helpful" list. This is a non-threatening way to talk openly about what works and what doesn't and to review treatment overall.

If you're feeling stuck with a client and try this technique out, let us know in the comments below! And if you want more help on using your documentation as a clinical tool, check out my upcoming workshops (inside the Meaningful Documentation Academy) or try using my paperwork packet. Sometimes it takes a little trial and error so be kind to yourself but keep at it. Your clients will thank you. 

What I Learned (about paperwork) from the Road to Success Summit

I had such a great time putting on the Road to Success Summit in June and I learned soooo much from all the experts I interviewed. It was pretty cool to do the interviewing because that means I aaaalllll the content!

I knew the Summit would be helpful for therapists in private practice and my goal was to cover as many different areas as possible. But there was one thing quite obviously missing... a lesson on paperwork!

So, I thought I'd take this opportunity to highlight how your documentation relates to everything in your private practice. And if you're interested in an opportunity join the LIVE version of the Summit, click here to find out more.

Below are the lessons I learned from all the experts who participated, and how it relates to your paperwork:

Casey Truffo and being the CEO of your private practice

-Casey dropped some major knowledge bombs about business in general and has such an easy way of explaining things. The big thing I got related to paperwork was to outline everything you do. Take the time to write out your process so you can later improve, refine and duplicate when needed.

Kelly Higdon and integrating coaching into your practice

-Kelly talked about the differences between coaching and therapy. One of the big differences was the intention behind the service you plan to provide. You might actually be working on the same area (stress at work, for example) but choosing a different way to focus together. And that means, your paperwork will look different! Kelly pointed out that with her coaching clients she actually takes notes during the session and sends them the notes. I do this with my individual consultations as well. We cover a lot so this way the client can stay focused!

Keri Nola and using your intuition in your private practice

-Keri and I talked a lot about the finer nuances of using your intuition in every part of your practice. I think this applies to your paperwork, as well. Don't just include things because you feel you have to, think about how you'd like to write. Never seen something in someone's intake packet but feel led to include it? Then do so! Listen to your heart as well as your ethical guidelines.

Jo Muirhead and creating a successful money mindset

-Money was the topic of Jo's interview and we discussed a lot of the ways we misperceive things and sabotage ourselves by often avoiding the topic. I see a lot of therapists uncomfortable with money and that impacts client care. Because if you're not able to create a clear plan and decide how much you need to charge to sustain your practice, you'll end up reducing your rates out of fear (and often telling yourself it's really out of client need). However, if you have a clear plan that's represented in your policies then that frees you up to provide pro bono or discounted services to those who need it without feeling resentful

Camille McDaniel and adding clinicians to your practice

-Camille brought up some excellent points about hiring and planning ahead. One of things this highlights is being really clear about the conditions of employment ahead of time and also very clearly outlining any conditions of subletting your space. One example she brought up was making sure her subletter's clientele was similar to her own so there weren't potentially awkward situations in the waiting room. 

Rajani Venkatraman Levis and building your practice through community, not competition

-Rajani is one of my favorite people on the planet. That has nothing to do with paperwork but I just want you know how awesome she is. Anyway, Rajani talked about the power of reaching out to others for support, without worrying about whether or not they might be your "competition." It's so crucial to have regular access to some clinicians whose opinions you value so that you can receive feedback when needed. Changing your forms or not sure how to write something up? Call someone you trust so you can talk it through!

Roy Huggins and using technology to serve your clients

-If you know Roy, then you were not surprised that this interview was packed full of extremely useful info! He talked about how the internet actually works and why that means it's our job as a counselor/therapist to review with our clients any risks with technology. Make sure you have a statement in your informed consent about those risks and then document reviewing them with your clients.

Melvin Varghese and starting a podcast 

-Melvin shared some very practical steps for how to start a podcast, as well as the tools he uses for his own successful podcast. He also talked about monetizing his podcast recently and how valuable it has been for creating authority and networking with other professionals. How does this relate to paperwork? Well, do you have a place for clients to write down where they found you? This will help you to gear your marketing efforts toward what is working best. And maybe, that's a podcast!

Ernesto Segismundo and using video to promote your practice

-Okay, I'll be honest, it's difficult to tie this interview into a documentation lesson. But you know what? I think Ernesto really highlighted why video is such a powerful tool. What if you had a video on your website explaining your intake process, rather than just telling people to download forms? The more interactive and personalized you can make things, the more your clients will appreciate that effort. And boy, will it make you stand out as going the extra mile!

Kat Love and creating a beautiful website

-Kat shared insight into how to create a website that is appealing your clients. This is huge because you're competing with all sorts of distractions online. Since my focus is on making your documentation meaningful to both you and your clients, this really begins with your website copy and presence. Make sure everything flows together smoothly. Use a lot of casual language and pretty colors on your website but then have very stoic sounding forms that are all black and white? That's a mismatch! So continue your branding from website to forms to service.

Clay Cockrell and providing counseling online

-Clay provides counseling online and also runs a directory for other therapists who provide online services. Since this whole online counseling thing is so easy for him, he shared sooooo many resources and tips! One big tip? Create a plan for what you'll do when technology fails, because it will at some point. If you're providing counseling online, include this in your informed consent form or create a separate document that explains what you'll both do (for example, will you call the client or should they call you?). This can decrease any stress that may occur, for both you and your clients.

Barbara Griswold and responding to insurance inquiries

-In Barbara's interview we talked about dealing with insurance companies and she shared a lot of the mistakes she sees therapists make. One of the big things is thinking they don't need to worry about insurance ever seeing their paperwork. Although it's not super common for insurance companies to audit your files, it does happen. And the way in which you document can impact whether or not your client's services will be rejected. So, even if you're just providing a super bill, make sure you're well informed about what's needed.

Samara Stone and building a practice based on insurance

-Samara talked about why it's important for her to have a large practice that bills insurance and also shared some of the mistakes she made early on when using insurance. One of the biggest mistakes was being unfamiliar with the billing process. Once she decided to suck it up and learn what was needed she was able to make sure billing was going smoothly. And, that allowed her to know the right person to hire when she needed to outsource that task because of the time it was taking. 

Nicol Stolar-Peterson and creating a court policy

-In Nicol's interview I tried to start off with "what do we do when we get a subpoena?" and Nicol let me know we had to back up first! Why? Because responding to legal requests and whether or not you get paid to do so is all about what you have in your court policy. So make sure you've outlined that ahead of time and don't get caught losing money while waiting around in the courthouse just to assert privilege. 

Agnes Wainman and identifying your ideal client

-Agnes talked about why it's important to identify an ideal client and then actually walked me through some exercises to do that. But marketing isn't where this stops. Make your intake paperwork speak to your clients, as well. Continue that relationship from whatever made them call you to them completing their forms and walking in your door to the two of you working together. If your forms are personalized to their needs, they'll immediately feel a sense of relief for taking the step and reaching out to you. 

Allison Puryear and networking your way to success

-Allison and I talked about how you can choose networking strategies that are specific to your personality and work with your strengths. Wondering what to talk about when you meet with other therapists for networking? Ask them what type of notes template they use! Trust me, most counselors are actually interested to talk about it because they're dying to hear what you do, too!!

Stephanie Adams and creating systems that sustain your practice

-And we're back to where we started... with systems! Stephanie focused on the ways in which creating systems for her practice has saved her time and stress. One of the first systems I recommend you automate and really spell out is your intake system. How do you give clients info in the beginning, how do they sign and read forms, how do they pay you, will you remind them of their first appointment and when, etc. Writing this all out will save you a lot of stress in the long run.

If you didn't get a chance to watch all the interviews, then check out the interviewees who sound the most useful to you. They ALL have great resources to be used at different points in your practice.

Also, make sure you're signed up for my weekly newsletter so you never miss info on awesome stuff like this! I've got a few things planned coming up, including some live workshops across the U.S. You won't want to miss it!

How to Start a Consultation Group

We're finishing up this "How To" series with something that can help you for the life of your career, starting a consultation group. 

Now, obviously I'm going to put a documentation spin on things (because that's why you're reading my blog!) but I've also got tips that apply to any clinical consultation group.

Not only am I the Documentation Diva but I'm also a supervisor and trainer. So I've collected some pretty awesome strategies for stretching your clinical muscles over the years. 

Getting the Group Started

There are two main ways to get your group started from scratch. The method you choose will likely depend on the purpose of your group and your particular clinical needs. First, identify what those are by answering these questions:

"What is our main purpose and our long-term vision?"

"Would various levels of experience work well with this group?"

"Are we focused on similar clientele, modalities or are we open to all types of treatment and specialties?"

"How many people would work well in this group and what is the limit?"

Now you have a place to start and can focus on one of the two main options below. But remember, a consultation group doesn't have to be limited geographically. You have many options for doing this group with others across the country (or the world!). Don't limit yourself.

  1. Start with a group of people you trust. Maybe you have a few colleagues that are already in the back of your mind as awesome people you trust and would love to meet with more officially. Easy, just shoot them an email or give them a call with your idea and bam! Consult group started!!
  2. Start with a topic of interest. Perhaps you don't have clear people in mind or are interested in focusing on something specific. In this case, you can reach out to a listserv, Facebook group or LinkedIn group to see who is also interested in your topic. If you go this route you'll want to have clear guidelines set up already so you can gauge who will be a good fit and try things out for a time. 

Now that your group is ready to go, I've got some ideas for what to actually do when you meet.  

Activities for Your Group

Below are 10 different activities for your new (or existing) consultation group. So if you decide to meet once a month you've got almost a year covered!

Identify the purpose of the group and the format. Your first meeting should clearly outline what is expected of everyone. You want to think about things like confidentiality, handling conflict, attendance expectations, method for accepting new members, who will take the lead and for how long, and how often you'll check in to see if the group is still meeting everyone's needs.

Do mock therapy sessions with one another, especially if you're focused on a particular modality or clientele. Remember how terrifying this was in grad school? Because we didn't know what the heck we were doing! It's just as important to do as we become more experienced. And it's a great way to get feedback on your own clinical style as well as pick up some new tips.

Write notes as a group. You can either do a mock therapy session and write notes based on that or someone in the group can describe a situation about which to write notes. I recommend you take 5-10 minutes for everyone to write individually and then (be brave) and share together. It's awesome to see the different styles but I guarantee you'll also be surprised to hear how similar the notes are... you just don't know because you never read anyone else's notes!

Present ethical dilemmas... like, your absolute scariest scenarios (or even the boring ones that happen all the time, like clients texting even when you told them not to). Maybe it's a story you read or heard from a colleague, maybe it's something that actually happened to you. The cool thing about ethical dilemmas is there's no black and white answer. And that's often where we find ourselves, walking in the grey areas. So bring it up and see what your colleagues are thinking!

Have an "intake day" where everyone brings in their intake forms and shares strategies with one another. You can pass the paper forms around and make comments for others while also taking some notes for yourself on ways to improve your own forms.

Train one another. Did someone just attend a really great conference? Maybe they can summarize some of the greater points in a handout or presentation. Have a topic you'd love to learn more about? Put something together and share it with the group.

Identify your clinical week. Have everyone share what their week looks like. You'd be amazed to hear the variety in schedules we all have. Perhaps you'll get an awesome tip from a colleague like Mari Lee, who takes every fifth week off from sessions.

Write a business plan. Many therapists have heard about business plans but feel intimidated actually writing one up. So do it together! Download a sample online and help one another through it. Share ideas and explain your plans to one another to get feedback. (You can read a great article on creating a business plan here)

Practice initial client phone calls. Similar to the mock therapy sessions, pretend to be an interested client and see how everyone does their initial screening calls. 

Watch a webinar or other training together and then discuss how it applies to you. I do monthly webinars and also have tons of trainings available if you're on my email list but you can also check out other things on topics of interest to your specific group.

Now the only thing left to do is to get out there and get started! Make sure you drop back over here to let us know how it's going. 

Looking for a little more structure and need help with your documentation? Check out my Meaningful Documentation Academy! This is the only time we're open for enrollment in 2016.

3 Ways to Use Facebook Groups to Improve Your Documentation

News flash: Facebook groups are NOT consultation groups! However, they can be useful when used the right way. In this video I've got some tips on how you can ethically use the hundreds of therapists virtually available for feedback in your Facebook groups. Click below to check it out...

Not getting the QA Prep newsletter yet? Sign up today so you get my free video trainings each month, notices about helpful resources and also the free Private Practice Paperwork Crash Course! See you in your inbox.

Documenting Consults: Protecting Your Assets

I've had a few therapists ask me recently about how to document a consultation with other psychotherapists. "When do I need to do it?" "What should I include?" "Where does the note go?"

My biggest piece of advice is first, to actually DO it! Many counselors in private practice don't think about how this simple task could save lots of trouble down the line. It doesn't have to be intense or scary (we'll get into that below), but it can be super helpful. 

So, let's get into the What, When, Why and Where of writing a consultation note...

Why

Documenting consultations with other professionals serves a few purposes. Firstly, it proves that you took action to be ethical. Some ethical concern came up and you took the appropriate action. Without documentation, how can your prove that happened? Answer: You can't!

It also helps you clinically. It's impossible to remember everything that goes on with your clients or even with your professional growth. However, if a situation ever comes up a second time, you now have a previous decision documented. You can go back and review without relying on your unfortunately, very fallible memory.

When

I recommend documenting a consultation with a colleague any time the issue is impacting the clinical work or any time it's an ethical concern. You may be part of a regular consultation group and do case presentations. It's not necessary to document each of those instances... unless it meets criteria A or B above.

There are times when ethical dilemmas arise in the moment and you don't have time to consult before you need to take action. These situations are also an excellent opportunity for consultation. Discuss the possible actions you could have taken and get feedback on how to proceed from that point on.

What

Now we're digging in... what in the world do you include?! If you only take away one thing from this post, focus on this word- rationale. The purpose of a consultation is really to document the discussion around the rationale for your decision. 

Include who you talked with and which ethical principles apply. Identify why you needed this consultation. Describe the action you will take and more importantly, the reason for your decision.

Maybe your client shared a significant issue in the last session and it's an area in which you're totally unfamiliar so you consult with a colleague to determine if you need to refer out to a specialist, continue treatment with supervision, or simply review some resources.

Perhaps your client presented you with a pricey gift (let's go with... a Caribbean cruise) and you graciously did NOT accept. Your client seemed miffed and you'd like to consult on how to proceed at this point because you have not had this experience before.

Or maybe your client is requesting ALL of their treatment notes out of the blue. You feel this could be harmful for them and want to be prepared when talking with them about it. You want to make sure you are considering all the laws, ethics and clinical issues at play. 

Note: A distinction is made here with countertransference issues. Often, issues will come up that prompt us to seek our own process and work through our own emotions. Although this does impact your clinical work, the distinction here is that the focus is on you. In some situations you may actually seek consultation as well as your own therapy. 

Where

Now that you've got this excellent consultation note, where the heck does it go? As long as it's specific to the client and a clinical issue with them, put it in their client file. If it's specific to yourself (this would be rare, but you never know!), create a consultation file and put it there. 

Consultation notes = easy... right?! 

Our work is so meaningful and often fun but the unknown, the scary, and (gasp) mistakes are bound to happen. That's where documentation comes in to save the day (cue super hero music). 

Just be your wonderful, ethical self and write about why you're doing what you're doing. Easy peasy. 

Still not totally comfortable with the whole note-writing thing? Check out my free Private Practice Paperwork Crash Course. I talk a lot about notes and even give you some samples to look over.