Documentation Consultations: Case Consult Notes, Collaterals and Collaborations!

This is a "meaty" documentation consult! My good friend and amazing therapist, Rajani Venkatraman Levis, LMFT, requested a consult to create a note template for her own case consultations. So, we create one in this video! 

We also create a template for interaction with collaterals, such as a former therapist, a physician or a psychiatrist. Rajani also discusses a "co-therapy session" she conducted with another therapist and we talk about how documentation might be different for such a scenario.

You can snag these templates by entering your info underneath the video. 

Lastly, Rajani shares a great resource for therapists! It's not related to notes per se, but it's certainly related to all the sitting we do in this profession. Hope you enjoy!

Click here to find out more about Rajani's resource for improving your posture. 

Enter your information below to sign up for weekly email tips and you'll also get immediate access to the two note templates we created in this video!

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And let us know what you think about the templates! How do you write your consultation and collateral notes?

Documentation Consultations: Crafting a Notes Strategy

In this installment of our consultation series I'm talking with Erin Findley, a licensed psychologist in California.

We dive deeper into writing notes and talk about some of the things that often keep therapists stuck in the cycle of catching up or avoiding notes. Part content, part process, we review the following:

  • What to do when you need to process sessions before writing notes
  • How to structure your day and schedule writing notes so you maximize your strengths and clinical process
  • How to avoid spending excessive amounts of time on your notes by identifying what is the most important information
  • Using structured therapies like EFT or EMDR to create some structure for your notes without making every note sound exactly the same

And just in case you haven't had a chance to download the sample notes from this series, enter your info below to sign up for weekly email tips and they'll be delivered straight to your inbox!

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Resources Discussed:

Click here to download the EMDR template created by my friend (and amazing therapist!) Rajani Venkatraman Levis.

And you can also click here to check out Simple Practice, Erin's electronic health record (EHR) that offers the option to customize your note templates. 

Now I'd love to hear from you. What other tips and strategies do you have for conceptualizing notes? 

Documentation Consultations: Social Media, Insurance and Notes

Welcome to the Documentation Consultation series! 

In this consultation I talk with Julee Cox, a Mental Health Counselor in Florida. We go through some hefty content in this interview and dive in to some of the following topics:

  • How to talk with clients about insurance and confidentiality from the initial phone consult
  • What kind of privacy clients can realistically expect with insurance
  • What to include in your social media policy and why it may be different for everyone
  • Things to look out for when interacting with clients on social media
  • What are "HIPAA notes" and do you need to prepare for them?
  • The most important thing to include in your notes if they may be seen by insurance companies

I hope you enjoyed this interview! If you'd like to sign up for my weekly email tips then you'll also receive copies of the sample notes I referenced, add your info below. 

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Resources we discussed in the video:

You can learn all about creating an initial phone consult script by checking out services from Kelly and Miranda of

You can also click here to check out an excellent book by Casey Truffo, where she also addresses these same issues. 

Tell us what you think about the topics we discussed and feel free to add any follow up questions in the comments below.

Documentation Consultations: How To Keep Up With Notes

In this episode of the Documentation Consultation Series, we're talking about some strategies for making notes easier to write so that keeping up with them is more feasible.

In this video I talk with Gina Della Penna, a Licensed Mental Health Counselor in New York. She shares some really common struggles with writing notes and we also talk about things like scheduling. More specifically, we talk about:

  • Creating a schedule for writing notes... and how to know exactly how much time you need to plan for writing notes each week
  • Common fears about who will read your notes and how to protect your client's confidentiality
  • How to use collaborative documentation to solve the problem when you can't think of what to write in a note
  • Tips for how to think about notes so they are easier to write
  • How to conceptualize which note template you're using and how to try out a new one if you're not happy with what you're using now

When you sign up for weekly email tips I'll also send you the link to download the sample notes I referenced! Enter your info below:

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Resources we discussed in this video:

If you want to check out Simple Practice, the EHR that Gina uses, click here.

Documentation Consultations: Policies, Forms and HIPAA

We're back with our consultation series where I'm recording consultations I conducted with real and practicing therapists across the country. This time I'm talking with Sandy Demopoulos, a licensed clinical social worker in New York. 

We talk about a lot of things in this interview (which is why it goes a bit longer), but go in depth regarding the following:

  • How the HIPAA Notice of Privacy Practices applies to mental health clinicians
  • How to determine what level of detail to include in your policies/forms
  • What to review with clients who may be court-ordered or working with other agencies
  • Dealing with payment issues, credit card maintenance and collections
  • What to consider with social media policies

I also do something in this interview I haven't done before... I review my own Services Agreement! It's the one that is included in my Therapist's Perfect Paperwork Packet and we go through the various sections that are included. 

Please excuse the phone ringing a couple times in this video... I promise, all the info you'll receive is worth ignoring it for a few seconds!

Resources we discussed in this video:

To check out the Model Notice of Privacy Practices available for free at, click here. Remember to scroll down a bit and select one of the options under the section titled "NPP Provider Files."

To get CE credits for watching the webinar Roy Huggins and I did on the informed consent process, click here

To check out IvyPay, a service that safely collects and maintains credit card information for clients (particularly if you don't use an EHR that provides this service), click here

If you've decided you don't want to deal with creating your own forms at all, then click here to check out my done for you paperwork packet

If you want to check out the more extensive (and free) social media policy available from Dr. Keely Kolmes, click here

If your forms are pretty much set in place but you don't have a court policy, click here to get a great copy from Therapist Court Prep.

Lastly, if you want to check out Counsol, the electronic health record Sandy and I are both using, click here. Note that if you choose to sign up with Counsol as a result of clicking my link, I will receive a discount on my service.

Enter your info below if you'd like to receive weekly email tips on documentation and check out my FREE Paperwork Crash Course!

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Documentation Consultations: Writing Notes Together

Welcome to the Documentation Consultation Series!

In this series, I record a live consultation with a real therapist who is dealing with a particular documentation issue. We problem-solve, adjust and work out some solutions together.

In this consultation I meet with Melissa Waggy, a Master's level psychologist in Michigan. She wanted to talk about what the heck to put in your notes... so we talk more about this and then we write a note together. 

Click below to watch us review things like...

  • Writing notes when you feel like a session didn't go that well
  • Tips for writing notes more quickly if you're still using paper notes
  • How to talk about other people in your client's life when writing notes
  • What to write when clients discuss multiple topics in one session

If you want to check out the article from Scott Miller that I referenced at the beginning, click here. And you can also add your info below to get weekly email resources, as well as the final version of the note Melissa and I wrote together

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Still have some questions or have something helpful to add to the conversation? Add it below in the comments!

Guest Interview on The Testing Psychologist

Psychologists and counselors who provide testing definitely deal with plenty of paperwork! Managing all that paperwork can be difficult... and it's another one of those things we rarely talk about that creates a lot of stress. 

That's why I'm so glad that Dr. Jeremy Sharp of The Testing Psychologist is now providing resources for those of us who love testing (yup, I'm one of the testing geeks!). He's built a Facebook community, as well as a podcast in order to share resources.

Jeremy recently interviewed me for his podcast and, of course, we talk about documentation! We get into things like what to include in your informed consent, options for storing records, and what to consider when sharing test results and reports with other parties. 

If you have a testing practice, you'll definitely want to check it out. Click here to listen

The "Best of" Series: Creating a Community Among Therapists, Not Competition

You know that feeling when you connect with someone right away? You're able to joke with one another, share similar values, and the conversation is so natural. That's what it was like the first time I talked with Rajani. 

Rajani Venkatraman Levis is a licensed marriage and family therapist with a practice in San Francisco. She specializes in trauma and EMDR and she is very involved in the larger EMDR community. So involved, in fact, that she (along with another colleague) created a Bay Area EMDR chapter. 

You see, Rajani was looking for a community that she could connect with. And when she had trouble finding that community, she decided to create it herself.

In this interview below, Rajani talks about how she created that community, why it's so important for those of us in the mental health profession to support one another, and why there are plenty of clients to go around.

This video is from an interview I did with Rajani in 2016 for the Road to Success Summit, but I really think it deserves to live on beyond the Summit, so I'm sharing with you here:

Rajani is seriously an example of clinical and business prowess. She has built a very successful practice by owning her strengths, being herself, sharing resources, and providing the services that clients in her community need. She is also on a mission to help other therapists do the same... but without offering courses or business consulting packages. She's doing it by creating community. 

If you want to become part of the online community Rajani is creating, check out her latest venture,

She currently has an awesome blog series called "Five Minute Magic" which highlights various things you can do in five minutes to improve different things within your practice. And yes, I did contribute to this series, of course! Click here to read my 5 quick tips for improving your paperwork

Clinical Supervision and Notes: How to train your clinicians

clinical supervision of notes

By far, the most common thing I hear from clinicians is that they didn't receive any (or sufficient) training in documentation.

This is a topic that is very important to all of you. I know because you tell me, you read this blog, you watch the videos and I consistently hear the same thing again and again in workshops. 

Since many people who are supervisors are the same counselors who never received training in documentation themselves, they often don't know where to start with their supervisees.

That's what this blog post is for!

I'm going to outline some different ways to review documentation and notes with your fellows, interns, practicum students and trainees. You may not use all of them, especially if you're new to this, but I guarantee some of these steps will give you ideas for where to start or how to improve. 

1. Review files and notes every week (or however often you meet).

It can be tempting to spend time in supervision focused on the more "interesting" clinical content or to address the crisis of the week. However, your supervision time should incorporate training on ALL aspects of being a clinician. 

And that includes getting paperwork done and evaluating how effective that paperwork is.

Spend some time looking through a client's file, particularly if it's a client about whom you're already discussing a crisis or clinical issue. Not only will this ensure all the legal ducks are in a row, but going back to earlier stages in treatment can often provide clinical insight now that you've spent some time with this client.

2. Read through an entire file, not just that week's notes.

This one is huge! Working as a Quality Improvement Specialist in a few different agencies, I noticed that I would often pick up on things the supervisor hadn't... even when they were regularly reading and approving weekly notes. 

That's because the supervisor was focused only one note.

Looking at that note alone, it seemed fine. However, when read within the context of the client's full file (as I was reading), certain things stand out.

For example, if something significant had happened in the previous session and that session's note had identified some follow up that would happen, I was looking for that in the next note. If that follow up was missing I picked up on it right away because it made the client's story disjointed. 

However, the supervisor could easily overlook this because they were simply focused on the one note and whether or not that content was coherent and professional. Not a bad thing, but taking a different approach every few weeks will provide a different context.

3. Practice together, especially in the beginning.

Do you remember writing your first case note? I do. I remember that I had a few samples in front of me and while they seemed great, they all of a sudden seemed completely irrelevant to the note I was writing. So I simply dove in and tested the waters to see what would be approved.

Now consider if my first experience writing notes had been with a supportive and experienced clinician guiding me. I would've had a chance to ask questions, compare things, get different ideas for wording, etc. 

I know what you're thinking... notes are boring and no one wants to spend time together writing notes. However, I've found this to be the opposite! 

One of the things people consistently mention about my trainings is that they enjoy seeing examples, watching me write notes, and writing notes together. They even really like getting feedback on the notes they've written.

However, this is something that is often nerve-wracking for people and it's unlikely anyone will ever ask you for it. You must initiate but I promise you that 99% of the time, it will go very well.

So take the time to review paperwork, practice writing things together, and continue to do these periodically throughout your supervision time, not only in the beginning or not only for people who appear to be struggling. 

You will create much more confident clinicians who are able to focus on what matters most- how to best help their clients. 

Now you tell us! What have you found to be helpful when working as a supervisor. What did a supervisor offer you that provided you the confidence and tools you needed to be successful? Let us know in the comments below.

My 4 Favorite Assessment Questions

Favorite Assessment Questions Therapy

I've mentioned before that clinical assessment is one of my absolute favorite topics, and one of my favorite things about being a therapist. 

I was fortunate that early in my career I was required to complete LOTS of intake assessments and this forced me to become good at two things in particular- time management and asking good questions (not to mention typing and writing quickly, too!). 

So I thought that I'd share with you my favorite assessment questions that I've continued to find useful over time. Many times, asking these questions leads into powerful and detailed conversations about the concerns clients are bringing to therapy

I encourage you to try them out and adjust as much as you like to make them fit with your clientele in each situation.

1) Describe a typical day for you.

I know, I know. The first one isn't even a question! But it's one of the first things I review with clients when they come in and I find it often leads in to getting more details on the way in which their identified problem impacts their every day life. Going through their typical day prompts them to think of things they may not have considered if I simply had them list off general concerns.

By the way, I do actually have them list off general concerns ahead of time in a quick checklist (available in my Paperwork Packet). But this question often leads in to much deeper topics.

Quick Tip: Adjust this for interviewing parents about child clients.

Parents often have difficulty identifying how often behaviors occur in children. It is important to get a detailed picture of this so you can highlight progress along the way, for the sake of both the parent and the child. 

When parents describe problem behaviors, ask how often they occur by going through their day. How often does the behavior occur between waking up and going to school? How often while at school? How often between returning home and having dinner? How often between dinner and going to bed?

This will help you identify times of day that may be more problematic, triggers to behaviors, and also give you a detailed baseline to visit when you want to praise the progress that is being made in counseling.

2) What strategies have you already used to try and solve the problem?

This question is very important to me because it helps us identify what doesn't work, or how to adjust the strategies already used. Most people have already tried solutions on their own or may have reached out to other professionals for help, whether that's another therapist or a religious leader, an acupuncturist, or a psychic.

Dig in to what led them to seeking out those solutions and why they didn't work. Some may have worked up until a certain point or helped with one aspect but could not address the whole problem.

This will often bring up the deeper meaning behind a more superficial problem or identify other areas that impact the problem for which they are coming to therapy. Then you're able to identify how you can best work together, what the focus is, and where is the best place to start.

Lastly, this also a great way to discover your client's resources, network of support, and personal strengths. These are all things you can use within therapy to assist process and progress. 

3) What would you like to get out of counseling? How will you know you are ready to finish?

Somewhat related to #2, I find this question hugely valuable. This is what helps guide me throughout my work with the client because I need to stay on task.

Of course, things may change and new things will come up over time, but knowing the client's goal helps to steer the ship and know whether something should be passed up (perhaps to address later on), addressed head on, and if you may need to take land at one particular problem for an extended period of time.

This is also a way to help clients who are having difficulty transitioning out of therapy. You can point them to their own goals and reasons they would know they are ready to move on. That's why I do document this one specifically, both by asking the client to write this out before seeing me and in my notes for that session in which we discussed it. 

4) Have you ever been arrested?

A little less "touchy-feely" than the above questions, but this question is still one of my absolute favorites that also provides a wealth of information. 

Note that this is different from asking whether or not someone has a criminal record.

This is a really key distinction. The point of asking about arrests is to gather information about potential problem behaviors that may not have resulted in a criminal charge. This also helps to simplify the question because, in my experience, many people do not view misdemeanors or DUI's as a criminal record and will genuinely answer "No." 

This question will be more or less important based on the type of work you do, but it is still an important question to ask every client in every setting. 

Never assume that someone does or does NOT have a criminal record or arrest history based on their presentation! I have had many unassuming people whom I would never predict having a record answer "yes" to this and it has been important for our work together.

For child and adolescent clients, it is important to follow up by asking "Has anyone in the family ever been arrested?" 

Obviously, this can provide information that you would often not receive by simply asking about a criminal record. And, regardless of guilt or charges being made, arrests of loved ones can significantly impact a child's emotions and view of the world. These are important things about which to be aware. 

There are so many things we could potentially review with clients during our intake assessment. 

This is obviously not an exhaustive or required list. But I have found all of these to be very helpful in a variety of work situations, including private practice. Some of them are in my intake assessment that I have clients complete ahead of time, and all of them I definitely review in person. 

What other questions have you found helpful during the assessment phase in private practice, or other settings? Share in the comments below!

Writing a Mental Status Exam

A few months ago I received a question about writing mental status exams (MSE) and realized I've never talked about this! So, here is some direction regarding all things MSE...

What is a Mental Status Exam (MSE)?

A mental status exam is a brief snapshot of a client's presentation. The MSE is meant to assist with diagnosis, capturing and identifying symptoms, but also to create a succinct picture of the presentation at a specific moment in time.

This means that a person's MSE may appear very different at various stages in treatment, and that's perfectly fine. For example, a client experiencing a manic episode will present very differently at the height of the episode than they will during times of mood stability or during a depressive episode. 

I should note that an MSE is always meant to be completed by the clinician who saw the client, and should include a visual assessment (meaning over the phone would not capture many of the applicable sections). 

The MSE is generally more useful for clients with acute, chronic or more severe symptoms. While it can be useful in all circumstances, many sections may not apply to clients with general adjustment or change of life issues. 

When to Use a Mental Status Exam

The most common use for the MSE is during a clinical assessment. The MSE can actually provide a great source of documentation to support diagnoses for clients. If you have difficulty diagnosing or worry about substantiating diagnoses for insurance companies, try using a mental status exam and then make sure DSM diagnostic criteria match up with the identified presentation. 

An MSE is generally completed during the first 1-2 sessions, and then any other time when re-assessing symptoms. 

That might include regular intervals of time, in order to identify progress, or only as needed during the treatment process. It can be helpful to complete one at the end of treatment to highlight any differences in presentation and celebrate growth.

Some clinicians do complete a brief MSE as part of every progress note but I find this unnecessary in most cases. Of course, that is a preference and if using the MSE every time works for you, great! Just remember to include some information about what transpired during the session, as well. 

How to Complete a Mental Status Exam

Like it or not, mental status exams were created to capture dysfunction, not ordinary function. That's why you'll find most of the categories very "clinical" sounding.

For this reason, it is generally acceptable to simply mark "Within Normal Limits" (or "WNL" for short) if there is no impairment found in the identified section. However, this creates that sense of obligation without purpose in documentation that you know I dislike! 

That's why I recommend that if you are using an MSE, then describe each section regardless of the impairment.

And if you don't find this useful, don't do an MSE! Or, perhaps pare down your MSE so that it only includes the sections you find helpful. These don't have to be long descriptions. Remember, the MSE is meant to be a brief assessment, a snapshot. Keep your answers to just one or two sentences, at most. 

Recommended Mental Status Exam Sections

I am listing these alphabetically, in order to keep things simple. However, these are often listed in notes more by level of depth or order of importance. Many sections are often combined so I have either outlined this or included the common names together.


Different from and similar to mood (below), affect is a bit more descriptive regarding how a client is presenting their mood. For example, affect and mood may both be depressed or sad. The client describes themselves as sad and appears to be so. 

However, affect can also include things like constriction, range of emotion, and appropriate expression of emotion. For example, mood was depressed and affect blunted. In this example, affect is describing the fact that the client exhibited limited emotion, although they may actually be feeling quite depressed. 

Due to the similarities and how these interact, affect and mood are often combined into one section on an MSE "Affect/Mood." I only included them separately here to review the difference between them. 


Self-explanatory, this is literally the physical appearance of the client. Note any unusual physical characteristics, grooming and clothing.

Tip: Stay objective here and avoid phrases like "attractive" that can be offensive and subjective depending on the person describing attractiveness. 


This is the physical behavior present during your assessment. Here you will note how the client moved and acted physically. This could be something like frequently fidgeting, shaking leg, unable to sit still, or walked very slowly. It may also include things like yelling or crying. 


Here you will note any difficulties with concentration, such as difficulty tracking the conversation, frequently getting distracted or going off task.


A more subjective measure, in this section you will comment on your perception of the client's insight based on the interview. You may note things like how well your client understands the reasons for their behavior or contribution to a problem, whether or not they recognize the severity of a problem, and what is their perception of how to address problems. 


Here you can describe the client's abilities based on the information you've gathered so far. In general, this is really meant to capture the more extreme ends of the spectrum, such as significant cognitive deficits or very advanced vocabulary for developmental age. 

Some clinicians will actually test things like working memory briefly during an MSE by doing serials 7's (counting backwards from 100 by 7's), having a client spell "world" backwards. While impairments here may alert you to something, they are certainly not an indicator of actual intelligence.


You may do a brief test of your client's memory (asking them to remember something at the beginning and then at the end) but then you again have a very low validity picture of memory. It is best to use this section to comment anecdotally on what was noticed during the session. Did your client leave out important details frequently? Have trouble remembering important events or specific periods of time? Also note if they identify any concern about their memory. 


This one seems obvious and yes, it sort of is. Mood includes common descriptors of how people are feeling and may use traditionally clinical language or more commonly used laymen's terms. These include phrases like depressed, anxious, worried, sad, euphoric, happy, irritable, etc.


This is probably the category most commonly used in the medical field and always included in general mental status exams. Orientation refers to how well the client was oriented to person (themselves), place (the setting in which your assessment occurred, as well as their general location), time (date, time of day) and situation (physical and emotional situation). Note that situation is usually but not always included.

This is typically a very brief section, simply noting something like "Client was oriented x4" or "Client was oriented to person but not time, situation or place."

Perceptual Disturbance

This section has some crossover with thought process and content but could be used to highlight things like hallucinations, if that is a common symptom you see. If so, identify the type of hallucination (e.g. auditory, visual, etc.) and any relevant info.


Another self-explanatory category, here you will consider anything related to speech quality. This includes things like speech impediments, rate of speech, volume, etc. 


This category is not always included in common MSE templates, but I always work from a strengths-based and client-focused perspective, so I'm including it here. You can identify strengths you noticed during your meeting with the client, and also ask the client (or parent/guardian) to identify strengths.


Here you will acknowledge your assessment of these areas and specifically note whether or not the client denied these, has a plan, has ideation only, etc. 

Even if your client was noted to be suicidal with a plan, don't feel the need to include extra information here. That will all be in your progress note where you describe your assessment in more detail, along with the identified plan. 

Thought Content

This section captures what was the main content your client presented during your session, as well as any noteworthy content items that came up. This may include delusions and hallucinations, if you prefer not to have a separate category for these symptoms. 

Regardless of things like delusions, this is also the area to include things the client focused on as important. That may be feelings of guilt, preoccupation with a particular topic (video games, sex, a specific person, etc.), irrational worries or even phrases that were repeated throughout. 

Thought Process

While content focuses on what was discussed/presented, process focuses on how the client presented that information. This includes things like ability to think abstractly, connections made as explanation for behaviors or mood, associations and ability to stay on track, flight of ideas, or magical thinking. 

Yes, there may be some crossover here with things like concentration and insight/judgement but this section really pulls those pieces together to describe how the client views the world and themselves.

Create Your Own Mental Status Exam

If you're in private practice then you have the flexibility to use which sections you like, complete an MSE whenever you feel it is relevant, or even avoid it altogether

I recommend you look through the sections and then identify anything you think would be helpful to document during intake assessments, then anything that may be helpful to track over time at various intervals, and anything you'd like to capture at the end of treatment for a more objective view of progress. 

You may find certain sections more or less relevant for different clients, and that's okay. Think about your current clients. If a section applies to at least half of them, then it will likely prove useful to you. If not, then scratch it and just add that in when it's needed.

You can also create an "Other" category for random things that come up but don't fit anywhere else. Simply use that as your catch all and then take note if you find yourself including the same thing over multiple clients. Then maybe it should become it's own category.

You have the power here to make the mental status exam whatever you'd like it to be for your practice. So make it meaningful to you and helpful to your clients. Otherwise, there's no point!

Let us know in the comments below... do you use a mental status exam in your practice?

What tips have you found to make it meaningful and easy to complete? 

5 Counterintuitive Ways to Improve Your Notes

By far, the most common concern presented to me by therapists is note quality. Clinicians are hoping their notes are good, but since no one else reads them or since they receive little training in this area, they actually have no idea if the quality is there.

For content related to writing, I've got sample notes available for free inside my Private Practice Paperwork Crash Course. You can also check out this blog post that has an example of necessary content and how to pare down note length.

Today I'm sharing with you five counterintuitive strategies that will help you improve your notes, no matter what your current quality may be... and they're all things you can try out right away!

1) Take a break

One of the best things you can do for your productivity is to take regular breaks. Whether it's five minutes every half hour, 10 minutes every hour it doesn't matter. The key is that you must schedule them in and take them!

Even if you feel like you're in a place of "flow" and working for over an hour, it is rarely helpful to continue working without a break. Trust me, as someone with ADHD, I know this struggle!

Lucky for you, I've made it a little easier to take a quick five minute break. Why not listen to some music that will help you rock out, give you a dance break, or pump you up for more work? Check out my new playlist on YouTube for some epic songs to keep you going... after a break to rock out or dance: 

Rock Out Dance Out Break From Notes Playlist

2) Reflect first

Taking the time to reflect on your session, your client's progress to date, any struggles you're encountering, etc. will clear your head and help you focus when writing your notes. It doesn't have to be long but pause for 1-2 minutes before your note and make sure you are in the right head space.

3) Plan ahead

You've heard that quote: "Fail to plan and plan to fail." That definitely applies to your notes! Make sure you give yourself enough time to write notes each day, allowing time for other administrative tasks at a different time of day.

Many counselors run into trouble because they forget to plan out note writing time when figuring out their schedule. Even then, they'll often add that time for general administrative tasks including notes. Doing this usually means notes become a last priority, behind answering voicemails and emails. 

4) Read through old notes

I recommend you spend time each quarter looking through your client's file. This will actually make you a better writer because you'll catch things you may have missed or recognize common phrases you like to use in notes.

This review time will also help you see how well you're able to blend sessions together to tell the complete journey your client is taking with you. Don't worry about spending hours on this. Simply plan for one hour each quarter and see your notes grow in quality!

5) Let your client help

Lastly, let your client help you write notes! Collaborative documentation has not only shown to be a faster way to write notes, but clinicians commonly report it also helps improve their note quality. They feel better about the content because it is up to date and their client has helped summarize things from session.

Plus, if your client is contributing to their notes each week, the fear of your client seeing their records is pretty much eliminated. ;)

If you'd like a more in-depth training related to collaborative documentation, consider signing up for my Meaningful Documentation Academy. There are already four previous trainings waiting to be viewed, one of them on how to incorporate collaborative documentation. You'll also get access to a new webinar (and CE credits!) each month.

Which of these strategies is the most helpful for you? Which one do you plan to try out this week? Let me know in the comments below!

How to Avoid Writing Notes

Sometimes we just need a little fun! Check out this video for some great ways to avoid writing your therapy notes:

What's your favorite way to avoid writing notes? Share your biggest vice in the comments below. Better yet, share your tips for overcoming these things!

And if you want help catching up on those notes, check out the Paperwork Catch Up Group starting Monday, January 9th.

Happy writing! 

Drafting Your Personalized Note Template

One way I recommend counselors save time on notes is to choose a notes template and stick with it. In my Private Practice Paperwork Crash Course I review five different types of templates you can use and these are basic copy and paste topics you can use across the board.

However, I do get feedback occasionally that some therapists have adjusted the templates and when they do this, therapists tell me the template is much easier to use and much more meaningful to their work... because it's personalized.

So, I thought I'd review all the different components of common therapy notes templates in case you'd prefer to simply pick and choose what works for you. These components all come from the following note template formats: DAP, GIRP, PAIP and SOAP.

I encourage you to check out what sections appeal to you and seem meaningful to your practice. Choose those and create your own therapy notes template that you'll find easy to use every day.

These are simply listed in alphabetical order, with no identified level of importance.


This section focuses on the clinical assessment of the client's symptoms, progress, presentation, etc. Here you can add more clinical language and also outline how the session may interact with previous sessions or experiences, as well as highlight things you think may be important to monitor.


This is the same as the "Objective" section below (so just choose one). Here you will add information that is objective and behavioral. These are things that occurred in session and any lay person would be able to describe. This could include quotes, acting out, crying, refusing to participate, nervous movements, etc. If it could be heard or seen on a video camera by a person on the street, then it goes here.


This is typically at the top of the note and includes whatever goal(s) the client is working on. Rather than making things complicated, simply copy and paste from your treatment plan wording. Keep it simple and direct, but also monitor to make sure your sessions are really in alignment with the goals you are including with each note.


These are the actions of you, the counselor leading the session. Whether this is something you did passively (like building rapport) or more actively (like teaching a technique), this section is meant to capture where you directed things and how you responded. If you tend to review or teach techniques, direct clients in certain behaviors or challenge and examine thought patterns, this will be an important section for you to include in your notes.


This is the same as the "Data" section above (so just choose one). Here you will add information that is objective and behavioral. These are things that occurred in session and any lay person would be able to describe. This could include quotes, acting out, crying, refusing to participate, nervous movements, etc. If it could be heard or seen on a video camera by a person on the street, then it goes in this section. 


The plan is one of the most important components of any notes template and I recommend you have a Plan section regardless of what other sections you include. This is where you identify follow-up, whether that is for you or the client. Here you can clearly identify how the client may incorporate what was learned in session over the next week. And you will also include when is the next planned session. This is crucial for documenting your continuity of care.


Similar to the "Goal" section, the Problem is whatever problem area the client identified they would like to work on in therapy. This may be just as specific as a goal, or may be somewhat vague, such as depressed mood or anxiety. Regardless of the specificity, this will help guide your treatment and allow you and the client to know you are on the same page with where things are headed.


This section is the opposite of the "Intervention" section because it is focused solely on the client and how they reacted to things during session. Similar to the "Data" section you will want to include objective information that would be easily seen or heard by anyone in the room. However, if you choose not to have an "Assessment" section, you may also include more subjective responses made by your client as well. Also, remember that refusing to participate or react to something is also a type of response and should be included here. 


This section is opposite to the "Objective" and includes information shared or observed during the session that is either subjective to you or to the client. This could include things like a prognosis or an interpretation of a response. It could also include subjective statements made by the client themselves.

So, how does this all look if we put it together in new formats? You'll notice that some sections are similar and I never recommend duplicating your work, so choose what you like best to have a complete note.

Some examples could be: 

PDAP (Problem, Data, Assessment, Plan)

GOAP (Goal, Objective, Assessment, Plan)

PIRP (Problem, Intervention, Response, Plan)

PIRAP (Problem, Intervention, Response, Assessment, Plan)

SOIAP (Subjective, Objective, Intervention, Assessment, Plan)

The amazing thing about being a therapist in private practice is that you get to make these decisions! Don't let it overwhelm you, let it make you a better clinician by personalizing things to yourself and your clients as much as possible. 

One last recommendation is to consider using one format for ongoing notes but a different template for assessment. A participant in my Meaningful Documentation program did this and found it was much easier for her to write the more in-depth assessment note for the first session but then she could take things down a notch going forward. 

Play around with things and see what works for you. Don't make it too complicated but also understand that sometimes creating these systems does take time. However, once you have a clear format for writing progress notes you are able to do them much more quickly and with less mental effort. 

That way you can spend time on what is most important- the clinical work!

Leave a comment below and let me know what you decided if you choose to mix and match. I'd love to hear and so would many of your colleagues!

Catching Up On Notes: An Interview with an Honest Therapist

We've ALL gotten behind on notes. Yes, all of us. 

The problem is that we never talk about it. And the more behind you get, the LESS you want to talk about it. But that makes the problem worse, and so things go on and on until you feel overwhelmed.

That's exactly what I'm talking to Dr. Traci Lowenthal about today. Traci got behind in her notes, and was courageous enough to let me interview her about how she's getting caught up and how she plans to avoid this happening again in the future.

Click below to check out the video and share this with your friends! I guarantee you know at least one counselor who is behind in notes right now, but too ashamed to discuss it. 

Wasn't she awesome to share her experience with us?! 

If you're also behind in your notes but not sure how to start getting caught up, or if you need some extra motivation, check out the Paperwork Catch Up Group

This is a group where you get the practical tips as well as the moral support you need to get caught up and stay caught up on notes. 

And if you have your own tips and tricks you'd like to share, leave a comment below! Remember, you're not alone.

Writing Your Client's Journey: Interview with Jo Muirhead

While blog posts are helpful, sometimes you just want to hear what someone else is doing and model things after them! That's what I'm doing with the regular "Writing Your Client's Journey" series and to kick things off I interviewed a very successful group practice owner in Australia, Jo Muirhead

Jo shares some excellent tips on things like streamlining, creating systems and encouraging your motivation to get paperwork done.

You'll notice some sound distortion in just a few spots but it's very brief and there's a ton of great tips so stick with it! And if you've only got a few minutes to check things out, scroll down further for the interview highlights.

My favorite quote from this interview is early on when Jo says about paperwork and systems, "If you can't learn to love it, you've got to respect it because hating it helps nobody."

In the beginning of her practice, she tried to customize her systems and forms to meet each individual client's need but then found out that wasn't working as her practice grew. So, Jo started to create systems for getting all the mundane but necessary stuff DONE.

Creating a system for yourself makes things more simple and easy. Without these in place, you can easily be distracted from the work you really want to do- your clinical work with clients. 

Prepare for growth by having directions for things written down for anyone who may need it later on (e.g. an assistant or a new clinician). This can save you hours of time... Jo and her team set up one system that turned end of month financials from a 10 day task into a two day task!

Specifically, some tips that Jo shared during the interview are: 

  • Set up a checklist for each task
  • Create a centralized place and system for all tasks
  • Teach a child or a partner (or team up with another clinician) how to implement each task to identify holes in the system
  • Schedule everything (especially notes and accounting)
  • Use LastPass to manage all your passwords for every site that requires a password

Important things to focus on streamlining: Intake and discharge

Important things to keep up with regularly: Notes and bookkeeping

Jo also had a great tip for those times when you become overwhelmed by a task. Ask yourself, "What could I have done to make this easy on myself?" Then focus on changing that one habit to improve things in the long-term.

And the big payoff from putting in all this work? Once you have a clear idea of how long it takes you to complete a task, you can decide if it will be worth delegating and, if so, you know what to expect from that person!

Feel free to share in the comments below. What have you found helpful for simplifying paperwork and other administrative tasks? 

Want to learn more about Jo and the coaching services she provides for others? Click here to learn more!

Paperwork Tips from Experienced Therapists

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I recently took to the Blissful Practice Facebook Group for some advice on documentation from those in the trenches... you! It was great to see all the tips everyone put together and also highlights that it is so important to find the paperwork practices that are meaningful to you

Here is some of the great information I collected from this fabulous group of therapists:

Use an Electronic Health Record (EHR)

Alicia Taverner, Owner of Rancho Counseling, and Sandy Demopoulos both say that using an electronic health record (EHR) has been instrumental in improving everything related to documentation. Alicia uses Simple Practice and is able to dictate case notes on her phone using the app, which helps her stay up to date. She notes it is a "game changer." Sandy uses Counsol, which offers many features, including virtual therapy rooms. 

Stay On Top Of Notes with Productivity Hacks

To help keep up with notes, Charlotte Hiler Easley schedules 30 minutes in between client sessions. That way she has time for self-care and notes. Jane Johnson Wall uses TheraNest, which helps her stay up on billing. She says this is one of the most important things to keep in mind because it is so easy to get backed up and that can result in lost revenue and lots of headaches! 

Shanna of Happy Nest Therapy has also made a point to stay on top of notes. She says she created a schedule and a note template early on and this was hugely impactful. Since she took the time to make this a habit in the beginning of her private practice, she is now always able to keep up with notes, writing notes within 24 hours of every session. She also keeps a call log and reviews that each month to insure she is documenting everything outside of regular sessions. 

Erin Gibb also created a note template based on common things she wrote and then takes some notes during session. She then sets a timer for five minutes after each session and makes sure to only spend that amount of time on her notes. That way she is done quickly but she is keeping the quality content. 

And Raquel Buchanan, also of Rancho Counseling, adds that she notices many clinicians fall behind because they are not ending sessions on time. She sticks to a 50 minute session, then 10 minutes of note writing. Raquel also notes that you can use this additional time write notes with your client, too.

You can also write intakes with your client during the first session, as Traci Lowenthal of Creative Insights Counseling does. She says this has been "miraculous" for keeping her up to date with bigger paperwork tasks. And when she gets behind on things like notes, Traci sets a timer for 20 minutes 1-2 times a day to make sure she is working to catch up.

Document the Little Things

Nicol Stolar-Peterson of Therapist Court Prep recommends two tips based on her experience as an expert witness who is often testifying in court: 1) Document your client's appearance, including what they wear. This way you are able to quickly and objectively note an changes that occur over time. 2) Time stamp everything. Document and time stamp when clients disclose new or significant information, when they sign or ask about documents or policies, etc. She notes that "once I start giving the exact times of disclosures, I find that attorneys back off quite a bit."

Use Your Experience as a Resource

Tiffanie Trudeau of Counseling Alliance is a former Clinical Director at an agency. When she opened her private practice she decided rather than give in to the temptation of forgoing all the agency documentation, she would take that foundation and use it in her practice. She is consistent with her paperwork practices, whether her client is pro bono, insurance or private pay. She even used one of my favorite quotes in her advice: "if you didn't write it down, it didn't happen."

On the flip side, Shirani Pathak of the Relationship Center of Silicon Valley recommends keeping things simple. Maintaining her previous agency's standards was difficult in private practice and so she made time to whittle down to just the necessities. Now she is confident that she's meeting ethical standards but it is also easy for her to keep up with everything.  

Being on top of things is even more important as you start to supervise others. Group practice owner and coach Sherry Shockey-Pope recommends documenting when you discuss cases with supervisees. Write down your discussion and then your follow up plan with the client... and then actually follow up!

Communicate With Your Clients

Similarly, Kate Pieper says that clients have commented on her follow up with them. She makes sure to note at the end of each session what they will be addressing in the next session. Kate also recommends not being afraid to take some notes during counseling sessions. She is casual with this and that makes her clients feel comfortable, too.

Maaliea Wilbur of Therapy Works wraps things up nicely with this advice: "Do it!"

Lastly, Amber Hawley of Fremont Counseling Services has one last tip for you... sign up for my Webinar CE Club! (Edit: the Webinar CE Club is no longer, but you still get access to all my ote writing tips and trainings in the Meaningful Documentation Academy!) I swear, I didn't tell her to say that ;) But it does highlight the importance of staying connected with colleagues and making room for this type of discussion so that you can always have the best resources. 

Feel free to share your tips below in the comments!

Credit Cards: Your Questions Answered

One thing I don't provide in my paperwork packet is a form that allows you to write the client's credit card number and save it in a file cabinet. How come? Because there are plenty of more secure ways to capture your client's credit card info.

I actually receive quite a few questions related to this so I was very happy to meet Emily from Ivy Pay. She is a therapist on the operations team for a company that provides convenient credit card processing for therapists who may not have other means, such as an EHR. Since IvyPay is specifically designed for counselors, I decided to ask her some of the common questions I receive and let the experts explain for us...

1. Is it okay to keep a client’s credit card number on file so I can bill them regularly?

It’s definitely okay to keep a client’s credit card number on file so that you can bill them regularly. How you maintain those records is what really needs to be kept in mind.  Previously, many folks kept client credit card numbers on file by taking a photo copy of the client’s credit card, or jotting the credit card details down on a piece of paper and storing this in what many deemed a secure manner for the time, such as a lock box. However, with new technologies and updates in banking security this is no longer a secure method of securing financial information. Therapists who do continue to store their client’s financial information in a non-secure manner are at the highest risk to be exploited by hackers which as covered entities would result in a breach in HIPAA. And ultimately, therapists are taking on the liability risk of the credit card information getting leaked and client’s cards being used fraudulently, which is an avoidable burden.

2. What type of security is required for keeping a credit card number on file?

Anyone who keeps a credit card number on file has to comply with PCI DSS (Payment Card Industry Data Security Standard). PCI compliance involves a lot of nuances that are implemented to protect cardholder data (such as maintaining a secure network, protecting cardholder data, maintaining a vulnerability program, implementing control measure, testing security systems and security policies)… in other words a lot of jargon. To avoid dealing with all these security standards, it’s best to outsource to a third party company or service that takes care of PCI compliance for you.

3. Do I need to make sure my credit card processor is HIPAA compliant?

It depends on how you are using the credit card processor. While financial transactions in and of themselves are exempt from HIPAA, if you use additional features that are part of many payment processors such as text receipts, this is then no longer exempt.  As a covered entity it’s important that the payment processor you use doesn’t violate HIPAA. There are a few guidelines that are helpful to keep in mind when selecting a payment processor.

1. Make sure your payment processor isn’t sending receipts via text. Text is not a secure technology, and since receipts contain PHI, they need to be sent via a secure method.

2. Sign a BAA with your processor. If you are storing any PHI through an online provider, to comply with HIPAA make sure you have a BAA signed.

3. Make sure any stored credit card numbers are secured in a PCI compliant manner.

Always remember that even if you have a BAA, if you are not using a service that’s designed to be HIPAA-compliant from the ground up that the provider might release a new feature that could violate HIPAA and you’d be responsible. In essence they are not guaranteeing you that their product roadmap will continue to stay HIPAA-compliant in every respect.

Also, even with a BAA, therapists are still held responsible to be using the service that better protects patient privacy and confidentiality if there’s minimal cost in changing to that service. So it’s important to be aware and keep in with the latest and most appropriate options.

4. I know plenty of therapists who still collect credit card numbers for paper files, are you saying they’re not being ethical?

When you store credit card information for a client it’s important to complete a risk analysis to take a look at how you are storing that information. The best way to store credit card data for recurring billing is through a third party processor that has a secure credit card vault and tokenization provider. When this is in place the card data is removed from your side and a token is returned so that you can continually bill your client for each session while the data is obscured. Storing credit card data on paper in a locked box does not provide the same precautions or level of security.

When you are storing a client’s credit card information it’s also important to tell the client in the informed consent how this information is being stored. It’s helpful if your processor already has this consent designed in, so that’s one less step for you. Ethically, a therapist can determine how their practice works - including if they are going to keep client credit cards on a paper file. However, therapists should be protecting all client information including financial information, in the utmost secure manner. With the ease of technology now, paper files in a lock box is no longer considered the most secure option available, and therefore maybe not the most ethical option either.  

5. Why do I need to pay credit card processing fees?

Think about all the ins and outs of maintaining PCI compliance that has already been talked about. The payment processor is providing that service of mitigating those risks, so you don’t have to.

6. Do most clients really want me to keep their card on file?

Yes! It’s beneficial for not only you but it’s also beneficial for the client. The client doesn’t have to remember to bring a cash or check, and can instead use the form of payment that they most likely use in the rest of their life. In a world that’s full of many means of technology - the therapy room is one of the last few places where credit cards has not necessarily become common hold for clients to use. Both therapists and clients can welcome this change when a few guidelines are met.

7. Can I use a card on file to bill clients for no shows?

This is one of the big benefits of having a client card on file - but is also one that needs to be looked at from an ethical standpoint. What needs to be kept in mind is making sure the client is made aware of your payment and cancellation policies upfront so that the client isn’t surprised when you bill them for a no show. With that said, once informed consent and policies have been discussed, having a card on file is a convenient way to collect fees that may otherwise be lost.

There you have it! Some awesome answers that explain all that complicated credit card HIPAA stuff :)

As mentioned above, always be sure to review any payment expectations with your clients as part of the informed consent process. I also recommend having a statement in your Services Agreement that clients initial or sign, particularly if you plan to charge their credit card for no shows or cancellations. 

Remember that if you use a payment processor through an EHR, you are likely covering all these bases, but it's always good to check. For those of you using paper forms and a separate payment processor, you may want to check out Ivy Pay. It's a convenient way to meet all these expectations without needing a card reader and without having the liability of collecting credit card info yourself. 

Clients put their cards on file with you via the Ivy Pay app, so it’s just a push of a button to take payment. Ivy Pay works with debit, credit, HSA and FSA cards and is tailor-made just for therapists. So it’s HIPAA-compliant, designed for the unique clinical model and code of conduct of therapists. It’s even been uniquely designed to not reveal the therapeutic relationship all the way down to the bank or card statement. For a limited time, get started with $1000 of free charges. Learn more about Ivy Pay here.

Please note that I do not receive any commission or compensation from Ivy Pay for this post. I merely think it is a helpful resource :)

Another helpful resource related to credit card payments is a very affordable course through Person-Centered Tech. It's called Credit/Debit Cards and Electronic Payments in Mental Health Practice: Regulatory and Ethical IssuesYou can click here to check it out.

Feel free to post any questions below!

Prepare Your Records for Release

Releasing records is an intimidating issue for many counselors and therapists. And while we hear a lot of rhetoric on the topic, many counselors are not clear on legal and ethical expectations and end up making poor judgment calls because of that.

A common scenario is that a client requests their records and a counselor automatically refuses to release the records, stating confidentiality concerns. While these concerns are valid, that is not following the law within the United States. Clients do have the right to access their records. From their physician. From their physical therapist. From their mental health therapist.

There are some exceptions and those differ slightly among state law; however,  those exceptions are typically in more extreme cases and require the therapist to prove that access to the records would cause significant harm. Furthermore, these laws still often allow access of the records to someone the client designates.

Does this mean that therapists then release records automatically any time a client makes such a request? Not necessarily. 

The most common practice is first to talk with your client about the purpose for the release. Determine what it is they are hoping to gain from releasing or accessing their records. Oftentimes, this discussion will help the client identify that they actually would prefer a treatment summary from the counselor.

During this discussion with your client it is important to highlight anything that could potentially be misconstrued or misinterpreted if released. However, there are many times when the client still requests the records and the therapist is required to release them. This can be an unsettling discussion for many therapists and that's why I encourage you to consider these scenarios ahead of time, before any complicated situation arises.

I have some strategies you can use to make releasing your records (if necessary) a much less stressful experience:

Think about your client viewing their notes

When writing notes, treatment plans and assessments, work under the assumption that your client will one day view these. This practice helps you to keep language more objective, strengths-based and to the point. 

This does not mean you hide important details or only write the positive things about your client. Keep things honest and real. Your ethics require you to document what actually happened as well as your professional assessment of the client's situation. However, there are often minor tweaks that therapists will make when considering their client actually reading the note and this will improve the objectivity and clarity of your notes.

Think about and discuss your policies

It is important to make sure your policies for releasing records are outlined in your informed consent document... and that you review this with your clients at the outset.

I do not recommend saying in your policy that you will NOT release records because this is not a practice you can legally uphold, except in special circumstances. Instead, note that you will discuss with your client the reasons for the request and make recommendations accordingly. This encourages collaboration should your client make a request at some time later on. 

Also, you can choose to charge for things like making copies, time spent writing a treatment summary or time consulting with other professionals on behalf of the client (such as their attorney). However, if you don't have these charges outlined in your Services Agreement then you may end up spending money and time without reasonable reimbursement. 

In my paperwork packet available for purchase, I make sure to include these things, along with a more in-depth court policy provided by Nicol Stolar-Peterson, LCSW BCD from If you already have a paperwork packet but are looking for a court policy to add on, you can purchase that on her website for a very reasonable $37. 

Have the insurance conversation

Lastly, if you have clients who are being reimbursed by their insurance company or if you contract with their insurance company, make sure they are aware that all records can be accessed by the insurance company. Like it or not, by allowing a third party to pay for services, clients are also allowing a third party to check up on those services

That also means that you need to consider how that relates to your records. For example, many therapists will downplay client symptoms in an attempt to avoid stigmatizing their clients. However, to an insurance company that makes it seem as though your client doesn't need the services you're providing. FYI, it's also considered fraud to either "downgrade" or "upgrade" your client's diagnosis. 

That's why a basic, easy to remember rule with documentation is to always keep things honest. 

However, if you're looking for help specifically with how insurance and your paperwork connect, you can check out my new on-demand training The Counselor's Guide to Documenting for Insurance (now available as part of the Meaningful Documentation Academy). There are so many things to think about with your work, let's make paperwork as stress-free as possible!

Do you have any other tips on what to consider when preparing your records for release? Any tips from past experience? Feel free to share in the comments below!

Resources for Online Counseling and Paperwork

As online therapy becomes more popular and mainstreamed, I see a lot of questions popping up in online forums. Counselors are looking for resources, answers to questions about HIPAA, and general pros and cons before taking the leap into online counseling. And now that I am also providing therapy online I had to make sure I was knowledgable about some of these issues.

I've been fortunate enough to connect with many other therapists and businesses who provide resources in these areas so I put this post together in order to share that knowledge with you! Below we'll look at everything from what your options are (there are likely many more than you think) to what to consider ethically and how to document... of course

Please note that all resources listed below are recommended at your discretion and I do not have an affiliate relationship with any of the recommended sources.

Online Options for Counselors

Video therapy using your own practice

The most seamless transition is to use video software to conduct therapy with your own clients online. There are many services out there that provide HIPAA secure video conferencing tools so you can do this and remain compliant with security standards. 

This type of counseling is very similar to the service you provide in your office but your clients may be in a different town or even overseas. I won't get in to the myriad of guidelines around who you can see online but will say that in general, you are limited to clients in your state and need to know your own state laws. 

There are a few different resources video conferencing but the one you should absolutely NOT use at this point (if you're in the U.S.) is Skype! For a service to be HIPAA compliant, it must provide you with a Business Associate Agreement (BAA) and even Skype for Business is not providing that currently, so it's a no-go. 

For video conferencing you can either sign up for an account that only provides the video or you can sign up for a service that integrates the video with a waiting room and even with your notes and forms for a complete EHR. Obviously, pricing varies greatly based on how much you want from the service but you can check out Vsee, Counsol and WeCounsel

Contractor for an app based video service

A new wave of therapy has arrived and that's video therapy using apps on your smart phone. Much like video conferencing with your own clients, you simply log in to an app on your phone rather than using a service on your computer.

These apps differ in that you typically contract with the app's company and clients are referred when seeking that specific service. The barrier to entry is very low with these services since you don't pay a membership fee. Once you're included in the listing and a client chooses you, they pay the company and the company pays you a pre-determined rate per session.

Since this system uses a contractor-based model, this is typically only available to licensed counselors and therapists. The fees are also lower than general private practice fees but the risk is very low in that there is almost no overhead for the therapist, other than having a smart phone and a quiet place to conduct a session. 

Current companies providing this service (which can also be a great referral source for potential clients requesting lower fees) are Maven and Level Therapy

Contractor for a text-based therapy service

Another form of therapy rising is email or text therapy. More similar to email than texting, this type of service allows clients to send secure messages to a therapist based on whatever scheduled is determined. That may be short, daily emails or longer emails once a week. The therapist then replies on a regular basis.

While this form of counseling may go against what we've traditionally learned about the therapeutic relationship, research is finding that it can be quite effective. Obviously, this is not the recommended method for dealing with crisis scenarios, significant trauma or suicidal clients (to name just a few). However, for many people who are used to online text communication this is a great tool.

Personally, I find the opportunity to interact with clients throughout the week more helpful than the traditional method of limiting conversation to 50 minute blocks. I can encourage people to check in if they have an important meeting or if something unexpected happens and we're able to problem-solve in the moment, rather than discussing it possibly a week later. 

While you could certainly provide this type of service on your own using personal (and secure) email, many therapists are using online services and apps with clients. There has been concern about certain companies and their ethics but places to find this type of service are BetterHelp and TalkSpace. You can also use a (FREE) service like Signal to text clients securely without using your regular phone texting or messaging settings.

What to Consider


Most of us first consider the ethical concerns with online counseling and our brains automatically go to the topic that has been of utmost importance since day one of our training- confidentiality. Many therapists are concerned with privacy and how "open source" things seem online. And while there is always risk in any interaction (yes, even traditional face to face), there are many ways in which online services are generally secure. 

The most important thing is to 1) Understand what risks there are with providing therapy online and 2) Inform clients of those risks, along with other general information related to therapy. This topic could be an entire graduate course so I won't attempt to cover everything in this little subpoint but those are the first things to consider. 

Here is a great article from Zur Institute outlining how to conduct a risk analysis (it's not quite as scary as it sounds), what to consider with email and how HIPAA relates to all of this. 


Your time is valuable and using email can both save and hurt your time management. Email is great for things like quick notices about appointments but it does leave the door open for more communication. What if your client happens to email very personal information? What if they write a very long email and expect you to read it outside of session?

These are things you must consider with online because whether or not you use text-based or video-based counseling, clients are more likely to email you when your relationship is largely online. Make sure you have very clear policies and procedures around this and have reviewed those with clients from the outset. 

Also, consider your time and resources and how that will be a fit for therapy online. This will help guide you in integrating online counseling services into your business plan and making sure it creates more ease rather than more stress in your practice. Make sure you allow yourself time for training or research before jumping in and definitely make sure you've updated your paperwork prior to starting with clients. 

How and What to  Document  

Aside from your regular private practice forms and policies, if you provide online counseling you'll also want to consider some extra things when it comes to paperwork. 

Informed Consent  

Some states require a separate consent form for online services. And if you provide services both online and in the office, you want to make sure you outline the differences in these types of therapy. Some things to include in your consent form are:

  • What happens if the client's needs increase beyond what can be ethically provided online
  • Procedures to follow in case of poor connectivity or internet outage
  • Procedures you'll follow if you feel your client is in any danger
  • Communication outside of session
  • Expectations for online interaction and the importance of checking in regularly

Emergency Procedures

More specifically, you want to consider how you will respond to clients in emergency situations since you may not be physically located near them. Make sure you have your client's home address, phone number and emergency contacts. Identify the local police and nearest hospital in the area and keep that number handy with your client's info. 

Making sure you're prepared will help you to be more confident about the services you provide and ensure you can keep your clients safe when needed.

Resources You Must Follow

There are many resources for therapists who are providing treatment online but here are some of the top ones that I recommend:

Person-Centered Tech

Roy Huggins is a licensed counselor and also a "tech guy" so he did everyone in mental health a favor when he started Person-Centered Tech. I recommend every therapist sign up for his newsletter. Roy is great about staying up to date on topics like cell phones, Google apps for business, changes to HIPAA, and everything else you have questions about that no one seems to provide a good answer for.

He also offers an affordable membership where you can have access to him for weekly office hours and provides one on one consultations if you just have a few questions while setting up your private practice. Lastly, he provides CE credits for counselors and therapists for reading some of his articles or taking his courses. I am anxiously awaiting his approval by APA so I can collect some of these as a psychologist ;)

Online Counselling Podcast

Yes, I spelled that correctly! Clay Cockrell is a U.S. based counselor who provides therapy online and started a podcast to talk about the many issues that arise as a result. He's had some great guests from around the world who discuss new techniques and strategies, legal concerns, tech issues and more. He also runs the Online Counselling Directory where you can list your online therapy practice for a monthly fee.  

Telemental Health Institute

There are many places where you can obtain CE credit and learn about online counseling services but this site has just about everything you need for training. You can do an entire certification program or take courses piecemeal. Certification is not required by most states but does reflect a level of training, so consider what is best suited for you.

Now what to do...

I hope this article arms you with the tools you need to determine if providing therapy online is right for you and your clients and that you feel better prepared to tackle this new arena. While online counseling isn't appropriate for every client, it can help so many who are unable to leave home, live in rural areas, or frequently travel for business. 

Let's continue to support one another in these emerging areas so we can increase the services offered to the public. Comment below if you have additional resources to share and bookmark this page to reference when those questions come up again!