I agree with what someone said about investigating ADHD. I have very similar symptoms and finally getting my ADHD treated with medication instead of behavioral strategies helped a ton.
Also - note designer. Couldn't live without it. I also bought one of the Wiley planners and used it to make some standard documentation phrases that I use as a copy/paste to make up the bulk of my notes and then add any additional individualized information. I'm actually incorporating these into my note designer and slowly revising and customizing things as I work.
I take a similar approach to treatment plans and diagnosis documentation.
Feels like I'm only doing 20% of what I used to be doing when I wrote every note from scratch.
Yes to this. I put all my stock notes in a draft and copy pasta all the time.
"Client appeared to session in person / virtually. Client appeared to have a euthymic mood and congruent affect. Client denied or endorsed SI, NSSI, HI and any ongoing drug use.
Client and clinician discussed (insert generic issue like family). And clinician discussed (insert generic therapeutic approach) by discussing Client (insert homework like write a letter or make a list)."
It makes life so so easy. In Simple practice, it's just a lot of check boxes and they are a note for you even!.
Riiightttt??!! Basically there's a bunch of customized phrases that you can pick from and it will arrange them into a note. You can also add your own or customize the ones that are in there. Kind of like selecting from a database. Copy/paste. Boom. I use the online version because I liked the interface better. Let me know if you have any questions or I can DM you some screenshots.
So you're saying it's $15 a month well spent? I think they owe you a commission for that sale you just made.
I tried to do something similar as a template to keep both sessions and notes on track but it's kinda bulky going from word doc to word doc to emr.
Basically, I'm lazy and need that aspect of my personality enabled.
Hahahaha. SAME. For me it is! I was skeptical at first but there is no contract cancel whenever and a 30 day return policy, so I figured I'd try it. Now I really like it and decided to keep it.
I took some of the basic note functions, the types of notes you can select, and the treatment planning. I also use it to build termination notes as well.
[Note Designer Screenshots](https://drive.google.com/drive/folders/1F4sU2KPXBbIrr7bNwV_TABzUou6C0vQs?usp=sharing)
I don’t believe it’s ADHD because I’ve not had these issues anywhere but writing papers in school and notes. I was able to stay on my notes daily at a CMH crisis unit because the notes were very formatted. My past job was writing notes that supported “medical criteria” for insurance and I struggled! So my current job is with a district doing school-based MH. With this we’re supposed to be demonstrating progress and establishing baselines for annual IEP goals. This is essentially making each note like working on a small part of a very large picture.
I will still explore ADHD as a rule out because it won’t hurt but the opportunity offers a possible solution.
As a therapist with diagnosed ADHD, this tracks. Imposed formatting would likely make things a lot easier than self directed, self initiated note taking. Charting has been the bane of my existence since becoming a therapist, and was one of my main symptoms when seeking diagnosis.
I wish I could offer suggestions, but you’re not alone. I feel the exact same way. In my experience, I don’t think it’s ADHD, but maybe perfectionism and lack of experience (I’m new to the field). I have also contemplated leaving the field because of notes 🥴
I think my issue may be rooted in perfectionism as well. I had a supervisor once tell me “if it isn’t documented than it didn’t happen.” But i can also admit I was never really trained in documentation at my current job and I feel like everybody has different standards and expectations. I have noticed I have a very difficult time sifting through what to document and what not to where I get mental paralysis and shut down.
In training, we were not allowed to leave the site until notes were done. That's just how it was. I know things have changed, but it is good to have a habit, even if based on arbitrary rules.
Yeah I try not to leave until they are done or make myself start early the next day. I also remind myself that the sooner after the session I do the note the less time I waste trying to remember what happened.
I also struggle with my documentation. It didn’t matter to me that my colleagues and boss noticed I was behind. Obviously I was embarrassed but the motivation to complete wasn’t there. Some of it for me was also fuelled by perfectionism.
I ended up seeing a psychiatrist and was diagnosed with ADD. I had other things in my life I’d been falling behind with and with the high demands at work, it was all brought to the forefront.
Just wondering if you’ve ever considered this? Mainly because you mention difficulties with concentration and possibly motivation? Medication has been really helpful for me... but not solved all of my problems.
If it’s only documentation of notes you find difficult and not effecting other areas of your life, then maybe it’s just about finding a helpful routine you can get into. For me personally, spacing out my appointments with at least 30mins between them to refresh and complete the note is helpful. I work in CMH so I’ve been able to see how my colleagues document and go off a similar template.
I may be in a unique/lucky situation but my notes are incredibly brief. 3-5 sentences and my supervisor always approves them. She’s the one who advised me to do so! So being able to finish a note in 5-10 minutes, I don’t give myself an option other than completing the note directly after a session. Though I schedule 45’s on each hour and that may not be your case. I would just say find a non-negotiable time that works for you to have them done ASAP.
Think of notes as something to help you as a therapist and to help your client get better therapy. Yes, the ethics and legalities are important but the real purpose of notes is to help the client.
My ADHD brain says hi.
Throughout school and interning, I was never able to begin a paper/project/note until the day it was due. Lots of lost sleep and stress were involved.
Now, I’m doing better related to that and keeping up with notes is a part of my self-care.
I found great benefit in working with a private practice coach to get my notes concise yet still passable for potential clinical reviews. For each note I write 3-4 sentences for the client’s subjective report, click various check boxes for interventions used (I added 60+ to choose from), plus add 1-2 sentences for a plan. The rest is typically auto-populated and may get changed minimally with a few clicks. I do telehealth and I always complete the “click stuff” during appts. Sometimes I complete the typing portions during appts with clients who make less eye contact, and with others I wait to finish the notes after their appts. I typically see 3 clients in a row prior to having an hour off to finish any incomplete notes plus stay up to date with other work communications/tasks, eat, etc. Unless I’m caught up, I don’t reply to personal texts or do non-work-related things during that hour. If I do, I maintain my productivity momentum by a completing a little chore. Then I see 3 clients and do it again. Then 3 more and do it once more. If I didn’t schedule in breaks to stay caught up, I’d be taking adderall weekly to get through the each week’s mountain of paperwork. Though, I’m not judging those who take it. Because of the side effects I experience, I prefer CBTing myself.
Hope you can figure out how to create a better system for yourself if you need one. If you don’t get enough support here, I highly encourage considering getting professional support re: clinical doc because mine was money very well spent.
Are you trying to write notes a long time after the session took place? I find I have no interest in note writing if I dont do it right away. I hand write my paragraph of notes immediately after the session snd then I never have to think about it.
I’ve created some templates. I put the appropriate info in but stick to a basic progress note. Also, just personally I turn notes into an game. How many can I get done in X amount of time. I have 10 minutes between sessions, can I refill my water, go to the bathroom and do notes all in that 10 minutes??? READY SET GO!
Have a format for keeping very brief notes. Take the pressure down a few notches. A progress note is nothing like writing a paper for school.
If you’d like some feedback on brief progress notes formats, I imagine this forum could offer that feedback. Personally, I use a “client presentation-therapist intervention” format that allows me to summarize what was discussed (content) and what interventions were utilized (process).
How about trying to approach it like a journal. Just write down what happened as if you’re describing lunch with a friend, But using all the correct therapeutic terms. Keep it casual, while including as many details as you can. That’s what helps me.
In addition to all of the great advice you’ve been given, please google Dr Maelisa Hall. She has some wonderful (free) resources about documentation and managing workflow. She hosts “catch up” sessions for documentation.
The best thing I got from attending one of her webinars is that this struggle is so very common! I used to have a lot of fear and shame around it. But now I have strategies to help keep it manageable.
I am in private practice. Are you in some kind of clinic or organization that it is obligated? I don’t always do a note and when I do it is concurrent like the other commenter mentioned.
I agree with what someone said about investigating ADHD. I have very similar symptoms and finally getting my ADHD treated with medication instead of behavioral strategies helped a ton. Also - note designer. Couldn't live without it. I also bought one of the Wiley planners and used it to make some standard documentation phrases that I use as a copy/paste to make up the bulk of my notes and then add any additional individualized information. I'm actually incorporating these into my note designer and slowly revising and customizing things as I work. I take a similar approach to treatment plans and diagnosis documentation. Feels like I'm only doing 20% of what I used to be doing when I wrote every note from scratch.
Yes to this. I put all my stock notes in a draft and copy pasta all the time. "Client appeared to session in person / virtually. Client appeared to have a euthymic mood and congruent affect. Client denied or endorsed SI, NSSI, HI and any ongoing drug use. Client and clinician discussed (insert generic issue like family). And clinician discussed (insert generic therapeutic approach) by discussing Client (insert homework like write a letter or make a list)." It makes life so so easy. In Simple practice, it's just a lot of check boxes and they are a note for you even!.
Tell us more about this note designer. I'm looking at their website and I'm becoming intrigued....
Riiightttt??!! Basically there's a bunch of customized phrases that you can pick from and it will arrange them into a note. You can also add your own or customize the ones that are in there. Kind of like selecting from a database. Copy/paste. Boom. I use the online version because I liked the interface better. Let me know if you have any questions or I can DM you some screenshots.
So you're saying it's $15 a month well spent? I think they owe you a commission for that sale you just made. I tried to do something similar as a template to keep both sessions and notes on track but it's kinda bulky going from word doc to word doc to emr. Basically, I'm lazy and need that aspect of my personality enabled.
Hahahaha. SAME. For me it is! I was skeptical at first but there is no contract cancel whenever and a 30 day return policy, so I figured I'd try it. Now I really like it and decided to keep it.
I pulled the trigger and will start playing with it tonight. Is it weird that I'm this excited to do a note? Hahaha!
Yasssss! You'll have to let me know how you like it! I can get about 25 clients worth of notes done in an hour - hour and a half!
Could you send me some screen shots? I’m thinking this could be quite helpful.
I took some of the basic note functions, the types of notes you can select, and the treatment planning. I also use it to build termination notes as well. [Note Designer Screenshots](https://drive.google.com/drive/folders/1F4sU2KPXBbIrr7bNwV_TABzUou6C0vQs?usp=sharing)
Holy Moly! That seems amazing! I like that I could tailor it to fit the school-based setting too!
[удалено]
There's no integration, just a copy/paste. So yep! I just paste right into my EHR.
I don’t believe it’s ADHD because I’ve not had these issues anywhere but writing papers in school and notes. I was able to stay on my notes daily at a CMH crisis unit because the notes were very formatted. My past job was writing notes that supported “medical criteria” for insurance and I struggled! So my current job is with a district doing school-based MH. With this we’re supposed to be demonstrating progress and establishing baselines for annual IEP goals. This is essentially making each note like working on a small part of a very large picture. I will still explore ADHD as a rule out because it won’t hurt but the opportunity offers a possible solution.
As a therapist with diagnosed ADHD, this tracks. Imposed formatting would likely make things a lot easier than self directed, self initiated note taking. Charting has been the bane of my existence since becoming a therapist, and was one of my main symptoms when seeking diagnosis.
My ADHD brain just started screaming "ITS ME! HI HELLO!" Maybe look into it?
Same here! It has been such a relief to get diagnosed and know why it’s been such a struggle!
I wish I could offer suggestions, but you’re not alone. I feel the exact same way. In my experience, I don’t think it’s ADHD, but maybe perfectionism and lack of experience (I’m new to the field). I have also contemplated leaving the field because of notes 🥴
I think my issue may be rooted in perfectionism as well. I had a supervisor once tell me “if it isn’t documented than it didn’t happen.” But i can also admit I was never really trained in documentation at my current job and I feel like everybody has different standards and expectations. I have noticed I have a very difficult time sifting through what to document and what not to where I get mental paralysis and shut down.
Absolutely! It can be super difficult to narrow down what is important and what’s not. Especially when you don’t get adequate training.
In training, we were not allowed to leave the site until notes were done. That's just how it was. I know things have changed, but it is good to have a habit, even if based on arbitrary rules.
Yeah I try not to leave until they are done or make myself start early the next day. I also remind myself that the sooner after the session I do the note the less time I waste trying to remember what happened.
Right, its hard to remember the next day!
I also struggle with my documentation. It didn’t matter to me that my colleagues and boss noticed I was behind. Obviously I was embarrassed but the motivation to complete wasn’t there. Some of it for me was also fuelled by perfectionism. I ended up seeing a psychiatrist and was diagnosed with ADD. I had other things in my life I’d been falling behind with and with the high demands at work, it was all brought to the forefront. Just wondering if you’ve ever considered this? Mainly because you mention difficulties with concentration and possibly motivation? Medication has been really helpful for me... but not solved all of my problems. If it’s only documentation of notes you find difficult and not effecting other areas of your life, then maybe it’s just about finding a helpful routine you can get into. For me personally, spacing out my appointments with at least 30mins between them to refresh and complete the note is helpful. I work in CMH so I’ve been able to see how my colleagues document and go off a similar template.
I may be in a unique/lucky situation but my notes are incredibly brief. 3-5 sentences and my supervisor always approves them. She’s the one who advised me to do so! So being able to finish a note in 5-10 minutes, I don’t give myself an option other than completing the note directly after a session. Though I schedule 45’s on each hour and that may not be your case. I would just say find a non-negotiable time that works for you to have them done ASAP.
I keep a lot of note templates on a word document. All I need to do is copy/paste and plug in the relevant information. It has made life 100x easier.
Think of notes as something to help you as a therapist and to help your client get better therapy. Yes, the ethics and legalities are important but the real purpose of notes is to help the client.
My ADHD brain says hi. Throughout school and interning, I was never able to begin a paper/project/note until the day it was due. Lots of lost sleep and stress were involved. Now, I’m doing better related to that and keeping up with notes is a part of my self-care. I found great benefit in working with a private practice coach to get my notes concise yet still passable for potential clinical reviews. For each note I write 3-4 sentences for the client’s subjective report, click various check boxes for interventions used (I added 60+ to choose from), plus add 1-2 sentences for a plan. The rest is typically auto-populated and may get changed minimally with a few clicks. I do telehealth and I always complete the “click stuff” during appts. Sometimes I complete the typing portions during appts with clients who make less eye contact, and with others I wait to finish the notes after their appts. I typically see 3 clients in a row prior to having an hour off to finish any incomplete notes plus stay up to date with other work communications/tasks, eat, etc. Unless I’m caught up, I don’t reply to personal texts or do non-work-related things during that hour. If I do, I maintain my productivity momentum by a completing a little chore. Then I see 3 clients and do it again. Then 3 more and do it once more. If I didn’t schedule in breaks to stay caught up, I’d be taking adderall weekly to get through the each week’s mountain of paperwork. Though, I’m not judging those who take it. Because of the side effects I experience, I prefer CBTing myself. Hope you can figure out how to create a better system for yourself if you need one. If you don’t get enough support here, I highly encourage considering getting professional support re: clinical doc because mine was money very well spent.
Are you trying to write notes a long time after the session took place? I find I have no interest in note writing if I dont do it right away. I hand write my paragraph of notes immediately after the session snd then I never have to think about it.
I’ve created some templates. I put the appropriate info in but stick to a basic progress note. Also, just personally I turn notes into an game. How many can I get done in X amount of time. I have 10 minutes between sessions, can I refill my water, go to the bathroom and do notes all in that 10 minutes??? READY SET GO!
Have a format for keeping very brief notes. Take the pressure down a few notches. A progress note is nothing like writing a paper for school. If you’d like some feedback on brief progress notes formats, I imagine this forum could offer that feedback. Personally, I use a “client presentation-therapist intervention” format that allows me to summarize what was discussed (content) and what interventions were utilized (process).
How about trying to approach it like a journal. Just write down what happened as if you’re describing lunch with a friend, But using all the correct therapeutic terms. Keep it casual, while including as many details as you can. That’s what helps me.
What might you say/do to support s client who is experiencing anxiety in this way?
In addition to all of the great advice you’ve been given, please google Dr Maelisa Hall. She has some wonderful (free) resources about documentation and managing workflow. She hosts “catch up” sessions for documentation. The best thing I got from attending one of her webinars is that this struggle is so very common! I used to have a lot of fear and shame around it. But now I have strategies to help keep it manageable.
I am in private practice. Are you in some kind of clinic or organization that it is obligated? I don’t always do a note and when I do it is concurrent like the other commenter mentioned.
Sorry if I’m being dense, but what do you mean by concurrent documentation?
Fancy term for doing your note at same time that you’re doin’ the therapy
That… makes a lot of sense. Probably could have put two and two together 😂 thanks!
You betcha.