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Is Documentation THAT hard? · Brilliant Minds?

• Olivia: Hey everyone, welcome back to the silly side of the internet Brilliant Minds. Andrea: Well said, well said. Olivia: I mean at least the silly side of two slightly unhinged therapists. Andrea: Yeah. Ain't that the truth? Olivia: I mean, there's no lies. No lies to be found. I I'm Olivia and this is my best friend business partner. Andrea: Andrea, hello. Olivia: Yeah, welcome back. today we're gonna be talking about the I like to call it the Achilles heel of mm our field. And anyone Andrea: Yeah, definitely. Olivia: that is a therapist listening to this, you've probably already thought about what we're going to talk about, which Andrea: Ha ha ha. Olivia: is documentation. Woohoo, yay, but Andrea: Yay Olivia: okay so I think the first thing that we should cover Andrea: Mm-hmm. Olivia: is just right out of the gate, let's just say that you and I don't struggle with documentation. So that's our bias going in. Andrea: Nope. Yeah. Olivia: We So we're gonna talk about a thing that is the Achilles heel of our field while also recognizing that it is not our Achilles heel. So I just wanted that to be like kinda said right out of the gate. Like that's our bias going in, like we both don't struggle with it. Like legitimately. Like I'm Andrea: We don't. Olivia: not even joking. Like we don't we don't struggle. Andrea: No, and we know that because we have been told that. And we Olivia: Yeah. Andrea: know that because we coach that. And I think the feedback like that we get from that is like, you know what you're doing. And I'm like, Yeah, after ten years, I'd hope so. Olivia: Yeah, that and like I know you had to audit my stuff and I think well I don't think Andrea: my god. Yeah. Olivia: I had to audit you 'cause I didn't really do audits, but yeah. you s you've seen my treatment records. So it's not yeah, it's there's no surprises. Andrea: Yeah, yeah, I have. I've seen I've seen a lot of treatment records, just generally speaking, so Olivia: I mean I have two. Not as many as you, 'cause you used to actually like audit treatment Andrea: Ha ha ha Olivia: records. I did not sign Andrea: Yeah. Olivia: up for that. Surprisingly, didn't sign up for that. Weirdly. Yeah. Andrea: Yeah. Yeah. And part of this topic do comes up today for us in lieu of the like big media case that's going around by of Olivia: Yeah. Andrea: what's her name? Lacey Clancy or something. I don't remember her name. whatever the mom is. Olivia: I think I think it's Lindsay. Andrea: Lindsay? I was like, Lant Lace, I don't know. The the mom case, right? And and a lot of what's coming out is this conversation amongst therapists or around documentation. So we figured today we're not gonna go over the case. We don't I do not have time to deep dive into that, nor do we really want to. So we're gonna talk generally about this Achilles heel, this thing that comes up a lot in court cases, media issues, and in just practice in general that have to do with documentation. Olivia: Yeah, yeah, absolutely. I mean I have a lot of different potential theories as to why I think this is, but why do you think clinicians struggle so much with documentation? Andrea: I think that's something that that I think about kind of often, especially as a as a supervisor, Olivia: Mm-hmm. Andrea: because I'm constantly looking at documentation. I'm constantly looking at this, and then I'm always like, but why don't I struggle with it? I think is another question I ask myself is like, how have I been able to do it? But so many people haven't. And I think it's hard Olivia: Yeah. Andrea: for me to answer that question because I that sounds so unhumble. But like because I don't struggle with it. Yeah. Yeah. Olivia: It it's true. Yeah, yeah, yeah, yeah. No, I f I feel the same way. I feel the same way. Of like Andrea: Mm-hmm. Olivia: especially you know, w we'll talk more about this idea but Clinicians in the field generally they struggle with this, but then especially like neurodivergent clinicians really struggle with documentation. Like the Andrea: Mm-hmm. Olivia: executive function piece of it and the like difficulty creating a routine or system around it really challenging. Andrea: Mm-hmm. Olivia: And so I often think this, I'm like, I have ADHD. Why don't I struggle with these same things in documentation? Like I see so Andrea: Right. Right. Olivia: many other people struggle with. Because like I have that same mental capacity to struggle and I don't and I don't know why. Totally. Andrea: Mm-hmm. Yeah. Yeah. I I mean, I think if I am to put some sort of reason or theory to to why people struggle, I think I think a lot of therapists out there go into therapy not thinking that that's a part of it. and Olivia: Mm. Andrea: and not really knowing or understanding or really truly realizing the importance of it and and why why it is a crucial part of our job. I think so many therapists just kinda like throw it out and then have a hard time being like connecting it when they don't experience why it's important. I think both you and I have had experiences where we know and can see why documentation is important and have experienced things. You know, I worked in ERs before going into getting my masters and like it is critical to document everything. And and so I had just kind of had that natural muscle like starting in the field, but I I I think there are so many therapists that just don't take it that seriously. I I don't I don't know. That's my only reason that I can think about it. Cause school teaches you documentation. Mine sure did. A lot. Olivia: Mine did not. Andrea: Really? That's interesting to me. Olivia: Of course social workers didn't. Andrea: I mean I've heard b I've I've heard some have it. Olivia: I mean, I hope they do now, but definitely like way back in the day. when I went and caught my masters. No. Andrea: That's so interesting. You'd think that that would be Olivia: We barely had a Andrea: really important. Olivia: I mean we barely had a like diagnosing class. I mean b part of it I think is just because social workers can do so many different things that like the idea of Andrea: Yeah, that's fair. Olivia: training and documentation, it's like it's going to look different depending Andrea: Yeah. Olivia: on the kind of social work you're doing. Like in schools, in hospitals, Andrea: Mm. Olivia: nonprofit work at the county, community mental health, like all of it's gonna be so different. Like there there wouldn't be a good way to encapsulate that. But Andrea: True. I guess I guess I've worked with some social work students who are like specifically in a course line work Olivia: Like a clinical Andrea: for that. Yeah. So that's probably where that comes from. Olivia: Yeah, I mean, now more than ever there's a lot more like ways to specialize in your masters in social work. Like back when I did it Andrea: Mm yeah. Olivia: was basically like, are you gonna do macro work? Are you gonna do like you know, like more like Andrea: Yeah, that makes sense. Olivia: like meso micro kind of work? That was Andrea: Yeah. Olivia: basically the distinction. And now it's like, you can do a clinical social work track, you can do a I don't know, like youth and families track or you know, whatever. So I would Andrea: Right. Olivia: be surprised that documentation's a part of it now, but definitely not across the board. Andrea: Yeah. Yeah. I mean, I guess then it's still like that theory still doesn't apply, right? Because if some programs do include it, if they don't include it, there are still therapists, so many therapists that struggle with this. Olivia: I almost feel like it's I see more the inverse is that I think clinicians know how important documentation is Andrea: Yeah Olivia: and then they like don't know how to do it out of fear that they're going to get it wrong because they know it's important. Andrea: that's an interesting theory too. I have seen that. Olivia: Right. Of like, I know it's important and I know I need to do it and like I know I need to include all these things but like I feel like I'm gonna screw it up or it's wrong or I don't wanna do it wrong so then I like just don't do it or don't start Andrea: Yeah. Yeah. Olivia: or whatever. Andrea: Yeah, that's interesting. I mean, I guess like we are told different things too in different settings about what's important and what's not important and how much to put and how little to put and it can get really overwhelming and to also know that that documentation is for is for the client and it's for the insurance company, right? And so it's like I can see how it could be also feel really overwhelming. And and that fear of like, well then what do I put? Well I'm just gonna avoid it or w or whatever that, you know, defense mechanism is to that. Olivia: Right, right. Yeah, so I think it's part that and the other thing I see when I see the documentation is like I guess maybe lack of standardization or like training around documentation. At least like from my experience, like I said, in my master's, like we didn't Andrea: Well Yeah. Olivia: have any documentation training at all. And it basically Andrea: Right. Olivia: all it they just were like, hey, rely on your place of work, rely on your place of internship to teach you. Well, it's like Andrea: Yeah. Olivia: sometimes that can be like blind leading the blind, respectfully. Shout out to my internships. Andrea: Ja Olivia: But like w w like what what makes them qualified or not qualified and like n there's really no like there's no set standard or like structure around documentation. Andrea: No, and and there's also certain states do also implement their own requirements, which not in this not in the primary state that we are licensed in, but in my secondary state there is. Olivia: Thank God. Andrea: and so we have we have a lot of things to look at. And to kind of go back to what you said about like training too, what I've heard, I've never taken an outside documentation training myself. I've taken one Mm my master's program had a bunch. We had to write Dap Notes and SOAP notes like over and over and over again. Olivia: Hm. Andrea: and we can maybe get into those later. But I have heard from people who have taken outside documentation courses so much anxiety come from them. I think there is a certain someone that you and I know and are aware of that does that that does that does a training that I've had. Olivia: I have no idea who you're talking about. Andrea: I've had multiple associates or or clinicians go to that training and come back and be like, I need to do this and this and this and this and this in my documentation. I'm like, G chill. Throw some water on your hot pants here. Like Olivia: I've actually taken Andrea: Breathe. Olivia: two different documentation trainings. Andrea: You have, okay. Olivia: Yeah. The first one I took was like a fully online one. And I took it when I first transitioned to a clinical role of like being a therapist because at the time I didn't feel like I was getting any supervision support on my documentation. Andrea: Haha. I mean you weren't. Olivia: I wasn't. And I like specifically Andrea: Ha ha ha. Olivia: asked for feedback because I was like, hey, all all the documentation I've done up to this point is through like my nonprofit work and Andrea: Mm-hmm. Olivia: we're grant funded. And so the documentation is basically like directed by this grant and like what we have to document to keep our funding and like for audits and stuff. But Andrea: Right. Right. Olivia: it's not necessarily like clinical and and nature. And so like I w I asked for a lot of direct feedback on like, okay How do I do this? And all I got by was like, like your notes so good. And I was like, but to like n n nothing, like no feedback at all. So I ended up taking a a documentation training. And to be honest with you, well, this was like, you know, what, seven years ago? Eight eight years ago? Jesus Christ. Andrea: Yeah. Olivia: don't remember a lot of it. but I will say the one I did online, maybe just because it was online, it was way less anxiety inducing than the documentation I took that was like, Andrea: Makes sense. Olivia: I almost said live action. That's not what I mean. What what what what's the what's the Andrea: Kinda. Live? Olivia: Yeah, live. I was like it wasn't in person. I was gonna say in person. I was like, that's not Andrea: This is live. Olivia: this live action. Live action therapy. Could you imagine? Andrea: That was good. Olivia: Sorry, that's so funny. definitely like less anxiety inducing. and she seemed like pretty informative. It was long, but like overall it was helpful and like I liked the way it was structured and I think there were like some actual takeaways that I like I would still use in training somebody else in how to document. So Andrea: nice. Yeah. Olivia: like that's impressive. Andrea: Mm-hmm. Olivia: But then the documentation training that I took that was live action Andrea: Yeah. Olivia: It was a lot. Like i i it was Andrea: Mm. Olivia: g Andrea: Was it that one that I'm talking about? Olivia: Yeah. Yeah. Andrea: Okay. Olivia: I don't think it was that I don't think it was that anxiety inducing. I think it's anxiety inducing for people that are not good at documentation. And most of the people that aren't good Andrea: That's fair. Olivia: at documentation would take that training because they'd want to get better at documentation. They would take that training and then be immediately sent into panic mode because they think about all the things they're doing wrong. And I went into that training being like, okay, I think I can like finesse a couple of extra things or like include a couple of things in my documentation that would really like like Andrea: Mm. Olivia: be beneficial that I might recommend to somebody else to implement, but I don't know if I would inherently require it. It's just like ways Andrea: Right. Yeah. Olivia: of like, okay, well I do these, like I structure it this way and I like think through it this way, but like that wording is helpful. Like I'll include some of that wording here and here or like I've adapted a little bit of my style. But overall I would say like it felt more like a scare tactic. And and that and that's what Andrea: We like that in this podcast. We've said scare tactic Olivia: We do Andrea: in like half of our episodes. Olivia: That's so funny. we should have a scare tactic counter, like word counter. You know? Andrea: Yeah, truly. Olivia: because so that's why I say I think a lot of people struggle with documentation because they know it's important and then they get like totally freaked out by it. Or they hear some Andrea: Mm. Yeah. Yeah. Olivia: like horror story and they're like panicked. Andrea: I definitely think this whole like documentation approach is very much like a spectrum. Right. Like I I Olivia: Hm. Andrea: think there are people that think they're really good at it and just don't care. And then I like just don't do enough. I have seen that. And then then there's the opposite end that's like super anxious, like afraid they're not doing it right, don't know what to do, write maybe too much. Like there's these extremes, and then in the middle is kind of where you wanna be, which is like aware of the issues, but not so unaware like that you can just do it. Olivia: Yeah. Yeah. I mean, yeah, so maybe like part of it's like training, part of it's standardization. I think Andrea: Mm. Olivia: the other piece is like I said, I feel like it's a lot of blind leading the blind. Andrea: Yeah. yeah. We have we have so many there's no guideline. Like there is no like obvious guideline for anything in this. There are Olivia: Correct. Andrea: right, there are codes of ethics that we have to follow that don't clearly state documentation guidelines. There are state regulations Olivia: Mm-hmm. Andrea: that we have to follow per state depending. Olivia: Mm-hmm. Andrea: There are insurance guidelines that we have to follow. There's just like general Olivia: Mm-hmm. Andrea: good human guidelines that we have to follow. And then there's also like potential practice guidelines. Olivia: That and then then like ca that's all the guidelines. And then there's style. Like your writing style or your like clinical Andrea: Yeah. Yeah. Olivia: approach or style. Andrea: Yeah, totally. Totally. There is no there's no standardization. And there is not there are ways to and I always switch the two, make notes. inherently notes can be or documentation can be super subjective. What's Olivia: Uh-huh. Andrea: the w yeah. But so there isn't really a standardization in that because it is so much of like our experience that we're recalling. Olivia: Right. And I think that's part of why on a deeper level documentation is challenging because we're having to take an hour's worth of time which parts of it were incredibly subjective. or very like prone to be incredibly subjective. And we have to document it in the most objective way possible. Andrea: Correct. Yeah. It's that translation. Yeah. Olivia: That I think is the hardest part of yes, it's a translation. And I think like if for me, who doesn't struggle with it? Andrea: Ha ha Olivia: head to pinpoint I think the hardest part of learning documentation, it's that. It's being Andrea: Mm-hmm. Olivia: able to like take the emotions out of it and write as objectively as possible and like Andrea: Right. Yeah. Olivia: really boil things down. Andrea: Mm-hmm. Yeah. So I'm I'm curious, since since we're kind of headed in this direction, what would you say or is that the number one issue that you see as a supervisor when it comes to documentation? Olivia: No, the number one issue I Andrea: Or barrier. Olivia: see in documentation is that it's too long. Andrea: Yeah. Same. Taking too much time, it's too long. It's too many words. Yeah. I would fully agree. Yeah. Olivia: Yeah, it's too much information. Yeah. To be honest, I haven't really I don't think I've ever seen documentation be too short. Andrea: I have and it was because I told someone that their initial one was too long and then they went completely opposite and I was like, gosh. Olivia: Usually when it's too long, it is a painstaking process to get that person to like become more succinct. Andrea: Yeah, that was a super rare situation and I was like, How did we get one sentence? They're like you told me it was too long. Olivia: One sentence? Andrea: Literally. Olivia: That's wild. Can't you imagine? my gosh, one sentence? Was it a run-on sentence at the least? Andrea: No. A regular size sentence. Olivia: That is bonkers. Yeah. Andrea: Yeah, but but it the like the more common experiences is it is painstakingly hard to bring it down and like get it to a point that feels not like a novel. Olivia: Seriously. Yeah. 'Cause I think like an a a part of that is learning to be to be able to summarize better. Andrea: Yes. Yeah. And Olivia: Yeah. Andrea: like I I I think I hear a lot. Well, I'm I don't want to miss something or I don't want to forget something is a big one. Yeah. Olivia: Forget. Yeah, forget's a big thing. Yeah, yeah, yeah. Andrea: And and I talk so much about how documentation is not for me. It's Olivia: Exactly. Andrea: it's not for me. It's not for you as the therapist. It's for your client, number one. And it's for your tracking purposes for insurance for the most part. And I don't remember what the third thing is as I say. I say a couple things, but I don't know. What do you say in that? Olivia: I say that w kind of the same thing as you but like different flavor, which is like It all feels relevant because you care so much about your client and you wanna be able to remember things and track things. And you're going to have to trust the process that if something is significant to the client it will continue to come up. So you'll be able to remember it. Like it it it will be there. Like, give yourself the benefit of the doubt that you are going to remember these things. So it's not about documenting every single little thing of like their dog's name and the place they went to school and and and and you like Andrea: Right. If you're worried about all those Olivia: It's okay. Andrea: things, you're gonna burn out. Like if you're constantly Olivia: yeah. Andrea: trying to track all of that. And also, like, I forgot someone's name this week in a session. And did my client really care? Not really. They were really nice about it. Olivia: Dude, I've had that. Andrea: Like it wasn't the client's name. It wasn't the client's name, I forgot, just to be clear. Olivia: No, I actually have had that. Back when I was seeing like a billion clients, I would like Andrea: Mm-hmm. Olivia: l like boot up the session and like the second I would get in I'd be like thinking to myself like I I couldn't for the life of me tell you this person's name. And it's not like the client's Andrea: Ha ha ha Olivia: name's really like coming up in session, right? So like thank God. Andrea: No. Olivia: But yeah, yeah, no, it well and that's Andrea: Yeah. Olivia: usually what I all say is like, okay, so you forget their dog's name. That's okay. Andrea: Yeah. Mm-hmm. Olivia: Like i i it it's all right you're allowed to forget those things and be human. Like yeah. Totally. Andrea: Yeah. I think I think I I get a lot of questions from some people. They're like, how do you not write notes like during session? Like how do you not sit there with a notebook and like write while you're talking? And I'm like, 'cause I don't need that. Like that's not that that to me takes away from my work. And they're like, well then how do you how do you document your note afterwards? I'm like, 'cause it's in here. Like I talked to someone the other day that took a documentation training and they were recommended to write the note during session. And I was like, Olivia: Like physically? Andrea: Yeah. And and I think that the trainer was probably talking about the treatment planning process, not the documentation, but it was like this mix up that I was like, no no no. Like if you at the beginning, if you're a fresh new therapist, I do think it's okay to write notes a little bit. If you're feeling anxious, if you want to get that out of your system, go for it. But I would never rely on that. Olivia: I like remember way back, like throwback to way long ago podcast Andrea: Mm-hmm. Olivia: episode where he talked about how like you like write the alphabet Andrea: Yeah. Olivia: In session. I I cannot write and listen. Even if it's doodling. Even if it's mundane, Andrea: Mm-hmm. Yeah. Olivia: doesn't matter. I get too focused on that thing. I Andrea: Mm-hmm. Olivia: would like mentally shut down if I was writing down notes. There'd be no way. Andrea: Yeah. I don't know how I used to write notes all the time. Like really early young baby therapist Andrea would like write notes during session all the time. And it just like Olivia: I mean like I'll r I'll jot something down to like email if I'm like need to follow up on something 'cause like I don't wanna forget. So I'll write that down. I'll be like, email blah blah blah r right? Andrea: yeah. I still do that. Yeah. Olivia: But that's like to me, that's more of like a to do than an than like documenting a note, you know? Andrea: Yeah. I used to go through notebooks. I used to just like at the end of a week like tear out pages and shred them. Like when I was ready to let go of the information. Yeah. Olivia: That's wild. No, I've never I've Andrea: Mm-hmm. Olivia: never done that. Again, mostly 'cause I can't do that and focus. There's no there's no way. Absolutely no way. Andrea: Yeah. Yeah. It I mean everybody's process is different, right? And but I think it's I think it's interesting then like how so many people feel like they need to hold on to every single detail of that session. Like I don't need Olivia: Yeah. Andrea: to know that your client went to McDonald's yesterday. Like Olivia: Yeah. Andrea: Why is that important? And it is that important to the session. Was that part of the session? That's what I want to know. Olivia: Yeah. Yeah, exactly. Like is that related to what they're in therapy for? No? Then it doesn't need to be in there. Andrea: Right. Like did they go to McDonald's? Did it go to McDonald's and it send them down a shame spiral and then you talked about body dysmorphia? Well then you wanna say client went down a shame spiral and we focused on body dysmorphia. Olivia: Well, take notes everyone. Andrea: Ha ha ha. Olivia: take notes now before we get to the next topic so you can still okay Andrea: One one I will say, one of my favorite supervision tasks when it comes to documentation. I don't know why I enjoy this. I also love editing papers, which is so funny because I'm not good at it. Like for myself for myself. But when it's someone else's. Yeah. But Olivia: Wait, wait, wa okay. Like I like doing this thing but I'm not good. I'm like, that's a really weird marketing strategy. Andrea: like if I'm typing something up, then there's Errors upon errors, but I like seeing somebody else's thing and then me editing it. But I love when some when I have a clinician who writes really long notes, and I'm like, all right, pull up your notes and I'm gonna walk you through how to make that note into three sentences. And their mind is usually soul blown after like the first reframe of like the first three sentences. And I'm just like, here's how I would do it. Olivia: I love that. Okay. And a surprise to no one, I do something very similar. Andrea: Yeah. Olivia: I will write a really lengthy note for a session I've already had. Andrea: Mm-hmm. Olivia: Like a really long version. And then I'll have them edit it down. Andrea: Ooh, that's a good idea. Olivia: And the reason I like to do it that way is because I think it's easier when it's not your client to summarize. Andrea: Hmm. Yeah. Olivia: And if like summary is a s it's like summarizing is a skill and it's so much a part of documentation, I'm like, okay, it's gonna be easier if it's not your client. So I will give them a long note of my client and we like summarize it, like boil it down to like four or five sentences, and Andrea: Mm-hmm. Olivia: then I'll show them the one I actually did after. Andrea: That's great. I like that. That's a good skill. Olivia: So it's like v it's very, very similar. 'cause I I've done it the other way where like they'll show me a note and I'll be like, Okay, well I would like take out this sentence Andrea: Mm-hmm. Olivia: and I would do this and da da da da. And like that is helpful for some people. Like I've I've done that a lot and I and I like that. Andrea: Mm-hmm. Olivia: and I've I've done it the other way that I mention when the lengthy notes are like killing them Andrea: Yeah. Olivia: and myself because it's like I can't like cannot keep reading long notes. Andrea: Yeah. I've I've never intentionally like written a note myself that was long for them to edit, but I have ha s told them like, okay, next note you write, I do want you to write it long, and then I want you to do a second version of it and shorten it and see if you can do it. And that practice has been really helpful too. Olivia: Yeah, yeah. And I think I think that's like the biggest thing is practicing it. And yeah. Andrea: Yeah. Yeah. Well, I think this is also a maybe a good spot to talk about like why they shouldn't be long. Like I I'm thinking for the for the client, right? Why as therapists, in your opinion, do we want those notes to be short? Olivia: Out of respect for the client's confidentiality. Andrea: Yeah. A hundred percent. Olivia: 'Cause 'cause a lot of the inform yeah, 'cause it's a lot of the information they share in session is relevant to their life, but is not relevant Andrea: Mm-hmm. Olivia: to treatment of why they're coming to therapy in the first place. So like I I use this analogy a lot. It's like if you're coming in for anxiety and you talk about tw like about your grandma for like twenty minutes and how ridiculous she is, I don't need Andrea: Mm. Olivia: to put in the note that your grandma likes purple. Because it has nothing to do with you having anxiety. So that twenty minutes is like client disgust current dynamic with grandmother. Andrea: Yep, exactly. Yeah. Yeah. Olivia: That's twenty minutes in one sentence, right? Andrea: I'm totally. Totally. Olivia: Yeah. Andrea: And and in addition to that too, you know, all of our notes are subject to some sort of legal subpoena if anything is ever to happen or an insurance audit. And we don't Olivia: Yeah. Andrea: want all that information to be out there. It's not necessary. And in the off chance that you write your notes like novels and go crazy and somebody's notes are subpoenaed, well, then there's all this extra information that could be twisted and turned and used in different like pro and be problematic. I mean, that's an extreme Olivia: absolutely. Andrea: situation, but it but it has happened. Olivia: Yeah, and I think that's like the big bad that clinicians are scared of is like, like what if I get subpoenaed? And it's like, yes, it is possible. But the worst Andrea: Mm-hmm. Olivia: thing a c a clinician I mean, you might have a different idea than me, but I'm guessing we'll agree 'cause we're the same person. Andrea: Yeah. Olivia: is I think I think the worst thing a clinician could do in regards to documentation is not do it. Not having anything is worse than having too long Andrea: Wait. mm-hmm. Olivia: of a note. Andrea: Yep. Totally. Yeah. Olivia: So like if you're out there and you're struggling, I I hear you and there's people out there that can support you, but like no documentation Andrea: Mm. Olivia: is the worst possible outcome. Like, at least Andrea: Correct. Correct. Olivia: something. Even if it's a sentence, even if it's a novel, something is literally Andrea: Yeah. Olivia: better than nothing. Andrea: Yep. I I fully agree. I fully agree. Like there are so many problems with just documentation not existing. As like what we're seeing in the media, right? Like it you know, there was there's lack of documentation or there's missing documentation, right? We see this in so many circumstances. Olivia: Yeah. Or inadequate documentation, which is kinda like more what we're talking about, which is like Andrea: Mm-hmm. Olivia: cross your T's dot your I's it's like not quite that challenging. yeah. Andrea: Yeah. Yeah. Yeah. Well then I mean that also touches, I think, a little bit on other guidelines that we do and do not have, which is some practices require treatment plans and diagnostic criteria statements and discharge planning Olivia: Mm. Andrea: and and mental status exams. But n you know, there isn't that regulation for private practice necessarily. And there is for some like it And and Medicaid requires certain documentation that others don't. So it's like there isn't a set standard. And and I think I am of the mindset of like I'm always gonna do a treatment plan, whether it's thorough or not, because like I it is a good practice for me and and it is helpful for my clients in a lot of circumstances. But a lot of times, like who knows when I'm gonna need that, right? Like it can be helpful. Olivia: Yeah, and I think I think that's part of why documentation can be such an Achilles heel for people is because there's again, like there's no set structure. Like if you're in private practice, you're in group practice, you're working out the county, whatever, like the structure of documentation is so different. It's so, so different. And a lot of times it puts the responsibility on the clinician to figure out how they wanna document and then even like setting their Andrea: Mm-hmm. Olivia: own structure and then the I think the other piece of documentation we haven't directly talked about yet is like creating their own system for doing it. Andrea: Yeah. Olivia: That's I think the other really like big challenge of of clinicians getting Andrea: Mm-hmm. Olivia: documentation done in the field is like they don't know how to create a system to be able to do it. Andrea: Yeah. Yeah. I mean it Olivia: And I have a very, very rigid system. Andrea: I'm curious what your system is because I think mine's not as rigid, but it is it's I think mine has become more of a hab habitual system where it just is like it's just what I do and it works for me. And like, am I rigid on it? Yeah. But like if I mess up, I'm okay, I'm gonna catch up on it the next day. Like Olivia: Yeah, I don't Andrea: But it's a habit. Olivia: Yeah, that's the thing is is like it's very much a habit for me. I don't even really think about it. So maybe I I should just like take this opportunity to like thank the autism part of my brain. I don't know. Andrea: Ha ha ha. Olivia: Because most ADHD people like couldn't make a habit out of this, right? Like habit Andrea: Mm. Yeah. Olivia: formation is really, really challenging for ADHD people. But yeah, Andrea: Yeah. Olivia: no, I I've got a r I got a rigid system. Like I My notes are always done before I like stop working for the day, basically. Always. Andrea: Mm. I do my notes the next morning every single time. Before I do anything. Mm-hmm. Olivia: I can't. It's too hard for me to get back into. So I always have to do it same day. Andrea: It's it's oddly it's oddly my way of getting back into therapy brain. Like it's like this interest for me, it's like a it's like, I gotta write this note. I gotta exactly, exactly. Because like Olivia: It's like a transitional activity. Yeah, interesting. Andrea: at the end of the day, for me, I'm such a sh switch it off and head out of the room person that sitting here for any like moment longer makes me like, I need like vibrating. So I need to go. but in the morning, it's a great transitional thing for me where I can sit here with my coffee and like and just go and do it. And that was what worked for me. And obviously it's a it's different for everyone, but it is like Olivia: Yeah, yeah. Andrea: now it's a habit. And yeah, it's a struggle for me. for some days, and some days I'll totally forget, especially now that I have to like run a practice. I'm like, wait a second, there's other shit I gotta do. Or I'll get like excited about doing something else. But it's still like every morning I check in and and the good thing about the eight the the health record system that we use is that it reminds you and then it reminds you and it reminds you until you get it done. Olivia: True. Yeah, I feel like, you know, when you you described yours as kinda like a way to get back into work essentially. It it made Andrea: Mm-hmm. Olivia: me realize that my way of doing is like a way for me to like turn my brain off Andrea: Yeah. Olivia: and feel like I am done because it's complete. Andrea: Yeah. That makes sense. That's yeah. And it's a different Olivia: Right? Yeah. Andrea: if a different level of transitionary object. Yeah. Olivia: Right. The other thing is is like I've done documentation enough to know that like if I actually sit and focus on it it will not take me long at all. Andrea: Totally. I I told someone yesterday, I think I said, my notes, I asked them first, how long are you spending on one note? And their out answer was outrageous, but I love asking that question because then I tell them how long it I exactly. Exactly. Olivia: I hate love that question. I hate I know, I hate love it. I hate love that question. Andrea: And and then I told them how long I take. And I think I probably take like maybe a minute. Olivia: Yeah, I was gonna say like minute or two. Two tops. Two tops. Andrea: Like yeah. Yeah. If it's a long term client, sometimes it's 30 seconds. Like 'cause I know I have the words in my head. I have I know what therapeutic interventions I do regularly. Like I can pull those out and just pop them in. Yeah. Olivia: Yeah. Every time I've ever been tempted to and have asked the question, how long does it take you to write a note? I never Andrea: Mm-hmm. Olivia: get an answer back. That's mine. Never. Andrea: Mm mm. Olivia: Never. I never do. Yeah. It's always like, maybe like twenty minutes. I'm like, Twenty minutes. Andrea: Yeah. Well, and then, you know, this is a this is a whole other track we could go down, but there are still a lot of practices that do not pay for documentation time. And like, Olivia: yeah. Andrea: why are you spending as much time on your documentation as you are that you could have like two other clients? Not saying Olivia: Or Andrea: you should have two more clients, but Olivia: But yeah, for example, like literally do anything else with your life. Yeah. 'Cause like Andrea: Mm-hmm. Rest, eat. Olivia: Yeah. Like like Andrea used to do, take seven minute power naps between Between sessions. I mean, even Andrea: So true. Yeah. Olivia: if I had a packed day and it was like full of meetings, I got to the end of the day and I hadn't been able to document it all. Let's Andrea: Mm-hmm. Olivia: say it's five sessions I had to document. Ten minutes. Andrea: Max. Olivia: So it's like it's so much easier Andrea: Mm-hmm. Olivia: for me to stay in work brain and just be like, I don't want to do this, it's gonna take forever and I'm like, it's never gonna take me for like it never takes me that long. And then it just like boom boom boom boom boom, I'm done. Right. So Andrea: Right. Yeah. Yeah. Olivia: I think it's I think part of it is like being able to have the habit and a system for it, but also it's like training your brain and having the discipline to know that it won't Andrea: Mm-hmm. Olivia: actually take you forever. But you you do have to like focus and work at it. Andrea: Yeah. Now I will preface this too by saying, like, we are in private practice, which does mean that we don't have some of the additional documentation that things like Medicare, community mental health requires. But even if Olivia: Right. Andrea: I think back to when I was in community mental health and I had endless paperwork, I still don't think it took me an hour to get a full day's worth of clients done. I think maybe an hour. Like And and at that time I did get paid for that hour, but it was like because I was, you know, maybe I didn't intake that day, or maybe I like you know, Olivia: The intakes. Andrea: it's the intakes, right? And that is gonna be the the longest thing. And so I acknowledge that. But even then I was like, I'm still not taking like I would leave if my last client ended at five, I would leave at six and there would still be people documenting in there. And I'm like, what's come on. What are we doing? Olivia: Yeah. That does make me curious, like, how long do you think it takes you to write an intake note? I actually just did one today, so I generally know about how long it takes. Andrea: Mm now I mean maximum five minutes, not even? Olivia: Really? Andrea: Well, for intakes, I do probably write more in like on a piece of paper, usually. Olivia: Yeah, I do too. Yeah, yeah. Andrea: and I will sometimes have my like intake questions pulled up on my computer so that I'm like writing and and kind of comparing and making sure I'm answering everything. So I think I have a system down pretty much now where I'm just like entering in what I wrote in session. Olivia: Interesting. Andrea: Yeah. So I'm not having to like recall all of 'cause intakes are so much more Olivia: In depth. Andrea: Yeah. Olivia: Yeah, yeah. I mean I think if you included like all of the initial session documentation, so not just like the initial session note, but then the like other pieces of documentation you usually do at the first session. Andrea: Mm. Olivia: Like I put a diagnosis in, not a treatment plan, but I put like a diagnosis in, right, and I save it. Or like Andrea: Hmm. Yeah. Olivia: I do a mental status exam and I save it. Andrea: Yeah. Olivia: like I sign the consent forms too, that kind of thing. Like if I put it all together fifteen. Maybe twenty. Andrea: Yeah, I guess I guess with with like a treatment plan, depending on if I talked about treatment plan in a session or not, you know, treatment plan for me does include like diagnosis. then maybe more like ten fifteen. but I do I do that kind of collaboratively f collaboratively with my clients, so it's pretty easy for me to do that. Olivia: Yeah. Yeah, that's fair. Yeah, I I just do initial sessions infrequently enough. Andrea: Yeah. Yeah. Olivia: that I I haven't r really like I don't know, been able to get super formulaic with it, so they usually just take me longer. Andrea: Yeah. When I was when I was in community mental health, I was in both clinics that I worked in, I did like a day where I was the intake coordinator or whatever. So I would just do intakes or and then at one job I s would have two hour chunks throughout the week that were for intakes. And they were two hours long. And I would have to do like go question by question. Olivia: god. Andrea: Make sure I did a safety plan if that was necessary. I'd have to do a genogram on these in these intakes. I'd have to do like yeah. Olivia: The last time I did a genogram was when I was in school. Wow, Andrea: Ha ha ha. Olivia: fly a kite. That's insane. Andrea: Yeah. And they were two hours long and I do not sometimes I'm like I do kind I liked that because I didn't have to continue to see the client. I just got to assign the client and that was fun sometimes. Like I got to like diagnose them and kind of get into the nitty gritty but then be like, I don't have to see you anymore. But it's this I don't miss yeah. Olivia: Yeah, I have solved your mystery. Peace. Andrea: But I don't miss the documentation piece of that at all. Olivia: yeah, that sounds brutal. I didn't really have anything Andrea: Yeah. Olivia: like like that. So I yeah. Oof. Andrea: Yeah. It was interesting. Olivia: Yeah, that's rough. A genogram for an intake? barf. Andrea: Yeah. Mm-hmm. Yeah, for every single client. Uh-huh. I love them, but I'm a weirdo. Olivia: Barf I mean, it'd be one thing if you chose to do it voluntarily. Andrea: That's fair. That's fair. Yeah. Olivia: That's bongers. Couldn't be me. Andrea: Yeah, but needless to say, like there's so man like and that was a practice, that was a practice guideline. So like that was the clinic's Olivia: Great. Andrea: guideline, right? And that's not for everyone. That's not what we do. Olivia: Yeah, that's not what I do. Andrea: No. Olivia: Mm mm no. Yeah, documentation's Andrea: Yeah. Olivia: such an interesting one. And Andrea: Mm-hmm. Olivia: I just don't think Andrea: Mm. Olivia: it discriminates for clinicians. Andrea: Mm. Olivia: Like I think s I mean I can't think of a single person I supervise that hasn't struggled with documentation, at least in some way. Andrea: Right. Right. I mean, do we feel like we need to spend a moment on like severe documentation, mandated reporting type documentation? Olivia: like we have what do you mean like weigh in on like how we Andrea: Yeah. Olivia: do it or like how tricky it is or like things to consider. Andrea: Maybe yeah, like the ha the trickiness of it and the like ethics and and things that come with that. Because I think that's another major source of what do I do? How much do I document? What do I say? and and aga like this is tough to talk about generally because there are there's so much context that comes with that. And a lot of times I will tell people If you don't know what to document, reach out to someone. Talk to a colleague. Reach out to a supervisor. Talk like there are people out there that can help and support you if you're feeling stuck. But if you're sitting there and you're like, I don't know how to do this, then ask for help. Like you don't have to sit there and do it and feel like you're doing it wrong or be afraid that you're gonna do it wrong or that you're gonna miss something. Consult with someone. Olivia: Yeah. I mean I think I think that's why I I almost like even hesitate to go into that because of context. Andrea: Yeah. A hundred percent. Olivia: Because i it is a really important thing and it's a necessary thing and obviously Andrea: Mm-hmm. Olivia: like I have a lot to say about that but I don't want Andrea: Yeah. Olivia: any of it to be without context. Andrea: I and there isn't really a way to bring context to this, right? Unless we Olivia: Right. Andrea: were doing some sort of a case study. And I think that's why I bring this up as like this idea of if if you're stuck or if you're struggling, that there is support for that. Because I think some therapists isolate themselves in that and think that they need to be able to do it all on their own, which then leads to issues and errors. And Olivia: Yeah. Andrea: and I think that is something that we see in media is this Clinician didn't call the police, right? this clinician didn't document this suicidality. And it's like, well, there is actually a lot of context that goes into those decisions. And maybe that, you know, maybe not calling the cops was an appropriate decision. Maybe like doing this other thing was a better decision in that moment, right? But documenting and and consulting and finding support in that is very important. Olivia: Absolutely. And also too, like, the idea is nobody else struggles with this and that's the reason why you're isolating yourself. That's just again, that's just not the case. Like Andrea: Yeah. Olivia: I just I ha I really have not met clinicians that don't struggle with documentation or have struggled with documentation. Right? Andrea: Completely. Yeah. Olivia: Like My struggle looked a lot different, right? Because I had no idea what Andrea: Mm-hmm. Olivia: I was doing and I tried to get support and I like didn't have it. Hashtag Andrea: Yeah. Yeah. Olivia: bad supervision. Andrea: Mm-hmm. Olivia: but then I like took trainings and I like looked at other people's documentation and Had to work at it and like work with it and Andrea: Yeah. Olivia: I'm glad I did and and now I don't really struggle with it. And I get that, you know, somebody might look at that and be like, that you didn't really struggle. And it's like, yes. It could have been a lot worse. Yes, like absolutely, but like Andrea: Yeah. Yeah. Olivia: everyone struggles a with dra with documentation. They just do. Andrea: totally. Totally. And and I hope that like us saying that we no longer struggle or we've made it through that struggle gives like maybe a new clinician some idea of hope that there is a way to make it work. You know, Olivia and I had different struggles with this and we do have different methods, but we all both don't struggle anymore. And and I'll admit sometimes my notes are a little bit longer than others if I'm real getting into it and then I have to check myself. But like it It it gets better Olivia: It does, yeah. Like and and there's ways to there there's ways to get better and there's things you can do. There's systems you can try. and Andrea: Yeah. Olivia: you're definitely like not alone in it. And it is it yeah, it is a tricky thing. There's a lot of misinformation, there's a lot of like Andrea: Mm-hmm. Olivia: fear mongering, there's a lot of like lack of structure and gray area, but like it's an important part of the work that we do and it's totally possible to do it well. Andrea: Hundred percent. Olivia: Yeah. So hopefully we were encouraging and not, you know, scared everyone off from documentation. Andrea: I think we I think I do think we took like more of a normalization approach rather than a like make sure you do all these things approach. So Olivia: Well, I don't what what what would be the point of doing that in a podcast? Andrea: I know, right? Like Olivia: Yeah, I I maybe I'd wanna do that if I wanted to do like a training on documentation, but I can't train anyone for any reason at all ever. Andrea: Mm-hmm. Yeah. Olivia: Like that would mean I'd have to basically be a teacher and Andrea: Ha ha. Olivia: I think I'd be a terrible teacher, so not gonna be doing that. Yes, but that's on a one on Andrea: Well, you're a supervisor, so you're kind of already a teacher. Olivia: one yeah, one on one I can teach. Group setting, I don't wanna do that. Mm-mm. Mm mm. Andrea: That's fair. That's fair. Olivia: Well, curious what what you all think about documentation, maybe why you struggle with it, what's been helpful for you, or just like maybe shout out people that have been supportive for you in the process of trying to figure out a system or like help you in documentation. this is a challenging work and so it's good to remember that we're all in this together and it's totally normal to struggle with it and it'll get better. Andrea: I love it. I love it. And I'm fighting Olivia: Yeah. Andrea: the urge to start singing high school musical. We're all in this. Okay, I'm done. That's all I needed. Olivia: You got it out. It was like burning in your brain. Andrea: Yeah, it was. Olivia: my goodness. Well be sure to like, comment, and subscribe. All the above. Let us know if there's anything that you want us to talk about in our podcast in relation to the field. and we will catch all of you in the next episode. Bye everyone. See ya. Andrea: Woohoo! Good night. Olivia: This podcast is for entertainment, informational, educational purposes only. Although the hosts are licensed therapists, this podcast is not a substitute for professional mental health services. Listening to this podcast does not create a therapist-client relationship. Andrea: If you are experiencing mental health concerns, please seek help from a qualified mental health professional in your area. If you are in crisis, call or text a suicide prevention line in your country immediately. In the U.S., you can call or text 988 or use online chat at 988lifeline.org.