Private Practice Startup Podcast

Episode 112: 3 Quick Tips to Write Better Notes
Hosts: Dr. Kate Campbell & Katie Lemieux
Guest: Dr. Melissa Hall
Date: November 17, 2018

Episode Overview

This episode dives into a challenge that virtually every therapist faces in private practice: writing clinical notes. Dr. Melissa Hall, psychologist, productivity expert, and founder of QA Prep, joins Dr. Kate and Katie to share three actionable tips to help therapists write better, more meaningful, and less dreaded notes. The discussion blends practical strategies with mindset shifts—making documentation a tool for serving both clinician and client, rather than a source of ongoing stress.

Key Discussion Points & Insights

1. Changing Your Relationship with Note Writing

• Mindset Shift: Move away from fear and anxiety (especially fear of attorneys/audits) and see notes as a tool to help both therapist and client.
• Purposeful Documentation: Notes are not just legal protection; they can offer valuable insights for therapeutic work and track client progress.
  • Quote:

    "Really what should be motivating us is: how are these notes helping our clients? Because when you have a good set of notes...you will notice something you didn’t see three months ago."
    — Dr. Melissa Hall [14:55]

• Detangle from Fear of Litigation:
  • Most notes are rarely read in court.
  • Therapists often restrict content out of fear, but Dr. Hall highlights that a good attorney can always find any angle, so the focus should be on clinical utility instead.

2. Make Notes Work for You (Not Just the Auditors)

• Get Personal with Templates:
  • Use checkboxes or templates only if they genuinely streamline your process and reflect your practice.
  • Avoid generic lists—customize templates to your interventions to make notes useful for you in practice.
    • "If you just checked off things like cognitive restructuring or mindfulness techniques, what does that actually tell you? You go back and read that note and you’re like, not much."
      — Dr. Melissa Hall [17:15]
• Templates as Time Management Tools:
  • Go through your notes, extract common interventions, and create your own brief list for efficiency.
  • Personalized checklists enhance recall and utility, especially for sporadic client attendance or long-term cases.

3. Involve Clients in the Note Writing Process

• Collaborative Note Writing:
  • Try writing notes with clients at the end of sessions—boosts transparency, can empower clients, and supports therapist time management.
  • Research shows this approach especially benefits “resistant” populations (e.g., teens), reduces client anxiety about what’s recorded, and increases engagement.
    • "When clients have access to their notes, most clients report that they secretly feel like their therapist thinks they're crazy. And when they see the notes, it’s just about them like a normal person struggling with something."
      — Dr. Melissa Hall [21:58]
• Practical Tips for Introducing This Practice:
  • Frame it as an experiment for client benefit: “I’d love to get your feedback on what you thought about today’s session...” [24:33]
  • Allow 6–8 weeks to determine if this method works for you and your clients. Not every client will benefit, but for many it’s “life-changing” and improves efficiency.

4. Time Management: The Pomodoro Technique

• Great for Catch-up Work:
  • 25 minutes focused work, 5-minute break, repeat three times, then take a longer break.
  • Prevents overwhelm and burnout, structures procrastination, and helps therapists realistically gauge how long notes take.
    • "Having that structured time is really helpful because you don’t feel exhausted at the end... If you are really dreading the task, you can at least commit to the first 25 minutes."
      — Dr. Melissa Hall [27:26]

Notable Quotes & Memorable Moments

• The Mindset Reframe:

  "Forget about attorneys and court cases. That is not your focus. Your job is to write notes about what happened in treatment."
  — Dr. Melissa Hall [14:55]

• Make It Personal:

  "If you just have a list of 15 checkboxes, that’s going to cover 95% of what you would write in a note. But make them personalized so they actually mean something to what happened with the client that day."
  — Dr. Melissa Hall [17:15]

• Client Transparency:

  "If they have a say in what the therapist is putting in the note, then I think it’s very empowering and it likely helps them to feel like they actually have something to contribute to the process."
  — Dr. Melissa Hall [21:58]

• On Trying Collaborative Note Writing:

  “Across multiple studies, it was consistent that it worked for about 75% of clients. But it took about six to eight weeks for both client and therapist to be totally comfortable.”
  — Dr. Melissa Hall [24:33]

• Pomodoro Power:

  “It’s a great way to structure things...and if you are really dreading doing that task, then you can at least commit to 25 minutes.”
  — Dr. Melissa Hall [27:26]

Important Timestamps

• [06:06] Living on a Boat: Melissa shares her unique lifestyle, living and working from a sailboat, and how this supports work-life balance.
• [11:49] QA Prep Origins: Background on her business teaching documentation, agency training, and filling gaps left by grad school.
• [14:55] Mindset Shift About Notes: Begin conversation on reframing the mindset about note writing and fear-based thinking.
• [17:15] Personalizing Note Templates: Strategies for using templates and checklists effectively.
• [21:58] Collaborative Note Writing: Involving clients in documentation; the research and practical outcomes.
• [24:33] Making It Work in Session: How to introduce note-writing in session and why it benefits both therapist and client.
• [27:26] Pomodoro Technique: Explaining the Pomodoro method for time management when catching up on notes.
• [29:01] Key Takeaways: Melissa shares parting wisdom on shifting your approach to notes.

Episode Takeaways

• Shift your documentation mindset: view notes as a clinical tool, not a legal burden.
• Personalize and streamline your templates to save time and boost clarity.
• Wherever possible, involve clients in the process; it enhances transparency, engagement, and saves you time.
• Use structured time blocks like the Pomodoro Technique to tackle a backlog or stay caught up.
• Don’t be afraid to be transparent with clients about new approaches—authenticity breeds trust.

For Further Resources

• Check out Dr. Melissa Hall at QA Prep
• Download Private Practice Startup’s A-Z Cheat Sheet for practice essentials: PrivatePracticeStartup.com

Summary prepared for clinicians seeking a fresh, practical, and client-centered approach to managing documentation in private practice.