A (3:03)

Oh man, that would be a big pile of notes to get through. A lot of people have that love hate relationship. So I'm curious how you're going to help people transform their relationship so maybe they'll actually enjoy the note taking process.

B (3:16)

Do you think it's a love hate relationship, Kate, or are we usually like a hate hate? Oh yeah.

A (3:21)

Well, I'm just curious to see if we can get to that like or love place. We'll see.

B (3:25)

We'll see what Melissa has to share with us today. If you're brand new listening to us, welcome. This is a great podcast to be join because like I said, if you're a therapist, you're doing notes. So what better way to feel more productive doing something that most of us don't like doing? And also we have a special gift for you. Head over to PrivatePracticesStartup.com right over to our resources tab and download our A Z cheat sheet, the essentials for building and growing your dream practice. There you'll get a huge awesome list of A to Z things for your practice, but also five days of free practice building emails are going to come your way. We're going to invite you to feel inspired by them and most importantly, take action on that. So, so that is yours from us. So before we get into our topic today, let's just take a quick break for our sponsor.

A (4:10)

Today's sponsor for this episode is Gusto. If you're in private practice, you definitely wear a lot of different hats and manage a lot of roles. Some of those hats are totally great, but some like filing taxes and running payroll for example, not so great. That's where Gusto comes in. Gusto makes payroll, taxes and HR actually easy for small businesses. Fast, simple payroll processing, benefits and expert HR to support you all in one place. Gusto automatically pays and files your federal, state and local taxes so you don't have to worry about it. Plus they make it easy to add on health benefits and even a 401k for your team. So let them wear one of your many hats and you have so many other aspects of your business to focus on. Anyone who wants to take advantage of this sponsorship opportunity, you can actually get three free months when you run your first payroll. You can try a demo to see for yourself how Gusto works, so make sure to go ahead and check that out on our website. That's gusto.compps and you'll see it on our show Notes where you'll have the link for the demo and then those first three months. There are so many ways to keep your practice organized, but TherapyNotes is by far the best. They're easy to use, secure platform, lets you not only do billing, scheduling and progress notes, but also create a client portal to share documents and request signatures. Plus they offer amazing unlimited phone support so when you have a question, they're there so you can get help fast. Get started with TherapyNotes today, trusted by over 60,000 professionals. Go to therapynotes.com and enter promo code PPS as in Private Practice Startup and you'll get two months for free. Also, you can listen to episode 54 where we interviewed Brad Pleiner and took an in depth view into their ehr.

B (6:06)

So hey Melissa, how are you?

C (6:08)

Good. Thanks for having me.

B (6:10)

It is a pleasure. So when we were getting prepped and getting you in a spot for our podcast, you had we were getting ready to move on a boat. Like get rid of all your stuff and live on a boat. So share with our listeners. Just out of curiosity, what's that been.

A (6:25)

Like on a sailboat?

B (6:26)

On a sailboat?

C (6:27)

Yes. Yeah. So we, my husband and I sold almost everything we own and now live on a sailboat most of the time when he's not traveling or I'm not traveling because it seems like ever since we've moved we've both been doing that a lot too. But it's been really exciting. It's, you know, it's different. It's kind of like permanent camping in a way because we live on a really Tiny boat. So it's not like. Like we don't have a full bathro room or anything like that. And we have to use, like, a little camping stove to cook. And so it's, you know, it's all very, very different. But it's really helped me with one of the things that I struggle with, which is kind of being a workaholic. So it's really helped me balance, like, when I'm working, like, right now, like, that's what I'm focused on. And then when I go back to the boat, like, there's just not as much time or it's not as easy to get work done. So it's a lot easier to just focus on relaxing or, you know, doing stuff on the boat. Hanging out with my husband and spending time with him.

A (7:34)

Sounds like adventure.

C (7:37)

Yeah. Hopefully it will be exciting, but not scary adventure.

B (7:42)

So it was kind of like a dream of your guys. Like, this is what, like, when you think of dream lifestyle, you're like, let's do this.

C (7:49)

Yeah. I think we've always been into. I keep wanting. I don't know, like, the appropriate phrase, but I guess it would be like, alternative lifestyle. I don't know. You know, like, we have talked about doing the RV thing, like, just traveling around the country. We talked about moving to Thailand. We talked about being on a sailboat, But I think the sailboat kind of won us over because it's one of those things where even if you have the cheapest boat and you could be next door to, you know, a $2 million yacht, you both have the same view, you both are looking at the same sunset. And it's also a great way, kind of like having an RV where you can go and travel to all these different places, but keep your home with you. So it makes it easier in that way. And I think we both want to travel to other countries and. And do a lot of that. So this seemed kind of like the easiest way to do that. And then also learn a new skill, spend a lot of time outdoors, and kind of have a more active lifestyle and also to do it, like, while we're a little bit younger, because a lot of people do this when they're, like, in their 60s, and then they're a little bit more limited with what they can do. Like, our. You know, we can handle a little bit more physically. And that means, like, just being strong enough to do certain things, but also, like, really basic things. Like, you're just a little bit more tolerant of not having a bathroom. I think when you're in your 30s than when you are maybe in your 60s.

B (9:20)

Right.

C (9:22)

So some things about that we're like, you know what, let's do this now.

B (9:28)

Very interesting.

A (9:29)

For those of you who are listening, we just lost the lights with Melissa, so she looks like she's podcasting in the dark. It's really kind of creepy. We are in the month of Halloween, so I don't know what's going on.

B (9:39)

That's what I was thinking. I thought that was cool.

C (9:43)

I am podcasting in the dark. This is the first time I've used this. I'm in a co working space now because we're on the boat and apparently the lights have a timer.

A (9:51)

Apparently.

B (9:51)

Do you have to like, wave your hands or something like that to see if they turn back on?

C (9:55)

I was trying, but we'll see. Either way, I have a nice glow from the computer.

A (10:00)

You really do. You have like this halo glow and then you have this looks like a neon blue microphone that's just glowing right there. So this will be a first up. And the lights are back on it. It's so interesting to hear about your experience with just letting go of so much of life and moving on to a sailboat. And with an online business, you can work from anywhere. So you can travel the world and your office follows you, which is so cool. We live down here in South Florida and Fort Lauderdale is one of the biggest yachting boating capitals in the world. And I actually attract a lot of yachties and those who work on the yachts in my practice. So I'm always hearing about all the stories about living on the boats and the drama that will happen with the crew and all of that. So it's cool to hear about you actually living on the boat and bringing your business on the boat and all of that. Good stuff.

C (10:54)

Yeah, yeah, it's really exciting. And that was part of it. We were like, you know what? My business is at a place right now where we can actually do this, and this business is what is sustaining us. So it's really, really exciting to have an online business that offers that flexibility, but also is still, like, I'm still able to engage with people really regularly, you know, and talk with my customers and everyone is just an email away. And like, with smartphones, it's so easy to stay connected to everyone. So that's been really cool.

B (11:28)

And I really like the, like, kind of like the reframe. Like, it's actually helped you focus better.

C (11:33)

Right.

B (11:33)

Focus on work and then focus on personal, which I think a lot of times Especially getting into business. That is a journey to get there. So I love that. And I think that's a perfect segue into our topic about three quick tips to better note writing.

C (11:47)

Yeah, I'm excited to talk about it.

A (11:49)

I was curious. Before we get into the topic, tell us a little bit about QA prep and how you had the inspiration to create this company.

C (11:58)

Yeah, well, I was actually working in an agency and was a quality improvement training specialist. So I was teaching everyone how to do the documentation for the agency and that agency did a great job of training. So we had like pre created trainings that I would do. But then we also had a lot of flexibility to create trainings for the staff based on what we saw that they needed. And I found, number one, that I really loved training and that it was a gift of mine, that I was pretty good at it. So that was exciting to discover that. But then also I would constantly get feedback from people that, you know, we never learned anything about this in grad school or, you know, I've had two other jobs before this one and we've never gotten any training like this. This is so helpful. Thank you so much. So then I started talking to friends in private practice and asking them, would something like this be helpful for you? And they were all like, oh my gosh, yes, I need that so badly. So I tried it out and offered some trainings and then started writing some blogs. And it's really been picking up because there is very little help in this area. And it's really sad how little training there is and how many stories I've heard of supervisors who say things like, oh, well, that's not my job to teach you that to people and just expect that someone will have learned documentation already. And it's also really sad to see how much shame there is around like what you were talking about at the beginning of so many people being really behind in paperwork and notes specifically. And it's difficult to know where to go for help or who to reach out to when that happens.

A (13:41)

It is so great to have that resource that you've created to support clinicians in this area. Because what we know from teaching a lot of the licensure renewal courses down here in South Florida is that therapists incur the most liability in their documentation. And so if they're not documenting properly, they don't know how to do that, they're not supported, then they're leaving themselves wide open to risk and liability.

C (14:03)

Yeah, it's really, it's, it's scary and it's also just. I know it's like a constant dark cloud that's hanging over people's heads, you know, so that's part of my goal, is to provide the practical information so people are protected, but also provide practical information around how to make your notes more meaningful to what you're doing so that they aren't this dreaded task that you're scared of all the time or that you're constantly avoiding.

B (14:30)

So let's talk about that relationship and how do you. I guess it really starts. I mean, it's funny as you were kind of talking about like note writing and stuff, I'm like chuckling in my mind, like, leave it to the therapist to totally reframe this piece of paper as a relationship, you know what I mean? And talk about shame and all that stuff in regards to note writing. So how do you, like, I feel like there's maybe like a mindset shift. So how do you begin to think about it differently or what do you suggest therapists do?

C (14:55)

Yeah, I mean, there are a lot of different things, but I think one of the biggest things is to consider, like we do with everything, how does this impact your clients? You know, I think a lot of times we talk about paperwork, it's all fear based. And we're constantly focused on like attorneys and, you know, court. And I hear that so often. And like, how often are our notes actually read in court? It's super freaking rare, right? Like, that is just not really happening that often. It does happen, but that is the thing that seems to motivate people the most when they're talking about notes. And really what should be motivating us is how are these notes helping our clients? Because when you have a good set of notes and you can. And you're feeling stuck with a client, for example, and you can go back and look through Your notes, you, 99.9% of the time will find some insight that will help you work with that client better. You will notice something that you didn't notice three months ago because you have different information. Be able to go through and identify wins that you maybe hadn't noticed. You'll be able to see progress that maybe doesn't feel as that's not quite so obvious in the moment. And you'll be able to share those types of things with your clients. So when you have good notes, like they help you be a better therapist and ultimately they help your clients. So I mean, I know the. One of the first tips I have is to just completely forget about attorneys and court cases. Because that is what we always hear as the big message is like, oh, what if an attorney reads your notes? And I constantly hear like, oh, well, I don't put very much in my notes because I don't want an attorney to be able to do something with them for my clients. And that's not your job as a therapist. Your job as a therapist is to write notes about what happened in treatment. Right. Not to worry about, like, how is an attorney going to flip something around? Because a good attorney doesn't matter how good your note is. They're going to be able to pick something out of that and mess with it. Right. So, like, don't freak out about that and don't make that your focus. Like, make your focus. How are these notes going to help me be a better therapist? How are these notes going to help me be a better therapist for this client? Nice.

B (17:10)

So what's the next step after that? Like, as we really get into the note writing?

C (17:15)

Yeah. So another thing that I see is really common is people say, oh, you know, I. I want to use this program that has all of these checkboxes created for me or, you know, like a progress notes planner or something like that. And what I actually find is that those type of things confuse people more than they help. You know, if you have one of those things and they do work for you, great, keep using it, go for it. It's just that a lot of times people think that's going to solve their problem, because their problem is that they feel very confused about what to put in their notes. And then just having a giant list of checkboxes doesn't really help that problem. It also doesn't really help you get that information. Like I was saying before, if you want to have a good note that you can go back to and see what you did with someone, if you just checked off things like cognitive restructuring, reinforcement, mindfulness techniques, and just checked off a bunch of boxes for those things, what does that actually tell you? You go back and read that note and you're like, not much. Yeah, I don't know what I did. I don't know what this person did with this. So I recommend that people, if you. That you do use things like checkboxes, like, absolutely. Use whatever time management strategies you can, save time on your notes, but make it personal, you know, and the easy way to do this is to go back through some of your notes and pick out the common interventions that you find yourself writing over and over and then create your own checkboxes from that or Create your own, like, templated sentence that you can then finish off the end with, like, what you did. So reinforce for client. Okay, then what, what did you reinforce? You know, gave client insight regarding what. What was it about? Don't just say that you gave insight or, or helped them to provide insight. So looking through it and giving yourself some time management strategies so you're not constantly worried. If you just have a list of 15 checkboxes, that's going to cover probably 95% of what you would typically write in a note. So you can do that and it'll save you a lot of time. Because the flip side is all here from people who spend 25, 30 minutes per note because they are not worried about writing too little, but they're just so paralyzed by the process of writing the note and don't know what to put in there and then end up putting all kinds of things in there. So if you use some kind of checkboxes, that can help you save time and kind of focus on what you need to actually put in there. But then just make them personalized so that they actually mean something to what happened with the client that day.

B (19:51)

You know, as I hear you talk, like, one of the things that I find really helpful is when you practice therapy from a certain model, you're almost given the interventions, right? It's not like you have to like, figure out, like, well, what did I do today? What model? But, you know, if you practice. Kate and I both work with couples, so it's a lot of Gottman stuff and putting that. And I've always learned I'm kind of in the same boat as. As you were, Melissa, that I sat on the other side being a supervisor. We talked about this a little bit and how to teach people to write notes. And one thing that I always say is, yeah, so you put the intervention and then you ask yourself, what was the response or result?

C (20:23)

Right.

B (20:24)

So provide an insight. What response or result did the client get? Right. And so when you have, I mean, this is just overall how to be successful in life, right? When you have a blueprint, blueprint template or system, it becomes easier just to plug that in because it's the same and it's effective and it also creates better time management. So I like how you say that. And you're right. Like, we think about checkboxes as helping time management wise. And it might help, but also too, it leaves a question of when you do look back. Yes, what did I do? I know sometimes if, like, I don't see a client for Three weeks. Like, I need my notes to be like, where do we leave off? What did I say I was going to do next? Like, I utilize my notes to assure. Do that. So I would definitely. I don't know that the checkboxes would help me.

C (21:05)

Yeah, yeah. And I mean, I just know that from being someone who read probably thousands of notes at this point by other therapists, you know, it's. It's really difficult when you read through and you're like, I don't. Every note sounds exactly the same. I have no idea what you did with this person. And, and each week sounds the same and they're not helpful. And then you're just doing paperwork just to do paperwork, and that's pointless. You know, I think that's what I, what I mean when I'm talking about making your, your documentation meaningful, it shouldn't be. Like, sometimes does happen in agencies. Oh, we don't. We just do this form because we have to do this form. Right. And sometimes that is the case in that setting. But if you're in a private practice, you don't have to do that. So don't, you know, write a note just to write a note. Write a note that's actually going to serve a purpose.

B (21:52)

So what other tips do you have in regards to how to write better notes?

C (21:58)

Yeah, I think the. Well, I have a bunch of tips, but the last tip we'll talk about here, because I could talk about this stuff all day, is to involve your clients in the process. So this, this one is really scary for a lot of people, but when I really dug into research around this, it was extremely compelling and pretty surprising. So. And by involving your clients in the process, I mean literally writing notes with your clients, this is a great strategy to consider. If you are bad with time management, if you're constantly getting behind, then it's something to at least consider trying out. And some of the benefits that I was surprised to read about when I was looking this up is that when clients have access to their notes, most clients report that they secretly feel like their therapist thinks they're crazy. And when they had access to notes, they were like, oh, no, she's not just writing that. She thinks I have all of these issues. Like, she's just writing about me like I'm a normal person, you know, struggling with something. And also it was really, really helpful with clients who are quote, unquote resistant. So if you think about, like, teenagers who are, you know, sort of being forced into therapy by their parents. Right. But maybe they're not totally on board. And my theory on why that is is that I think if you think about a population like that, they feel very stuck and they feel like they have to do something. You know, they're being forced into this meeting with therapist every week. But 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, you know, have something to contribute to the process. So those two things I thought were really, really interesting results of a bunch of studies on actually writing notes with clients and giving clients access to notes. And, and that's what I used to do, was give clients access to my notes and it was hugely beneficial.

A (24:06)

Yeah. I'm curious about what your recommendations are for how clinicians can do this in a way where they collaborate with the clients and involve the clients. And it doesn't because sometimes clinicians can feel really intimidated by that and have a lot of assumptions about how it might impact the client's experience. So what do you recommend for how clinicians approach this with their clients so that it is well received and clients can really understand where they're coming from?

C (24:33)

Yeah, I think you always approach it as how it's going to benefit them. So first of all, saying something like, you know, you probably know that I write notes about each of our sessions after we meet, but this week I want to try out something new and I want to get your feedback on what you thought about today's session. So we're just going to spend the last five minutes wrapping up what we talked about today and make sure we're both on the same page. And I'd love to see, see what you thought about, about today. And you know, that's a really easy thing to do, right? And I mean, practically you want to practice having something like that to say so you don't like stumble over your words or get really nervous if it is something that's kind of nerve wracking for you. And then the other thing is you want to make sure that it's a trial period. So with actually writing notes with clients. According to the research, across multiple studies, it was pretty consistent that it worked for about 75% of clients. So it's not going to work for everyone. And you want to make sure that people know that they have the option not to do it if it doesn't work. But that it also took about six to eight weeks for both the client and the therapist to be totally comfortable with the process. So you want to give Yourself time. You know, if you try it two weeks in a row and it still feels kind of awkward, don't just quit, because this really can be. I've heard from so many people that this is like a life changing time management strategy. And when you hear the results from clients too, on the client end, it's, it seems to be pretty positive overall. So it's definitely worth checking out. But make sure you don't, you know, quit before you feel like you like gave it a good go. So make sure you do try it like six to eight weeks first.

B (26:17)

And I love that you talk about that. And I think that's so important because when I was leading and managing teams, I actually taught a lot of therapists how to do that in session and make it part of the clinical process. And it's like a summary, right? So it allows the client to summarize what they're taking away and it also creates ownership, you know, like they're owning their session and they're giving you the summary, the feedback. And I always kind of like to say, so if you're a therapist that likes to assign homework or whatnot, is what's the next step that you want to take out of everything that we talked about today, the things that you've highlighted and it is a really good clinical summary. And also, you know, I think about the fact that many therapists bill insurance. Well, when you're writing your note at home on the couch, you know, watching your favorite show for hours and hours and hours trying to catch up, you can't bill for that. But if you're doing it in the session, that's part of the session time and you can. So we're looking at really creative ways to manage your time and maximize your time and effectiveness. So this was super helpful. And again, I really like talking about the relationship. And kind of before we kind of close, I want you to share with us what you're talking about. The Pomodoro session. So maybe if you're a therapist and you're not ready to write notes in session, but you got to get caught up. Share with us about that really cool time mastery tip.

C (27:26)

Yeah, yeah. So the Pomodoro technique is a technique that I use actually a lot in like my membership community. We actually have co working sessions consistently because it's a great, great way to catch up on notes. So if you are behind on notes, what you do is you work on a specific task for 25 minutes, then you take a five minute break and you do that three times. Then you take a 15 minute break and then you go back into another three sessions, and then you should take a longer break, like an hour, and then you can go back into it again if you want. But having that structured time is really, really helpful because you don't feel exhausted at the end because you've been taking consistent breaks. And if you are really dreading doing that task, then you can at least commit. Okay, the first 25 minutes I will work on notes. And then if I am just absolutely hated the task and feel horrible after it, then the next 25 minutes I can do something different. You know, maybe I can work on some marketing or whatever. So it's a great way to structure out things that you're doing. It's also what I found from, you know, running these sessions where therapists are catching up on notes. It's a great way to identify how long you're taking on your notes because a lot of people will say, oh my gosh, I only got one note done. And that lets you know, okay, you probably need to work on, you know, either minimizing what you're writing or structuring your notes so that you can write it a little bit more quickly.

B (28:49)

Yeah. The numbers don't lie, right?

A (28:51)

Yeah.

B (28:52)

And really doing some data research and that really helps. So thank you so much for being with us today, Melissa. And what do you want to make sure our listeners take away from your message?

C (29:01)

I think the biggest thing to take away is that notes don't have to be dreaded, but you will have to shift the way you're thinking about them a little bit and to focus on how do your notes serve you and serve your clients, how can they help you be a better therapist to your clients?

B (29:17)

And also just being willing to step out of your comfort zone a little bit. Like if you've always done notes a certain way and trying to do it in session, you know, like letting people know when we're transparent and say, hey, I'm trying something new. This might not work. It might feel a little awkward, but I think it will benefit you and I and just be transparent about that. I always find when I'm uncomfortable about something, just sharing that just kind of de escalates the anxiety and helps so well. I really hope that those of you are listening today and I know that there's therapists in your guys world that need to hear this podcast. So please share this. And you know, we want you guys to have fruitful practices that are just expansive. They're your dream practice and we know that note, writing is just part of the process and part of what we do. So if you know Melissa's words of wisdom can help you be more effective, create better time mastery as it pertains to your practice, we definitely hope that that that happens. So join us next week as we talk to Dr. Keely Combs. We are so excited to have them on our podcast because we've been talking about them for a really long time. For those of you who've joined us on one of our webinars and we talk about paperwork, we're always talking about Keely's social media policy. So we're super excited to have them talking about this on our podcast. It's been a long time coming. So join us and listen to that and all the social media tips and how we can really protect ourselves and protect our clients as it pertains to social media because we're in a technology based world. So, so join us for that podcast and we hope you guys have an amazing, inspired, awesome day and week and we'll see you next time.

A (30:47)

See you next time. Startup Nation. Thanks for joining us on the Private practice startup. Visit theprivatepracticestartup.com for awesome resources, free trainings, attorney approved private practice paperwork and and so much more.