Photo of a notebook with writing on it. Text over the image reads,

Now Modern Therapists Need to Document Every F*cking Thing in Our Progress Notes?!?

Curt and Katie discuss a recent citation from the California Board of Behavioral Sciences (BBS) to a therapist for cursing while in session. We explore: How do we document ruptures during the therapy session? Is the BBS over-reaching by controlling what therapists document? What are the best practices for note taking? All of this and more in the episode.

Transcript

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In this podcast episode we talk about appropriate documentation practices for modern therapists

As therapists it’s important that we take accurate notes. But what is important to include in the notes, and how much should we really be documenting?

Wait – Is it alright to use curse words in session?

  • Therapists should be first and foremost aware of the client and their potential reaction.
  • Note the therapeutic relationship with the client, their history, and how the client empowers themself when making language selections.
  • If considering using casual language, consider the client’s vernacular.
  • Follow the client’s lead when it comes to their language in session, including cursing.
  • The BBS has no specific statute related to cursing or swearing.

“If things aren’t written down, they did still happen – but now it’s open to interpretation.”
– Curt Widhalm

What should modern therapists document in clinical notes?

  • It is important to document any bold interventions or ruptures in the therapeutic relationship and repair attempts for ruptures.
  • In note taking, it is important to follow the clinical loop: assessment, diagnosis, treatment plan, intervention, use of intervention, and the client’s reaction and progress.
  • Your notes will be a balance of covering your liability and creating notes that help you remember the session.
  • Therapists should consider documenting the use of any language that could be deemed not clinically appropriate, even positive statements like “I’m proud of you,” or “Yes, my dear.”

“I think any rupture in the treatment relationship is worthy to document because it’s potentially clinically rich, but also a point of liability.” – Katie Vernoy

Does the California Board of Behavioral Sciences (BBS) outline what we should say in our notes?

  • In the 300-page PDF outlining the statutes for LPCCs, LMFTs, LCSWs, and Educational Psychologists, notes are only mentioned 10 times.
  • There is no mention in the statutes of what can be said and what can’t be said in notes.
  • Some agencies and institutions will stress writing very little to ensure protection from liability, but as this citation showcases, this might not be best practice.
  • The BBS wants to ensure the protection of clients and you might need to justify your words, just as you would justify the use of an intervention.
  • This is a reminder that the BBS can and do look at therapist’s notes.

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Dr. Tequilla Hill

The practice of psychotherapy is unique, creative, and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion, fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey.

If you are tired of going in and out of the burnout cycle and you desire to optimize your wellness, Dr. Tequilla Hill a mindful entrepreneur, yoga, and somatic meditation teacher has curated How to Stay Well While You Work Therapist Wellness Guide to support providers that are struggling to manage your own self-care.  Subscribe to Dr. Hill’s Stay Well While You Work! Therapist Wellness Guide and you can find many of the inspiring offerings from Dr. Hill’s 17 years as a practice leader, supervisor, mentor, human systems consultant and wellness enthusiast.

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Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Statutes and Regulations Relating to the Practices of Professional Clinical Counseling, Marriage and Family Therapy, Educational Psychology, and Clinical Social Work
The Case for Cursing

Client’s Experiences and Perceptions of the Therapist’s use of Swear Words and the Resulting Impact on the Therapeutic Alliance in the Context of the Therapeutic Relationship by HollyAnne Giffin

Swearing as a Response to Pain: Assessing Hypoalgesic Effects of Novel “Swear” Words by Richard Stephens and Olly Robertson

Relevant Episodes of MTSG Podcast:

Do Therapists Curse in Session?

Make Your Paperwork Meaningful: An Interview with Dr. Maelisa McCaffrey Hall of QA Prep

Noteworthy Documentation: An Interview with Dr. Ben Caldwell, PsyD, LMFT

CAMFT Ethics Code Updates

Bad Business Practices

Who we are:

Picture of Curt Widhalm, LMFT, co-host of the Modern Therapist's Survival Guide podcast; a nice young man with a glorious beard.Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Picture of Katie Vernoy, LMFT, co-host of the Modern Therapist's Survival Guide podcastKatie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm  00:00

This episode of The Modern Therapist’s Survival Guide is brought to you by Dr. Tequilla Hill.

Katie Vernoy  00:05

The practice of psychotherapy is unique, creative and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey.

Curt Widhalm  00:26

Dr. Tequilla Hill with mindful entrepreneur, yoga and somatic meditation teacher has curated how to stay well while you work therapist wellness guide to support providers that are struggling to manage your own self care. Stay tuned at the end of the episode to learn more.

Katie Vernoy  00:41

Hey everyone, before we get started with the episode Curt and I wanted to make sure you were aware that we have opportunities for you to support us for as little as $2 a month.

Curt Widhalm  00:50

Whether you want to make that monthly contribution at patreon.com/MTSGpodcast or a one time donation over at buymeacoffee.com/moderntherapist. Every donation helps us out and continues to help us bring great content to you. Listen at the end of the episode for more information.

Announcer  01:12

You’re listening to The Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm  01:30

Welcome back modern therapists. This is The Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about all of the things that therapists should worry about. And this is part two of an episode that we started last week about a citation from the California Board of Behavioral Sciences to a therapist about using a curse word in session. And if you haven’t listened to last week’s episodes, we talked a little bit about, we talked a lot about using curse words and sessions. And today, we’re gonna focus on a different part of the citation. In the citation, it talks about the therapist not documenting about their decision to use a curse word, how it fits within the treatment, what the client’s response to it was, and this being a part of why the therapist was being investigated and wanting to do a dive into: what are we actually supposed to put in our notes? We’ve had a couple of episodes in the past. So one with Dr. Melissa Hall and one with Dr. Ben Caldwell about what you need to put in your notes. We’ll link to those in our show notes over at MTSGpodcast.com. We’re not talking about SOAP Notes or structure, that kind of stuff. Today we’re talking about legitimately, what do you need to put in your notes? And what is this signal by the California BBS really mean for the rest of us here? So, Katie, what needs to go in our notes?

Katie Vernoy  03:11

Well, I think just for folks that want a quick primer, because I when they can go over to both of those episodes and get stuff I’ll say something and kind of lead into the rest of this. The documentation for services should follow the clinical loop. Dr. Melissa McCaffrey Hall is someone who talked about it really well and meaningful documentation. But you start with an assessment that leads to a diagnosis that then has a treatment plan, that then on a weekly or a session by session basis, you talk about the interventions that you’re putting forward to help the client to meet their treatment goals that’s on the treatment plan. And that’s a clinical loop, you know, diagnosis, treatment plan, session notes – comes back, and hopefully you’re addressing the diagnosis. In this situation. Again, we talked about the cursing before, it seems like there is a discussion around were all of the interventions put into the note. And I don’t know if we have to include all interventions. I think there’s a lot of mirroring and reflection and active listening and all of those things. But I think potentially you can put some of those things in the notes, but I don’t think every single micro intervention needs to go in notes. But I think big interventions probably do, especially ones that are truly impactful to our clients, as well as the responses to those interventions and an even like group notes or SOAP Notes or any of the notes. There is an idea, pretty established, that we must put down the interventions that we’re using and the client response.

Curt Widhalm  04:55

So in the very nature of this you’re bringing up intervention is there are planned interventions, and then there are also the ones that just kind of slip out. And I think it’s important for us to read from this citation. So that way, our audience here has the same knowledge of what’s going on here. So I’m going to quote, I’m going to quote from the citation. And once again, we’re not releasing the name of the therapists themselves, due to respecting their privacy on this, but I think that this is a key indicator of looking at how our licensing boards are enforcing stuff Yeah, and, and potentially looking at their their overreach here. So jumping into the middle of this, we talked in last week’s episode about the therapists use of a curse words towards a minor in session, and quoting from the citation, regarding the record keeping a portion of your notes which you had handwritten are illegible. Additionally, your notes failed to identify which minor you had confronted during the session. Furthermore, your notes do not document either your decision to use a curse word as part of your description of the minor clients behavior. What’s your rationale was for doing so what the minor client’s response was to your description of his behavior, or that you would apologized to the minor client regarding the wording you had to use to describe his behavior. End quote.

Katie Vernoy  06:25

I think that there are pieces of that that are fair. And I feel like there’s still information that we don’t know to identify at the word that you used as overreach. I think that the level of policing around our documentation seems surprising to me. But I don’t know if I particularly disagree with any of their statements. It sounds like you do, though.

Curt Widhalm  06:49

My reaction on this is, if this is in fact used as an intervention within the the treatment session, which by all accounts seems to be what this therapist and the therapist attorney justified that no other ways of reaching this client really made any sort of emphasis. That doing something big and bold in session in order to try and get through a client does seem to be a maybe very on the spot decision as an intervention to kind of disrupt and shake things up a little bit. That maybe not planned as a intervention strategy. You know, I think last week, you and I both admitted that, yeah, we use curse words in sessions from time to time. I don’t think that any of my treatment plans will ever include session seven, use curse word with this client to disrupt what is the therapy in order to help them gain a new perspective. But I think it is something where, with intentional interventions, and that that clinical feedback loops that you were talking about, yeah, we do need to include in our notes, intervention use client reaction. And I think that that’s the language that the Board of Behavioral Sciences is using here, that is kind of a catch all for this. Where maybe there’s a little bit more nuance in here is in some of the off the cuff interventions that we do, or things that are human relations, sort of impacts that we have on other people that we might not consider in the traditional sense of interventions that it gets into kind of a fuzzy space of are we leaning towards the the cya of covering our asses of needing to transcribe the entirety of our sessions just to prove what has happened? That’s kind of where my initial reading of this is. Do we have to document everything that is said, and moving into even some of the direct quotations that we use in session with more frequency?

Katie Vernoy  09:06

That may be what the BBS is describing? I think, for me, I don’t take that in in that way. I think in this situation, it is hard to know if this is something that is coming from a parent that is is upset at the therapist or the therapist decision making. I’m not sure if this is a truly harmful therapist who is saying really inappropriate things in session, or some other thing, right. Like I can’t speak to this particular situation. And I certainly don’t feel like we need to do transcription of our sessions and quotations of our own stuff. So that’s, that’s my caveat. If I was in a session, and I said something to a client, they said that hurt my feelings, and we talked about it and I apologized and there was a repair or there wasn’t a repair, I would document that I think any rupture in the treatment relationship is worthy to document because it’s potentially very clinically rich, but it also is a point of liability. And so to me, it feels like if I recognize that a client is upset by an intervention or specific words that I use, I would document that.

Curt Widhalm  10:24

And I think that this is the difficulty in looking at information like this because it gets much more complicated with the more people who are in the room. Having worked on legislative language before and worked on trying to define things before and creating language for statutes that is broad enough that it speaks to what we do in our profession. A lot of times, we just borrow language from where it’s already written. And one of the things, especially for couples and family therapy is that there hasn’t really been a good definition of how in statute, it looks different than working with individuals. You know, we have 100 plus years of psychologists language to, you know, work with individual people. But sure, the theories around marriage and family therapy, we can borrow some of the language that statutes should suggest that those go in there. But for really being conscious of the steps that we’re making towards putting this information into our documentation. What I’m hearing you say is that if you’re really calling out one member in this citation saying the same thing, if you’re really holding one member accountable, you need to be specific to that up to an including emphatic language. Is that what you’re saying here?

Katie Vernoy  12:01

Well, I think you’re, we’re talking and I feel like we’re talking into different areas. I think, in this situation, we have someone who clearly was overwhelmed, or at least that’s what we’ve assumed, has illegible notes, and there’s not specifics in it. So to me, the flavor I’m getting is that if this person if this therapist would have put in their notes, something along the lines of confronted X member of the family or use disruption by confronting X member and had some bold language and discuss the use of that language, and provided a repair within the session, without saying, I cursed at this kid, the family got upset, and I whatever, but like actually using clinical language to describe what happened, the confrontation, the disruption within the family system, as well as repair and planning for the future. To me, I don’t know that we would, that this would have been part of the citation. We’re assuming because they said you did not you say you used a curse word and your rationale for using the curse word that we’re like, oh, we have to transcribe. I don’t know that. I don’t know that. I agree with that. And I do share your concern that should this become statute? Yeah. I don’t think we need to transcribe our sessions, or put forward really dramatic tales in our progress notes, so that we cover everything. But I think it’s, it’s a jump in this situation to say, Oh, well, they wanted this. It sounds like they were appalled at what they found. And they put language to how they put it forward. I honestly have no idea. And I don’t fault this therapist at all. I can’t make a judgment on that. But if we’re looking at the notes were illegible and incomplete. Everything was missing. Right?

Curt Widhalm  13:55

Well, the eligibility, part of it, I think, is a curious piece. And I think you and I have both heard from clinicians. And I haven’t heard this as much in the last 10 years. And yeah, I do want to give you credit for being the one who brings up this point, before we started recording today. So but you and I both heard for most of our careers, about therapists who’ve taken the approach of well, if it’s illegible, then people have to ask me what was meant there. And that’s another way of protecting me in my practice. And this is a very clear indication that that is not true.

Katie Vernoy  14:35

Not true at all. We need to type stuff into an electronic health record. That’s pretty clear at this point.

Curt Widhalm  14:43

I think it’s really important to be able to have clear notes, do them well. And I think getting into the nuance of just like how descriptive do we need to be in the response to that But I take your point, as far as you know, what may need to be, as far as you know, use this disruption. Is it, you know, needing to put in more and more exact quotes? Is it, you know, just in the more confrontive ones? Or is it also going to be in any sort of situation where a different perspective is going to need that nuance reflected in the notes as well?

Katie Vernoy  15:27

What do you mean by that?

Curt Widhalm  15:28

So, you know, there’s the clients that therapists use curse words to disrupt them. Yeah. There’s also the other end of the spectrum where therapists may use more affectionate language to help to emphasize a point to that maybe seen as a boundary crossing of, you know, expressing some affection in a way that has some context sway, you know, hey, I really care for you. And I really want to see you be successful in this, do we need to then document that same nuance in that direction?

Katie Vernoy  16:06

From the description that you’re providing there, I think the answer is the therapist, it depends. To me, when I express something that I think that therapists typically don’t, you know, I tell my clients, I’m proud of them, I tell them, I care that care about them, or I care about what’s going on with them, or whatever it is, I do show genuine human connection. I think that with one client, it may be completely documenting it out, not necessarily for the cya purposes, but for reminding myself what I’m doing. And, and and having that as part of the clinical record, because I think it’s important. For other clients, if I slip up and say, hey, yeah, you and me both buddy, or Yes, my dear, or have a wonderful weekend, my dear, or something where I slip into a phrase that I might use with friends versus with my clients. And it is a client who may have a response to that that would be not clinically appropriate, or their, their response is clinically appropriate, but it would not be conducive, and it would need to have a conversation about it. I may document, you know, used informal language of care, we’ll address it the next session, you know, to close out the session, I will address that at the next session and talk about the conversation of like, Hey, I was pretty casual at the end, I feel connected to you. But I wanted to make sure that we talk about our relationship. Like I think if there’s a clinical reason, that or a personality reason why the client may take in something in a way that it was not intended or feel that it may be harmful. Yeah, I’m gonna document what I said and how I addressed it. And so I think it’s, it’s something where, depending on your relationship with the client, that context and what context may be needed, should a complaint or a concern or a clinical conversation comes down the pipe, and you need to remember kind of what was going on there? I think, yeah, I would document that for myself.

Curt Widhalm  18:06

As many of our listeners know, I sit on the California Association of Marriage and Family Therapists ethics committee, and not speaking for them, but a discussion that has come up at one of our meetings with one of the staff attorneys who also is on the ethics committee, talking about the way that opposing counsels would approach therapists and depositions specifically around their notes. And hearing you say, you know, use informal language of affection. I’m thinking of the way that that could be interpreted by somebody who’s looking at your notes, who’s not involved, and the kinds of questions that would come up. But what do you mean, why, why didn’t you write with that exact language is? That, you know, this could be anything. My client remembered this as being something completely different than what you’re saying now, that may lends towards needing to go even a step further than what you’re talking about here.

Katie Vernoy  19:10

Sure. And I think that’s part of the ‘it depends,’ I think, if it’s a client that potentially is going to have that as a complaint, yeah, I’d write the exact phrase.

Curt Widhalm  19:19

How do you make a decision that about which clients are likely to make complaints versus those that are not?

Katie Vernoy  19:25

I think that’s a good point. I think there are times when it comes from past history of whether it’s kind of being litigious or other things. I think, for me, it’s more my feeling in the moment, you know, and so this is more intuitive or instinctive. Do I need to be more descriptive in my notes or not, is a client that I, I think, may want to see their notes may or may have other things that they’re doing with these notes, or if they would be potentially more confrontational or litigious, but you’re right, I don’t I don’t think that there’s a great way to make that assessment and maybe the the informal words have affection is not a good phrase to use. To me, I think it’s something where if there is a concern that comes up in session that you feel like you want to document, you have to decide do you document it with euphemisms, clinical language? Or do you quote yourself? I don’t know. I think there’s, there’s arguments both ways.

Curt Widhalm  20:21

Yeah, as you’re talking, I’m thinking about the number of times that we may start down a path with clients that clients just kind of give indication that it’s not the appropriate way of of going. That, you know, we may bring up an idea of, let’s say, for, I don’t know, working with anxiety or something where, you know, you might ask a question of, like, you know, have you ever, you know, considered doing this and the clients like, No, I’m not going to do that. Do you document every single one of those like, rejections that clients do? And in your notes?

Katie Vernoy  20:59

The ‘No, I’m not gonna do this.’ I think that’s different than I tried it. And I felt like it was harmful. I think that was a bad idea. Why did you tell me to do that? I mean, there’s different flavors to it. I think if it’s a conversation of like, okay, what kind of coping strategies are you going to use? Or what kind of interventions feel right to you? To me, that’s, that can be a higher level documentation. But if somebody says, “Hey, I was thinking about this thing all week, I didn’t do it, because I think it’s wrong. And this is, this is the thing, the mismatch I’m feeling in this relationship right now.” Yeah, I would document that.

Curt Widhalm  21:34

Because I think that there is a way that as you point out, my practice being more with kids, that there’s probably a lot more casual ways of bringing things up with kids and relating them, there might be even with some of the adult clients that I work with, you’re making me think within this conversation of kind of the being able to describe in documents, why I might do things differently from case to case where a lot of these statutes are written for kind of the here’s the standard for everybody. Yeah, I think if statutes had their way it would be everybody must do these things all the time here is very clearly what is okay. And very clearly what is not. Before the episode, Katie and I had looked at the California BBS’s statutes and regulations relating to the practices of professional clinical counseling, marriage and family therapy, educational psychology, and clinical social work. This is a 300 page PDF that’s available on the BBS website, we’ll include a link to that in the show notes as well. Now through the magic of computers, we control F, and put in the words and put in the word notes, out over 300 pages in four different disciplines, notes came up 10 times in this document. Wow. And most of them were about the requirements of education, what needs to be in graduate programs, as far as areas to cover, students need to be taught how to take notes. And most of the remaining other ones where supervisors need to check the notes. So this clinical feedback loop piece of this is something that is left to just kind of the undefined standards of the profession. That seems to be what is being grasped at. And Katie had also made the recommendation of can you control F documentation in the same documents, and we ended up with about 70 hits, and most of them were, these are documents that need to be provided to the board for proof of your hours and this kind of stuff. So getting back to this citation. Yes, I can agree, handwritten illegible notes. Not gonna fly.

Katie Vernoy  24:05

Not gonna fly.

Curt Widhalm  24:07

The guidance in what the state has said as far as what needs to be in the notes. I’m, I’m still kind of wrestling with, did this therapist do something wrong in their documentation? If it comes down to needing to specifically look at what is the threshold of things that need to be documented? As I’m hearing you talk about it in this episode, you’re saying it’s kind of things outside of the norm, things that if we wouldn’t do this with all of our clients, if there’s something specific to an individual client, we should probably make note of that. So that way, anybody else who’s reading it can understand our process of why this fits with this particular client or situation? Yes. Were you ever taught that?

Katie Vernoy  25:05

Was I ever taught that? I think I was. I don’t know that I was taught that as a clinician, when we were looking at this and how I was thinking about an even wrote this in my notes in preparation is when I was working as a child care worker, aka, a residence counselor in a group home, anything that happened that was out of the norm, especially if there was an injury, or some sort of horrible thing that happened to a kid, we did a serious incident report, or an SIR. And so for me, that was always the case that I would write stuff up, if it happened. And the the client, that kid was having some sort of reaction to it, or they got hurt, I would write that up, and just the facts and what happened and how you resolved it. And so for me, when I moved up the ranks in being a clinician, there’s always that in the back of my mind that if something goes down, that is different, that is potentially harmful, and/or could be perceived as harmful, because it was a mismatch or whatever. Write that stuff down and make sure that you talk about your rationale, what happened and how the client responded and any repairs. So to me, I don’t know that that was specific to clinical training, certainly, as I was working as a supervisor, the clinical loop was present. But there’s also all these liability issues. And I think especially working with kids and families that are very chaotic, or there’s a lot of factors that are making things very challenging for the family, I would encourage my clinicians to document those things because of how chaotic it was. So their supervisors would know so that the clinicians would remember what happened. I think there’s all of those pieces that that made it so I’m potentially a little bit more conservative in my note writing, meaning that I write more than other folks may because I feel like there is a need to understand, remember, and cya.

Curt Widhalm  27:11

From hearing from a lot of our listeners, past students, people who’ve consulted with me and other just general conversations. I think they your training might be more specific than what a lot of other people working in other agencies, maybe maybe not community mental health agencies, like I will group what you said in and assume that that is a largely kind of standard rule for a lot of community mental health. But for a lot of nonprofit agencies. I don’t hear this kind of emphasis, I hear a lot more of the document as minimally as possible that this audience right here, listen to this. This citation is proof that that is bad direction from shows agencies that way, keep Katie is talking about is really covering your ass, not the agency’s ass that this is the proof that boards can and do look at your notes. Yeah, they’re going to find faults, if notes are not up to standards. And this goes back to your law and ethics professors of if things aren’t written down, they did still happen. But now it’s open to interpretation. Yeah. And yeah, your justification, days, months, years later is not necessarily going to be protection, because what is written in the note at the time, is what is going to be first and foremost evaluated.

Katie Vernoy  28:50

And I think the the big difference from what you’re talking about with other kind of nonprofit agencies and agencies that have Medicaid billing, is I was also taught that my my progress notes the clinical documentation that I put together is a bill. And so there needs to be sufficient intervention to justify the minutes that I’m billing for. So the reverse was actually what I was taught all the way coming up, is your notes need to be longer for longer sessions, and you need to have sufficient documentation to prove that your time was worth what we’re billing for it. So the other piece and you brought this up before we begin was this kind of what do we remember? Yes. And I think when I am on top of my game, and I get my notes write down right away, I find that I have some details, some richness, and it does help me to remember from week to week, what’s happened when I’m not on my game and I start getting behind on my notes. I struggle with that. And I think that folks who are chronically overwhelmed, and I’m going to include a lot of the folks in community mental health but even practices that are very full Do get behind on their notes. And then how do we do this detail? And you talked about another issue with, potentially when you write the note and what’s in it. So let’s move to that part because I think that’s important too, before we close up.

Curt Widhalm  30:14

Well, and I will forever credit Dr. Melissa McCaffrey Hall for this advice, that the number one reason that most people seem to be behind on their notes is that they don’t end sessions on time. And this is phenomenal advice that I pass along to everybody, in that the reason that we do a 50 minute session or a 45 minute session is to leave yourself time to document this stuff correctly. Yeah. And I’m going back to talking about how attorneys might approach you in a deposition, they will ask you, when did you write this note? When? Why didn’t you write it earlier? What do you remember the next day about anything? Like, can you remember what you had for lunch yesterday? And who served it to you? And what was the interaction process? And this is all showing proof of just how much your memory can and does have errors to it? And if that’s the case, then you having errors in your notes from being written a day or a week or months later? Is very, not good practice. It is inviting liability.

Katie Vernoy  31:35

Yes, I think and I’ve been on the right, the note right after session and write the note a little bit later. I’m not gonna get myself too much more liability than saying that. But I do think that writing your notes from a state of fear doesn’t feel good, either. So going back to the citation to finish up because I know we’re getting short on time. I can see why they said what they said I can imagine a situation where it’s appropriate. If it becomes statute that every time we use a word that doesn’t seem quote unquote, professional, IE see the session from last week. I worry if that’s in statute, because I think there are different ways we speak with different clients, there are different things that we do. And so to me, I don’t I don’t want this to become a statute where we have to do these things. I do worry that this is some overreach. And I also feel like there are some things that we can do to protect ourselves which is sufficiently document what has happened, do it as close to finishing the session as you can and recognize that part of your documentation is your clinical reminder of what’s going on, as well as cya if somebody comes looking at those notes later.

Curt Widhalm  32:53

You can check out our show notes at MTSGpodcast.com. Follow our social media and take a moment and drop us a note your thoughts of what we’re covering here, stories that you’ve heard, and anything else that you would like to have us cover and until next time, I’m Curt Widhalm with Katie Vernoy.

Katie Vernoy  33:15

Thanks again to our sponsor, Dr. Tequilla Hill.

Curt Widhalm  33:18

Therapists, if you are tired of going in and out of the burnout cycle and you desire to optimize your wellness, Dr. Tequilla Hill has created and curated a wellness guide specifically with deep compassion for the dynamic personhood of the psychotherapist. Subscribe to Dr. Hills offerings at bit.ly/StayWellGuide that’s bit.ly/StayWellGuide and you can find many of the inspiring offerings from Dr. Hill 17 years as a practice leader, supervisor, mentor, human systems consultant and wellness enthusiast.

Katie Vernoy  33:56

Once again, subscribed to Dr. Tequilla Hill’s how to stay well while you work therapist wellness guide at bit.ly/StayWellGuide.

Curt Widhalm  34:06

Hey everyone Curt and Katie here. If you love our content and would like to bring conversations deeper, please support us on our Patreon. For as little as $2 per month we’re able to bring you more content, exclusive offerings and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more.

Katie Vernoy  34:29

If you don’t think you can make a monthly contribution no worries we also have a buy me a coffee profile for one time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/MTSGpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.

Announcer  34:50

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