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Let’s Talk Progress Notes

Let's Talk Progress Notes

If you ask around about the aspects of clinical work that cause problems for therapists, you will probably find writing progress notes to be in the top 3.

Progress notes can be hard on clinicians for a variety of reasons:

  1. The emotional toll of the session causes you to avoid writing the note and experiencing it again.
  2. You don’t have a good system in place to make sure you are on top of your notes.
  3. You have ADHD (like me), and find it hard to get motivated to do mundane tasks.
  4. You are so far behind that overload and fear of an audit have you paralyzed.
  5. You feel insecure about what should be in the note and worry that you are not covering all of the bases.
  6. Your EHR or note-taking system is cumbersome so you avoid it.

If you fit into any of the 6 categories I have listed, read on for some tips to get caught up and stay caught up with your progress notes

  1. Emotional toll: this can be especially difficult for some niches, such as those that do work around trauma. Writing the note immediately after the session while you are still in that emotional headspace can be really helpful. Also consider doing conjoint notes where you right the note as the session occurs. Or you can leave time at the end to summarize the session with your client and write the note with them there.

  2. Need a good system: There’s nothing better than ending your work day knowing all of your notes have been written and you have filed your claims. One way of achieving this is by allowing 5 minutes between sessions to complete the note immediately. If you don’t have time for that, take a minute to jot down key words and quotes from the session to make it easier when you return to write the full note.

  3. AHDH: For those of us with ADHD brains, systems are probably a huge part of your life. Having a firm rule about when you write the note, and not allowing yourself to negotiate a different time, can be key to making note taking at the end of the session or by the end of the day can be really useful. You might also consider using voice to text input if your EHR has option.

  4. Too far behind: It happens to all of us every now and then. Whether you have too much on your plate due to the demand for mental health services due to the pandemic, or you were sick, or you have been having a hard time doing them in general, the most helpful thing to do is the stay current with your notes. If you have overdue notes from 2 weeks ago, write the notes for today and work your way back. Some EHRs will allow you to move from one note to the next so you can go back and do the missing notes easily.

  5. What should be in a note: Writing notes for liability reasons and insurance reimbursement can be very different than those you wrote at an agency or even in grad school. Do a little research. Each insurance panel will outline what needs to be in a progress note for reimbursement. Many EHRs have note templates that you can use and modify to make sure everything is covered. Consider taking an e-course by someone familiar with auditing cases so you can learn what you need to include. You might also learn some tips and short-cuts.

  6. Cumbersome EHR: The system you use should work for you and the way you practice. There are a number of choices of EHRs and testing out several to see which one works well with how you practice is important. What works for your colleague may not be a good fit for you.

    A few more tips:
  • Have a specific procedure written down that defines how and when you need to write a progress note. (Within 24 hours of session, prior to submitting the claim, etc)

  • Work with a colleague. Many people find it easier to stay on task if they are working with someone else. For AHDH brains, we call this body-doubling. Set up a time to write notes with a colleague. Or have them be your accountability partner whom you can notify when you’ve completed your notes.

  • Use the Pomodoro method to set aside uninterrupted, focused time to get them done.

  • Set aside admin time each day so you will have uninterrupted time to get the damn things done!

    If I have missed a category that causes you problems with keeping current with your progress notes, or you have a helpful tip to share, hit reply and let me know so we can learn from each other!
Blog Psychotherapy Clinical Issues

You Get to Choose

You Get to Choose

Hello Colleagues!

As  you know, I meet with groups of amazing therapists every single week.

This gives me a bird’s eye view of the things going on in our field, issues other therapists are wresting with, and some of the fallacies we are taught in grad school which simply do not serve us.

One of the topics that comes up time and again is offering sliding scale fees and/or pro bono sessions.

Should you do it? How should you do it? Etc.

As a therapist, you are a natural giver.

You were likely drawn to this field because of the support you received at some point in your life OR because of the support you needed and didn’t receive at some point in your life.
You have a helper’s hearand you want to serve others with your talents and skills.

And yes! That is a wonderful way to give back.

But guess what, offering reduced or free sessions is not the only way to give back.

If you are a new clinician or in a practice building mode, offering these sessions may reduce your income in a way you cannot afford.

Choosing to give back through your work is a financial decision that is personal and specific to your situation.

But offering this type of session is just ONE way to give back.

Instead, you might find it more helpful to have a break from work and do something else. Such as:

  • volunteering at a food bank or homelessness prevention shelter.
  • volunteering at your child’s school
  • walking dogs and changing kitty litter at your local SPCA
  • maintaining a shelf at your local library
  • or recognize that it is not the right season for you to give more right now because as a first line worker, you are EXHAUSTED and need to give back to yourself and your family so you can continue to support your current clients.

I want to assure you that whatever you choose is right for you, IT IS OK! Trust yourself to choose what is right for you and your situation and ignore any unsolicited opinions that do not serve your best interests.

In my next post, I will talk about some ways you can give back with therapy work in a way that works with your practice.

Blog Psychotherapy Clinical Issues

Which Type of Therapist Are You?

Which Type of Therapist Are You?

Like all people, therapists come in lots of different flavors. As the facilitator of small clinical consultation groups, I have a bird’s eye view of a variety of personalities and work styles in our field. The beauty of our field is that this diversity allows us to grow and learn from each other which benefits not only the clinicians but also the clients.


Let’s look at a few examples of the types of clinicians out there:


Clinician 1: You have a big heart and sense of obligation in serving many clients to the best of your ability. Sometimes you take on too many clients for a sustainable case load. This may feel like it makes you a committed and caring clinician but it also can lead to burnout and it muddies the waters at times about who you bring into your practice and if/when/how you decide to refer out.

***If this is you, imagine, having an intimate, trusted group of colleagues who see you and help support you in making decisions about some of these blind spots. They are able to help you assess and address the need to refer out some potential clients or refer out current clients who need something different than what you offer. These colleagues value you as a clinician and understand that this is difficult for you and provide gentle support and helpful guidance in making these decisions.


Clinician 2: You have very clear perspectives about your scope of practice, which clients you see, your fee structure, how you get paid (private pay vs insurance vs a hybrid model). You have clear thoughts about decisions such as policies for no show/late cancellation fees but your views are shifting and you don’t know how to handle it. Your previous firmness with these things is causing issues that are becoming apparent to you. You have realized that this field is not one size fits all and that not all policies or practice structures work for your clients but you don’t quite know what to do about it.

 ***If this is you, imagine that you have regular consultation with clinicians you trust so you are able to talk these issues through knowing you will get a variety of supportive ideas and suggestions, as well as some insight about solutions you would not have thought to consider. They know you and your work and will give you space to figure this out.


Clinician 3: You have been doing this work a long time. You are very well regarded and effective in your clinical work. You even supervise pre-licensed clinicians with very good results. You feel confident in most of your clinical decisions. But every now and then you have a case that gives you pause. There’s a dynamic that is worrisome that you can’t quite conceptualize so you don’t reach out to a colleague because you are unclear about what you need or you worry it will impact the way others view you.

 ***If this is you, imagine leaving work with peace of mind, knowing that your clinical consultation group is meeting soon. You know they will help you process the case, offer supportive insights and differing perspectives. You love that you get to benefit from meeting with clinicians with a variety of skill sets and theoretical orientations. You trust them and know there will be no judgement about not having a specific question, or way to conceptualize the case, since we all face that at times.


Clinician 4: You are an experienced clinician and most days feel great about your work. But every now and then you experience imposter syndrome and feel embarrassed by it. You don’t have anyone you feel safe being vulnerable enough to sharing this with, or you worry colleagues will think less of you.

***If this is you, imagine knowing just who to process this with. Your small clinical consultation group whom you’ve grown to know and trust are able to validate this issue. They reassure you it has nothing to do with your skills. And because they know you, they are able to offer suggestions to help you feel more confident in your work.


Clinician 5: You are well-rounded, have built the perfect private practice for yourself and love doing this work. But as a solo or online therapist, you find yourself feeling lonely. You miss the camaraderie of having colleagues down the hall to chat with, get clinical advice or get support with cases where you are doing good work but the client’s circumstances are difficult and you worry that you should be doing more (even though logically you know you are doing a great job with a sucky situation).

***If this is you, imagine showing up to your consultation group and sharing about your case, the difficulties the client is struggling with, and your feelings that you want or need to be doing more. But your colleagues have all had similar cases and are able to offer empathy and to normalize the discomfort you are feeling. They are there to affirm you are doing good clinical work and remind you that aspects of our field, such as this, are difficult and take a toll on us.


That’s 5 different clinician profiles…not an exhaustive list by any means. Did you identify with one or more of these examples?


Do you feel stuck in needing support to address concerns like those examples but don’t know how to go about getting what you need?


If you are not getting clinical consultation on a regular basis or don’t have a trusted group of colleagues to consult with, commiserate with or just laugh with, you may want to consider how this type of support can help you level up as a clinician and help you love your work even more.

Blog Psychotherapy Clinical Issues

5 Things Every Private Practice Clinician Should be Mindful Of

5 Things Therapists in Private Practice Need to be Mindful Of

As I shifted into private practice work years ago, I stumbled upon some things that were the norm where I worked but I eventually realized were not working for me. The insight came when I was completely burnt out and very unhappy with my workplace dynamics.


I hope these tips will help you avoid some of the angst I experienced as I transitioned into private practice.


So here are my recommendations for 5 Things Every Private Practice Clinician Should be Mindful of:

  1. Lunch – You should eat lunch every day or at least take some breaks between clients. I used to see 12 clients back to back and only had lunch or a break if someone cancelled. It’s tempting to overschedule to allow for cancellations but this is not a healthy solution. This leads to burnout fast!
  2. End sessions on time –If you are coming from agency work where there are often different expectations about how long sessions or client work should last, learning to end on time can be challenging. Figure out how to begin wrapping up your session at least 5 minutes before the session ends. This can be done by beginning a recap of the session or with a phrase you use. “Well, I see we are out of time today” is not my favorite but if it works for you, great! There will obviously be times when a session needs extra time but that should be the exception instead of the rule.
  3. Handling no shows and late cancellations – Decide what your policy is or learn about the policy where you work, and check in with your values. Does this policy feel fair to you? Would you be OK with this policy being in place with a provider you see? Are there times you can choose to make an exception? Getting clear in your mind about this with yourself and with your clients is a must do. Holding boundaries is important but there may be times you decide to waive your policy or choose not to charge for them at all. Just be really clear with yourself and your client about why you are waiving it and about the expectation moving forward.
  4. How you feel about reducing rates – This was a doozy for me at one time. I had to define when and at what rate I would reduce to for clients in need. The last thing you want to do is give someone a reduced rate, with no time-limit to reassess the need, and then feel trapped and annoyed because they keep telling you about the new shoes they just bought. (Yes, this happened to me.) If you are gifting a reduced rate, set a time period to reassess the need then understand that their values may differ from yours around how they spend their money.
  5. Set boundaries around your schedule – In the early days especially, it’s easy to take clients whenever they are available. Over time though, this can create chaos in your life. Set your schedule and stick to it (emergencies aside of course). And remember, it is perfectly OK to change your schedule to accommodate your life. Clients sometimes need to change their appointment to accommodate their lives and with enough notice, you can do that too.

I fully recognize that there are LOTS of opinions out these about these things. The bottom line for me is, check your values, be super clear to yourself and your clients about the parameters, and understand that others will do it differently.


Different is OK.


It’s nice to learn about other options for managing some of these things but ultimately, you need to practice in a way that works for you!




Due to repeated requests, I am forming BRAND NEW groups for pre-licensed therapists!


These groups will run just like my current CollabOasis consultation groups except all group members will be pre-licensed. Members participate in closed, facilitated groups of 6-8 clinicians who meet virtually twice a month to get consultation on cases, discuss ethics, get business tips and resources, and find supportive colleagues you will get to know and trust.


The focus of these groups is on supporting each other and creating a place of benevolence to establish trust and get the clinical support that is so vital in our work.


The monthly fee includes 2 small group meetings per month. And once you are licensed, you will get 6 months at a reduced rate for the groups for fully licensed members as you work at or build a private practice.


**Please note, these hours will not count towards licensure since this is not supervision.


If you want to learn more about it, please set up a chat with Jeanene by clicking on the Contact Us tab of this website.

Blog Psychotherapy Clinical Issues

We Are Our Product and We Take Things Personally

We are Our Product and we take things personally

Dear therapists,

We are our product and we take things personally.

When I look at this sentence now, my response is “well, duh!”

But several years ago, when my family was dealing with the crisis of my dad being diagnosed with dementia, one of the resources we used was an attorney to help understand the legalities of protecting my dad in various regards.

Now this is what was so profound…

The attorney stated that she is her product. We are paying for her knowledge and experience to guide us.

Let me say that again in a different way dear therapist,

YOU are your product. Clients are paying YOU for your knowledge and experience.

If this is a new concept to you, please pause a minute and let it sink in.

YOU are your product. Clients are paying YOU for your knowledge and experience.

You see, unlike other types of providers, we can’t rely on bloodwork, CT scans, etc. to treat our clients. We need to pull from our years of schooling, supervision, peer consultation and experience to provide the right assessments and treatment to clients.

Now let’s up the ante a little bit.

We take things personally.

That’s right. When a client terminates unexpectedly, we have a no show, we have trouble filling our caseload, or we get difficult feedback from a client or colleague about our product (us!), WE take it personally.

For each of us, the things that activate shame, guilt and imposter syndrome, to name a few, are different. But the feelings we experience are pretty similar for most of us in our field.

I was recently at a networking event with other therapists and we were discussing imposter syndrome. I casually threw out the remark…”You know you need support from peers when you are sitting with a client and find yourself thinking that they could really benefit from therapy. And then you realize, they are in therapy…with you!”

It was amazing to see the head nods and smiles as this thought resonated with my peers.

Some of them may have even been allowing themselves to acknowledge this for the very first time (thanks shame button).

If you believe you are alone in any of these feelings, I can assure you you’re not.

Spending time with peers, and in supportive peer consultation groups, is a game changer in understanding how we bring our humanity to our work.

  • We NEED to hear other therapists talk about these issues.
  • We NEED to have colleagues not only normalize these experiences but also provide support so we can move beyond them.
  • WE NEED to put our product’s needs and reactions into the equation when we show up at work. (Hint, hint…remember I’m talking about you as your product.)

What are some ways you are struggling with the way your work impacts you?

What are you doing about it?

Blog Psychotherapy Clinical Issues

Is This Field Right for Me?

Is This Field Right for Me?

Therapists continue to spiral in overwhelm…
too many clients,
openings but not getting referrals due to limited networking capabilities,
huge issues with progress note writing,
compassion fatigue,
self-doubt, etc.
Along with that, I am hearing many therapists questioning if this field is right for them these days.
This is fairly typical for newish therapists facing overwhelm, but y’all, this is happening with more and more of us…even seasoned clinicians.
So what to do?
1. Take a breath and allow yourself to lean into the feeling. It’s ok that it’s there.
2. Give yourself some time off if possible. If you cannot afford that, there are alternatives to taking a full break from clients. Hear more about that in this video (jump to 4:18 in the video).
3. Reach out to peers who know you and can help you talk through your options.
4. Take a look at how you are caring for yourself.
5. Take a bird’s eye view of your life to see if there are other areas that are overly taxing.
6. Assess your budget. Are there places you can trim back to allow for a lower caseload.
7. Think about your passions. Are there ways you can leverage your clinical skills to work in a different way?
8. Understand that ‘passive income’ is mostly a myth. Branching out in new ways will take time and effort. Effort with a different focus may feel more expansive, however, so shifting your efforts might be a relief.
Please know you are not alone in this.
You have colleagues who are also struggling who can understand how the pandemic is impacting you in a way that those not in our professional do not.
Be kind to yourself.
Get support.
Your clients need you to be ok but YOU need you to be ok as well!
If you are looking for support in the form of peer consultation, now is a great time to reach out to me. I have a few openings in our small groups and would love to chat with you about what you are looking for.
Blog Psychotherapy Clinical Issues

Pandemic Stress and how it is Impacting our Sessions

Pandemic Stress and how it is Impacting our Sessions

As the toll of the pandemic continues on, therapists are seeing the effects becoming more and more present in their sessions. One issue that is being discussed regularly in recent months in our peer consultation groups is difficultly managing emotional regulation by the therapist. 


As therapists, we are used to compartmentalizing our lives during our sessions to keep the focus on the client and how to best serve them.


Many of us have experienced a time when something going on in our personal life would at times intrude into our thoughts during sessions.


Since the onset of the pandemic, more and more therapists are struggling to stay emotionally regulated during their clinical work.


I was horrified a few months ago when I found myself being questioned by a client about the vaccination status of our family before the upcoming holidays. Instead of exploring why they were asking, deflecting or using another therapeutic technique, I found myself feeling defensive and activated due to the way this issue was playing out in our family.


I have been practicing a loooong time and had not had that experience in many, many years.


When processing it later, I felt shame, concern for the therapeutic relationship and disappointment in myself.


Here’s the thing though, it is happening to a lot of us right now! 


For example, therapists with anxiety are reporting increasing symptoms before and during sessions as their clients discuss the very issues the therapist is also experiencing.


So what is a therapist to do when encountering this in their work?

  • Take a moment to center yourself and decide how the session should continue…addressing it, moving on or something else.
  • Be kind to yourself after the session. You are not the only one experiencing this.
  • Remember that we are hyperaware of our function during interactions with clients but what feels huge to us may not even be of note to the client.
  • Get peer support!!!! Now is a great time to reach out to your colleagues, consultation group or therapist besties for support.
  • Remember that even on our worst days, we are likely showing up for our clients in a beneficial way. Have you ever revisited something from the previous session with a client that felt concerning to you but they were unaware or unfazed by what happened?
  • Assess if this is a one-off happening or if it is occurring more often. This will guide your next steps.
    • Maybe you need to schedule your day with more time between sessions
    • distribute your sessions differently throughout the week
    • or if it’s an option, take some time off.
    • Canceling even just one or two clients during any given week can provide some much needed respite without a complete loss of income. (And yes, I did not there! Deciding to cancel a session factors in the needs of our client but in private practice, it also should factor in our finances and well-being, and it’s OK to name this. You are still a caring professional.)
  • Plan ahead. Before sessions, take time to check in with yourself and think about the client you are about to see. Are there topics or reactions that could be activating to you based on what you know about them? If you are virtual, do you need a sticky note on your monitor to remind you to breathe? Do you need to allow for additional self-care or time to yourself after the session?
  • Go wash your hands after the session. Focus on the warm water and foam of the soap on your skin. Take deep breaths, relax your shoulders and jaw, pull your tongue off the roof of your mouth, and rotate your head from side to side. Don’t forget to keep your favorite lotion nearby to apply for further comfort.
  • Talk to your own therapist to get help establishing a plan to address the increased feelings, reactions or burnout you are experiencing.
  • If you are a newer clinician, please understand this is not a typical scenario in our field. There are many overwhelmed newbies as well as seasoned therapists out there questioning if they can do this work. I will address this more in a future email.


As much as we don’t like to think about it, 

therapists are humans and our own needs have to be a part of the equation of our client work.


Long gone are the days when the sole focus is on what is best for the client. Sure, they are and should be our main focus but if we are compromised in any way, there is the potential for harm instead of good.


And as I have been saying for about a year now, we are looking for OK right now in terms of how people are doing. We need to lower the bar on what we are capable of as we approach 2 years of pandemic living.


None of us knows what our new normal will eventually be but the reality is that getting mental healthcare is becoming more widespread and normalized. While this has been a blessing for those of us working with populations of people who have previously never considered accessing therapy, it also means more clients are seeking services without more therapists to provide it.

Blog Psychotherapy Clinical Issues

Two Types of Therapist Self-disclosure

2 Types of Therapist Self-disclosure

If you asked a dozen therapists their views about self-disclosure, you’ll likely get a dozen different answers. For most of us, our training and treatment modality informs whether or not you think this is a good or bad thing. But have you considered that there are 2 types of self-disclosure?

Let’s break it down…

1. Voluntary self-disclosure

This occurs when a therapist shares something personal with a client. Those who do this, hopefully, assess the benefit to the client for the sharing it, and recognize the shift in the relationship that can occur because of it.

Most therapists I know who have been in practice a while, will tell you their views on this has changed over time. And the view may be client specific; you will disclose with some but not others. And that’s ok.

Keeping the therapeutic value in mind seems to be the common denominator with those who do occasionally self-disclose.

2. Involuntary self-disclosure

This type often occurs when there is some type of visual or auditory clue that the client picks up on. For example, your growing belly is likely a good sign you are pregnant or having something going on with your body.

Some other examples include moving into a new office or changing practices, traveling while working, a change of hairstyle or other outward feature, going on medical leave or being in the media (in a good way or not so much).

So what do you do about the involuntary-types of self-disclosure that sometimes occur in our work?

First, it’s important to think ahead about these types of things so you can determine how you want to respond.

You may choose to share some or all of the details or you may choose not to. In either case, it’s helpful to come up with specific language around your decision so you don’t have to figure it out on the spot.

For example, early in my career I got a very different haircut than I had previously had and was wholly unprepared for the deluge of comments and opinions I received from clients.

Wardrobe choices at times have fallen into that same category. “What carpet did that dress get cut from?” (On the upside, no matter how you handle those situations, it might be an indicator that you have developed trust with the client and there can be lots of therapeutic value in how you respond.)

Next consider that you will likely benefit from discussing this with colleagues. Consider the type of involuntary self-disclosure you will be experiencing and how you plan to respond.

When you run it by your colleague, they may have input you find helpful which can either help you feel confident in your decision or help you decide you want to handle it in a different way.

It’s hard to do this work in a vacuum so if you don’t have colleagues to bounce things off of, you should consider ways to meet other therapists and/or join a clinical consultation group.

After a few encounters, assess how it is going. If you get unanticipated responses, you may need to rethink your position or how you are conveying the information.

Again, this can be a great time to reach out to a colleague.

Like it or not, we are in a field that relies heavily on our relationship with our clients. That can make our exchanges with them more personal than we anticipate or desire.

By having an awareness of these types of possibilities, you give yourself the advantage of planning ahead, considering both your needs and those of your clients, and hopefully, you won’t experience feeling shell shocked in a session by something you didn’t see coming.

If you have experienced involuntary self-disclosure, comment below. I’d love to hear about it and how you handled it.