Why in the world would anybody put “selfcare” and “documentation” in the same sentence?
Because when therapists start feeling overwhelmed and burnt out the very first thing that’s sacrificed are progress notes! Then the inner Critic berates you by saying, “you’re a bad therapist because you’re behind on your notes. You need to catch up – now!”
What happens next is predictable. A young part of you believes the Critic and doesn’t write the notes – because you’re a bad therapist! You get further behind, proving that you’re really as bad as the Critic says you are. The shame cycle is vicious. The way out, as well all know, is through.
This blog is about four ways to take care of yourself and break the shame cycle of getting behind on notes.
Break the Shame Cycle
Selfcare isn’t just a buzzword. It’s a necessity for us as therapists. Selfcare doesn’t always look like taking a vacation, eating well, drinking enough water, exercising, going to the movies, or meditating. All these things are important but that’s not what I’m talking about.
Sometimes selfcare isn’t about doing things that make the present bearable but about doing things that make the future easier.
My recommendations are based on 11 years of providing clinical supervision. They address a very different form of selfcare – designed to break the shame cycle.
TIP #1 – Have friends who are therapists. Be part of a supervision group.
The hallmark of shame is trying to avoid it by not saying anything to anyone. If isolation is bad for our clients, it’s certainly not good for the therapist. It feeds the shame. Since our profession has unique stressors that most friends simply can’t understand, we need friends who are therapists. Having deep, meaningful, and compassionate conversations about the personal and professional issues we face week after week and year after year reminds us that we are not alone. It de-stigmatizes our struggles, helps us face our deficits and own our strengths. It makes us better therapists! So have friends who are therapists and join a supervision or consultation group. Feel the inner Critic soften. This is my #1 strategy because the antidote to shame is sharing – with people who love and support you.
TIP #2 – Write a List of Interventions
Many therapists tell me that one of the hardest parts of the progress note is writing interventions. You know what you did in session but struggle to put it into words. It’s particularly hard when you’re trying to squeeze note writing between clients or you’re tired at the end of the day.
You may have tried intervention books but like me, you find them overwhelming with too many choices. Or they may be written in a way that does not reflect the modalities you use or what you do in session.
In this case, selfcare looks like creating a cheat sheet.
Set aside one hour to go through your past notes and write down the most common interventions you use in session. Organize them by diagnosis or modality and keep them by your side wherever you write your notes. You may not find the exact intervention you need but having the list will spark your thinking so you can knock your notes out quickly.
They do not need to be written in psychobabble. They will be in your words and they will reflect your work. It’s ok if your interventions sound redundant if they accurately reflect your work because you use a limited number of modalities. If you’re not writing the exact same note each time, you’re fine. Plus, you’ll add interventions as you encounter new issues and expand your skills. I know this process works. Not only do I do have a list of interventions sitting on my desk, but therapists who consult with me have told me how much time it saves them.
This one hour of “research” will give you more time for doing what you really want to do.
Tip #3 – Make a Plan to Catch Up
If you were to ask that inner Critic why it’s so relentless, I’d bet it would say, “because I want you to catch up and be a better therapist!”
Acknowledge the Critic’s good intentions, thank it for sharing, and notice what happens. I bet the Critic calms down a bit. Then help it stay calm. Make a doable and achievable plan to catch up; the type of plan you would make with your clients, full of compassion.
Your notes don’t need to be perfect. They need to be done. Just not all in one day or even a weekend! If you need help to start catching up on your notes so you can stay caught up, download, 25 Tips to Get Notes Done. It’s yours and it’s free.
Tip #4 – Take a Training
Do you ever sit in a session so overwhelmed by your client’s affect and circumstances that you think, “Gee, this person needs to see a therapist” as if you aren’t a therapist! Or do you sometimes find your sessions feeling dull and it’s not because your client is talking a blue streak? It’s a miserable experience but YOU ARE NOT ALONE.
When I was a supervisor, therapists often came to me with these concerns. The first thing I did was “confess” that I have had the same experience. Then I often recommend taking a training. Trainings help for a few reasons: they combat imposter syndrome and reduce feelings of isolation. You learn new skills, which boosts your confidence and adds more zest to your sessions. Find a training that lights you up, dive in and see how it shifts your experience from burnout to excitement.
Struggling with documentation is a real joy killer. If not knowing what and how much to write is robbing you of the joy of being a therapist, I have a great training to help you go from misery to mastery.
Beth Rontal, LICSW, a private practice therapist and the Documentation Wizard® is a nationally recognized consultant on mental health documentation. Her Misery and Mastery® trainings and accompanying forms are developed to meet strict Medicare requirements. Beth’s Documentation Wizard® training program helps clinicians turn their clinical skill and intuition into a systematic review of treatment that helps to pass audits, protect income, maintain professional standards of care, reduce documentation anxiety and increase self-confidence. Beth’s forms have been approved by 3 attorneys and a bioethicist and have been used all over the world. She mastered her teaching skills with thousands of hours supervising and training both seasoned professionals and interns when supervising at an agency for 11 years.