Tips for Paperwork Management in Private Practice for ADHD Therapists
By Kristen Dammer
Most therapists will tell you that paperwork (or clinical documentation more formally) is their least favorite part of the job. Talk to a therapist with ADHD who is also in private practice and they will tell you a long list of challenges. The challenges come not only from having ADHD, but also from not having specific hard deadlines. Paperwork is not fun and it is not emotionally stimulating.
If you use Tamara Rosier’s Solve It Grid, then you understand, paperwork is a yellow task*. If you are a therapist at a private practice the yellow task rarely becomes red, unless you have a supervisor that is diligent about checking your paperwork. Here are some helpful tips to help you understand paperwork and time and energy for completing paperwork.
Communicate, Communicate, Communicate!
Most importantly, talk to your supervisor about paperwork challenges. Be open about how you might be behind or currently struggling to complete paperwork. Your supervisor can help you by having accountability and creating a plan to stay on track. If you work with an ADHD coach, create a plan with them. If your supervisor is familiar with ADHD concepts and tools that are helpful, you can work out a plan with them.
The main point here is to talk about it before the paperwork becomes a mountain too big to climb. ADHDers are great at avoiding non preferred tasks and telling themselves “that’s too much right now, I’m going to just do it tomorrow.” Tomorrow will come and without a “plan” of action that actually works, the “tomorrows” just keep going by.
Plan Enough Time for Paperwork
Don’t underestimate how long writing progress notes can take. On average a progress note for private practice takes 5-10 minutes to complete. It is helpful to keep in mind this realistic math: If you see 15 clients a week and it takes you 10 minutes to write a progress note, that equals 2 and ½ hours a week of paperwork.
If you also take into account, putting final touches on treatment plans and intake paperwork, you are looking at closer to a minimum of 3 hours a week in paperwork, depending on your caseload. If you have a difficult time understanding what to write in a progress note, or if your notes are taking more than 10 min, again, talk to your supervisor. Progress notes should not be novels, but they also need more than two sentences. Working with your supervisor or talking about the subject in a supervision group is important.
Remember the Purpose of Documentation
Remember that clients can have access to your clinical documentation at any time. If you are writing too much or too little, or if you are too far behind when the client asks for access to your notes, then you’re heading for a disaster.
Those red zones (in the Solve It Grid) can be stimulating and help motivate us to “get it done,” but procrastination can lead to burnout and worse yet, health problems. You can find yourself in the red to blue loop. Staying on top of your notes creates more space for green in the long run.
Managing the Not-Fun and Not-Stimulating Task of Paperwork
So if completing clinical documentation and paperwork is a yellow task (meaning not fun and not stimulating), how do you complete this task as an ADHD therapist?
I’m learning more about the concept of “time management” with ADHD. Remember ADHDers don’t know what to do or how to do it (most of the time). Trying to find a routine that works best for you is the key. How do you get yourself to consistently (most of the time) do an activity you enjoy? Do you need to schedule the activity with friends? Do you have a set routine, do you do the activity most mornings?
Once you find a system that is working, keep checking in to see where your stuck points are and how you can tweak your system to better work with your needs. Every clinician has their own system and every system will break down or need tweaking from time to time. With ADHD, we don’t know what to do,and how and when to do it because everything becomes too overwhelming (Tamara Rosier).
Here are some strategies to help with the what, when and how to complete clinical paperwork:
- Set a hard deadline for yourself that notes have to be done every Sunday. Have an accountability system to keep this in check.
- If you do fall behind with weekly notes, have a plan to catch up with those as soon as possible. Maybe you have to “skip” the few days that you fell behind and just concentrate on the current notes. If this happens, sit down and think of a way that you will catch up on those “skipped notes.”
- If it works for you, write the note after each session or complete your notes at the end of the day.
- Block off 3 hours a week that are specially for note time, whether you want the three hours consecutively or broken up. Find what works best for you.
- During this paperwork time, stick to the paperwork. You can pair the yellow task with a blue or green (listen to music, have tv in the background, find simple ways to make the yellow more stimulating such as body doubling, or soft mat under your feet, or sitting on a balance ball or drinking your favorite tea).
- Take time to celebrate with a blue or green activity (careful if it is blue to set a time limit). Or just do a happy dance after each note).
- Tell yourself, I can go for a walk after I write 6 notes, or get through my Wednesday notes. Or after I spend an hour writing notes, I can go ____.
- Use color coding and cross off completed notes with a green pen to add stimulation
- Talk to other ADHDer’s and their strategies to get more ideas.
- Work with a ADHD coach or a therapist that understands ADHD.
These are only a few strategies to help with completing paperwork. Find what works best for you, don’t suffer alone, and celebrate, celebrate, celebrate whenever you can.
Clinical documentation and paperwork is a necessary and important part of our jobs as therapists. We can look back at notes and see what tools we’ve worked with clients on in the past sessions and what tools might be helpful for us.
Notes help us gauge where our clients are in the change process and help us understand what interventions we’ve tried and what interventions could be helpful in the future. Clinical documentation, in particular progress notes, is a document of the magic that happens behind the closed doors that is necessary and what we are ethically bound to in our professions. Finding a way to make it more stimulating can make all the difference in the world.
*I refer to Tamara’s Solve it Grid and will include the chart to help with understanding. If you have more questions, she has a book called “Your Brain is Not Broken” and, ADDA is a wonderful organization with tons of helpful resources. The key to the Solve it Grid is to be more strategic in finding balance with the colors we spend our time in. Time management with ADHD leads to shame. Thinking of time management in terms of time, tasks, and energy is more helpful.
Kristen Dammer is a clinical supervisor, therapist, and blogger with Firelight Supervision and Catalyss Counseling. Kristen specializes in trauma, ADHD, and perinatal counseling with adults and is trained in EMDR. Kristen enjoys providing clinical supervision and consultation to beginning to advanced clinicians in private practice, hospital, and agency settings.