So Bob, we are in a weird situation in that for the first time in a long time I have recorded a bunch of audio episodes so much so that I have enough episodes for a few weeks and I don't like to get too far ahead because it feels weird to record an episode and then

publish it like two months later so normally you and I would record two episodes today and then publish those over the next couple weeks but I have yet to publish as of today episodes that we've recorded over the past month and so I think it would be a bad idea to record two episodes so I thought we'd do is record one really long episode but we would make the first half hour free and then the but this episode would probably be a few hours we will actually

try to answer every question that people have submitted that are relevant to our conversations what do you say Bob ambitious like it yeah anonymous patron they said I was listening to your podcast and you mentioned how you hate therapist writing notes in a particular style you know I will I'll often rant about how I'll read therapist notes and it'll be something like it'll have all these abbreviations in it that I don't even necessarily know what they mean it will have this super weird

cadence and syntax like you know DBT skill number five set to high level or I don't know something like that where I'm like I don't understand what that means you know and and I'm not even really describing it well just incomplete senses that because if it's a complete sentence if I say I talked with a client today about their relationship

that's an easy sentence to understand by anyone right but a lot of times they'll write something like client talk to therapist re you know just RE relationship or something like that and when I see those sentences in my supervisees notes it takes me I have to read it two or three times to remind myself

or they're referring to themselves client talk to therapist therapist is the author of this note it's not because you could conceivably write a note that says my client talked with their other therapist about their relationship that could how do you differentiate between that sentence and client talk to therapist meaning you client talk to me and I almost you're the one signing the fucking progress note just say client talked with me

or I talked with the client use I and me why is that a bad word in a in a clinical note but they avoid those those pronouns I and me it's it's never in these this style of no I'm I was just like it's confusing and unclear medical world

but I don't even know if medical people necessarily anyway oh yes they do okay well and I've always contended that it's born out of insecurity that these people are insecure

and they they're terribly insecure about their practice and their progress notes including you know because there's a lot of insecurity about progress notes because it's when you have to kind of commit to your work and describe it and trainees aren't trained enough in that area they're not supervised enough they're not helped enough some are but most aren't and so they resort to this convoluted way because in their head they're just like well if it looks technical maybe people

will think I'm competent and that's I don't know if that's true but it always kind of seemed that way to me the medical world will write in this third person way yeah and and I don't know about the medical world maybe they have

reasons for that but I've always taught my trainees to write in full sentences the big sense that because the other thing that I will say is that not only is it weird for me as a supervisor if I can't understand your notes you have failed as a supervisor if I don't understand what you're saying

you have failed because in order for me to supervise you I have to know what you're doing in a session to some extent and if in order for me to do that I have to understand what's in your notes because that's the only record of what you did the other thing is is it's clearly in our ethical codes that your notes should be understood by your client and you can't guarantee your client has a high level of education so the guideline is either eighth grade or tenth grade education so your your notes should be in that

readable area meaning that it should be extremely clear and devoid of any kind of lingo or jargon or or abbreviations it's it's in the training it's in the ethics if you have a progress note that your client can't understand

then why is there a progress note that's not you know because the file is there for a variety of people it's not just there for you it's there for you it's there for your supervisor it's there for auditors it's there for other clinicians that don't even work in the psychotherapy field it's also there for your client so that's what the progress note the treatment plan it's all there for for all those people it's not just there for you anyway

so I was ranting about that and I just ranted about it again you said that you think this has to do with clinicians being insecure however for myself so going back to it and obviously you said that you think this has to do with clinicians being insecure however for myself I was literally taught to write and document notes this way as an intern just trying to be in here yeah that's the problem people are taught to write in a stupid way which I'm like why justify that please any please people out there if you teach or you do

this and you feel like it's the right way email in give me a justification I'm willing to change my mind I'm guessing there isn't a good justification I'm just going to say that they go on a hate writing notes this way but I'm not sure how else to write my progress notes every other clinical

note I've seen has been written this way help how should a progress note look well so to answer that question it depends on what you mean because I haven't seen what you're referring to as annoying notes

but every instruction manual on treatment plans and on progress note writing will teach you the way I'm talking about it which is which is very clear it's it's supposed to be things like you know the client talks about their relationship this session and then you have maybe a client quote right some some notes you're required to put in a little quote like quote I am very sad about my relationship this week or so

and then you would write we discuss ways the client could manage the conflict and the client said they would give it a try this week and let me know so you have all the soap note format kind of a thing there's no jargon in there there's no abbreviations in there it's all understood at eighth grader could basically understand what that means

now sometimes there has to be some clinical stuff you know if you are doing a dbt module for example you might have like dbt module number five completed today or something like that so it's not wrong to have that but anyway

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