therapists


You might argue that the amount of time community mental health therapists spend writing paperwork is unethical, and you would be right in at least two ways: (1) It is an unethical use of tax payer money, paper, and storage space, as much of it is redundant, and (2) it squanders a valuable resource, attention from therapists, on writing, which we are not particularly good or efficient at.

But the worst part for me is that I consider myself a writer of sorts and really care about the quality of my writing, but now spend a large part of my full time week practicing how to write badly. I groan inwardly each time I write something like, “Clinician used psychoeducation about anchoring and adjustment and introduced perspective taking exercises. Client showed understanding of psychoeducation and participated in perspective taking exercises.” And there is no time or economic incentive to make it better.

At least, I tell myself, I did not “utilize” psychoeducation like many of my dear colleagues, but that is small comfort.

It reminds me of why I got out of the small-time freelance record production business. There I was, a songwriter, and the grist for my creative mill was whatever songs someone who could afford my hourly rate brought to me. And those over, and over, and over. Don’t get me wrong–I loved the work and most of what my client’s brought me was good, I just needed to curate what went into my ears more carefully.

The analogy is not perfect, but close. Therapist paperwork writing is not only bad, but emphasizes the least important parts of therapy. A good document of therapy would be more like one of Irvin Yalom’s novels, narrative, interesting, a document of confusion, exploration, courage, inspiration, a document of the development of a mutually beneficial relationship. But this is not what gets you paid. “Clinician challenged cognitive distortions” gets you paid.

And the writing of notes does intrude into therapy occasionally. Occasionally, in session, I have the thought, “How am I going to write this up?” Not a therapeutic thought. Brush it aside, suppress shudder, return attention to client.

One of my supervisors likes to say, “You need to own your charts, you need to love your charts. Your documentation is the only record of what you do.” In an economic and bureaucratic sense, she is exactly right. And I am committed to this career, so I know what I need to do: Fully master the paperwork. Spend as much time as necessary now so that the future me will have perfect case notes, perfect assessments, perfect charts, with no more than the minimal time, stress, and effort spent.  And hope that the bad writing I am practicing makes the minimal impression on my creative brain.

Advertisements

In 2011, Roger Walsh published a review of the research into ways we can improve our mental health and resiliency by changing how we live. He found eight that had both solid research behind them and strong effects. As therapeutic interventions go, these lifestyle changes tend to be enjoyable, inexpensive, and carry only positive side effects such as increased physical health, self-efficacy, and longevity. Despite that, mental health professionals do not emphasize lifestyle changes. This could be due to a spin on the instrument fallacy: Clients bring in a nail and all therapists can think of to use is their hammer. Walsh suggests this failing is because therapists have unhealthy lifestyles themselves.

  1. Exercise: 30 minutes or more of exercise has therapeutic and preventative emotional and cognitive effects.
  2. Nutrition & Diet: Fish, vegetables and fruit in the diet have both enhancing and protective psychological effects.
  3. Time in Nature offers cognitive and emotional benefits and stress relief.
  4. Good relationships: Being connected in rich relationships comes with cognitive benefits, happiness, and resiliency. In fact, the quality of a therapeutic relationship may account for a large part of the benefit of therapy.
  5. Recreation & Enjoyable Activities (AKA fun): Helps with stress, mood, and well-being.
  6. Relaxation & Stress Management: Mindfulness practices and muscle relaxation techniques can have strong and lasting positive effects on mood management.
  7. Religious & Spiritual Involvement is associated with good mental health, maybe especially with faiths centered on love and forgiveness.
  8. Contribution & Service: Giving time and energy to others boosts happiness, as long as it isn’t out of a sense of obligation.