Badass Therapists Creating Practices That Thrive
Welcome to Badass Therapists Building Practices That Thrive, the ultimate resource for mental health professionals ready to step into their power, grow their practices, and create a career they love. I'm Dr. Kate Walker, a Texas LPC/LMFT Supervisor, author, and business strategist who's here to show you the path to success.
Formerly Texas Counselors Creating Badass Businesses, we’ve rebranded because, well, we’re way too big for Texas now! This community of badass therapists is growing nationwide, and we’re here to help you create a career and practice you love, no matter where you are.
Every week, you'll get practical advice, proven strategies, and motivation to help you build a thriving practice—one that gives you the freedom to live your life on your terms. From mastering marketing to designing scalable systems and becoming a clinical supervisor, this podcast is your roadmap to leveling up without burnout.
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Badass Therapists Creating Practices That Thrive
118 AI for Therapist Notes: A Blessing or a Curse?
Can artificial intelligence revolutionize the way therapists document and manage their sessions? Join us as we unravel this compelling question with Dr. Melissa Mcafree, a leading voice in mental health innovation. You'll gain a deeper understanding of how AI is reshaping clinical documentation, balancing detail with efficiency, and addressing concerns like HIPAA compliance. Dr. Mcafree's insights will illuminate the path to harnessing AI as a powerful ally in maintaining accurate and secure progress notes, ultimately enhancing the therapeutic process.
We venture into the realm of AI-assisted progress notes from telehealth sessions, exploring both the potential and pitfalls these technologies present. Learn how thoughtful integration of AI can alleviate the administrative burden on therapists, while ensuring that session notes remain true to the client's experience. Through candid discussions, Dr. Mcafree emphasizes the importance of informed consent and ethical considerations when weaving AI into therapeutic practice, ensuring that client data remains protected and private.
As we discuss strategies to enhance documentation practices, discover how a hybrid approach of personal input and AI assistance can lead to stress-free, efficient note-taking. Dr. Mcafree offers actionable tips and resources, including her book "Stress-Free Documentation for Mental Health Therapists," equipping professionals with the tools they need to succeed. Whether you're a seasoned therapist or just starting out, this episode promises to expand your understanding of AI's role in therapy and inspire confidence in embracing these cutting-edge solutions.
Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit.
word and uh. Welcome dr melissa mcafree and welcome to uh texas counselors. Creating badass businesses free workshop awesome, thank you.
Speaker 3:Thank you for having me, and you will have to um excuse the unprofessional presentation today, meaning that my cat went to the vet this morning and was medicated and is just kind of loopy and whining. So she may make an appearance and you may hear her, and I apologize.
Speaker 2:That is totally okay.
Speaker 3:Thanks, hopefully you can't hear her in the background right now. No, I don't hear her. Kat, you're good? Okay, good, good. But yeah, I saw that we had a few questions coming in and yeah, so I'll let you take it from there and where we should go next.
Speaker 2:Excellent. Well, I just made you co-host. So if you need to share screen or anything, let us know Everyone else. You know-host. So if you need to share screen or anything, let us know Everyone else. You know the drill. If you need CEs for this presentation, leave your camera on and we will post a link. Oh, we just did Okay. So there's the link. It looks like I'm posting it, but it's actually my assistant, jennifer, who's logged in as me, because you know wifi. So here we go.
Speaker 3:Oh, awesome, and I I don't have a presentation, so I thought this was more just a Q&A. Oh no, no, absolutely. So if we wanted to start out with those, then that would be great. Or if you have anything in particular you want me to kind of riff on, I can talk forever, so please interrupt me. I love this talk forever.
Speaker 2:So please interrupt me. No, no, this is great, so I will. I will ask you guys take 30 seconds or less and put it to the chat. Why are you here? Why are you here? What are you hoping to learn about documentation? What is worrying you? What is? Does AI enter your brain? Are you looking to AI as something that could save the day, or are you looking at it as Terminator 5 or whatever we think AI might be? So start posting.
Speaker 3:Let me see. And yeah, and I could say that I would say there are some few common things that people reach out to me. For Obviously, we can get as nitty gritty and in detail as you want and we do sometimes but the most common things that I hear from people is like how do I balance? How much is too much in a progress note? When am I writing too much, when am I writing too little? Related to that, one that people don't often publicly say but is an extremely common experience, is how do I catch up on my progress notes, because I fell really behind.
Speaker 2:I don't know anything about that.
Speaker 3:Yeah, and I can't tell you how many people have told me. You know, please, you know I have to be the worst one that you've seen. You know, like there's no way you've heard how you know that someone else is as behind as I am and I'm like Nope, I have, I promise you. So I've met people who have never done notes so hard to beat that right. So you know, it's such a common concern, though, and it's a very shameful experience to have and to admit, on top of the whole experience of just not feeling confident in documentation and both of those in my like anecdotal, my own experience with working with people and I've been doing this for 10 years now has nothing to do with the school you went to, with the license type you have, with the amount of experience you have.
Speaker 3:I work with people who have been doing this for decades and people who are just fresh out of grad school.
Speaker 3:So those are two really common things, and I would say that, because you say we want to get into the AI stuff, ai is a problem or is a solution that people are hoping for that people think will solve either of those problems, right? So AI will write my note better than I can. Ai will choose interventions that I can't think up in my own head. Ai will write it in a clinical way. Ai will include the information that insurance wants to see, or, you know, ai will help me do this faster, and so I think of those two really common issues that I work with people on specifically for progress notes. I think that's what they usually want AI to do, and I will be the bearer of both bad and good news in that. I have worked with people who have said AI is like they've used the phrase life changing, so it really can help, and you still have to know what goes in a progress note to be able to use AI, because let's start there then.
Speaker 2:Yeah, I mean, like the first, I'm looking. We kind of released. You know we have tons of questions now, but I see the first one.
Speaker 2:I see HIPAA security and I know you'll talk about that, but wanting to hear how AI can assist with clinical documentation and you can address both of those things right, the quality of the note and can it help me catch up? Right, those two things you said are kind of the most, and this would be a good time to mention too. You help people with this and you just wrote a book, so you have lots of resources for us and you will be put up there. It is All right good, and you will be putting the link in the chat for us before we end today as well. So, yeah, talk about AI and how it can help with those two things, or if it can, or what we need to do to make it do that.
Speaker 3:Yeah, absolutely yeah, and I think we can combine quite a few of these questions into a kind of long winded answer. But please continue putting your questions in the chat. It is helpful if you put question and then a colon before you write your question out, as far as being able to see like who's just following up on something, who's writing a comment and who is actually asking a new question. So for AI, let me back up. So, yeah, we'll kind of talk about how it can be useful, what to look out for, and when we talk about what to look out for, we'll talk about HIPAA. So, because it's actually a lot more simple than you'd think, that part of it. So with AI, let me talk about how some of these work. I think that's a good place to start. So there are various options. You can log in all the way from. The AI platform will offer like a telehealth platform and you will do your session over telehealth that way and it is literally recording the entire session, listening into the whole session on both sides, and then after you end your session, it creates typically a transcript, because it's listened to the whole thing, and a progress note for that session. That can sound both very awesome and very scary for many therapists. So you know and both feelings are relevant this I have so many things because I do like a whole AI training on this. So with that, I would say, my biggest takeaway for anything AI. So, regardless of what I'm going to say in any of this other stuff, and if you take away anything, you have to edit the AI note. You must. You have to know what should be in that note. So I'll give you some examples.
Speaker 3:I use the same therapy session to test a lot of these AI platforms and I have a free YouTube series where I'm testing all the platforms. I had to take a break while I was finishing up my book, so I'm just now getting back into testing more of them and needing to retest them because they change so frequently that now, a year later, some of my reviews are almost obsolete because they have new features. Every single one of them has made up information, every single one has gotten something wrong and I would say my biggest critique of overall, all the AI platforms is that they are extremely wordy. They give you these huge giant summaries of information and so time-wise for most people. Ai doesn't really save time because you have to the time to read through the mountain of text that it gives you and then either delete it or even just say like it's perfect as it is, which I have never seen, I will tell you. But let's say you only had to change one thing. It really does take a lot of time.
Speaker 3:Now that doesn't mean it's not worth trying out if you really struggle with notes, because if it saves you the mental effort sometimes, if it takes the same amount of time but you are not needing to sit there and produce sorry, if you can hear my cat, she's being very loud If you're not needing to produce all of that information from your head, that can be a huge lifesaver. I mean, that can be dramatic and it might mean the difference between you avoiding writing a note and you feeling comfortable logging in and getting it done if it doesn't feel like it'll be a lot of work. So I wouldn't say that's a. It's not necessarily a drawback, it just is a fact.
Speaker 3:The other thing is that most of these AI platforms are much slower. If you have used something like ChatGPT for other things, that's not how this is going to work. You're going to hit submit or you're going to end your session and you're going to literally like they'll even say, go grab a coffee, enjoy doing something else while we write your notes. So I mean, it takes a while for these systems to produce a progress note for you. So you know, especially especially if they're processing like an hours long session. So it's not like end your session, click, submit and boom, here's a beautiful note that you can just be done with. That is not the case. Some ways you can bypass that and help it are testing out some of these different platforms. Some of them will now let you give it your own progress note template and actually give it directives. So you could say things like in the intervention section include three interventions. Include five interventions. Include five sentences. In the summary section include a two-sentence summary. In the summary section include a two-sentence summary. So, as with anything with AI, the more instruction you give it and the more specific that instruction is, the more helpful it would be to you. So again, it's not a matter of just log in and don't touch anything and just expect the system to work for you beautifully. You have to work with it a little bit and adapt it and kind of know what you're looking for. So it can be worth testing.
Speaker 3:I will say we are all in a really special place right now because these things are so new. These developers the vast majority of them who are in charge of these AI companies because I'm doing this YouTube series and because I'm one of the few people talking about it so openly they're all reaching out to me and they want to meet with me and they want to do demos and they want me to review their platform. So I've talked with most of them and many, with many of them, have an ongoing relationship. Most of them have really really good intentions. They're really good people. They have a lot of different reasons for why they've started these platforms. They want a good product. They know that there's high competition already and they want their product to be really good and they love getting feedback from their users. So if you're using one or if you're testing an AI platform, email them.
Speaker 3:If you find it difficult, they want you to reach out and say I'm struggling with how to use this or this isn't saving me any time. A lot of them, like the literal person who helped create it or is like in the back end, you know, created it and is updating things they will get on a call with you and want to talk to you and say what would you like it to do, what would be helpful. So a call with you and want to talk to you and say what would you like it to do, what would be helpful. So use this opportunity, because in two years that is not going to be the case. You are not going to be able to get on the phone or on a Zoom call with one of these developers. So if you're struggling or if you just feel like I have one but I'm not optimizing it, email them and say hey, it's still taking me a long time to do my note. Do you have some tips for me? Or I'd like to be able? The summary is super long. Most of them know they they'll straight up be like okay, we've seen your other reviews. Ours is also really long. We know this. We're trying to work on it. So ask them, can I give it a directive to only give me a two sentence summary? You know so. So don't feel like you're stuck with what it's giving you, because I think some people log in and get a little disappointed. It requires a little effort and, just like when you start using an electronic health record. It requires some getting used to. You're probably not going to log in and immediately just hit the ground running. It takes some figuring out and some testing and they're so different. So let me get back to we talked about.
Speaker 3:You log into a session. You use that platform to do your telehealth session. It records everything. It gives you a transcript, it gives you a note. There's a ton of variety all the way to. You log in and you type up a summary and then it creates a note for you.
Speaker 3:You can, for some of these platforms, you can, log in and you type up a summary and then it creates a note for you. You can, for some of these platforms, you can, log in and you can give it a verbal summary of what happened in the session and then it will create a note for you. For some of these platforms, you can check off that. You don't want the transcript, it will just give you a note. Let's see I'm trying to think so, yeah, you can do the transcript, you can verbally do it, you can type in a summary, you can upload a recording. So if you're doing in session, in person sessions, then some of them you can have that listen in on in person, or or you can do that on a different type of device and then have it listen to that. So there's a variety of options for how you give it the information.
Speaker 2:And yeah, my cat is that's all right, it's okay, it's like those of us with kids, it's okay, thank you. Yeah, my kids are launched, so he may run in. Yeah, I'm hoping she'd just come and hang out, but okay, yeah so questions about hippa, questions about confidentiality, and got all these scary stories about, you know, people selling information or they go out of business, and then where's the information? What so?
Speaker 3:talk a little bit about that yeah, yeah, so, and these are kind of the things to look out for. So I'd say the first thing is there's one ethics code that has released a statement on using AI, and I think that we can all use that as a good example. So, for example I'm a psychologist APA hasn't released a statement. They're not going to release a statement for probably years, right, cause they wait to be the last one. They wait for everybody else to figure it out, and then they'll release a very vague statement about what we're going to do for AI. But it's gosh, I always butcher the name MHCA, lmhca, mhca the Mental Health Counselors Association. So their statement essentially says that AI is a new technology it's okay to use, as long as you get informed consent, and this kind of jives with what all of our ethics codes say in general about anything that's new. Right, it's okay to try something new, to do something new, as long as you are checking that it's as secure as you can check for and as long as you are informing people. Hey, this is a new thing. None of us can say that we know what AI will be in two years, right, and so the key is to inform people.
Speaker 3:I would like to use AI to write my progress notes, and, yes, I would recommend so. Again, apa has not released a statement, right? So I have no, as a psychologist, no way to say I could get in trouble for using or not using it. But I could tell you I can extrapolate from the rest of informed consent policies and guidance on ethics and using new technology that I better let people know this is new and that I can't know all of the potential downsides yet. So that's one thing that's really key is to let people know I'd like to use this AI and then let people know are you using it afterwards?
Speaker 3:Is it not recording a session? It's just something you want to use to write your progress note, or is it something you want to use to record a session? Because then that can get into state specific things where certain states say, if you're going to record a session, that requires its own consent as well as different ethics codes say that too. So so you might have a two part thing there where you're talking about getting consent for AI and then also getting consent to record them. So think about both of those things and, as you're hearing me talk about this stuff, if you've already played around with AI and you're like oh my gosh, I haven't done that. Don't freak out, it's okay. Just do it the next time you see your clients right, that's what we always say. And just do it better from now on. And that's the thing with this new stuff. You know, we will experiment and we'll learn and we'll learn. Oh, I may have done that wrong. Okay, let me do better. And it's not anything that you need to really freak out about or worry about.
Speaker 2:So that's the thing that everybody signs a BAA.
Speaker 3:Yes.
Speaker 3:So number one is informed consent. Right, make sure you get informed consent from your clients. And I would say the other part of the MHCA guidance that I think other ethics codes will probably agree with is that if your client says no, I don't want you to use AI, you can't then say I can't see you Like. Ai is not a standard of care that you can use to excuse not using it or getting rid of a client for not using it. So if a client feels uncomfortable with it, you have to be OK with saying, all right, I won't use it. So the next part is technology wise. How can you know what is safe? All you're required to do is to have a BAA with that organization. So that's with pretty much any technology.
Speaker 3:Ai is not different in this regard. Think of it just like an EHR, your electronic health record, your electronic health record. You are giving it very personal client data. You're giving it client records. You're giving it client insurance numbers, date of birth, everything right, and you don't personally research that technology to see if you feel like they are doing all of their data security the right way, because we don't have degrees in that. We don't know how to do that that's the point of a BAA, a business associate agreement. That that's the point of a BAA, a business associate agreement. That is a tech company, any technology, says we understand that healthcare information needs to be more secure. We understand that there is this law called HIPAA. We know it exists and we are creating our technology to coincide with that law and to be in compliance with that law. And so we are giving you a legal agreement, a BAA, that says we are protecting this information in compliance with HIPAA. So all you need, as the practitioner, is that BAA. That's what makes you compliant.
Speaker 3:Now, how you get the BAA is it varies. So for some of these companies you have to request it. So you might be using it and not have a BAA, and technically you are not HIPAA compliant. The software is still HIPAA compliant, it's doing the same thing. They're not changing the software as soon as you download a BAA right, but you are not HIPAA compliant without that BAA. Some of them automatically just give it to you, send it to you as soon as you sign up. Some of them require you to sign something when you sign up and then it's downloaded. So it's all different.
Speaker 3:But you do want to check and make sure that you have a copy. It should be a physical copy of that BAA, and so you typically get that during the sign up process. But if you don't then reach out and ask for it and if they can't give it to you, then you are not being HIPAA compliant if you do not have that BAA. And I emphasize that because there are companies unfortunately there was one that is now HIPAA compliant that for a long time was not. They were not giving people BAAs and they were saying they were HIPAA compliant because technically they're HIPAA compliant. But you are not HIPAA compliant if you don't have that BAA from them. So don't be duped. That's the only thing you have to do is get that BAA.
Speaker 2:Is there? We have a. I'm skipping around in the notes because you're answering a lot of this or not. Notes the chat. Is there any? We have a. I'm skipping around in the notes because you're answering a lot of this or not. Notes the chat. Is there any way you could screen share and just show us what a note would look like from AI? I mean, you said you had some sample sessions or things that you do.
Speaker 3:Yeah, let me pull up. Let me pull it up before I screen share. I gotta dig around through my you know see all these handouts that I have. So I do have a handout Actually it's somewhere else. Let me just search for it to find it more quickly. But I have a handout that has all of the different progress notes I have generated from different AI progress note generators and what I use. The session that I use is the session with Carl Rogers and Gloria. If any of you are familiar with that, it's a very popular common training session from the 60s and I'll go ahead and share my screen if that's okay. Then If any of you are familiar with that, it's a very popular common training session from the 60s and I'll go ahead and share my screen if that's OK, then hold it up, all right, so, and I'll share this link with you guys too, so you can reference it. This is a handout that I offer for anybody as part of that YouTube series anyways. So I have some important notes here and I have comments on all these different platforms. There are many platforms that are not listed here yet. I will say AutoNotes is one that was not HIPAA compliant previously and now is. That still gives me a little caution that they at one point were not and we're not quite upfront about that. So they're not my first that I would recommend.
Speaker 3:But here's an example of a therapy session note, of adapt note, data, assessment and plan. As you can see, this is a really long note. I mean, look at this, look at the plan section. Your plan section does not have to be that long. Okay, I'll just like give you like the quickest note feedback ever and say that, unless this person was suicidal and we created a whole plan for what to do and they had never been suicidal before, right, and so this is like a really big deal and we're making a whole documentation. You know, we're changing our treatment plan and do all kinds of stuff. Your plan doesn't need to be this long. It could be one or two sentences really. So here I emphasize in the orange these are kind of like caution things where it made things up.
Speaker 3:So here's a good example, and this is not to pick on auto notes, but to just say all of these AI platforms do this. It says moving forward, the therapeutic plan will focus on helping Gloria navigate her feelings of guilt, et cetera, et cetera. There was no therapeutic plan discussed. This was a first and only session with this client. Therapeutic plan, treatment plans anything like that was not a thing. I don't think they even had to do that in the 60s, right? So this was not discussed in any way.
Speaker 3:But AI this is a general rule of AI. It wants to make you happy. It wants to fulfill your request. This is a general rule of AI. It wants to make you happy. It wants to fulfill your request. And if it has been trained by the developers to say it needs to include certain interventions or that always mention a therapeutic plan, things like that, it's going to do that, even if that's not what actually happened. So it will create these kind of clinical sounding things that didn't exist.
Speaker 3:And I want to emphasize that, because one of the big things I hear from people when they start using AI is like, oh my gosh, I could never write a note this good. And a lot of you might be looking at this and like, oh, I want to write down what it says or how it phrased it. You don't even know if this is accurate. It could be totally making stuff up. You don't even know if this is accurate. It could be totally making stuff up. So this is not for me. This is actually not new. This has been going on and ever since I've been training people on writing progress notes. It's not about making a note sound clinical. No one is grading you on that. We want to see what actually happened in the session, and I would rather that a 12 year old could read your progress note and understand what happened than for you to overcomplicate it by putting in a bunch of clinical jargon. So it is much more important that progress notes are just clearly read and understood.
Speaker 3:Let me show you one that looks really different. So some of them, like I said, will give you only options like this, where it's a big field of text, and then typically what you would do is you would copy it all and paste it into your EHR or whatever record system you have, and so you might tweak it, adjust it, only copy paste other parts over, et cetera. Actually, I will highlight here because I'm going to highlight this in the next note too where it says Gloria is currently facing sorry that doesn't make it easier to read, does it Significant emotional distress primarily centered around her feelings of guilt and fear of rejection. Her mood was anxious and her tearful affect suggests a high level of emotional turmoil, et cetera. If you have seen this session, I would not say that Gloria exhibited significant emotional distress or that someone being tearful suggests a high level of emotional turmoil, right, would we say that about someone who's crying because their father passed away and they got tearful? No, that's normal, right.
Speaker 3:And so I will say that some of the AI platforms because they are trying to incorporate what they know we need, which is often to show medical necessity it does tend to over-pathologize or overemphasize things and it'll take what might be a stressor or a worry or a concern and it then blows it up to be like significant distress. And there is a balance of yes, we do want to show things and document well, for insurance, but I wouldn't want someone in this session she primarily is talking about she lied to her daughter about having sex, and her daughter is nine, I think, and so I think we could. There are different people who could argue that, like, that is totally appropriate to lie to your daughter about having sex when your daughter is nine years old, right? And then there are people who could argue well, it actually could be a really healthy conversation to have. All of those could be right, answers right. The point is that's a really normal parenting experience and she was distressed about it. She's more distressed about, like, essentially, all the things going on. Am I going to mess up my kid? Is it going to mess up my kid If I tell her I lied? I feel guilty, but is it, you know? Should I just deal with that on my own? These are normal parenting experiences that people have, right, um? And so I worry that some of these notes will overemphasize things like that and just kind of inaccurately reflect someone's actual level of distress. So I wanted to mention that. Let's look at.
Speaker 3:Mentalic is another one that I will say they win shortest note award. So although it looks long, you can see it's like broken up a little bit better and they don't have giant paragraphs of things. Um, it is written very similar Like. It looks more like a psychiatry note than a psychotherapy note to me, but it still has pretty good. Here it said client is struggling with adjustment to single life after divorce, guilt over lying to her daughter, concerns about her relationship with her partner. There's no partner, there's no concern about relationship with a partner. They just made this up. Single life after divorce, yes, but no, that's not there. So there are times where, again, I don't know if the AI took her talking about her divorce to kind of mean partner, how that's working. But these companies, you have to read these notes and you have to edit them and unfortunately, you have to read them in a. You have to edit them and unfortunately, you have to read them in a fairly detailed way in order to know if it's accurate or not Right. So, like this one phrase I would take out. The rest of it is fine, but let's just browse through this note and then, like I said, I'll give you guys this, this handout, and then this handout is the one that I update every time I do a new review, so you'll continue to get those updates if you follow along with that YouTube series.
Speaker 3:Then interventions it kind of breaks things out into approach and modality, actual interventions here I'll pick on mentalic because it's still a pretty good note. Here it's kind of doing the opposite. The therapist used active listening, reflection, validation and empathic responses to help the client feel heard and understood. This is Carl Rogers. 100%. This is how Carl Rogers works. This is an accurate statement. This is not what an insurance company wants to see for your therapeutic interventions, right? So here we're constantly balancing these two things, and this is why I call documentation an art. This is constantly the art that we're doing is balancing both insurance type statements, progress, what insurance wants to see, and what actually happened. Now I think that we can also identify other interventions that Carl Rogers presented that are more insurance appropriate. Here I'll give you a little sidebar tip. So how do you know if your interventions are appropriate for insurance or not?
Speaker 3:I like to use what I call the grandma rule. So if you, assuming you have a good relationship with a you know a nice grandmother, with your nice grandmother, how would you expect her to listen to you, or how do you expect interactions with her to go? Are you expecting her to actively listen? Probably. Are you expecting her to be empathic? Probably. You can also extrapolate this to your best friend. How would you talk to your best friend about something? Are they validating?
Speaker 3:Yes, you don't need a graduate degree to do any of those things, right? Do we hone those skills in graduate school? Absolutely. Are those necessary for effective therapy? Absolutely, but those are baseline things that you don't need a graduate degree to do. So for insurance. That's why I call it the grandma rule.
Speaker 3:What is something that you had to go to graduate school to learn to do? Those are the types of interventions that you want to focus on having in your progress notes. So here, mentalic kind of over-pathologized the client and then kind of underrepresented what the therapist did from an intervention response. But I will say, with a lot of these things you can teach these platforms what you want it to say. So there is one Clinical Notes, ai, where you can give it a lot more direction and you can tell it, for example, choose five of these interventions to put in my progress note and you could give it a list of 50 interventions and that way you know that at least it's from kind of an approved list that you've curated. All right, let me stop sharing and just check in here and see, see how everybody's doing and what you guys think.
Speaker 2:Well, one of the questions I saw. But so in, I think this is. But so and I think this is dovetailing on what you're saying it's not really able. Like with ChatGPT, we could put in something we had written and ChatGPT will start giving us responses that sound like us. So this isn't like that. We're not able to train it that well yet.
Speaker 3:It depends on the platform. So this is why I need to re-review. So, for example, clinical Notes AI. I think you can do that a little bit more. Session Aid is another one, but the way you're going to do that really well is by using a platform where you can give it those really specific directives from the beginning and then maybe adjusting your template based on how it's writing.
Speaker 3:I do think Orchid is one that's an EHR and an AI platform and that one does learn how you work over time because it has a lot more information from you, because it's literally integrated within the EHR, which is likely the future of how this will work, and so I do think that is what this will look like in two to five years. But right now it's a lot more effort and just like if you found with ChatGPT, you still have to do a lot of work to oh, I forgot to tell it this, oh, it gave me this and I realized I actually want something different, and then you have to rework it. So you're kind of doing that with your template and with the directives you're giving the AI.
Speaker 2:Okay, One question was we hear a lot of scary information about AI taking the place of clinicians in the long term.
Speaker 3:What are your thoughts on that? All you have to do is read these notes to know that's not happening anytime soon. It's not. I mean, I train people on how to write progress notes. I'm not worried about AI taking my job, so it's definitely not taking your job. I do think, and why I'm excited for this next round of the reviews I'm doing in the next month.
Speaker 3:A lot of the companies are getting on board with kind of this integrated approach of the clinician. Can, you know, use the AI to write progress notes and send messages to the client, send homework assignments to the client, and the client can log in too and check up on things. So I know that young sidekick is one that I'm about to test that offers that already. Ooh, and I'm going to blank on the other one. So I feel bad, but they'll all get YouTube videos so you'll be able to see those. But I'm really excited about that because I think that's the reality of how we can use these and how clients will be able to use them. So think about, in one of the groups that I run, people were talking about some people were talking about the benefits of doing sessions every other week, for example, and one therapist I work with was saying they work with a lot of trauma and a lot of times, sessions are really deep and intense, and so they actually find it more beneficial to take a break and do sessions every other week. Well, if you could add on an AI component, where then the AI knows to like follow up with a client, maybe a week later, or give an assignment, and then they can log in and have some kind of an app that they can reference To me, that would be hugely beneficial to the therapeutic process and I think a lot of people would like that. So I'm excited for that. And where it's an integrated, clinician can use it for these things and client can use it for these things, and client can use it for these things. Related to that, I do want to bring up one other caveat that I think is really important and hasn't been brought up as much, which is, as I'm talking about this, think of all this data that's going back and forth in this AI platform and this is the AI platform. In this AI platform and this is the AI platform. It's not your EHR and it has maybe it has a full transcript of every session. It has maybe client reports that they're submitting to you. It has now also progress notes, maybe three versions of the same progress note that you revised or that you had it produced for you in different templates that you revised or that you had it produced for you in different templates, and so now you essentially have client PHI in two systems and you're maintaining it in two systems and they could be two HIPAA compliant systems. That's great.
Speaker 3:What happens when that client submits a records request and they say I'd like a copy of my records and you give them a copy of the records and they say well, what about the transcripts? Isn't it giving you a transcript? Isn't it producing a transcript of the whole session? I worry that that is going to happen one day to an unsuspecting therapist who will then realize oh like, releasing a whole transcript to someone is a little different than releasing a progress note and it's their record. And in the US and in Canada as well, it's really difficult to tell someone you can't access your own record. So think about if you went to a physician and there was a transcript of that session and you knew there was a transcript and you said I'd like a copy of that and the physician said no.
Speaker 3:That now becomes a client rights issue, right? I think that the law in most cases and in most states would side with. People get access to their medical records and personally I think that's probably the right call. Right, people need access, should have access, to their medical records. So what does that mean? For us, that means, if you want to use one of these platforms, that that is a question to ask them.
Speaker 3:When you sign up, do you automatically delete these things? So some of the platforms will let you create that as a setting. So at once a week it's deleting all the notes or it's deleting all the records. Some of them will let you override that. Some of them automatically delete that. So session aid, I think, is one that is very transparent about. We do not plan to be an EHR. We do not plan to maintain this information long term. It's going to be regularly deleted. That could be really beneficial for managing this issue. It could also be a real struggle if you're using it because you tend to get behind in your progress notes and you want to have access to those progress notes two weeks later, right? So that's why I'm bringing it up, as it's not necessarily a good or bad thing, but you do need to consider that ahead of time and what you're going to do with it and what the platform offers you in the way of options for deleting or saving the information options for deleting or saving the information.
Speaker 2:So one of the questions here would love to just know how we can best utilize AI in an ethical way, then mostly to save time with treatment plans, you know. Is there like a hybrid way to use it, Like if we're not just recording everything, then how would you use it? Or how would you, how do you recommend that we use it?
Speaker 3:Yeah, I think this is where I don't think it's always the solution and it really depends on what your particular problem with progress notes is. If it's just time, it's rarely just time, I will say. Usually the time issue is actually it takes me 20 minutes to write a progress note because I sit there and question everything I'm writing and rewrite it. So that's time is not your issue. It's feeling confident in what you're writing. That's actually the problem to sort out there, right, and I would say that's the most common scenario I see. And if time is your issue, is it that you're ending? Are you ending sessions on time? That's not going to change with AI, right? Are you giving yourself enough time to write progress notes? Do you have time in your schedule for progress notes? You're still going to need that with the AI platform because you'll have to review that, review them and then copy paste it into your EHR, right? So, really, you know, I do think it's the first thing I always recommend for everyone is look at what is the real reason that I'm struggling with progress notes and try to address that first. If it is genuinely time, which I do understand, that is a big part of it for many people. That is where this hybrid method can be really helpful. That is a big part of it for many people. That is where this hybrid method can be really helpful. But for me, the hybrid method, I think, is more effective if you are literally thinking of it like collaborative documentation.
Speaker 3:So for treatment planning, for example, I always recommend you never need to do a treatment plan outside of a session. The treatment plan is literally what you and the client are agreeing to do in therapy. There is nothing more valuable that you could talk about with them, right, you want to? Literally. It's an opportunity to literally be on the same page about what you can accomplish together, what they can expect from you, what you can expect from them, where you want to be, where you want to work and focus on. I don't think that you need to sit there and you know, like some of us have done in agency days, and spend half an hour filling out a really long form with them, but absolutely talking to them about the goals that you want to work on and identify like why are you here? What is it that you would like to work on? There is no question, based on research, that that is a valuable clinical discussion to have, and then having that clinical discussion will have a positive impact on the therapy you do with clients and it's empowering for people. So to me, that is something you don't really need AI to help you with.
Speaker 3:Now, where that might come up is you say, okay, but how am I supposed to sit here and write this with a client when I'm thinking of what to write and I'm trying to produce this content and, yes, you're saying, make it understandable, but I still got to write an intervention, right, and it takes me some time to think of that. And so that's where I think that having cheat sheets and templates and I think that was one of the questions that came in ahead of time too, that you had sent me that having like pre-created statements is the most valuable thing. And that way you're just either filling in the blank or you're circling things or you're checking off boxes, but they're detailed, they're not. When I say checking off boxes, I don't mean, like what your EHR gives you as the standard checkbox interventions list. That says cognitive behavioral therapy that's a thousand interventions, right. We're not checking that off as an intervention.
Speaker 3:Cognitive restructuring that's a more specific intervention.
Speaker 3:Creating a pros and cons list intervention, creating a pros and cons list.
Speaker 3:That's a more specific intervention.
Speaker 3:You know, reframing, grounding work, deep breathing exercises, exploring patterns in family behaviors, exploring patterns in the family. I would say Carl Rogers did that in that session with Gloria, but that's not one of the interventions that any of these AIs are picking up from that session. But he absolutely did that and talked about how her relationship with her father is having an impact on this situation she's having with her daughter, and so it was a very active reflection. So, to me, curating a list of statements that you use and of phrases that you use that apply to the way you work and the clients you work with is the most useful thing. And if you can use that to then give one of these AI platforms a template and a cheat sheet, then it's already going to sound like you and that's kind of bypassing what you're talking about with, like using chat, gpt and having it teach you how to write. So using one of the platforms where you can give it a lot of direction and you can really curate the template to your own, I think is the best bet.
Speaker 2:Well, and I think that helps with the next question as well, because when you talked earlier about the quality of the note and it, you know you talked about, you know making up things. Well, if we're trying to also create a note that protects our client, right, because of the things like we're in Texas and there are things that our clients are going to discuss and we don't want to put that in the note, and so I'm hearing you say that a template with these sort of responses that you usually use could really be helpful.
Speaker 3:Yeah, and I always recommend that too, when I've done a couple of YouTube lives as well on this particular topic, like, how do you document sensitive topics and this has become much more of an issue over the last few years right, and so having I think, whether or not you use AI having some of these statements ready to go so that you don't have to think about them in the moment when it's stressful, is really helpful.
Speaker 3:So I'll give you some really specific examples.
Speaker 3:So, let's say, your client is talking to you about their feelings around having an abortion and, regardless of the state you live in, that could be a really heavy and important topic to your client and is a really emotional experience, regardless, right or could be, and so that's pregnancy loss, and pregnancy loss allows you to capture the emotion around the event without actually talking about the event itself and how it happened, actually talking about the event itself and how it happened.
Speaker 3:But having some kind of like pre-created statements like that for these highly sensitive topics will help, and I encourage people you know you can watch one of my YouTube lives to get information on that to get ideas for what to write. Talk with your colleagues about what they write, but the fact is, if you have a client who's really stressed about that experience, it might be something they're talking about for months, right? So it's not a matter of like. Let me be as vague as possible and never document this. That might be an extremely that is an extremely relevant thing to document for many clients, and so having an idea of how to phrase it is really, really important.
Speaker 1:Excellent.
Speaker 2:So, if it's okay with you folks, if you have the hand, raise emoji or if you want to post in the chat, I'd love to open it up to your questions If you'd like more detail about things that Dr McCaffrey's talked about or just more information. So Alyssa says how to phrase it verbally as it is recording or in the edits. Now, alyssa, if you unmute, you're going to be on the recording.
Speaker 1:So I totally get it if you don't want to do that, but I'm fine with that. Okay, I don't care. My concern is so. I'm just like I hear all the HIPAA and I hear the business associates, agreements and all these kinds of things, but in the end of the day, someone is listening into my session, whether it's AI or not, and then that's being transcribed. So when you said phrasing, are you referring to as we're talking to them to change our dialogue? Are you referring to when we get the note that we have to edit and everything that we're having go-to statements for that? I was just unsure about that part.
Speaker 3:Yeah, really good question. So that might be a consideration for whether or not you use recording, Because to follow up with that, you know very real example of a client discussing concerns around an abortion, right? Maybe they're deciding what to do. Whatever that might be, Once that word pops in, it becomes a very charged issue. So is your AI platform going to pick up that word in a transcript? Probably and that may or may not be something you can that's likely not something you can control, so that's something something to think about.
Speaker 3:Now, that's absolutely. You can delete the transcript immediately or make sure that you're using a platform where you can, right, Because maybe your practice is just you delete the transcript immediately for all sessions, not a big deal. But the AI needs some data to give you a progress note, right, and the more data it has, the better note it will give you. Just like with anything, I could give you a better progress note if I have more data about the session too, right? So anything that's, it's always going to work that way.
Speaker 3:So if you, you could either not do the recording and you could curate the information you give it, and that way you can just straight up use the word pregnancy loss from the beginning. It never hears anything else, and that's what the AI will use. Or you can wait for it to give you the information and then you edit it in the note, but then you would want to make sure that you delete any transcript that there is. And I will say you know, and having a transcript isn't always all bad. If you do supervision, that could be awesome, because you get way better information about what's happening in sessions than you will secondhand from talking to trainees, right? So you know, it's not that it's right or wrong, but it's important to think through all the potential ramifications Awesome, Thank you.
Speaker 2:Yeah, Keisha wants to know is there one platform that you found to be the most accurate in capturing the session without making things up? And you said I know, you said you're re-reviewing these things, but what have you found?
Speaker 3:Yeah, no, I haven't really. They all like they all made some kind of mistake at some point. I forget which one. Like one of them, even this is a good example of how AI is not going to take your job. Okay, so one of them literally phrased something how Carl Rogers did.
Speaker 3:But guess what Carl Rogers did? He reflected back to Gloria what she had said and she had said I forget exactly the phrase it was, but I would find it if I could remember which platform it was but she specifically said something like you know, my daughter's going to hate me if I do this. And he said you're afraid your daughter's going to hate you if you do this. Right, he just reflected it back to her, which is what a lot of us would do. And so then the the, the note it generated was like you know, therapist told client that her daughter would hate her if she did this. So it took it out of context, right, so in context, like I never would have even thought to phrase it that way. But then the AI, it's just an AI, it doesn't know. So things like that are an example of how it didn't get it wrong. It wasn't necessarily wrong, but it was out of context, and so those are the things that you have to look out for.
Speaker 2:There was a question earlier about shredding a note once you put it into AI, and I know we've talked about deleting notes and things like that. I want to be really clear. There is nothing in the LPC, lmft, bhec, social work. Well, actually I take that back. Lmft speaks to how we get rid of our notes, or at least it did. I don't know if they do anymore. So this is all best practices at this point, right? Until we have more precedent, until we have things written into the rules. So this is the best we've got right now, right, right, melissa? I mean.
Speaker 3:Yeah, and I would also say I think it can be helpful because a lot of this stuff is so vague and this is literally why I have a job, because documentation requirements are vague so it can be really helpful to make it less vague by like what is your progress note? And really define that. What is your progress note? If you use an EHR, it's typically whatever note is submitted to that EHR. So if that's my progress note, any other notes I have floating around need to be gone. So if that's a transcript somewhere, if that's the progress note, that's in the AI platform.
Speaker 3:That is unedited, because then I put it over here and edited it and maybe I edited it a little bit over there, but then when I copy pasted it, oh, I didn't realize that and so I made a change over here. So now I have two different versions of the same note. Right, I mean, that would absolutely happen. It could get very confusing. The easiest way is just once I have that progress note in that system, I get rid of all my other notes, and so you could also shred. Yeah, if you took notes, if you take tons of people take notes by hand, totally fine, you can absolutely do that. Take your notes by hand and then, as soon as it's in an EHR, shred that. Or in your computer somewhere else, shred it. So kind of make a rule for yourself about where you're going to have your notes. What is the note, and just keep that one, okay.
Speaker 2:We're getting requests here if you have sample informed consent. So this is a good time, I think, for you to drop some links into the chat and everybody. You know the drill when you see a link, click it, Because once the meeting ends, the links go away and then you'll have that tab open amongst all the hundreds of other tabs I'm sure you have open. What's the best way to contact you?
Speaker 3:Yeah, so the best way, I will put in the link for my website and then I will will put in the link for my website, um, and then I will also put in, um, the direct link to the book as well. So, um, my business called QA prep. Here's the website, qaprepcom for those listening later, so just qaprepcom. Uh, takes you there. The book is called Stress-Free Documentation for Mental Health Therapists. There is a paperback version and a Kindle version and Amazon. It's available on Amazon. Amazon randomly puts things on sale and it is on sale right now and I still get the same amount of money. So go buy it on sale. And it is on sale right now and I still get the same amount of money. So go buy it on sale. Um, yeah, um, and that book has. I'm going to put the name of the book in the chat stress-free documentation for mental health therapists um you've got a follow-up.
Speaker 2:Has been following your your youtube chin page oh exciting.
Speaker 3:Thank you, keisha. Yeah, and in in the book it has all of my templates, it has my full paperwork packet, and so there's also links in the book so that you can log in and get them electronically. So you don't have to sit there and photocopy or copy copy into your own. You can just download the forms and and use them directly. So that'd be the book I would say is the easiest way to get a copy of of my all my consent forms.
Speaker 2:Excellent. I love that, thank you, thank you. Thank you so much, and everybody. This has been wonderful. I'm so glad you're here. Step it uppers. If you are in the membership, you will get this as an asynchronous CE. Once we process it, y'all know what to do. Go visit Dr McCaffrey, get your notes in shape, get rid of the get rid of the shame of getting behind that I know nothing about. And, yeah, enjoy your Monday evening. I think you made us all feel better. Dr McCaffrey, thank you so much.
Speaker 3:Good, good, I'm glad. Thank you all for your questions. That helps so, so much and I really I value your trust and vulnerability there. So thank you all.
Speaker 2:All right, we'll see you later. Guys, have a wonderful evening. Bye.