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CARL: Acrostic to use when writing client notes

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CARL is an acrostic to use with clinical notes: Context. Adequate. Relevant. Limited. Andy Williams, one of our Training Directors talks us through it.

Part of a series of materials to support you to become the best therapist that you can be.

Once of the questions that often comes up in supervision is about clincial notes and how to think about them. There aren’t rules about this but we do support our learners in thinking about this area.

C – Content. Thinking about the context in which we are working whether private practice, voluntary placements, charities etc. Some organisations have local procedures about how to approach clinical notes.

A – Adequate. The notes need to be adequate for purpose. I use them for reviewing treatment week to week and an overall view of the treatment plan. My notes need to be adequate as a reminder of where we have got to in the treatment sequence.

R – Relevant. Its very important that we don’t make conjecture or guess work and only record information that is relevant to the treatment. For example do the details given by the client in check in need to be recorded if they are not relevant to the therapy contract.

L – Limited. The final area in CARL. Think about a boundary around our work. What is in and out but also not putting in excessive details that aren’t linked to their therapy. You may also need to consider time boundaries.

It goes without saying that all clinical notes come under the GDPR regulations and data protection. Do make sure you get consent from the client about keeping clinical notes.

Want to know more?

If you are thinking of starting in private practice, our First Steps to Successful Private Practice 1 day course covers writing and keeping client notes in more detail and GDPR. Go to our Events Diary page for the next course dates.

Setting up in Private Practice.

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Here is another in my series of tips and how to’s. This time I have turned my thoughts to when I set up in private practice and all the things I know now, that I wish I had known when I first started. So, if you are beginning in private practice here are some ideas that I hope will be useful.

Geographical location. I think this is hugely important and is not necessarily as simple as practicing from where you live. The key question to answer is: does your current location offer enough opportunities for you to build a sustainable practice? It may not be as simple as “I’m in a large city or town so yes” because whilst there may potentially be a lot more people looking for counselling and therapy in a large city there will also be more therapists practicing. The opposite of course is also true, in a smaller town there may be less competition but will there be enough work to sustain you. Doing some quick research to look at how many therapists are listed in your area and the population size may help in making your decision.

Continuing on the subject of place – will you practice from home or will you rent premises? There are advantages and disadvantages to both, practical, financial and therapeutic. In your home the practical and financial advantages are that you have pretty much complete control over your environment and if you have suitable space, this can be a very cost effective and flexible option. From a personal perspective you might like to consider the impact having a steady stream of clients coming into your personal space may have. How you will manage the divide between the personal and work? You may also wish to consider some of the implications for the nature of the therapeutic relationship of having clients in your home and seeing aspects of your life they might not necessarily know about if you were renting premises.

In choosing rented accommodation versus home some of the things you might also like to take into consideration are ease of access to your planned location; for example the availability of public transport and parking, your contract with your landlord and if you situated in an area where people can afford to pay for private psychotherapy.
What areas of work will you provide? Will you specialise in a particular area or niche in your practice, some therapists focus on bereavement, or couples work. Have you a particular area of skill or interest, if you can offer something unique in your area, that may put your services in demand because of your specialist expertise.

What are you intending to charge for your services? What does the level at which you are pitching your pricing say about how you are valuing what you have to offer. It can be useful to see what other counsellors and therapists charging by including this in your research. A comparison with what others are charging can be useful and give you a sense of market value in your area. Being too expensive in comparison may deter people as well as being too cheap.
Marketing and how you will promote your business is another substantial question and one I will write more about in future articles.

Finally – insurances. You will need both public liability and professional indemnity insurance and if working from home check to see if your what house insurance policy says about working from home.