From Dread to Done: How Clinicians Can Rethink Note-Writing Through an Executive Functioning Lens

By Flourish Consulting and Supervision

Ugh… we all hate notes. Unless, of course, you’re part of that tiny percentage of clinicians who feel grounded by documentation at the end of a session, where writing it out actually strengthens your connection to your work. For the rest of us, notes can feel like a tedious obligation—but they are essential, ethical, and incredibly valuable to the treatment process.

If you find yourself sighing, procrastinating, or staring at your EHR long after your last client, you’re not alone. Note-writing is one of the most universally dreaded parts of our work. At Flourish, we acknowledge it openly because struggling with documentation often carries unnecessary shame. The reality? Writing notes demands cognitive skills that are often depleted by the time you finish sessions.

Why Notes Feel So Hard

• Note-writing requires sustained attention, sequencing, working memory, and task initiation. After a day of emotional labor and decision-making, these systems are often depleted.

• Even when executive functioning is strong, fatigue, context-switching, and emotional labor can make notes feel overwhelming.

• For those with EF challenges, starting, sustaining, or sequencing notes may feel especially difficult. Understanding this can help normalize the struggle and guide strategies that support focus and completion.

What the Research Tells Us

Russell Barkley (2020) describes executive functioning as the brain’s “self-management system”—the set of processes that allow us to plan, organize, and complete complex tasks. When this system is taxed or under-stimulated, our brains default to what feels easier or more rewarding.

Thomas E. Brown’s research on ADHD adds that motivation isn’t just about willpower; it’s about how our brains regulate attention and effort in response to reward. When the reward is delayed or low-stimulation—like finishing a note—our system struggles to engage.

This means traditional “just power through” approaches are often ineffective. Instead, strategies that align with how our brains function yield better results.

Strategies That Work (and Why)

1. Micro-task your notes

Break each note into smaller steps: write the intervention, jot down the client’s response, then add the assessment. Each micro-completion provides a small dopamine boost and reduces overwhelm.

2. Pair writing with accountability

“Body doubling”—working alongside another person, even virtually—helps your brain stay engaged. Consider coworking with a colleague or joining a documentation session at your practice.

3. Create a dopamine-friendly environment

Music, lighting, or focus apps can make documentation more inviting. Small sensory cues can help bridge the gap between resistance and readiness.

4. Build structured habits, not heroic sprints

Ten minutes at the end of each session or a dedicated “note power hour” can build consistency. Over time, these habits reduce decision fatigue and create a rhythm rather than a chore.

• For those with EF challenges, pairing routines with external supports like timers, checklists, or body doubling can make these habits easier to maintain.

5. Use templates to reduce cognitive load

Keep frameworks like SOAP, DAP, or BIRP handy, and reuse phrasing when appropriate. Templates minimize mental effort and streamline your workflow.

6. Time yourself and reframe the story

Track how long a progress note versus an intake note takes at different times of day. Notice when your focus is strongest and design your workflow around natural energy peaks.

Knowing your actual timing combats the “this will take forever” dread. When you see that a note typically takes 20–25 minutes instead of an hour, you can approach it realistically, stay on task, and protect your personal time—essential for clinician self-care.

• For those with EF challenges, timing can also reveal attention windows, helping you plan note-writing sessions that match your capacity and reduce the risk of procrastination or burnout.

Reframing the Narrative

It’s easy to believe that “good therapists never get behind on notes.” Productivity is not a measure of competence. Therapists we supervise at Flourish are deeply reflective, emotionally present, and skilled—but still find note-writing challenging.

Approaching this difficulty with curiosity rather than criticism opens space for growth. Notes are part of care, capturing your clinical insights, attunement, and intervention strategies. The goal is consistency, not perfection.

Reflection Corner (For Supervision or Self-Reflection)

Consider reflecting on:

• When do you feel most resistant to writing notes?

• What thoughts, distractions, or fatigue patterns show up?

• How can you structure your environment or workflow to stay engaged and protect personal time?

• Which supports or strategies help you sustain focus and follow through on documentation?

Use these reflections in supervision to discuss self-compassion, boundaries, and sustainable workflows. Thriving as a clinician isn’t about eliminating challenges—it’s about learning to work with your brain and energy, not against it.

Resources & Further Reading

Books & Guides

• Barkley, R. A. (2020). Executive Functions: What They Are, How They Work, and Why They Evolved. Guilford Press.

• Brown, T. E. (2020). Smart but Stuck: Emotions in Teens and Adults with ADHD. John Wiley & Sons.

• Cloud, T., & Shellenbarger, T. (2018). The Organized Therapist: Tools and Tips for Managing Your Caseload and Documentation.

Articles & Research

• Brown, T. E. (2013). “Executive Functions and ADHD in Adults: Implications for Clinicians.” Journal of Attention Disorders, 17(4), 328–338.

• Barkley, R. A. (2011). “EF and Self-Regulation in Daily Life: Strategies for Professionals.” Clinical Psychology Review, 31(1), 1–12.

Practical Tools & Templates

• Free SOAP/DAP/BIRP templates: SimplePractice Resource Hub

• ADHD/EF-focused productivity tools: ADDitude Magazine Resources

• Clinician self-care and workflow support: Therapy Notes Blog

Flourish Consulting & Supervision

• For supervision, mentorship, and consultation on note-writing strategies and executive functioning support: Flourish Consulting and Supervision

At Flourish Consulting and Supervision, we believe your executive functioning style doesn’t define your competence—it shapes how you work best. By understanding your brain and creating systems that honor it, you can move from dread to done—and maybe even find a little ease along the way.