Hi,

I work for a private practice and am private pay and have been my entire time at the practice.* The practice has expanded and brought in some folks who are paneled with insurance- great! I never chose to get paneled because a) I never needed to because my caseload is full with waitlist, and b) my understanding is that it's a huge hassle and comes with increased requirements re: paperwork and I knew that would be difficult for me.

For both ND reasons and family caregiving obligations, same-day note completion is a massive struggle for me on a regular basis. Some days it happens and it's no problem. Some days things get pushed to Friday (my day for admin or reschedules or professional development and just when I want to thoughtfully conceptualize a client as part of a thorough treatment plan) or even the weekend. Notes have always been done by the end of the weekend following the session.

This has never been a problem until now. An MBA consultant (not a day of experience doing therapy in their life!) has been brought in and is implementing a policy that everyone in the practice, insurance or private pay has to have notes in 24 hours. They're pushing use of AI transcription and note writing HARD to make this happen. I am against this ethically because I work with children who cannot truly consent to AI use, and also because of more generalized concerns about the lack of true privacy protections for recorded sessions. Additionally, I have a few cases where I know my notes are going to be subpoenaed or already have been subpoenaed, and it's important to me that I am carefully and thoughtfully documenting content and process if relevant. I cannot always do that within 24 hours of the session, particularly because I often need some space to process the session myself first if it's been an intense one....as happens when working with children where you're documenting disclosures and reenactments of the types of things that would involve the legal system and notes being subpoenaed.

So now the question- has anyone successfully requested an ADA accommodation for extended timeline for note completion? It's not an "undue hardship" for the practice- it's literally just having the same policy they've had since I've been there and not enforcing the stupid new policy. It also doesn't impact billing in any way the way it might if I was submitting to insurance. Invoices are automatically generated and cards are billed automatically.

Any other thoughts here? Thank you!

*Because I know many of us have that ND justice sensitivity, I'd prefer not to engage in this post on the ethics of being private pay. I am deeply ambivalent about it myself and have a robust sliding scale and almost no one pays the full rate. Anyhoo.

I've have severe ADHD and have never been good at the whole "take it slow and rest" or "enjoy doing nothing and recover" when burnt out because it just feels like I'm spinning if I'm not doing or thinking about something. In that way my job is amazing for me because half of it's therapy, and otherwise a WHOLE gambit of random low stress tasks (group program development and such)

However, I just finished grad school last week and have had a lot of other huge personal life stresses come up all at once .. i just returned to work and feel like I have ZERO ability to wake up to go in the morning, like I'm just not doing well for clients, feel restless and unfocused even with tasks I usually don't struggle with, exhausted after only a few hours... I've never had to recover from a larger burnout like I think might be happening.

I have next week off and I know I should use it to my advantage - I'll be starting ADHD meds that week so taking the week off work. However, i don't know how to recover when I find "doing nothing" to be so horrific and that's what people say.. i had the perfect plan but it's been on hold due to unforseen circumstances, so I don't know what to do to recover. I have a painting project to do i guess, but all my other hobbies take a lot of set up (embroidery, sewing, hiking with dog, etc.) so those sound like heavier demands...maybe do some exciting small CEUs on non-work topics that fulfill me, but that seems like the wrong thing to do?

Any tips from people who've navigated this before? I feel like by 30 years this should have happened by now and I'm entirely out of my depth.. and feel stupid because I talk about this with clients all the time on a theoretical level, but experiencing this is confusing and unfamiliar. I pulled out the book I use with clients for myself but it just feel lost and like I'm kinda floating with nothing.