What is psychotherapy?

One dictionary describes it like this: "The treatment of mental and emotional disorders through the use of psychological techniques designed to encourage communication of conflicts and insight into problems, with the goal being relief of symptoms, changes in behavior leading to improved social and vocational functioning, and personality growth."

The truth is that psychotherapy is not easily described in general statements such as that one (nor is it as boring as it sounds!). It varies depending on the personalities of the psychologist and client, the particular problems that client wants to work on, and the therapist's skills. Therefore, there really is a unique treatment for each client. Psychotherapy is not like most medical doctor visits where you complain about something and get a prescription and hope you don't have to go back with the same complaint. There are many different methods I may use to address the problems that you bring to our therapeutic relationship. As such, it involves a very active relationship between the two of us. In order for the therapy to be most successful, you will have to work on things we talk about both during our sessions and at home.

If you have never been in therapy before, you need to know that therapy is a collaborative effort between the psychologist and client, and as such results cannot be guaranteed. Progress in therapy depends on many factors including the client's motivation, effort, and other life circumstances as well as the "therapeutic connection" and the interaction between a therapist's skill set and the client's presenting problem.

Are there risks to psychotherapy?

Yes, psychotherapy can have risks. Because therapy often involves sharing unpleasant and painful aspects of your life, you may experience uncomfortable feelings like grief, sadness, fear, guilt, anger, frustration, and loneliness. Because of the changes you might make as a result of our work together, your relationships might also change and the people in them might not be happy about that. On the other hand, psychotherapy has been proven to have benefits for people who go through it. Although there are no guarantees of what you will experience, therapy often leads to feelings of well-being, better relationships, feelings of empowerment and efficacy, solutions to specific problems, and reductions in feelings of distress.

What is the difference between a psychologist and a psychiatrist?

The work of psychologists and psychiatrists often overlaps, but there are some important differences -- the biggest of which is that psychologists go to graduate school for training and receive a doctorate (Ph.D. or Psy.D.) while psychiatrists go to medical school and receive an M.D. Psychiatrists are medical doctors who can prescribe medications for psychological distress, whereas most psychologists do not have prescription privileges. Because there is strong research that supports a combination of medication and psychotherapy as working best to help some people resolving certain problems, I sometimes recommend that a client of mine see a psychiatrist to be evaluated for medication. In these situations, the psychiatrist, client, and I all work collaboratively to relieve symptoms and stabilize moods so that psychotherapy can be more effective. (To see my training and credentials, click on the "Resume" tab at the top of this page.)

What happens in the beginning of therapy?

Our first few sessions will involve a clinical assessment of whether my skill set matches your needs (i.e., whether I can be of service to you) and whether we feel we can work together as a team. By the end of that time, I might (a) recommend that you consult with someone else who might better help you (e.g., someone with an area of specialization I do not possess), (b) suggest that you consult with another professional (such as a medical doctor so we can rule out possible underlying medical causes for your concerns; or a psychiatrist for a medication consultation) as part of our work together, and/or (c) offer you some preliminary impressions of diagnoses and what our work together will include (often referred to as a "treatment plan"). You should take this information, along with your "gut instinct" of whether you feel comfortable working with me, to make a decision about whether to continue therapy with me. Therapy involves a real commitment of time, money, and energy, so you should feel good about the therapist you select. If you have questions about my clinical assessment, my treatment plan, or anything else that might concern you, I welcome you to discuss them with me. I know that I can't be the best fit for everyone, so if we decide I am not the right therapist for you, I will be happy to refer you to another mental health professional who might work better for you.

I have insurance, can we use that?

Well, we can certainly try. If you have a health insurance policy, it will often (but not in all cases) provide some coverage for mental health treatment. I am considered an "out-of-network provider" for most health insurance plans. This means that if you want to see me, you will have to pay for my services up front and I will give you receipts and provide you with whatever help you need so you can receive the reimbursement you might be entitled to receive. Alternatively, I employ a billing company who can file the claim for you. 

Some benefit plans only permit a small number of sessions (or dollar amount) per year or per life-time, or they might not reimburse for different types of treatment (e.g., couples therapy) or certain diagnoses (see below). It is therefore very important that you find out exactly what mental health services your insurance policy covers. Carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, discuss them with your plan administrator or your human resources officer.

You should be aware that insurance companies require you to authorize me to provide them with a clinical diagnosis. This diagnosis will become part of a permanent record that may have implications for whether you can be insured for both health insurance and life insurance in the future and the kind of coverage (e.g., "exclusions" or "riders") you can get. Sometimes insurance companies may ask me to provide additional clinical information such as treatment plans or summaries while they determine whether to allow us to continue using your insurance in our work together. This information will become part of the insurance company files and will probably be stored in a computer or in the "cloud." Though all insurance companies claim to keep such information confidential, once it is in their hands I have no control over what they do with the information or the computers or servers on which they store this information. In some cases, they may share your personal information with a national medical information databank.

Do remember that you always have the right not to seek reimbursement for the services I offer to avoid the problems described above (and below).

What is a "clinical diagnosis?"

Good question. As interpreted by many people and organizations (including insurance companies), a "clinical diagnosis" is the naming of a specific disorder (e.g., Generalized Anxiety Disorder). Psychologists and other mental health professionals use the ICD 10 or DSM V a reference for making a clinical diagnosis. These references describe the symptoms for many mental disorders, as well as the criteria that must be met to receive a diagnosis of each disorder. Unfortunately, not all disorders in these references are treated equally in the eyes of insurance companies and some diagnoses are not eligible for reimbursement by insurance companies. It is important that we discuss your diagnosis to see if you can use your health insurance to help you pay for therapy.

In my practice, however, a clinical diagnosis is more than a label. It is a question, or a series of them: "Why does this person (or couple or family) have this problem?"" "How did it come about?" "Why does it persist?" "What can we do about it?" The answers to these questions are often theoretically and research driven and more important to the process of therapy than a diagnostic label itself.

The things I want to talk about in therapy are very personal. Will you keep my therapy private?

The privacy and confidentiality of our sessions are extremely important to me. In all aspects of my practice, communication between my clients and me (or between me and those who my clients have authorized me to contact) are protected by confidentiality regulations as stipulated by federal and state laws, and by professional standards and ethics. To the degree allowed by law, information about your therapy will not be disclosed to any person or organization unless you give me a specific, and when possible written, release to do so. While you are free to discuss anything that occurs in our sessions with anyone, I may not discuss you or our communications without your authorization. However, you must know that there are some situations written into law that deny me complete control over confidentiality. Because this topic is so important, I have created some documents that explain this more fully and I will provide them to you prior to our first session.

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