What should I expect at my first visit?
Prior to your first visit, you’ll be required to fill out encrypted paperwork that gives me appropriate information about you and how you want your private information to be handled, as well as basic information that would be necessary in order to allow me legally to have a first session with you. You will be given information about privacy, the limits of confidentiality, and office policies in that initial paperwork. During your first visit, you’ll have a chance to discuss all of these issues with me to clarify any concerns you have. Then we will discuss what matters most to you--why you have come to see me, what concerns you, what you think contributes to the issues you face, and what you hope to accomplish. For more detail, see the section entitled, "Your First Visit," on this website.
How many sessions are required to complete therapy?
The number of sessions required to complete therapy is highly variable. While the average client will have anywhere from twelve to twenty sessions, there are people who see me for much briefer treatment (sometimes as brief as two sessions--this is not the norm but it does occur) and those who see me for much longer: there are in fact people who stay in therapy for years for completely legitimate reasons. The course of therapy is determined by multiple factors, including the complexity of the current problem, complexity of the history contributing to the problem, personality factors of the client, level of effort applied by the client in treatment, specific goals of the client and desired level of depth, and unscripted life events that happen to the client during treatment. Ultimately, the "right" length of treatment is what is right for you. Because people are so unique in what they desire and need, it is important to remember that every client has the right to a second opinion, to engage in therapy or discontinue it according to their own wishes.
How long is a therapy "hour"?
A therapy hour is typically forty-five to fifty minutes long.
How frequently would I be expected to attend sessions?
Initially, more frequently is better, as this facilitates information gathering and treatment planning. For most people, it really is best to come in once a week and to maintain this schedule for maximum speed and progress. However, frequency of visits is always informed by the individual client needs and complexity of his or her issues. Once treatment is well underway, some clients move to biweekly visits, feel satisfied with their progress, and feel less stressed by the pressure of their own demanding schedules. While some clients would like to visit on a monthly basis, this is usually not very helpful, as so much happens between visits it is not possible to deal productively with the events that have transpired and planning needs too. Monthly visits are ideal, however, for those who are at the end of their therapy and are "tapering off"--monitoring to "fine tune" their adjustment to their changes while preparing to terminate therapy.
What will be expected of me between visits?
Once a treatment plan has been formulated, you will often be given "homework" to apply to your life outside of therapy appointments. This is to help you make real change happen in the real world. Homework often involves new challenges and skill-building efforts. At times, this can be a little intimidating. Courage is necessary to make positive change occur, but know that your needs, sensitivity – and common sense! – will always be respected. Striking a balance between making changes and not becoming overwhelmed is important.
What if I have to cancel my appointment?
An appointment time is like a hotel reservation--if it's being held in your name, nobody else can have it. But sometimes schedules need to be changed! Please be courteous and call as soon as you know you need to cancel or reschedule. This is for both your benefit and mine. If a cancellation is received less than twenty-four hours before appointment time (or after Friday for a Monday appointment), or if the client fails to show for an appointment, he or she is charged for the length of time that was reserved for him/her. Insurance does not touch this charge; it is a full fee charge that comes directly out of the client’s pocket.
Why should I have to pay a fee for a late cancellation or no-show, when I didn’t get the session?
Sometimes, people express the belief that being charged for a late cancellation (or no-show) is a form of punishment. It is also often viewed as an act of greed, whether viewed positively (as a “smart business practice”) or negatively (“getting something for doing nothing”). Furthermore, because a therapeutic relationship really is different from other professional relationships, clients will sometimes indicate at the beginning of therapy, when the idea of a no-show or late cancellation is more hypothetical, that they understand and respect the policy, only to express anger and a sense of betrayal later if it is applied to them personally when they really do late cancel or no-show. The implication is often that the therapist is failing to have sufficient empathy for the client’s particular circumstances and is being unfeeling, uncaring, or exploitative. Clients will sometimes have greater expectations that the therapist should be much more understanding of their feelings, conflicts, and circumstances than others would be, because it’s therapy – it’s not a dentist visit, a hotel stay, or a hairdresser’s appointment. The belief is often that the therapist is supposed to have strong caring about the frustration the policy creates for the client, and about the stress of the client's personal finances: therapist adherence to their business policy is believed to be inconsistent with caring about the client. This leads to the conclusion that a caring therapist would and should waive the fee. These are understandable but very unfortunate beliefs which are hurtful to the client and reflect an inaccurate understanding of this common policy. While it is true that a timely notice for cancellation makes schedule openings available to others who might need them, it is actually the rare case that a late cancellation or even a timely cancellation can ever be filled in a therapy practice. More often than not, a lost appointment is just a lost appointment. And clients without question have every right to cancel appointments should they wish to do so. Therapists usually work to prevent the need for emergency care as much as possible, and even people who would like to utilize an unexpectedly open therapy slot generally find that a late cancellation doesn't give them enough notice to obtain permission to carve out time from work, get a babysitter, make sure they have privacy for their telehealth visit in their home, etc. So the cancelled hour is one in which no therapy can happen. However, a timely cancellation does help prevent additional wasted preparation time caused by a late cancellation, and prevents needless waste of the therapist's time on the day of the appointment as the therapist waits for someone who doesn't show.
The above description makes it sound like “it’s all about the therapist.” However, the most significant reason for the policy is the one that is almost never discussed or rightly understood. It addresses a primary aspect of scheduling and cancelling of appointments unique to the psychotherapist's office. Because of the nature of our work, our scheduling differs radically from that of a physician's practice. Psychotherapists must spend much greater periods of time with each client and typically see each client repeatedly, usually on a weekly basis, until therapy is concluded. Prudent therapists are very careful about maintaining a cap on the number of people they see. If a new client is added every time an existing client cancels or no-shows to make up for a missed hour, that is one more hour a week that must now be available not just for one week but for every week until therapy for that added person ends. Repeat this cycle with multiple cancellations across multiple weeks, and in no time at all a situation has developed in which existing clients suddenly can't be seen because there aren't enough openings for everyone, the therapist is overextended, and the quality of therapy suffers notably, while client frustration rises considerably. Needless to say, a client who is being ignored or unable to book an appointment due to therapist exhaustion and overload is not fooled into believing that he or she is receiving quality care. This is no way to conduct therapy. On the other hand, the therapist who never charges for late cancels or no-shows out of guilt, fear of hurting client’s feelings/making them angry, and even just out of a personally held principle, while also not adding a new client for late cancels and no-shows, risks either being run out of business or carrying additional stress which can then fold negatively back into therapy. Like it or not, the simple truth is that that stress can include developing a resentment of clients, particularly those who cancel or no-show frequently – which again will have a strong chance of negatively impacting the quality of therapy. Being responsible for maintaining a regular schedule, and for missed appointments when they occur, protects the quality of your therapy and the availability of appointments for the duration of your therapy.
What are your clients usually like?
My clients are adults, ages 21 and up, who are being seen individually. Most of the people who come to see me are goal-oriented folks who are motivated to be successful in their personal and work lives, in whatever way success is defined by them; they are willing to commit the time and effort to expand their horizons and grow emotionally, vocationally, and personally.
Are there any clients you don't see or services you don’t offer?
Yes. While some of my clients continue to be in ongoing recovery from substance abuse, those individuals have typically been "sober" or "dry" for at least two years before seeing me. Additionally, some clients have active secondary substance problems that hinge on their emotional stress but are not life-threatening or primary. I do not treat people whose primary problem is an active and overwhelming struggle with the excessive use of illicit substances, prescription drugs, or alcohol, and will refer those in need of substance abuse rehabilitation to appropriate professionals. If they have just come out of rehab and their primary need or objective is to stay sober, again, they are better suited to working with a therapist whose work is centered around primary substance abuse issues. Though I have significant experience with very young children and will do some consultation with clients regarding their youngsters and parenting concerns, I do not work with children, nor do I provide couple or family counseling for multiple adult family members. And while I do a great deal of work with individuals with trauma history and significant dissociative symptoms, I do not provide services for Dissociative Identity Disorder. People who have concerns about their safety due to the fear of their phone or devices being tapped are encouraged to seek services with an in-person therapist simply because of the level of emotional distress and conflict it would put such clients in to have a session online. Finally, I do not offer forensic (legal) services, and I do not currently offer full battery testing for complex clinical issues, disability issues, school or job applications. While I have done a tremendous amount of psychological testing in my career, I frankly stopped offering this as a service once insurance companies started making it very difficult to offer it in an easily manageable way. I support the value of full-battery testing and will be happy to make referrals for this service when it is desired or needed.
What is your therapeutic orientation?
While I use a variety of tools from different therapeutic approaches depending on client needs, the very core of my therapeutic perspective is humanistic. The tools that inform and shape my therapeutic approach include cognitive behavioral tools, radical acceptance and mindfulness, as well as some dialectical behavioral concepts. Very specific skills and interventions I also use include EMDR, Somatic Experiencing, and Hypnotherapy, where appropriate and for those who have interest.
When will therapy be over?
Most often, therapy ends when the client is no longer struggling with the issues for which therapy was started. The client comes in and reports repeated successful management of the problem situation on an ongoing basis, and there are fewer "glitches" in problem management. By the end of therapy, the client has expanded his or her skills sufficiently to manage these "glitches" effectively and with confidence in his or her own skills and choices. Typically, this becomes evident to therapist and client at the same time. Usually there is a tapering-off period with the end of therapy, but again this depends upon the client's needs.
Once therapy is completed, does that mean I should never need therapy again?
Not necessarily. If you successfully addressed a medical problem with the aid of your physician, but later developed a new medical problem, it would be advisable to go back to your physician to address the new problem. Life is unpredictable, with new troubles being thrown at us when we sometimes least expect them. Tending to your own emotional health, like tending to your physical health, is an ongoing process, and it is quite legitimate to seek additional counsel and support when circumstances become challenging.