F.A.Q
Frequently Asked Questions
1. I am not sure I need psychotherapy. What should I do?
2. What is your approach to therapy? And how can I know if you are the right therapist for me?
3. How do I begin? What happens in the first sessions?
4. What happens in a psychotherapy session?
5. How long will this process last?
6. Why come to long-term therapy twice a week, or three times?
7. Most therapists bill for missed sessions—do you? Why do therapists do this?
8. Do you provide medication? Do you work with people on medication?
1. I am not sure I need psychotherapy. What should I do?
Come in for the first therapy session, which is also an assessment. Remember: at the end of the assessment, I may agree that you do not need psychotherapy. And if I do think you need psychotherapy, you will have a chance to talk about your doubts or worries and to make a choice. You can always decide against entering therapy.
In my experience, this question sometimes comes from people who are afraid of the cost or are afraid of the emotional risks. If cost is the issue, look at my statement on my Sliding Scale on the Fee, Insurance, Sliding Scale page. If the fear is about the emotional risks or pains, remember that I have 25 years of experience, enough to say with confidence that I will help you past such fears in our first meeting
2. What is your approach to therapy? And how can I know if you are the right therapist for me?
Read my essay Thoughts On Choosing a Therapist and read the page in Experience section titled My Approach. But come to a session; you can judge and experience for yourself. You will ultimately decide if you want to begin the therapy process with me. In my experience, the answer is almost always yes, but if the answer is no, I will actively work to find you a suitable therapist. There are many good therapists in Ann Arbor, where I work, and the most important outcome from the assessment process is that you begin to receive the help you need.
3. How do I begin? What happens in the first sessions?
You begin by calling for an appointment and coming to it.
Our first two to four therapy sessions are also an assessment time so I have a clear understanding of the issues and you have a chance to meet me and decide if you are comfortable working with me. The very first session is mostly about why you are seeking therapy now, though we may wander on to other topics. You will have time to ask me questions. I also need to obtain certain information at the end– address, phone number, etc.– and there are a few forms to complete, so I schedule the first session for an hour instead of the usual 45 minutes.
If I think I can be of help, I will offer to continue psychotherapy with you beyond these assessment sessions. I will share my initial thoughts about the issues you raised. I offer both long-term and short-term therapy, and I will discuss the frequency and possible duration of therapy.
In general, everyone can benefit from a safe confidential talk with a trained therapist they trust who strives to understand them. But on rare occasions, the therapy help you need is not work that I do. I would then explain what kind of therapeutic help you need and where you might get it. I would offer to assist you track down the proper treatment and offer to stay in touch by telephone or in person until you had successfully made the transition to the new treatment. Since most people who see me already know they need psychotherapy, this outcome is uncommon.
4. What happens in a psychotherapy session?
You talk about what is on your mind and I make comments. That may sound pretty bland, or even boring, but actually it should become deeply meaningful and very intense. After all, you are talking about your life.
5. How long will this process last?
I will a have better idea after the assessment sessions and I will discuss it then. Long-term intensive psychotherapy may last a year to several years. Short-term work will last at least several months.
6. Why come to long-term therapy twice a week, or three times?
Many people choose long-term psychotherapy to understand themselves in depth and to attempt more fundamental change. In addition, when problems are persistent or severe, long-term psychotherapy is essential. Once a week long-term therapy is a very intense experience but patients who can manage coming more often have a more powerful experience. Considerable energy in once a week therapy goes in to working through the events of the past week; this is important of course, as it is your life. But coming more often enables us to work on the deeper patterns.
7. Most therapists bill for missed sessions—do you? Why do therapists do this?
I do; indeed, every therapist I know does. The reason is simple: when we set up a regular appointment with you, we are giving you exclusive access to that time slot, which is not how other professionals work. Physicians usually work with a waiting room filled with people so if one person is late they just see the next person. Other professionals, such as lawyers or accountants, can fill the cancellation time with other billable work such as work on briefs or tax returns.
The only billable work most therapists do is their time seeing patients and the time we schedule with you is exclusively yours, not available for anyone else. With enough advance notice we can do something productive with the time created by a cancellation but with little or no notice we literally sit in our office waiting for you. Of course I do know that emergencies happen, so I have struggled to come up with a policy that is fair to all. I describe my policy on the page titled Information for My Current Patients and I remain open to suggestions for a fairer policy.
8. Do you provide medication? Do you work with people on medication?
I do not provide medication; a psychiatrist would do this. I am very comfortable working with patients on medication, perhaps because I was Director of a hospital-based program for many years (see My Work Experience page). I occasionally refer a patient to a psychiatrist for a medication review.
But medication does not replace psychotherapy; it should just provide enough relief that the work of psychotherapy continues. I have had many patients who either rejected my suggestion that they see a psychiatrist for a medication review or who did go and then refused medication, and in all these cases, they continued to do very successful work in psychotherapy.
9. You were Director of both an Adult and an Adolescent Partial Hospitalization program: what are these programs?
The State of Michigan licenses Partial Hospital Programs (PHP) to provide a level of care between twenty-four hour in-patient care and once a week outpatient care. Day Hospital patients live at home and attend each weekday, receiving five hours of intensive programming daily. My Adult PHP staff consisted of two PhD psychologists, two clinical social workers, a nurse, an art therapist, an activities therapist and two activity assistants; in the smaller Youth PHP program I supervised a separate staff of a teacher, a social worker, a clinical psychologist, a nurse, an occupational therapist and a treatment assistant.
In fairness to Blue Cross, I believe the contract change was aimed at other, far more costly areas of medicine than mental health and I believe the less expensive treatments they cite for reclaiming payments will only be those backed by scientific studies (double blind studies, peer-review journals, etc.). Here is the problem: while breakthroughs in medicine have vastly improved the lives of many patients with the most severe kinds of mental disorder, the kinds of disorder that may send someone to a hospital, such as schizophrenia or certain kinds of severe depression, such results are much less clear-cut for patients who seek out-patient psychotherapy. There is first a problem in all medication studies that has recently been widely reported in the press, namely that pharmaceutical companies that sponsor these medication studies often suppress unsatisfactory results, a problem that will not be solved until there is a registry, by law, of ALL on-going studies, so the scientific community and the public alike know the supportive studies are conclusive and not a non-random sub-set of studies from a much larger set of inconclusive or failed studies. More importantly for mental health treatment, the diagnosis of a pure form of a severe illness, such of schizophrenia, is much more reliable than a diagnosis given in an out-patient practice such as mine where people arrive with very complicated life situations. The mental health researchers who seek to test a medication or other treatment solely on patients with one particular diagnosis will often eliminate from their study the very people who show up at my door, people with complicated lives and complicated diagnoses. Drew Westen, Ph.D. of Emory University has done widely cited work on this issue of the mis-match in mental health between these clinical trial studies and actual clinical work, how they lack "ecological" validity. Finally, even when these studies demonstrate that a particular intervention, such as a new medication, is effective these studies are rarely designed to show one intervention is actually superior to another.
There is a cost to Blue Cross insurance holders in seeing an a "non-participating" provider such as me. First you will pay approximately $15.00 dollars more per session– the Blue Cross adjusted rate is about $115.00 and my rate is $130.00. Second, your deductible may be slightly higher, and third, your co-pay may vary too. There are so many variations in Blue Cross policies that you will need to call Blue Cross for clarification about the co-pay and the deductible. Finally you will pay me for the full amount of your therapy (generally on a monthly basis, after we finish the initial assessment sessions) and then obtain reimbursement from Blue Cross. In my experience these differences are small enough that it is not a barrier to working with me in therapy. But if you are under financial pressure, we could discuss a fee adjustment in our first session.
