1) How long will I have to attend counseling sessions?
Most individuals are able to resolve their presenting issues within three to five months of seeing a therapist, all things considered. However, there are individuals that will need to attend counseling for a longer period of time to resolve their presenting issues. Initially, you and your therapist may decide to meet once a week, gradually tapering off to less frequent sessions, once every two weeks to once a month. It’s important to remember that all people are different and each person participates differently in therapy, usually as they are ready to deal with their presenting issues, this makes it difficult to put time-frames around the therapeutic process. Further, it is important to give the therapeutic process an opportunity to work; however, if your therapist is not able to engage you in the therapeutic process and a sincere level of trust is not established, it may be time to seek out a new therapist. By no means does this reflect poorly on the therapist or the client, it simply means that for some reason the therapist and/or the client are not compatible. If you decide to change your therapist, ask your current therapist for a list of referrals for other therapists in your area.
2) How much will counseling cost me?
Counseling costs vary per therapist and practice, the range is from $100-$200 per 45-50 minute session. Some therapists operate a sliding fee scale, for a percentage of their clientele, based on level of income/ability to pay and the current rate of insurance industry standard co-pays ($40-$50 per 45-50 minute session).
3) Why do some counselors/therapists accept private insurance & Medicaid, while other’s only accept cash and credit?
It is entirely based on personal preference, willingness to forgo time to deal with filing paperwork, a willingness to wait for payment and a willingness to have an outside entity determine how much a therapist should receive for his or her counseling services. Additionally, therapists that choose to accept private insurance and Medicaid have to submit official coding/diagnosis that become part of a client’s permanent medical records. These diagnosis then follow clients for the rest of their lives and can influence a clients ability to qualify for insurance coverage and what he or she may pay for future insurance coverage/premiums. Nationally, there is a movement among the counseling, medical and dental fields to provide services for cash and credit only. The results of operating a cash/credit practice are more quality time with clients, more time to see clients and no outside interference from third-party entities dictating a clients level of services and time-frames for services.
4) How does a sliding fee scale work?
Sliding scale fees are based on a client’s ability to pay for services. Most therapists only accept a certain number of sliding scale fee clients. Fees are usually set based on the insurance industry standard co-pay schedule which varies between $40-$50 per 45-50 minute counseling session. Additionally, a therapist may ask for documentation of a client’s ability to pay through submission of pay stubs etc… while some utilize the honor method.
5) Who do I see if I need a medication evaluation and subsequently medications?
If you and your therapist believe that you have symptoms consistent with a diagnosis that could be treated more effectively with therapy and medication, a referral will be made to a psychiatrist for further evaluation (medication evaluation) and if medications are prescribed (medication monitoring). It is important to note, psychotropic medications should only be prescribed by a psychiatrist, not a family practitioner, most family practitioners only complete a brief psychiatric rotation as part of their overall medical education/training and are not fully qualified, in most cases, to be prescribing psychotropic medications. Further, there is a growing trend in psychiatry, and medicine as a whole, towards a more holistic approach to treating mental illness symptoms and other physical illnesses; these new methods include diet/nutrition, exercise, nutritional supplements, and somatic therapies.
6) Does my Diagnosis go into my permanent medical record?
If a client chooses to see a therapist that accepts insurance and Medicaid, their diagnosis must go into their permanent medical record. Additionally, if a client is referred to a psychiatrist for a medication evaluation and a prescription for therapeutic medications are made, and this also occurs through the private insurance or Medicaid processes, then the diagnosis/medication prescribed is recorded in the client’s permanent medical record.
7) What if my counselor decides that my significant other and I need marriage/relationship counseling?
It is appropriate for the therapist to provide a referral to another therapist for the individual client and his/her significant other to see a marriage counselor. It is not appropriate for an individual therapist to see a couple on an ongoing basis for marriage/relationship counseling, also. It is common for a therapist to bring in a significant other to do therapeutic work that will benefit the individual client. It is also appropriate for a marriage/relationship counselor to see each partner in a relationship for, several, individual sessions throughout the therapeutic process to achieve clarification, to address highly conflictual topics, and to address suspected areas of inconsistency, non-truths and other areas of concern that may be more effectually addressed in an individual session, before bringing it back to the couples counseling session.
8) What if I need additional types of counseling services not provided by my counselor?
During the course of the therapeutic process it may be discovered that the client is in need of a treatment modality that would be helpful in fully resolving a clients issues. Not all therapists are practitioners of every treatment modality, it just is not possible, at this point a referral would be made to another therapist who practices and is proficient at another treatment modality. Certain situations where this would occur, would be if the current therapist did not practice Eye Movement Desensitization and Reprocessing (EMDR) therapy a common treatment modality utilized in addressing chronic and acute trauma symptoms.
9) What if I need additional medical testing, examinations etc…?
It is not uncommon for a therapist to ask a client to participate in additional medical testing, examinations, medication evaluations etc… As the science and practice of counseling continues to move forward more and more evidence is pointing to a holistic approach to treating the entire person. While not every client that comes to therapy will require additional medical intervention, there are many that will need some kind of additional assistance. Again, counselors and physicians alike are realizing the interrelatedness of the functioning of mind and body.
10) Will my information be kept confidential?
Client information is confidential and HIPPA requires that client information be kept confidential. All therapists/counselors are bound by legal and ethical requirements when handling client phone calls, sessions, paperwork etc… No client information can be given out to any entity without the written permission by the client to do so.
However, if during a session a client reveals any information related to current or recently occurring child abuse, neglect or sexual abuse a report would, by law, need to be made to the appropriate agency/authority (Police and/or Department of Human Services).
Additionally, if a client makes serious threats of bodily harm, death or suicide during a session and the therapist believes, upon further inquisition, that the client has the ability and intention of carrying out the threats the therapist must notify both the intended victim(s) and the police.
11) What do I do if I am feeling suicidal and/or homicidal?
Call 911 or Go To Your Local Emergency Room!