Frequently Asked Questions
You may have some questions as you begin your healing journey--and that's a good thing! This page aims to answer some of the most commonly asked questions and help clients to make the most of their time before, during, and after therapy. Common questions about other services I offer are also answered.
How common are mental health issues?
Very. According to the National Institute of Mental Health, more than a quarter of American adults experience depression, anxiety or another mental disorder in any given year. Still, others need help coping with a serious illness, losing weight, or stopping smoking. And even more others struggle to cope with relationship troubles, past trauma or neglect, suicidality, job loss, the death of a loved one, stress, substance abuse, or other issues. You are not alone, nor should you be ashamed to ask for help.
Why do you refer to me as a client instead of a patient?
These terms are essentially interchangeable, but I prefer to use client. To me, the word patient implies sickness or helplessness, dependency on me as an "expert" instead of relying on your own independent drive and customership for change, and otherwise assumes you have a problem that needs "curing."
What is the difference between a psychiatrist, psychologist, psychotherapist, counselor, coach, etc.?
These terms and others are sometimes used interchangeably when referring to a variety of talk-based helping services (which can cause a little confusion). Definitions vary greatly, but the services themselves all share a common goal--to help clients work through issues that have begun to effect themselves, others, or their lives in a negative way. The differences between these services are in the ways a professional approaches the process of helping and healing. For example, the method, timing, nature, style, interventions, and duration of therapy versus psychiatry are very different. A therapist, counselor, or psychologist might work with clients to understand the root cause of their issue, while a psychiatrist would focus on treating the symptoms of the issue. Further, a coach or social worker might connect a client to outside resources in the community or help clients tap into the strengths they already possess.
While all of the above are important, perhaps the largest differences between these professions lie in the education, training, and licensing processes each of these professionals must go through before they are legally allowed to practice and the major differences between how they are legally allowed to help. Please see below for a basic description of some of the most common helping professionals:
Psychiatrists must go through the same education as any other medical doctor (such as an internal medicine physician or a pediatrician) and, therefore, must earn a doctor of medicine degree (M.D.). In addition to and after medical school, psychiatrists must undergo a four-year training called residency, during which they specialize and focus their training on the assessment, diagnosis, and treatment of mental health disorders. After residency, they can choose to further their education in a sub-specialty by doing a fellowship (sub-specialties are things like child psychiatry, adolescent psychiatry, or neuropsychiatry, etc.). Psychiatrists most often help by prescribing and managing psychiatric medication for their patients, as their expertise focuses on the chemical imbalances within the brain that cause or worsen mental health disorders; though, their residency also includes training in non-medicinal, talk-based therapeutic techniques. Psychiatrists can work in a variety of settings such as private practice, academia, hospitals, research, inpatient facilities, and many others. Clients may be referred to psychiatrists by other helping professionals to obtain medication as part of a comprehensive treatment plan (e.g., if a therapist believes a client could progress farther in therapy with the addition of an anti-depressant medication), or can come to see a psychiatrist on their own.
Psychologists must earn a doctoral degree in a qualifying subject (such as Clinical Psychology) and must further complete 3,000+ hours of supervised experience before they can take their state-board licensing exams. Their doctoral degree can be in the form of a Ph. D. (a doctor of philosophy; more research based) or a Psy. D. (a doctor of psychology; more clinically based). Psychologists are social scientists who study human behavior and mental processes and are able to diagnose and treat mental disorders. Though they hold a doctoral degree, they are not medical doctors, and are thus unable to write prescriptions for medications. Psychologists most often help by conducting psychological testing and assessment to determine if a client suffers from a mental health disorder; though, their education also includes training in non-evaluative, talk-based therapeutic techniques. Psychologists can work in a variety of settings such as private practice, academia, research, hospitals, and many others. Clients may be referred to a psychologist by other helping professionals to obtain testing, evaluation, assessment, or talk-based treatment as part of a comprehensive treatment plan (e.g., if a therapist believes a client may have dyslexia and wants to confirm this with a test), or can come to see a psychologist on their own.
MARRIAGE AND FAMILY THERAPISTS
Marriage and Family Therapists (MFTs) must earn a master's degree in a qualifying subject (such as Psychology with an Emphasis in Marriage and Family Therapy) and must further complete 3,000+ hours of supervised experience before they can take their state-board licensing exams. MFTs are trained to assess, diagnose, and treat a wide variety of mental health disorders and are also trained to assist clients in adjusting to various life issues (like death, loss, trauma, divorce, or low self-esteem ), within the context of a client's relationship with themselves or others. Despite the state-designated "Marriage and Family" title, MFTs are qualified to provide therapy on an individual, couple, child, family, and group basis, depending on a client's needs. MFTs receive extensive training in many therapeutic techniques, talk-based and otherwise, and can choose to approach therapy from a wide a variety of therapeutic theories or orientations (e.g,. Freudian/Psychoanalytic, Cognitive Behavioral, Solution-Focused, etc.); however, MFTs cannot write prescriptions, and can only perform psychological tests or assessments they are specifically trained to administer. MFTs work in a variety of settings including private practice, schools, hospitals, rehabilitations, and many others. Some MFTs practice early crisis intervention and brief, focused psychotherapy to resolve problems or reduce symptoms quickly. Others have the expertise and skills to provide more intensive, long-term treatment, as necessary.
PROFESSIONAL CLINICAL COUNSELORS
Professional Clinical Counselors (PCCs) are very similar to MFTs. While MFTs were not recognized in all states until just recently, PCCs have become the most common form of therapist or counselor in the United States. In order to become licensed, individuals will need the same amount of education, training, and 3,000+ supervised hours of experience as that of an MFT. Although, PCCs generally have more career counseling and rehabilitation experience than MFTs, they are not qualified to see couples and families unless they have completed relevant training or are dually licensed as a PCC and MFT. This mostly depends on the curriculum they have while earning their master's degree and supervised hours, and is slightly different for each practitioner. Like MFTs, PCCs are also trained to assess, diagnose, and treat a wide variety of mental health disorders and are also trained to assist clients in adjusting to various life issues (like death, loss, trauma, divorce, self-esteem, etc.).
OTHER HELPING PROFESSIONALS
Other helping professionals include Licensed Educational Psychologists, Licensed Clinical Social Workers, Career Counselors, Case Managers, Drug and Alcohol Counselors, Behavioral Therapists (Applied Behavioral Analysts), Life Coaches, and Executive Coaches. All, with the exception of Life and Executive Coaches, have minimum education, training, and licensing requirements. Life and Executive Coaches can undergo education, training, and certification, but they are not required to. This leaves clients with more risk when they are shopping for coaches, as the field is still unregulated and anyone with a business card and an office can open for business. This is not to say that all, or even a majority of coaches are fakes--just that clients should take extra precautions to look into the provider's background before making their final choice.
Before Therapy Begins
Is therapy right for me?
Maybe! There are many reasons people enter therapy, including to treat mental disorders, adjust, cope with, and work through difficult or new life situations, or to simply better themselves (e.g., to improve self-esteem, learn communication skills, or become more successful in their career, sport, or relationships). One does not need to have a mental disorder or be in crisis (though, therapy can help with both of those, too). Please see the Who I Help page to see if your issue(s) is one I specialize in or work with on a regular basis. If it isn't, that does not mean therapy isn't right for you--it may just mean that you may be better served by another therapist. If you are unsure whether or not your issue(s) falls within my scope of practice or specialty, you can always Contact Me to ask. If it turns out that I do not work with your particular issue(s), I will do my best to refer you to someone who does. If you are curious or simply want to see a more complete list of some of the most common issues and reasons why people enter the therapeutic process, check out this list.
Will therapy work for me?
Research supports the assertions that therapy works for most clients. Many report relief from depression, anxiety, relationship problems, and issues surrounding difficult life changes, events, or situations, amongst numerous other issues. Many also report seeking therapy as a means of personal growth and exploration. As a general rule, therapy will work for you if you work hard, stay committed, and don't give up.
How long are therapy sessions?
My standard sessions are either 50 or 90 minutes, depending on our agreement; however, due to the inexact nature of conversation, sessions can run +/- 5 minutes early or late. I do my best to start and end our sessions on time.
How long will I be in therapy?
Therapy is hard work and should not be considered a "quick fix" or "cure." That being said, a majority of clients usually notice a benefit or improvement in their symptoms within the first several sessions (and beyond). Though some clients can benefit from shorter-term treatment, most clients attend for months to years because building a safe, trusting, vulnerable, and truly honest relationship takes time. Thus, without the required time, effort, and commitment, clients will not achieve their desired results. Please see the My Approach page to learn more about my beliefs on therapy and the timing of the therapeutic process.
I tried therapy before and it didn’t work, why should I try it again?
Sometimes the chemistry between the therapist and client or the therapeutic modality just isn’t a good fit. Just as you sometimes have to switch medication, you may need to switch therapists or treatment modalities to achieve the results you desire. Therapy works best when you are open to the process, complete outside tasks or assignments, and are willing to actively participate in your own healing.
What should I ask myself before and during the first session?
· What do I hope to gain from therapy? Will this therapist help me do that?
· Am I comfortable with this therapist? Would I want to come back? (Remember: The most important factor in securing effective therapy is a good relationship between you and your therapist.)
· Do I feel assured that the therapist is qualified to help me with the issues or concerns that have motivated me to seek therapy at this time?
· Am I willing to do the work necessary to participate in therapy?
What can I expect my first session (and others) to be like?
In our first session, I will spend the first few minutes going over my policies and procedures, the limits of confidentiality, and a brief summary of my approach to therapy. Then, I will ask that you share what is bringing you into therapy at this time, what your hopes and goals are for the process, and allow you to ask any questions and share any concerns. For a general idea of what our subsequent sessions will be like and the structure I employ when performing therapy, check out the My Approach page, under "My Structure."
Is it ok to tell you I am shopping around for a therapist?
Absolutely! Interview several. It is vitally important to work with a therapist who is a good fit for your personality and who makes you feel comfortable/safe to be honest. Be wary about the therapist who dismisses the idea of you interviewing more than one. Note: it is normal for most therapists to charge for the initial in-person session, even if you are shopping.
Is therapy totally confidential?
Yes, and no. It is understood that information disclosed during sessions is confidential and will not be disclosed to anyone without prior written permission from you, except as required by law. Disclosure may be required by law in any of the following circumstances:
A) When there is reasonable suspicion of abuse or neglect of an elder, dependent adult, or minor child.
B) When a client communicates a threat of harm to self, others, or property.
C) When disclosure is required pursuant to court or legal proceedings.
D) Parents'/legal guardians' right to know their minor child's progress.
In any of the above situations, I will employ clinical judgment in deciding appropriate measures needed to ensure safety/best interest of all parties.
What about confidentiality between clients in a couple or family therapy session?
When one or more people are being seen for therapy, I collectively view all members of the treatment unit ( couple, family, or group) as "the client." Therefore, any release of information to an outside party (except as noted above by law) would require the written approval from each individual member of the treatment unit.
Additionally, each member of the treatment unit must agree to a "No Secrets Policy." This policy means that information shared with me by one member of the treatment unit when the other member(s) are not present may be disclosed to the other member(s), based on my clinical judgment of what is in the best interest of the whole treatment unit and therapeutic process.
How much will therapy cost?
Please see the Finances section of the website for more information about my financial policies and rates for different services.
Does your practice take my insurance?
No. Please see the Finances section of the website for more information about insurance and the possibility of reimbursement from insurance.
Can I bring in my friend, family member, coworker, etc.?
Visitors are always welcome! I just ask that you try to let me know ahead of time. If you want to change the overall treatment unit to include a new person permanently (e.g., going from individual to couples therapy), or if you are just interested in bringing them in on a temporary-visitor basis, let me know and I will do my best to accommodate you. If for some reason I can't or I believe it would be a conflict of interest or an ethical issue to include another person, I will attempt to explain this as well as possible.
I have something I want to bring up to you... but I'm scared.
That's ok. Except in the cases explained in the above "Is therapy totally confidential?" and "What about confidentiality between clients in a couple or family therapy session?" sections, anything you tell me will stay between the treatment unit (just you, or you and other members) and me. Even if you admit to committing an old crime, cheating on your partner, stealing something from work, want to come out as gay, lesbian, or transgender, or you engaged in sexual behavior you feel ashamed of--even if it's just that you lied to me five minutes ago during our session and you have no clue why--please feel safe to tell me. I will not judge you. Most importantly, if I don't know about it, I can't help you with it--and that is what matters to me most. You deserve to be honest with me, yourself, and the process, and will likely feel much lighter, and free from the heaviness and suffering of guilt or shame if you tell me. Try it!
What if I feel like I'm not making progress?
Then you're probably very, very normal, and you would be about the billionth client to worry this. First of all, therapy will not always feel progressive, even though it feels positive, progressive, and motivating a lot of the time. Therapy is not a linear, straight-shot-to-the-top type of thing. In other words, people go through many natural ups and downs as they learn about, talk about, and cope with the issues in their lives. Due to these natural ups and downs, self-doubt and other worries about one's progress pop up for most clients at some point during the therapeutic process. This is especially true if you have been doing well for a while and then you reach what feels like a plateau or downward turn--you might wonder, "Therapy was going so well, what changed?" If you ever find yourself feeling this way, I would first encourage you to ask yourself if any recent life events could be stressing you out or causing a change in your mood, thoughts, or feelings. Next, you might ask yourself whether or not you are avoiding bringing certain subjects into therapy or are resisting any assignments or ideas we agreed you would practice or complete. By doing a "self-check," you are essentially asking yourself what evidence you have for your claim of "no progress." Very often through the process of asking, you will find that you were not avoiding anything, and that there is more evidence of your hard work and progress than of the opposite. If it turns out you are being avoidant of something, challenge yourself to bring this up to me. Doing so can feel scary, but please know that no matter how long it took you to bring the issue up, I will only see you as brave for having done so, not as a failure for how long it took. Further, bringing up topics you've been avoiding is most often rewarding and will likely put you back on a progressive path.
Worrying about one's progress is actually so common, that if you report always feeling successful and progressive in treatment, I might suspect that you are either trying to impress or please me by looking like a "successful, progressive student of therapy," or are hiding your true feelings from me. These issues are also common in therapy. In either case, these would be detrimental to your treatment and healing process in the long run, if left unaddressed. So, if you believe either situation (or another) applies to you, I encourage you to bring it up in session. I will not judge you, nor should you feel ashamed or like you have failed. Bringing up your feelings to me is a healthy way to cope and can be a very powerful tool for your healing. Further, being open and honest with me about your real worries--even if they are about therapy itself--will only help you heal faster and more effectively (i.e., if I don't know about it, I can't help you with it). You may also always ask me for feedback on how I think you're doing. I will be honest--I promise. A large and important part of our relationship requires that I be honest so that you have the best opportunity to grow, and/or understand if anything is holding you back. You don't need another friend or cheerleader--you came to a professional, and my job is to provide honest, nonjudgmental feedback (among other things) so that you can help yourself. Your growth and progression is our shared goal!
All that said, it is possible (although, more rare) that clients sometimes are genuinely not progressing in treatment. If that happens, I would work with you to help you realize that your progress has slowed or stopped, help point out what I believe is causing the issue, and help you get back on track. After a reasonable number of adjustments are made and time is spent (including coordination with outside professionals, other interventions, medical evaluations, etc.), if we are still unable to get back on track, I will attempt to connect you with someone who I believe could better serve your needs.
What if I need paperwork from you to give to someone else?
It depends on what you need, and for whom. Please feel free to bring this up during session, and I will be happy to discuss your needs. Generally speaking, I am able to write letters that state your name, that you are attending therapy, the number of sessions you've attended and on what dates those sessions were, and whether or not you are actively participating. As is standard for the safety and confidentiality of my clients, I do not write or justify diagnoses in writing. Additionally, please be mindful about who you are giving any paperwork to, why they are requesting it, and if it will impact your future in any way. For more questions about records and documentation, please see the last section on this page.
I can't afford to come to therapy anymore, or need to stop for another reason ... what do I do?
You may always stop therapy for any reason, at any time. If you feel that you need to stop based on affordability, please feel safe to bring this up with me in session so that I have the opportunity to adjust my rate, if necessary. At the very least, if I can't accommodate your financial needs, I will try my best to refer you to someone who can. Everyone deserves help, regardless of income. If you wish to stop for any other reason, but feel uncomfortable telling me why, please feel safe in knowing that I will not take offense or take it personally if you feel the need to stop treatment, whatever the reason. Sometimes clients may wish to stop therapy if they feel they are not making progress or if they are scared to It is my policy and normal practice in my field to schedule at least one termination session to discuss these reasons, gather feedback, and/or hear your concerns, so that I can help others most effectively in the future.
Can I see another therapist or helper for another issue while in therapy with you?
Yes. For example, many of my clients see me for individual issues, and also see another therapist with a spouse, partner, friend, coworker, etc. This is actually encouraged so that each member of a multi-person treatment unit has the opportunity to process and work in their own objective environment between or alongside their joint sessions. If you would like me to speak with another professional to collaborate, I would be more than happy to have you sign a Release of Information form so that your confidential information can be discussed with another party. If I am aware that you see another clinician, I may also ask your permission to speak with them (which would also require the signed Release of Information; please note, you always have the right to say no).
As Therapy Ends, And Beyond
How will I know when it's time to end therapy?
This will be up to you and me, whenever we agree it's time. A good time to end therapy would be when:
· The reasons that brought you into therapy in the first place are resolved or no longer trouble you
· You can manage your symptoms, thoughts, feelings, behavior, communication, etc. effectively and without resorting to unhealthy coping methods or defense mechanisms
· You have acquired new or enlightened perspectives that bring you feelings of joy, peace, calm, and happiness
· If for some reason you believe therapy is not helping you, or is harming you in any way (if you are able, please bring this to my attention before exiting the process so that I may have the opportunity to help you, fix the issue, or refer you to someone who can).
· You have achieved your goals, success, or other measures (e.g., quit smoking, got good grades, are sleeping well, stopped getting written up at work, etc.)
I stopped therapy, but can I come back?
Absolutely. My door is always open. Many people go in and out of therapy at several different times in their lives, depending on what's going on for them. I will do my best to accommodate and fit you in. If I can't, I will add you to my waitlist. If it can't wait, I will do my best to refer you to someone who I think may be a good match.
Questions Pertaining to Records
How long do you keep your records?
Under California law, it is unprofessional conduct to, “[Fail] to keep records consistent with sound clinical judgment, the standards of the profession, and the nature of the services being rendered.”1 Under California’s new record retention law, LMFTs are required to do the following:
- Retain a client’s health care service record for a minimum of seven (7) years from the date therapy terminates;
- Retain a minor client’s health care service record for a minimum of seven (7) years from the date the minor client reaches eighteen (18) years of age; and,
- Maintain the record in either electronic or written form.
While the law prescribes the length of time a client record must be retained, the law does not specify the format in which the record should be organized or written; or, provide information about how records should be stored. The CAMFT Code of Ethics provides important guidelines to address some of these practical issues.
Can I request my records?
Under California law, a therapist has three (3) options to respond to a client’s request to either inspect or receive a copy of his or her record. A provider shall do one of the following:
- Allow the client to inspect or receive a copy of his or her record;
- Provide the client with a treatment summary in lieu of providing a copy of the record; or,
- Decline the client’s request.
Do I have a right to my records?
Under California Health and Safety Code any adult client, a minor client authorized by law to consent to his or her own treatment, or the client’s legal representative, (i.e., a parent, guardian, conservator, or personal representative of a deceased client) has a right to access the clinical record. As per Section 123110, if the client or representative requests to inspect the record, the request to inspect must be in writing and the record must be made available during regular business hours within five (5) working days after the request is received. If the client wants a copy of all or part of the record, the request for copies must be in writing, and copies must be provided within fifteen (15) days after receiving the request. Under the code, providers may recover up to .25 cents per page for the cost of copying the record, as well as, the reasonable cost for locating the record and making the record available.
You only gave me a summary of my records--why?
Section 123130 of the California Health and Safety Code allows a mental health professional to provide a summary of treatment rather than the complete record. The summary must be provided within ten (10) working days from the date of the request. More time may be taken to prepare the summary as long as the summary is provided no later than thirty (30) days from the request. The summary must contain the following information if applicable:
- Chief complaint or complaints including pertinent history.
- Findings from consultations and referrals to other health care providers.
- Diagnosis, where determined.
- Treatment plan and regimen including medications prescribed.
- Progress of the treatment.
- Prognosis including significant continuing problems or conditions.
- Pertinent reports of diagnostic procedures and tests and all discharge summaries.
- Objective findings from the most recent physical examination, such as blood pressure, weight, and actual values from routine laboratory tests.
In preparing the summary, a therapist may confer with the client to clarify what information is sought and the reason for wanting a treatment summary. The summary does not have to include information which is not contained in the original record. Also, a reasonable fee may be charged for the cost and actual time spent in preparing the summary for the client. In allowing a provider to be reimbursed for the time spent to prepare the summary, the express intent of the Legislature was to ensure that summaries be made available at the lowest possible cost to the client.
Can you deny me access to my records?
Under California Health and Safety Code, a mental health care provider may decline a client’s request to inspect or receive a copy of his or her record. In making the declination, the health care provider must determine there is a “substantial risk of significant adverse or detrimental consequences to the client in seeing or receiving” a copy of the record. To properly decline a client’s request the health care provider must do the following:
- State in the record a written explanation for refusing to permit inspection or provide copies of the record, including a description of the “specific adverse or detrimental consequences to the client” the provider anticipates would occur if inspection or copying were permitted;
- Inform the client of the right to require the provider to permit inspection by, or provide copies to, a licensed physician and surgeon, licensed psychologist, licensed marriage and family therapist, licensed clinical social worker, or licensed professional clinical counselor designated by written authorization of the client;
- Permit inspection by, or provide copies of, the record to a licensed physician and surgeon, licensed psychologist, licensed marriage and family therapist, licensed clinical social worker, or licensed professional clinical counselor, designated by request of the client;
- Inform the client of the provider’s refusal to permit him or her to inspect or obtain copies of the requested record; and
- Record whether the client requested that another health professional inspect or obtain the requested records.
It is important to document in detail the reasons why there is a substantial risk of adverse or detrimental consequences to the client. Under the Health and Safety Code, a marriage and family therapist who willfully withholds a client’s record commits unprofessional conduct for which a license can be suspended or revoked. Withholding the record without cause, without a mandated or permissive legal or ethical justification, or disregarding the request of the client due to the therapists own personal interest, are acts which constitute a willful withholding.
Can you deny a minor’s representative the right to inspect the minor's record?
Under California Health and Safety Code, there are circumstances that preclude the representative of a minor from inspecting or obtaining a copy of the minor client’s record. First, the representative of a minor–whether a parent or legal guardian–is not entitled to inspect or obtain a copy of the minor client’s record if the minor has inspection rights of his or her own. A minor has inspection rights of his or her own when the minor consents to his or her own treatment. Second, a provider may deny a representative’s request to inspect or receive a copy of the minor’s record if the provider determines that access to the minor’s record would either have a detrimental effect on the provider’s professional relationship with the minor or, be detrimental to the minor’s physical safety or wellbeing.
Are there any documents I should not be allowed to inspect or receive a copy of?
Yes. Child abuse reports and elder and/or dependent adult abuse reports are confidential documents and should not be released to the client unless mandated by the Court.
If I believe my record is incomplete or inaccurate, can I request that the record be amended?
Yes. Under California Health and Safety Code, an adult client who inspects his or her client records and believes part of the record is incomplete–or contains inaccuracies–has the right to provide to the health care provider a written addendum with respect to any item or statement in his or her record the client believes to be incomplete or incorrect. The addendum shall only contain up to 250 words per alleged incomplete or incorrect item and clearly indicate the client wishes the addendum to be made a part of his or her record. The health care provider is required to attach the addendum to the client’s record and include the addendum whenever the health care provider makes a disclosure of the allegedly incomplete or incorrect portion of the client’s record to a third party.
Can you refuse my request if I owe an outstanding balance?
No. A mental health professional may not withhold a client’s record or summary because the client has not paid their bill. To withhold a record or summary because of an unpaid bill is considered unprofessional conduct.