Psychotherapy is not easily described in general statements. It varies depending on the personalities of the psychologist and patient, and the particular problems you are experiencing. There are many different methods that we may use to deal with the problems that you hope to address. Psychotherapy is not like a medical doctor visit – it is an interactive process and we rely on your experience both inside and outside of our office to guide us. Therapy should be a safe and comfortable place where you feel understood, and supported to address elements of your life that have been scaring and holding you back.
Do I have to do all the talking? I don’t like to feel judged." Sometimes people can feel uncomfortable by the quiet intensity of therapy. We work hard to avoid raising anxiety in a situation that is already uncomfortable for many, and believe being an engaged participant is an important part of this. While you should be prepared to speak about yourself candidly about the feelings and situations you are facing in your life, you should also expect to feel understood. In actively listening, our goal is to express understanding in a way that comforts you and empowers you. When we have ideas or thoughts about patterns we notice, we will share them with you openly. Not only do we rely on your experience to guide and determine the validity of our focus, but we overtly intend to demonstrate the insight process so that ultimately you can continue this process yourself.
Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have many benefits. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. Feeling understood and supported in working through uncomfortable feelings usually helps reduce the discomfort of the feelings and is an important goal of every session.
Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. The best way to know if we might be a good team is to meet for a consultation, so that we can discuss your needs, my sense of how we can help, and most importantly determine your comfort level in moving ahead. In practice we treat this consultation as much as possible like a typical therapy session so that you can get an accurate sense of what working with us would be like, and ideally leave the session feeling some benefit. Because time will not allow us to cover all the areas of your life that are bearing on your distress in a first session, it is normal to feel like we haven’t covered everything. Fleshing out these details will take some time and is part of the early process of therapy. In determining if we are the right fit for you, we find it helps to reflect on your feelings about sitting with us in the initial consultation. Research and clinical experience shows that people get the most benefit out of therapy when they feel comfortable with their therapist. Either in the consultation or down the road, if you have questions about our procedures, we should discuss them whenever they arise. Therapy is a collaborative process that relies on your involvement to be effective!
If we decide to move forward, the next few sessions will involve more thoroughly evaluating your needs and relevant history. By the end of the evaluation, we will be able to offer you some first impressions of what our work will include and a treatment plan to follow. Like with all interactions we will have, we will rely on your insights and feelings to guide us both within and between sessions. Length of therapy varies individually but generally depends on the goals we identify and the efficiency with which you are able what you learn in therapy to your outside life. Ending therapy is an empowering part of the process and a goal that is actively worked towards. The more you put into therapy, the more you will get out of it!
What about medication vs. psychotherapy? Research has shown that the combination of medication and psychotherapy provides the greatest long-term solution to mental and emotional problems and the pain they cause. Not all symptoms lend themselves to medication, but many do. Medication can provide important symptom relief that allows a person to function, and make the most out of therapy. However, medication can only help so much, and is not necessary to achieve positive therapeutic results. Therapy addresses the cause of our distress and the behavior patterns that curb our progress. Sustainable growth and a greater sense of well-being is often achieved with an integrative approach to wellness. Depending on your symptoms, we may recommend you consult with your medical doctor or psychiatrist to determine if a combination of medication and therapy is right for you.
People pursue therapy for a variety of reasons. Some benefit from help in going through a major life transition (unemployment, divorce, new job, etc.), especially when they don’t handle stressful circumstances as well as they’d like. Some people need assistance managing a range of other issues such as low self-esteem, depression, anxiety, relationship problems, career decisions, attention issues, and creative blocks. Therapy can help provide some much-needed encouragement and help with skills to get them through these periods. Others may be at a point where they are ready to learn more about themselves or want to be more effective with their goals in life. All people seeking psychotherapy share a desire to meet life’s challenges and make positive changes in their lives.
If psychotherapy is begun, we will agree on a regular meeting time, and our evaluation will continue for another 2 to 4 sessions. In most cases, we will meet weekly, though alternative frequencies might be considered. The regular hour (50 minutes) we agree on will be considered your time, and will not be rescheduled or canceled, except with significant advance notice. Due to the nature of a psychotherapy practice, we must adhere firmly to time guidelines, and sessions are scheduled for 50 minutes. Thus if you are late for a scheduled session, the time will be lost for that session. If we are late for a session, we will either make up the lost time of adjust the fee accordingly. If a session runs over 60 minutes, we will bill the extra time accordingly.
Because this time cannot be offered to anyone else, we must require 48 hours advance notice for the cancellation of a session. If you do not call to cancel within 48 hours (two days) of a scheduled session, the full fee will be charged. It is important to note that insurance companies do not provide reimbursement for canceled sessions. We will always do our best to offer another time in that week to reschedule the appointment when time is available. However, we cannot guarantee that rescheduling will be possible.
Due to our work schedules, we are generally not immediately available by telephone. If you need to reach us between regularly scheduled appointment times you may call the office at (202) 969-2277 and leave a message. The voicemail at that number is confidential and monitored regularly. We will make every effort to return your call on the same day you make it, Monday through Thursday. The office is closed Fridays, so messages left after Thursday afternoon will not be heard until the following Monday. If you are a current patient and your call is urgent, please call Dr. Clark on her cell phone (202) 625-1313. If you are unable to reach her and cannot wait for her to return your call, contact your family physician or the nearest emergency room and ask for the psychiatrist on call. If we will be unavailable for an extended time, I will provide you with the name of a colleague to contact, if necessary.
Unless otherwise arranged for, therapy and coaching sessions run 50 minutes and are scheduled on the hour. Our current rate for individual therapy and coaching is $260/session, and for couples therapy and coaching is $275/session. Credit cards are my preferred form of payment, but you can also pay by check or cash if we meet in person. All remote coaching sessions must be paid by credit card, and payment is due at the time of service.
In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have health insurance, it will usually provide some coverage for mental health psychotherapy. Coaching services are not always covered.
We do not participate with any insurance companies, so the services we provide you would be considered “out of network” by your insurance company. Monthly you will receive an electronic summary of services and payments along with the other typical information needed by insurance companies to reimburse you. We are happy to complete any necessary insurance forms that are required so that you can receive the benefits to which you are entitled; however, you (not your insurance company) are responsible for full payment of our fees.
The following is information that may be useful should you choose to use your insurance coverage. First, it is very important that you find out exactly what mental health services your insurance policy covers. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator. Some helpful questions you can ask them are:
- What are my out-of-network mental health benefits?
- What is the coverage amount per therapy session (CPT code is 90834)?
- Is the covered amount a percentage of the billed amount or of a "reasonable and customary" amount set by my insurance company?
- How many therapy sessions does my plan cover?
- What is my deductible and has it been met?
- Is approval required by my primary care physician?
Confidentiality is a cornerstone of the therapist-client relationship. Successful therapy requires a high degree of trust so that highly sensitive subject matter can be discussed in a meaningful way. We will provide you a written copy of our confidential disclosure agreement, and you can expect that what you discuss with us will not be shared with anyone without your consent. Sometimes, however, you may want us to share information or give an update to someone on your healthcare team (your Physician, Nutritionist, Teacher), but by law, we cannot release this information without obtaining your written permission. However, there are some disclosures that do not require your Authorization, as follows:
- Disclosures required by health insurers or necessary to collect overdue fees that are discussed in the Agreement to begin therapy.
- If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychologist-patient privilege law. We cannot provide any information without your (or your legal representative’s) written authorization, or a court order. If you are involved in or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order me to disclose information.
- If a government agency is requesting the information for health oversight activities, we may be required to provide it for them.
- If a patient files a complaint or lawsuit against me, we may disclose relevant information regarding that patient in order to defend ourselves.
- If a patient files a worker’s compensation claim, we must, upon appropriate request, provide a copy of the patient’s record to the D.C. Office of Hearings and Adjudications, the patient’s employer or insurer.
There are some situations in which we are legally obligated to take actions, which we believe are necessary to attempt to protect others from harm and we may have to reveal some information about your treatment. These situations are unusual in our practice and include the following circumstances:
- If we know or have reason to suspect that a child has been or is in immediate danger of being a mentally or physically abused or neglected child, the law requires that we file a report with the appropriate governmental agency, usually the Child Protective Services Division of the Department of Human Services. Once such a report is filed, we may be required to provide additional information.
- If we have substantial cause to believe that an adult is in need of protective services because of abuse, neglect or exploitation by someone other than our patient, the law requires that we file a report with the appropriate governmental agency, usually the Department of Human Services. Once such a report is filed, we may be required to provide additional information.
- In an emergency, if we believe that a patient presents a substantial risk of imminent and serious injury to him/herself, we may be required to take protective actions, including notifying individuals who can protect the patient or initiating emergency hospitalization.
- If we believe that a patient presents a substantial risk of imminent and serious injury to another individual, we may be required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the patient.
If such a situation arises, we will make every effort to fully discuss it with you before taking any action and we will limit our disclosure to what is necessary. In all other situations, we will ask you for an advance authorization before disclosing any information about you. While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have now or in the future. The laws governing confidentiality can be quite complex, and we are not attorneys. In situations where specific advice is required, formal legal advice may be needed.