Your First Therapy Session

November 13, 2009 by  
Filed under Therapy 101

Many people are unfamiliar with therapy and want to know in advance what it’s like. If you’ve ever seen therapy sessions on tv or in the movies, please be assured that it’s probably not like that.

There will be some paperwork to fill out. Arrive ten minutes before your appointment time to fill out the paperwork. You were probably informed about financial arrangements when you made the appointment. Bring your insurance card, your pre-authorization number (if required by your insurance), and your co-pay.

The initial visit is a period for you and your therapist to get to know each other and get an idea where to proceed.  You will probably be asked what brings you to therapy. The therapist will be assessing your situation. You will be asked what you feel is wrong in your life, and any symptoms you are experiencing (such as insomnia, nervousness, weight loss, etc.) You may also be asked to tell a little bit about your history. Feel free to bring notes.

Telling your story

Some people think that they need to spend an hour or more explaining their background and history. Not so. Your history can come out gradually, particularly if you want brief, solution-focused therapy. It’s often better for you if you limit the amount of time that you spend talking about your history to no more than 15 – 20 minutes. This way you can spend part of the hour getting feedback from your therapist and developing a plan. Some people only have a vague idea of what is bothering them. That’s OK.  We’ll help you to put words to what’s bothering you. If you are in therapy because a spouse or parent thinks you ought to go, we’ll want that person in the first session with you explaining the problem from their point of view. Sometimes parents come alone the first time to give a lot of important background history.

Summarize your history

You’ll want to spend the majority of your session (which lasts anywhere from forty-five minutes to an hour, depending on the therapist) developing a plan. So, it’s important to tell your story briefly. Here are some examples:

“I’ve been depressed for at least six months.”

“I’ve always been anxious, but it’s worse when I have to take a test at school.”

“I’ve been pretty lonely since moving here a year ago.”

“My boyfriend and I got along well for the first three years that we knew each other. Now it seems like we’re fighting all the time.”

“My wife says she’s going to leave me if I don’t stop drinking.”

Your therapist will ask for clarification on some points and then ask you what you want.

Creating a treatment plan

In order to change your life so that you’re happier, we’ll help you with a treatment plan that identifies your strengths, your problems, and your goals. This treatment plan is a highly individualized path to wellness. It’s an action plan that also describes which methods will be used to help you to reach your goals.

Thinking about strengths

I know, I know. You hate to talk about your strengths. But the reason we need to know your strengths is so that we can use them to maximize your success in therapy. Perhaps you could have a friend or family member help you with a list of strengths that you can bring to your session. Let your therapist know that you’ve done this.

Establishing goals

One of the most important parts of the session is to establish goals. Goals help both the therapist and the client to focus on what the client wants. You may already know what you don’t want. So, establishing what you do want is generally not too difficult.

For example, you say that you’ve been sad and unmotivated. You lack energy and are prone to crying spells. If we think about the opposite of those signs and symptoms, your goals might be:

1. Increase happiness

2. Increase motivation

3. Increase energy

4. Decrease crying spells

How will you know?

You may be asked how you will know if you have reached your goal. We want to put this in concrete terms. For example, if you’re depressed, you will know that you’re not depressed because….

1. You’ll have the motivation to follow through with projects and assignments in your world.

2. You’ll be crying less.

3. You’ll have more energy.

4. Others will tell you that you’re smiling more.

How do you feel?

You will be evaluating how you feel about your connection with your therapist that first hour. Do you feel like your therapist cares about your situation, and is invested in helping you? Do you feel comfortable asking questions and sharing sensitive information? If the answer to any of these questions is “no,” consider trying someone else. In fact, most therapists honestly don’t mind referring a client to someone else if that connection just isn’t there. We want what is best for you. Good luck!

10 Myths About Therapy

November 5, 2009 by  
Filed under Therapy 101

I used to dislike telling people what I did for a living because of the myths associated with therapy. Some of these myths are still out there, so I’m hoping to dispel them with this post.

1.    Therapy is for crazy people.

Therapy is for people who have enough self-awareness to realize they need a helping hand. Therapy helps you  learn tools and techniques to improve your quality of life and intimate relationships.

2.    The therapist will fix my problems.

The therapist focuses on strengths while helping you to identify unhealthy patterns and symptoms in your life that you need to change. The therapist is somewhat like a personal trainer in a gym – they can make suggestions and be a guide, but you still have to do the work.

3.    If I go to counseling, everyone will know.

Therapy is confidential. We can’t tell your family members, employers, or friends what you’ve said without your written consent. The exceptions to this are if you threaten to harm yourself or someone else, we’re required by law to tell appropriate authorities. We are also required by law to report child abuse if it has occurred within the past eight years. Some people ask about reportable abuse by saying something like, “Suppose I had a friend who….    Would you report that?”  We can talk about your “friend.”

4.    The counselor will judge me and my life.

We are actually trained to be nonjudgmental. And we’ve heard it all. We’re here to help you, not judge you. A friend recently said to me, “If you really knew me, you wouldn’t like me.” That’s a fear that she shares with a lot of people. And it just says that you’re judging yourself harshly. If you stop to think about it, don’t you love your friends and loved ones even more when they open up to you?

5.    The counselor will tell me what to do.

I heard it again just the other day. “Are you going to tell us to get a divorce?” We can’t do that. You are the one who must make your important life decisions. If you’re severely depressed, we may highly recommend that you see your doctor for antidepressants. But we’re not going to tell you what you have to do. It’s still your life, your path. And you must make your own decisions.

6.    Therapy takes forever.

That used to be the case many years ago. It’s no longer the case today. Most therapists are trained in brief, solution-focused therapy. The average person comes six times. Some people only need one or two visits. Once they have a few suggestions and resources, they can handle things on their own.

7.    Therapy is too expensive.

Although it can be expensive, it doesn’t have to be.  I regularly see clients whose insurance pays everything except a $10 – $20 copay. There are community resources that can help you if you need free or low-cost therapy.

8.    Therapy doesn’t work.

There’s a lot of research that says therapy is a highly effective tool to guide you toward the physical, emotional, and spiritual place you’re missing. It is important to understand what therapy can and cannot accomplish. It’s also important to recognize your goals for therapy.

9.    Therapy is about being analyzed.

Most of today’s therapy is about working toward goals, not being psychologically dissected. It’s very here-and-now. And, no, I don’t sit and analyze people when I’m at a dinner party. I enjoy their company. I have the privilege of helping people to focus on their strengths, identify their problem areas, and help them to find solutions to problems.

10.    Going to therapy means that I am not strong enough.

We all need help now and then. And none of us can see ourselves in the way that an outsider can see us. And the problem with just talking to a friend is that your friend may not have the skills, training, patience, or courage to tell you what you really need to hear. Sometimes an impartial third party can give you feedback that your closest friends wouldn’t dare say.

Now that you know the common myths about therapy, won’t you give it a try? Your life will improve in so many ways.

Calling Your Insurance Company

October 30, 2009 by  
Filed under Therapy 101

We bless them and we curse them. We try to understand their rules. We get caught in loopholes. Claims are delayed or disallowed for the most ridiculous reasons. We get just as frustrated as you do. At Resolutions we spend thousands of dollars every year so that we can bill them, comply with their rules, allow their audits, see their members, and provide you with the services that you want. Every month we bill dozens of insurance companies. Most are reputable and very helpful; some are not. Some plans are excellent; most are mediocre at best. Some are downright outrageous. I’m sorry if you’re in that group.

Being an educated consumer can save you lots of money!

Of course, you don’t have to use your insurance. We’re glad to accept credit or debit cards or cash for a discounted rate.  For those with a high deductible paying the cash discount could be a way to keep therapy affordable without the hassle. But, if you want to use your insurance, it pays to educate yourself. We bill dozens and dozens of different plans every year and are happy to do so as a courtesy to you. Please understand, however, that we offer no guarantee that your insurance company will pay. That is between you and your insurance company.

We are happy to bill for you.  We know a lot about insurance companies in general. We may not know about yours. There are just too many out there. In addition to that , plans change, rules change, and we’re not informed of those changes–you are. We expect that you do your part by being an educated consumer, asking questions if you don’t understand, and communicating with your insurance company should a problem arise.  Many, many clients have saved themselves hundreds of dollars by understanding their insurance plans and taking the trouble to authorize their mental health visits ahead of time.

How to educate yourself

Navigating through the health insurance industry is a challenge. It is even more of a challenge if you do not understand the language that is used by those in the industry. So, to help you out, we are happy to tell you how to ask about your mental health benefits. We really do want you to be an educated consumer. Here’s what to do:

Look at your insurance card.

The “member ID” is on the front. Have the card in hand when you call your insurance company.

Turn your card over.

On the back you’ll see various numbers. Perhaps you’ll see an 800 number for customer service. More specifically, if your insurance company lists an 800 number for “behavioral health” or “outpatient mental health services,” that’s the number you’ll want to call.

When you call the number, you’ll reach a representative who will ask you what you want.

Ask ALL of these questions.

“I’m calling to determine eligibility and benefits for outpatient mental health therapy with Kathie Keeler, licensed clinical social worker.” They will ask you for your name, your member ID (or social security number), and date of birth. After they have determined that you are who you say you are, be sure to ask the following:

  • Do I need a pre-authorization number prior to seeing someone?
  • Do I need to keep track of the number of visits? (Usually you do.)
  • Do I have a copay? How much is it?
  • Do I have co-insurance? (This is a cost-sharing arrangement between you and your insurance company in which you pay a percentage of each visit.) What is the percentage? This is usually true for some Blue Cross/Blue Shield plans, which have both a copay and co-insurance. (It gets tricky because you have to pay both a percentage of each visit as well as a copay each time.)
  • Do I have a mental health deductible? If so, has it been met this year? Some companies have a separate mental health deductible. So, even if you’ve met your medical deductible, it doesn’t necessarily mean that you’ve met your mental health deductible. If it hasn’t been met, you’ll want to find out what you will need to pay at the time of the visit. You can do this by asking the following.
  • What is the contracted reimbursement rate on my plan for an initial visit, billed under the CPT code 90801?
  • What is the contracted reimbursement rate on my plan for subsequent visits, billed under the CPT code 90806?

More information you may need to know:

  • If your insurance company only gives you five visits, you have the obligation to count your visits so that you don’t go over your allotted amount. This is your job; not ours.
  • Some companies will want to know the date and time of your visit prior to giving you a pre-authorization number. They ask this to determine whether or not the therapist has availability. Give them a date and time.
  • Some insurance companies will want to know why you want to see a therapist. They ask this to determine whether or not the problem is “medically necessary.” Most insurance companies will only cover medically necessary diagnoses, such as depression or anxiety. You have the right to privacy. You don’t need to tell your story to an insurance company representative, and probably shouldn’t.
  • Be aware that insurance companies can only stay in business by making a profit. They do this by saving money. And this is where the horror stories begin. What you say can used against you.

    What NOT to say:

  1. “I’m court-ordered to therapy.”
  2. “I want marriage counseling.”
  3. “My child has AD/HD.”
  4. “I’m just stressed and want to talk to someone.”
  5. “I need some anger management classes.”

Although all of these things may be true and legitimate, your insurance company could use this information to disallow visits. Please talk to me first.

You will be given a diagnosis.

Please be aware that your insurance company cannot be billed without a legitimate “medically necessary” diagnosis. This diagnosis is part of your permanent record–not only with the insurance company, but also with the Medical Information Bureau (MIB) The MIB is a central database of medical information shared by insurance companies. About 600 insurance firms use the services of the MIB primarily to obtain information about life insurance and individual health insurance policy applicants. When you apply for life or health insurance, your insurance company may look for codes in the MIB that indicate you’ve had a problem in the past. The MIB is not subject to HIPAA. So, even though our records are confidential; your insurance company will likely forward the diagnostic codes to the MIB. Not only can insurance companies deny applicants based on prior treatment, certain government positions may require an explanation of why you were treated for a medically necessary diagnosis–even many years previously.