What should I expect at my first visit?
At your first visit, you will be asked to fill out paperwork that gives me appropriate information about you and how you want your private information to be handled. You will be given information about privacy, the limits of confidentiality, and office policies, and will have a chance to discuss all of these issues with me to clarify any concerns you have. Then we will discuss what matters most to you--why you have come to see me, what concerns you, what you think contributes to the issues you face, and what you hope to accomplish. For more detail, see the section entitled, "Your First Visit," on this website.
How many sessions are required to complete therapy?
The number of sessions required to complete therapy is highly variable. While the average client comes in anywhere from twelve to twenty sessions, there are people who come to see me for much briefer treatment (sometimes as brief as two sessions--this is not the norm but it does occur) and those who see me for much longer. The course of therapy is determined by multiple factors, including the complexity of the current problem, complexity of the history contributing to the problem, personality factors of the client, level of effort applied by the client in treatment, and unscripted life events that happen to the client during treatment. Ultimately, the "right" length of treatment is what is right for you.
How long is a therapy "hour"?
A therapy hour is typically forty-five to fifty minutes long.
How frequently would I be expected to attend sessions?
Initially, more frequently is better, as this facilitates information gathering and treatment planning. For most people, it really is best to come in once a week and to maintain this schedule for maximum speed and progress. However, frequency of visits is always informed by the individual client needs and complexity of his or her issues. Once treatment is well underway, some clients move to biweekly visits, feel satisfied with their progress, and feel less stressed by the pressure of their own demanding schedules. While some clients would like to visit on a monthly basis, this is usually not very helpful, as so much happens between visits it is not possible to deal productively with the events that have transpired and planning needs too. Monthly visits are ideal, however, for those who are at the end of their therapy and are "tapering off"--monitoring to "fine tune" their adjustment to their changes while preparing to terminate therapy.
What will be expected of me between visits?
Once a treatment plan has been formulated, you will often be given "homework" to apply to your life outside of therapy appointments. This is to help you make real change happen in the real world. Homework often involves new challenges and skill-building efforts. At times, this can be a little intimidating. Courage is necessary to make positive change occur, but know that your needs, sensitivity--and common sense!-- will always be respected. Striking a balance between making changes and not becoming overwhelmed is important.
What if I have to cancel my appointment?
An appointment time is like a hotel reservation--if it's being held in your name, nobody else can have it. But sometimes schedules need to be changed! Please be courteous and call as soon as you know you need to cancel or reschedule. If a cancellation is received less than twenty-four hours before appointment time (or after Friday for a Monday appointment), or if the client fails to show for an appointment, he or she is charged for the length of time that was reserved for him/her.
Sometimes, people express the belief that being charged for a late cancellation (or no-show) is a form of punishment. This is a very unfortunate belief, as it is hurtful to the client and reflects an inaccurate understanding of this common policy. While it is true that a timely notice for cancellation makes schedule openings available to others who might need them, it is actually the rare case that a late cancellation can be filled in a therapy practice. Therapists usually work to prevent the need for emergency care as much as possible, and even people who would like to utilize the time generally find that a late cancellation doesn't give them enough notice to leave work with permission, obtain a babysitter, etc. More typically, the cancelled hour is simply lost for therapy. However, a timely cancellation does help prevent additional wasted preparation time caused by a late cancellation, and prevents needless waste of the therapist's time on the day of the appointment as the therapist waits for someone who doesn't show.
The most significant reason for the policy is the one that is almost never discussed. It addresses a primary aspect of scheduling and cancelling of appointments unique to the psychotherapist's office. Because of the nature of our work, our scheduling differs radically from that of a physician's practice. Psychotherapists must spend much greater periods of time with each client and typically see each client repeatedly, usually on a weekly basis, until therapy is concluded. Prudent therapists are very careful about maintaining a cap on the number of people they see. If a new client is added every time an existing client cancels, that is one more hour a week that must now be available not just for one week but for every week until therapy ends. Repeat this cycle with multiple cancellations across multiple weeks, and in no time at all a situation has developed in which existing clients suddenly can't be seen because there aren't enough openings for everyone, the therapist is overextended, and the quality of therapy suffers notably, while client frustration rises considerably. Needless to say, a client who is being ignored due to therapist exhaustion is not fooled into believing that he or she is receiving quality care. This is no way to conduct therapy. Being responsible for maintaining a regular schedule, and for missed appointments when they occur, protects the quality of your therapy and the availability of appointments for the duration of your therapy.
What are your clients usually like?
My clients are adults, being seen individually or as couples. Most of the people who come to see me are goal-oriented folks who are motivated to be successful in their personal and work lives; they are willing to commit the time and effort to expand their horizons and grow emotionally, vocationally, and personally.
Are there any clients you don't see?
Yes. While some of my clients continue to be in ongoing recovery from substance abuse, those individuals have typically been "sober" or "dry" for at least two years before seeing me. I do not treat people actively struggling with the excessive use of illicit substances, prescription drugs, or alcohol, and will refer those in need of substance abuse rehabilitation to appropriate professionals. Though I have significant experience with very young children and will do some consultation with clients regarding their youngsters and parenting concerns, I have accepted my last young child client and from this point forward will be focusing only on adults and older adolescents.
What is your therapeutic orientation?
While I use a variety of tools from different therapeutic approaches depending on client needs, my primary approaches are cognitive-behavioral, humanistic, and mindfulness-based.
When will therapy be over?
Most often, therapy ends when the client is no longer struggling with the issues for which therapy was started. The client comes in and reports repeated successful management of the problem situation on an ongoing basis, and there are fewer "glitches" in problem management. By the end of therapy, the client has expanded his or her skills sufficiently to manage these "glitches" effectively and with confidence in his or her own skills and choices. Typically, this becomes evident to therapist and client at the same time. Usually there is a tapering-off period with the end of therapy, but again this depends upon the client's needs.
Once therapy is completed, does that mean I should never need therapy again?
Not necessarily. If you successfully addressed a medical problem with the aid of your physician, but later developed a new medical problem, it would be advisable to go back to your physician to address the new problem. Life is unpredictable, with new troubles being thrown at us when we sometimes least expect them. Tending to your own emotional health, like tending to your physical health, is an ongoing process, and it is quite legitimate to seek additional counsel and support when circumstances become challenging.