Counseling Information

What is counseling?

Counseling is a special relationship between a person or a couple  who want to work on a problem or personal growth and a person who is specially trained to help with that process. It is different from a friendship because the counselor is there to help you, but you are not expected to reciprocate. The time belongs to you. This means that you do not need to apologize for focusing exclusively on yourself and your problem, to worry about being boring or not choosing the right word or making sense.   It also means that if you are not getting what you want, you can ask for it and discuss whether therapy is the place to get what you want.

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What do people do in therapy?

People come to counseling wanting:

  • to change a behavior (shyness, brashness, fighting, boundary setting)
  • to work on feelings (lack of confidence, anger, loneliness, depression)
  • to break a habit (drug or alcohol dependence, nail biting or obsessive eating)
  • to improve skills (time management, meeting new people, saying "no" when they want, coping with a chronic illness, becoming a better partner/lover)
  • to understand how things in the past continue to affect them (incest, rape, physical abuse, a parent's death, a parent's use of alcohol, ADD)
  • to understand their family better
  • to grow and expand the joy in their lives
  • to cope with medical/biopsychological problems

Families and couples may want:

  • to improve communication
  • to address issues of intimacy
  • to work on mediating child custody or divorce
  • to regain trust
  • to work on parenting skills

This list only touches on a FEW of the problems that people bring to counseling. 

In counseling, you will talk about situations and emotions and try to figure out more skillful ways to handle them. Many therapists will give you reading or assignments of things to try to see if they help and then you will discuss the results. The goal is for you to develop better ways to handle things, to change old patterns, and to feel more empowered and confident.

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How do I start?

Call to set up an appointment. If you call me for an appointment, I will ask you to fill out some forms before your first appointment. These forms are a way to help me understand your issues and see what coping strengths you already have. Some people find that filling out the forms alone help them understand things better.

When we meet for the first time you will either start out describing your problem the best you can or I will help you by asking questions until I have a starting level of understanding. The first session will last about 50 minutes and is called an intake or evaluation.

Sometimes people want to meet several therapists before choosing the one with whom they feel most comfortable. This can be a good idea, however, remember that therapists get paid for their time and expertise. Most therapists will answer a few questions over the phone without charge. However, if you actually make an appointment, you should be willing to pay for that time, even if you decide not to keep the appointment.

Some personal problems are very hard to talk about to a stranger (but it is also easier to talk to a stranger sometimes than to someone you know). It is easy to feel that you are different or strange if you have had certain experiences. Some people feel ashamed of themselves or their families because of things that have happened. You may want to see if the relationship in counseling feels safe before you share some information. You have a right to go at your own speed.

Counselors are accustomed to hearing about personal problems. In fact, after a therapist has been in the profession for a few years, it is hard to find a problem that the counselor hasn't heard about before. The more openly you can bring up these issues, the faster counseling begins to accomplish your goals. If something is particularly difficult to bring up, you might write it in a letter to the therapist.

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What is the cost of therapy?

This depends on the type of counselor, whether they are licensed, and the type of place you go. It may also depend on whether you are planning to use insurance or to pay out-of-pocket. Insurance companies work out contracts with therapists for lower fees and then they may pay for 50-90% of the cost for you.

Usually the cost of counseling increases with the amount of education and experience your therapist has. In general, private therapy will cost between $50-200 for a 50 minute appointment Beginning therapists or counselors who are not licensed may charge as little as $20 an hour. Some religious counselors ask for a "love offering" or "dana" which leaves the donation up to you. Some therapists have a few hours available for low income clients with special needs and will offer a fee based on your income.

Group therapy is usually less expensive than individual therapy. Some colleges that train counselors and public agencies offer very inexpensive therapy. Contact your county mental health agency to learn about alternatives. If you need medication, your therapist will either work with your primary care physician or refer you to a psychiatrist or nurse practitioner who is able to write prescriptions.

Knowing about your insurance is very important. It is good to find out if your therapist is on your insurance panel. When you call a therapist, feel free to ask what they charge. If you do not have insurance or do not want to use your insurance, ask about whether the therapist has a sliding fee for cash payments. Ethics codes state that therapists should discuss finances so that you will not be surprised by your bill. When a counselor asks questions about money and insurance, it is to meet this responsibility, not because your ability to pay is more important than helping you.

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If I want to use insurance to pay for my counseling, what do I need to know?

Before calling a therapist, it is wise to call your insurance company. Some insurance will allow you to go only to therapists that the insurance companies have chosen. If you go to anyone else, you will have to pay the entire fee. The people they have chosen are called a panel. Other insurance companies pay more of the bill if you go to their panel therapists but will pay part of the bill for therapists not on their panel. Usually you can see who is on the panel for your insurance by going to the web page for your insurance company. You can also call and get names of therapists from your insurance company.

Start with the 800 phone number on the back of your insurance card. There may be a number that is just for mental health and substance abuse counseling. There are a number of questions you will want to ask so have paper and pen available. Write down the time of the call, the date, and the name of everyone with whom you talk. Keep this paper as long as you are in therapy. It is a way to prove that you were given certain information, if the insurance company denies a claim.

Ask the insurance representative the following:

  • Ask how many sessions of therapy you can get.
  • Ask whether there are limitations on what therapists you can see and if there is a pre-authorization number or process you must complete.
  • Find out about your deductible and what date your insurance year starts. The deductible is the amount you must pay before your insurance starts paying.
  • Ask if you have a co-pay (the part that you have to pay). Some companies call this co-insurance.
  • If you are wanting marriage counseling, you will need to ask if that is covered by your policy.
  • Finally, ask what company the person you are talking with represents. Insurance is quite complex and sometimes the company that pays for mental health care is not the same as the one that pays for your physical health care. For instance, if you have Providence Insurance, the mental health services will be covered by Pacific Behavioral Health, which in turn, is owned by United Behavioral Health.

Marriage and couples counseling is often not covered by insurance because it is not considered "medically necessary." Please be aware that asking a therapist to bill for something else can put the therapist at risk for sanctions from the insurance company.

If, however, one person has a diagnosable problem (depression, anxiety, etc.) and it is increased by the marital problems, insurance may cover counseling that approaches the problem from the marriage standpoint.

While this is a subtle issue, the question often becomes "Who is the client?"  In true marriage counseling, the client is the relationship. Sometimes what is best for the relationship is not what is best for one or the other clients. Sometimes leaving a relationship is the best thing for one of the individuals. These boundary lines can become complicated.

While insurance often will not pay for marriage counseling, Employee Assistance Programs will. Check to see if your workplace has an "EAP."

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Who are you and how much do you charge?

I am a clinical psychologist with licensure in Oregon. I have a doctorate degree and law degree from the University of Nebraska. My master's degree in human relations is from the University of Oklahoma. I did my internship at the UCLA Neuropsychiatric Institute (part of the medical school at UCLA).

I have taught in graduate schools and at several colleges. I have also directed two counseling centers. I do consulting with lawyers, other therapists, and programs such as Head Start. I work with a broad range of problems—individual, couple, and family.

In addition, I have specialized training in depression, sexual dysfunctions, recovery from sexual assault, and men's and women's issues. I am a trained mediator.

Please call me about my fees. I give a 20% discount for cash payments at the time of therapy if insurance is not being used. I have a two hours a week set aside for sliding fee clients but there is often a waiting list for these hours.

My office is close to the Hawthorne and Belmont bus routes.

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Will anyone else know what happens in my therapy sessions?

Counselors are required by law and by their ethical codes to protect your right to confidentiality. Unless you give written permission to release information (or unless the law requires it) therapy information is not shared. To get more information about this, see the Confidentiality and HIPAA forms.

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How can I make the best use of counseling?

Keep your appointments. If you need to cancel an appointment, do so as soon as possible (I ask for two business days notice). Consistency is very important to a good counseling experience. Ask for "homework" and reading that you can do between sessions to speed the process of change.

Start a journal about your therapy. Before each session, write about what you want to cover in the session. After each session, as soon as possible, write down what was discussed. Write about your feelings during the time between sessions. Take notes in session. Sometimes, you may have a profound insight into something in your life—and by the time you get home, you may not be able to remember it as well as you want. 

Talk to your therapist about how you are feeling about the counseling relationship. It is common for people to feel frustrated or angry at their counselor at some stage. Some people may feel attracted to their counselor because this person has understood and cared about them—but that attraction should never lead to a sexual or inappropriate relationship with a therapist. These feelings in therapy may be "transference"—transference of feelings you have had for someone else that comes out in therapy.

Sometimes, you find that you cannot work with the therapist. Counselors understand these issues. The first step is to talk to your counselor or to write a note to him or her. Always schedule a final session, even when you are unhappy with therapy, to talk about stopping. (If a counselor responds to you in an unethical manner, you may file a grievance with the state licensing board. Physical intimacy between counselor and therapist is always considered unethical.) Your appointments will usually last between 45-50 minutes. The counselor uses the rest of the hour for making notes and record keeping. Remember that your counselor's income is dependent on the clients they see in a week. They do not get paid by insurance if you miss your appointment. Many counselors will charge you for your hour  if you fail to show up or do not cancel it early enough, unless they can fill that hour with another client.

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