What do I say when I call a therapist for the first time?

You can say anything. There is no right or wrong way of doing this. Feel free to ask any questions that you want. First, many people ask if I’m taking on new patients. People often want to tell me a little about themselves or their situation and then ask if I can help them. Sometimes they’ll ask if I have a specialty in a particular area, like anxiety or depression. People often have questions about the financial aspects of therapy. It’s OK to leave a detailed message and I will get back to you as soon as I can to answer any questions that you may have about therapy in general or my practice specifically but, oftentimes it makes sense to meet in person to ask questions. It’s not a bad idea to meet as a “consultation” which means meeting once or twice in order to get ideas about and learn more about what therapy might be like. This gives you a sense of what I’m like as a therapist. The client is a consumer and it’s OK if you want to “shop around” by looking online for therapists, asking friends or family for recommendations, or meeting in person with one or two before deciding. If you email me, you are welcome to ask your questions in your first email to me.

What’s the first appointment like?

First appointments usually last about 60 minutes.  I don’t like overly-structured interviews and so generally, we’ll discuss why you came to see a therapist and what is going on and what you think might be most helpful to you. Specifically, we might discuss the problems you are having, begin to take a history of those problems, identify patterns of relating to important people in your life, and examine your coping skills. I very much believe that my clients know deep down inside what might be most helpful to them.  When you can steer the direction for what we talk about in therapy, it can work best. If you need help getting started, just ask and I can ask lots of questions too. We’ll often discuss plans for treatment and allow time for you to ask as many questions as you would like. Subsequent sessions are usually 50 minutes long and my fee is the same for those sessions, $180.00.

How long are sessions?

Each session is 50 minutes long. If you want to bring a family member or you are coming from a long distance, sometimes it might make sense to do a double session. Occasionally, patients want to keep sessions to 45 mins or be certain they are an hour and we can adjust the fee accordingly.

How long does therapy take?

The length of treatment depends on the issues you want to address. While it is true that many people often feel better after a few sessions and even resolve the issues that brought them in after 6-8 sessions, this is not always the case. Clients often have a preconceived idea about how long therapy should take. Many therapists seem to believe that good therapy takes about a year. There seems to be some evidence for this that may be related to the longer time allowing for therapist and client to be able to ensure that gains are maintained and to track someone during the course of struggles and issues that arise through the natural progression of the seasons, holidays, relationship conflicts, and issues that emerge and cycle. I seem to have as many people who come for 1-2 sessions as I have people who come for 1-2 years. After our first meeting, if it seems important to you, I can assess and offer a suggested length of therapy for you. Some clients like to contract for a length of time since that seems comforting or helps to provide us with structure. As you make progress, you and I can discuss the option of changing the frequency of meeting times to every other week, monthly, or even every other month.

How often would I come for therapy?

That depends on how much support you need and how eager you are to do the work and how quickly you want to tackle issues. Most patients come weekly, but I see a lot of people twice a week or twice a month. Sometimes the reasons for coming every other week are financial. It’s a lot cheaper to come once every two weeks. In general, it makes sense to start off weekly until we get to know each other and then after some time, it might become clear that a second session a week is necessary or, that it would be fine to move towards every other week. I prefer to see people over a longer period of time even if less frequently because I find this allows me to get to know clients in a deeper and more genuine way.

What’s the difference between the terms “clients” and “patients”?

Nothing, really. The term “patient” can imply a medical model in which the doctor works on and heals the patient, and so many people feel the term “patient” refers to someone who is passively receiving treatment. Since psychotherapy involves active and collaborative participation many people prefer the term “client” to capture this collaborative nature. A client hires the therapist to work with him or her. Psychiatrists tend to use the term “patient” more, probably because they are steeped in the medical model. Freudian therapists of all types tend to use the term “patient” more often. College and university counselors tend to use the term “client” more frequently. Most of my colleagues are pretty good at switching back and forth.

Confidentiality: What does that mean exactly?

Your confidentiality is protected by state law and by the ethical guidelines of the practice of psychology. All information concerning patients is held confidential and can only be released through your authorization. There are a few instances when confidentiality can be broken, which generally involve a child being abused or the possibility that you might hurt yourself or someone else. In these rare instances, I encourage my patients to report this first. If you have questions about these topics, please feel free to ask.  Nine times out of ten, we are able to arrange for your safety. I work with a lot of clients who think about suicide or who hurt themselves often, and it is critically important that you can talk to your therapist about this without fearing that you will be sent to a hospital.

What if I think about or talk about suicide? Will I automatically have to be hospitalized?

This is a complicated issue. As mentioned above, therapists and clients are usually able to arrange a plan for safety that is clear and solid and that minimizes risk sufficiently. I do work with a lot of clients who think about suicide or who hurt themselves sometimes as a way of coping with stress or establishing control over their feelings and it is critically important that a client can talk to his or her therapist about these behaviors and feelings without fearing that they’ll be sent to a hospital. For many people, suicide is a way out and it is an option. Just thinking about it can actually give some clients some relief, though the recognition that one thinks about suicide can be terribly scary to others. If you think about suicide, I’ll regularly ask a series of questions to determine your level of risk and make suggestions and recommendations accordingly.

Can you prescribe medication? What if I need medication?

No, I practice psychology, not psychiatry or medicine. I know a lot of psychiatrists in Philadelphia and the surrounding suburbs and regularly consult with physicians and psychiatrists who can prescribe medication or who can consult you about your options and continued medication management. I like to work closely with your physician or psychiatrist and I’ll ask you for a release of information in order to be able to speak freely with him or her.

How do I track progress?

After our first session together, we will begin to identify some goals and objectives that you would like to accomplish during therapy. We will continue to measure your progress by evaluating these goals from time to time. There are some tests and measures that we can use to track progress statistically if you’re interested but, I find that most clients know deep down if they’re getting better or not. There is extreme variability in how much clients find that they improve over time. Some clients tend to feel better just knowing that they’ve begun the difficult process of seeking help. Occasionally, clients feel worse before they feel better. Most clients have a good internal sense of how they know they are capable of feeling and will know when they are feeling better.

Do you take insurance?

Not exactly. “Take insurance” is insurance talk for “a signed contract with an insurance company.” I don’t sign contracts with insurance companies for several reasons (see below), but I can work with your insurance company as an “out-of-network” or “paneled” provider. It is usually an easy process and I can help you with it. You’ll have to contact your insurance company and ask about your mental health or substance abuse “out-of-network benefits.” Insurance companies can reimburse any amount they chose to though, which could be 30% or maybe 80% percent depending on your plan and deductible. All my patients pay my fee at the time of our session or before and then I will provide you receipts that you can submit directly to your insurance company for reimbursement.

It’s important to ask your insurance company whether you will have a deductible, how many sessions they’ll pay for, and what percent they’ll pay for. Also, ask them if they will need a diagnosis and, if you’re concerned, ask if your diagnosis will be kept confidential or will it be transmitted to future insurance companies should you ever change plans. Unfortunately, because of the difficulties with insurance companies today, many people I work with do not end up using their insurance plans. About half of my patients don’t submit claims at all and for those that do, there is a large range of reimbursements that they receive. If you really need to be fully reimbursed for all of your treatment, the only way to do that is to contact a therapist that has contracted with your insurance company. If you want to choose a therapist who you match with well, then you may need to choose someone who is out-of-network.

Why are an increasing number of psychologists not on “insurance panels” or “in-network providers”?

I have chosen not to join insurance panels as an in-network provider for a few reasons: 1) there is a great amount of paperwork to submit for in-network benefits and the filing process usually requires a significant amount of time and can often involve a potential breach of client confidentiality 2) insurance companies want a psychiatric diagnosis and will then determine based on the diagnosis given how many sessions they will cover. This information often becomes a permanent part of your medical file and might increase the cost of your future health insurance premiums and 3) the insurance panel fee schedules are well below the national average and are therefore not ideal for established psychologists. Most psychologists who choose to accept insurance are either just starting out or are striving to fill their practice as insurance companies make frequent referrals to psychologists in their network.

What are your fees?

My fee is $270.00 per session and sessions are 50 minutes long. I charge the same rate for an initial consultation. In some instances I can do a sliding fee scale down to 240. My ability to offer a sliding fee scale depends on how many patients I currently have who I am seeing on a sliding fee scale. Additionally, I have associates that I work with who offer sliding scale fees of $180-220.  My ability to offer a sliding fee scale also depends on how many current patients I have who I am seeing on a sliding fee scale. I have several sliding fee slots, so please don’t hesitate to ask. I require 48 hours notice for cancellations so it’s important to remember that I do have to bill for sessions that are canceled without at least 48 hours notice regardless for the reason for the cancellation. This is standard in our field. People can pay by check or cash at the time of the session. I do not have a credit card system but many clients find it easier to pay for sessions in advance. I prefer you to write a check out before our session which allows for a few extra minutes of time for us.

For more information about counseling services in the Philadelphia and Bala Cynwyd areas, please contact Jeremy Frank and Associates.