Is therapy right for me?
Can't we simply solve the problems on our own?
How can therapy help me, my child, and my family?
What is it like to be in therapy?
What therapeutic techniques do you use to help me reach my goals?
What is a psychoeducational evaluation?
When is a psychoeducational evaluation needed?
What are the advantages of retaining the services of a clinical psychololgist who is also a licensed educational psychologist?
Do you accept insurance?
Is therapy confidential?
Seeking out therapy is an individual choice. There are many reasons why people come to therapy. Some want to get help for a child who is struggling academically or socially. Others feel they need help dealing with a child who has anxiety and unrealistic fears, lacks confidence or has self esteem issues. Parents want to develop skills and strategies that help them become more effective parents and to get assistance with managing tantrums, aggression, oppositional behavior and factors that hold a child back from doing his or her best. Some want to get help with long-standing psychological issues and problems with anxiety or depression that continue to affect their relationships and are holding them back from leading the life they want to live. Others enter therapy in response to unexpected changes in their lives such as a divorce, work transition or death of a loved one. Many seek the advice of a counselor as they pursue their own personal exploration of identity and growth. Working with a therapist can help provide insight, support, and new strategies for all types of life challenges. Therapy can help address many types of issues and is right for anyone who is interested in getting the most out of their life by taking responsibility, creating greater self-awareness, and working towards change in their lives.
What's the difference between counseling and psychotherapy?
You will find that these two terms are used interchangeably. Technically, however there is a difference. In a counseling relationship, the counselor or therapist may provide guidance, dispense advise or counsel much like an attorney dispenses legal counsel, an accountant dispenses financial advise, or a member of the clergy dispenses spiritual counsel. In a counseling relationship, the "counselor" may teach or provide information in a didactic manner. An example would be providing parenting education or parenting support to teach parenting skills. Psychotherapy, on the other hand, refers to the treatment of psycholgical or emotional problems using techniques proven effective for particular disorders such as depression, anxiety, PTSD, or OCD. Chances are that in every therapy session, there is a little of both going on.
Can't we simply solve the problems on our own?
Everyone goes through challenging situations in life. Although your child, you and/or your family may have successfully navigated through other difficulties you've faced by talking with trusted friends, family members, or clergy, there are times when this may not be enough and professional help is necessary. Therapy is for anyone who has enough self confidence to admit that they are not perfect and that there is always room to improve. It is for people who have enough self-awareness to realize that the way they have been conducting their lives isn't working out so well. It is for those who have enough common sense to know that something needs to change and for those who have the motivation to make those changes. Acknowledging a problem and taking the time to understand it and make changes is a sign of strength and courage. It is an expression of one's love for self and others. By admitting there is a problem you have taken the first step. You are taking responsibility by acknowleding the current state of your life and making a commitment to change what is no longer working for you and your family. This is an action that deserves praise, encouragement, and a pat on the back.
How can therapy help me, my child, and my family?
A number of benefits are available from participating in psychotherapy. Therapy has the potential to provide long-lasting benefits and support, giving your child and you the tools you need to avoid triggers, re-direct damaging patterns, and overcome whatever challenges you may face.
Therapists can provide support, problem-solving skills, and enhanced coping strategies to address issues such as tantrums, aggression, oppositional behavior, depression, anxiety, relationship troubles, unresolved childhood issues, grief, stress management, body image issues and creative blocks. Many people also find that therapists can be a tremendous asset to managing personal growth, interpersonal relationships, family concerns, marriage issues, and the hassles of daily life. Therapists can provide a fresh perspective on a difficult problem or point you in the direction of a solution. The benefits you obtain from therapy depend on how well you use the process and put into practice what you learn. Some of the benefits available from therapy include:
Attaining a better understanding of your child
- Developing realistic expectations for your child
Attaining a better understanding of your behavior and how you may be contibuting to your problem or disatsifaction with life
Developing skills for improving your relationships with your partner, spouse and children
- Developing appropriate and effective ways to curtail behavior problems and manage them when they do occur
- Reducing the tension and negativity in your family
Increase positive family interactions and improve your relationships
- Finding resolution to the issues or concerns that led you to seek therapy
- Learning new ways to cope with stress and anxiety
- Managing anger, grief, depression, and other emotional pressures
- Improving communications and listening skills
- Changing old behavior patterns and developing new ones
- Discovering new ways to solve problems in your family or marriage
- Improving self-esteem and boosting self-confidence
- Developing self-acceptance
What is it like to be in therapy?
Therapy is "an intimate form of learning" (Corey, 2009). Every therapy session is unique and caters to each individual and his or her specific goals. Sessions may be conducted in the therapist's office, in your home, or out in the community; It all depends on your and your family's needs. It is standard for you to discuss the primary issues and concerns in your life during therapy sessions. It is common to schedule a series of weekly sessions, where each session lasts about an hour. Therapy can be short-term, focusing on a specific issue, or longer-term, addressing more complex issues or ongoing personal growth. There may be times when you are asked to take certain actions outside of the therapy sessions, such as reading a relevant book or keeping records to track certain behaviors. You may be asked to be more mindful (i.e., pay closer attention) to your behavior and how it affects others. You may be asked to "try out" new behaviors and explore the results. You may be asked to challenge your assumptions about yourself, others and the world and explore the accuracy of your assumptions. It is important to reflect upon what has been discussed and integrate it into your life between sessions. For therapy to be most effective you must be an active participant, both during and between the sessions and you must attend your sessions regularly. People seeking psychotherapy are willing to take responsibility for their actions, work towards self-change and create greater awareness in their lives. Here are some things you can expect out of therapy:
- Compassion, respect and understanding
- Perspectives to illuminate persistent behavioral patterns and negative feelings
- Real strategies for enacting positive change
- Collaborative process that helps you with making independent choices and accepting the consequences of those choices
Effective and proven techniques along with practical guidance
The methods used vary and depend on the unique needs of the client. I tailor interventions or select the best treatment techniques for the individual the presenting problem, and the desired outcome. Therefore my therapeutic orientation can be described as integrated and "client driven." Below is a description of the various intervention models that may be implemented:
Cognitive Behavior Therapy
Individuals tend to incorporate faulty thinking or negative self-beliefs as they go about their day. Our views of ourselves and what we think others are thinking about us are often quite distorted and this leads to emotional and behavioral disturbances (e.g., depression, anxiety, acting out, feelings of inadequacy). How we think (i.e., our "cognitions") are the major determinants of how we feel and act. Cognitive Behavior Therapy or CBT is based on the premise that if we can change the way we think, we can change the way we feel and behave. CBT is a psychoeducational model that views therapy as a learning process. The goal is identify and challenge distorted cognitions, acquire and practice new skills, learn new ways of thinking, and acquire more effective ways of coping with problems. Research suggests that CBT is one of the most effective treatment modalities for depression.
Behavior is the product of learning. We continue to do things for which we've received reinforcement or some type of "payoff" (e.g., praise, acknowledgment, attention, or relief from discomfort, money, etc.) in the past. We continue to do things because the behavior gets us what we want, need, or desire. We discontinue behaviors for which we no longer receive reinforcement. Sometimes parents may do things that inadvertently reinforce undesirable behaviors in their children (e.g., trantrums or non-compliance) and a therapist can help you identify these patterns, help you understand why you are getting the reaction you're getting from others, and help you develop more effective strategies to bring about a desired outcome. This form of therapy is used to treat conditions such as social anxiety, phobias, PTSD, and obsessive compulsive behavior. This form of therapy, like CBT, is a psychoeducational model that emphasizes how we learn, why we continue to do what we do, and focuses on how to come up with alternative ways to get needs met.
The basic focus of reality therapy, which is also known as "choice theory," is on what clients are "doing" (i.e., their behavior) and how to get them to evaluate whether their present actions are working for them. This model is based on the premise that people are mainly motivated to satisfy their needs, especially the need for significant relationships and that with rare exceptions, everything we do is by choice. Contemporary reality therapy focuses quickly on the unsatisfying relationship or lack of a relationship, which is often the cause of the client's problems. When client's complain about how other people are causing them pain, the therapist will be supportive and compassionate, but he or she will not spend too much time focusing on finding fault. Instead, the reality therapist will ask clients to consider how effective their choices have been, especially as these choices affect their relatioships with significant people in their lives. When using this model, the therapist will deal with clients "as if" they have choices and if we all choose what we do, we must also be responsible for what we choose or the consequences of our actions. And if the choices we are making aren't working, we must consider alternative choices. The basic axiom of choice theory is this: "The only person you can control is yourself." (adpated from Corey, 2009)
Post Modern Approaches
These approaches, which include solution focused brief therapy and narrative therapy tend to be brief and fit well with the limitations imposed by a managed care structure. The emphasis on client strengths and competence appeals to clients who want to create solutions and revise their life stories in a positive direction. It involves reframing experiences or putting a "new spin" on past experiences and viewing them in a new light and from a more positive perspective. Clients are not blamed for their problems but are helped to understand how they might relate in more satisfying ways to such problems.(adapted from Corey, 2009)
Family Systems Therapy
As much as we would like to view ourselves as autonomous individuals, capable of free and independent choice, the reality is that we are all born into families that most of us are attached to --whether we like it or not -- our entire lives. And although we are born with a certain temperament (our nature) that influences who we will become and how we interact in the world, our family, and how we are nurtured, shapes us, too. Our family influences who we are, how we feel about ourselves, what we will become, what are values will be, and how we behave in the world. As part of a family, we develop our sense of self; we grow and change; and hopefully we give and receive the support we need to survive.
The Family Systems approach is based on the idea that individuals and their symptoms or presenting problems are best understood within the context of their family and the interactions that go on in that family. The development and behavior of one family member is inextricably interconnected with others in the family. So what one member does, affects the others. Families develop maladaptive patterns of interacting for a variety of reasons. When using any one of the family systems approaches, the therapist will help the family identify these patterns, help them understand what is going on and why, and help the family make changes. From a systemic approach, neither the individual nor the family is blamed for a particular dysfunction; each member contributes to the functioning or dysfunction of the system. This is why the family is considered "the identified patient." Working with the entire family unit provides a new perspective on understanding and working through both individual problems and relationship concerns. Although it has its limitations--as all models do--by exploring one's family of origin and transgenerational patterns (i.e. from one generation to the next) there are increased opportunities to understand why we do what we do and to resolve conflicts. (adpated from Corey, 2009)
The practice of psychoanalytic based psychotherapy has come along way since the days of Freud. Although there are still those clinicians who practice as Freud and his colleagues did (with the patient on the couch and the analyst sitting behind the patient, taking notes and not saying much), the contemporary version of psychoanalytic therapy looks a lot different. Not only do the patient and therapist sit facing one another but, these days, there is a lot more talking going on. The "relationship" between the therapist and the patient takes center stage. This relationship is analyzed and explored in a collaborative manner as this is the primary means by which the therapist begins to understand the patient's past and present pattern of relating to others. The therapist may interpret dreams, analyze the patient's use of particular defense mechanisms, and use techniques such as free association to gain insight into the patient's unconscious processes. Whatever methods the therapist uses, the goal is to unearth conficts that are causing anxiety or distress in the patient. This approach is typically used when clients wish to spend time gaining personal insight into how their past relationships and experiences influence their present life and the choices they make. It can be brief (a few sessions) or of longer duration (years). The psychodynamic approach can be used for individual as well as family therapy.
Children like to play. Oftentimes children are unable to identify and talk about their emotions/feelings the way adults do. Play becomes therapeutic to children as they give expression to their experiences and emotions. As they play, children can recreate the experiences that are part of their daily life: their anger, fears, sadness or frustrations that may be currently influencing their behavior. It is the natural way for them to work through their conflicts and distress. Children are referred for play therapy to resolve their problems/challenges at home, with friends, and at school. Through play, therapists help children learn to cope with difficult emotions, practice more adaptive behaviors and find solutions to problems. By confronting problems in the clinical setting, children find healthier solutions when there are emotional or social skills deficits. Through play therapy, children learn to communicate with others, express feelings, modify behavior, develop problem-solving skills, and learn a variety of ways of relating to others.
Play provides children with a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development. The positive relationship that develops between therapist and child during play therapy sessions provides an emotional experience necessary for healing. Through the play therapy process, children can change their personal view of events in the world and begin to better enjoy their interactions with others. This leads to higher self-esteem and more enjoyment of activities with family, friends and peers.
Play therapy is appropriate for children ages 3 through 12 years old to address a variety of behavioral and/or emotional issues. Each weekly play therapy session usually lasts about an hour. It is difficult to determine how long treatment will take and depends on four important factors: (1) the developmental stage of the child; (2) the age of the child at the onset of the issue; (3) the consistency or regularity of attendance at scheduled sessions; and (4) the degree of commitment of the parent(s) to follow through and be consistent with suggested interventions.
In all cases, families play an important role in children's healing processes. The interaction between children's problems and their families is always complex. Sometimes children develop problems as a way of coping with something wrong in the family; other times, the family becomes distressed because the child's problems are so disruptive. The therapist will make decisions about how and when to involve some or all members of the family in the play therapy. At a minimum, the therapist will communicate with the child's caretakers to develop a plan for resolving problems as they are identified and to monitor the progress of the treatment. Other options might include involving the parents or the entire family in treatment.
Is medication a substitute for therapy?
In some cases a combination of medication and therapy is the right course of action. Working with your medical doctor you can determine what's best for you. It is well established that the long-term solution to mental and emotional problems and the pain they cause cannot be solved solely by medication. Instead of just treating the symptom, therapy addresses the cause of our distress and the behavior patterns that curb our progress. You can best achieve sustainable growth and a greater sense of well-being with an integrative approach to wellness.
What is a Psychoeducational Evaluation?
A psychoeducational evaluation is a comprehensive and systematic investigation of various mental functions that is used to arrive at an understanding of how a person thinks, behaves, and learns as part of the educational or occupational system. A comprehensive psychoeducational evaluation identifies both strengths and weakness and focuses on how deficits in various domains may affect school and work functioning. The various mental functions or domains that are investigated include, but are not limited to, the following:
- Academic Skills
- Language Development and Communication Skills
- Cognition including problem solving, reasoning, and conceptualization
- Attention and memory
- Learning styles
- Executive functioning (i.e. planning, organization, initiation, shifting, etc.)
- Auditory and visual perception
- Sensory motor integration
- Social Skills
- Adaptive Skills
- Emotions, behavior and personality
- Vocational Skills
A psychoeducational evaluation can assist in planning educational and vocational programs, identify the most appropriate methods of intervention and/or accommodations in the school, home, and/or work setting. The evaluation can also assist in tracking the progress of interventions.
When is a psychoeducational evaluation needed?
A psychoeducational evaluation is needed when it is suspected that a child , teen or adult may have conditions that are impacting their ability to learn and/or function adequately within the educational setting or work environment. These conditions may include, but are not limited to, the following:
- Developmental learning disabilities that may affect reading, math, writing, and receptive and expressive language.
- Processing disorders
- Attention and concentration disorders
- Memory problems
- Difficulty planning, organizing, and initiating tasks
- Poor school or work performance despite apparent ability
- Behavior problems
- Social and emotional difficulties including anxiety related to academic tasks
- Language and communication deficits including pragmatics i.e. social language
- Pervasive Developmental Disorders such as Asperger's Syndrome
A psychoeducational evaluation can be conducted at any age at which an educationally related problem is suspected or when information regarding present levels of functioning is desired. If you answer "yes" to any of the following statements you may want to consider a consult to determine if a psychoeducational evaluation is the next step for your child.
- I am concerned about my child's academic progress.
- My child is struggling with reading, spelling, or math.
- My child has trouble understanding what he or she reads.
- My child has trouble understanding directions.
- My child seems unmotivated or complains of being bored.
- My child is easily frustrated and has "meltdowns" and cries when doing homework.
- My child does whatever he or she can to avoid doing homework.
- We have frequent battles when doing homework.
- After studying for a test, my child forgets what he or she has learned by the following day.
- Information seem to go in one ear and out the other.
- My child seems very distracted, has difficulty focusing, or loses interest easily.
- My child becomes unduly upset by changes in plans.
- My child seems depressed, irritable and his or her moods change frequently.
- My child seems excessively worried or anxious about school.
- My child is disorganized and forgetful.
- My child has trouble relating to other children, has trouble making or keeping friends or has trouble getting along with peers.
- I feel my child needs accommodations in the classroom to help him or her be more successful in school.
- I feel my child may need to be in special education.
What are the advantages of retaining the services of a clinical psychologist who is also a licensed educational psychologist (LEP)?
All clinical psychologists have had some degree of training in testing, but only some of us are trained in conducting comprehensive psychological and psychoeducational evaluations, as this is a specialized area of practice. Clinical psychologists who do conduct evaluations may or may not have spent time working or training in a school setting and this is a helpful experience to have as a clinician. One of the advantages of using the services of a clinical psychologist who is also a licensed educational psychologist is that all LEPs have spent time working within the school system at some point during their career. Consequently they bring a unique and valuable perspective to the evaluation and intervention process that many clinical psychologists may not have. We know how the school system works. We are familiar with district and state curriculum and grade level standards, eligibility criteria, and the IEP and 504 Accommodation processes.
Working in the public school system for over 25 years as a school psychologist and over 30 years as a licensed educational psychologist in private practice has given me the opportunity to work with a wide range of special needs populations. I have first-hand knowledge of the supports available for students within the school setting. This knowledge can be a real asset to a family who is attempting to secure school based assistance for their child.
Do you accept insurance? How does insurance work?
- What are my mental health benefits?
Does my insurance carrier reimburse for out-of-network providers?
If so, how much does my insurance pay for an out-of-network provider?
What type of verification do they require to facilitate reimbursement ?
- What is the coverage amount per therapy session?
How many therapy sessions does my plan cover?
- Is approval required from my primary care physician?
Is therapy confidential?
In general, the law protects the confidentiality of all communications between a client and psychotherapist. No information is disclosed without prior written permission from the client.
However, there are some exceptions required by law to this rule. Exceptions include:
- Suspected child abuse or dependant adult or elder abuse. The therapist is required to report this to the appropriate authorities immediately.
- If a client is threatening serious bodily harm to another person. The therapist is required to notify the police.
- If a client intends to harm himself or herself. The therapist will make every effort to work with the individual to ensure their safety. However, if an individual does not cooperate, additional measures may need to be taken.