Answers to Some of Your Questions About Psychotherapy

Answers to Some of
Your Questions About Psychotherapy

How Do I Choose the Right Counselor or Psychotherapist?
What Can I Expect on the Phone and at the First Session?
What Happens After the First Session?
I am a Businesswoman Who Travels Occasionally for Work. Can I Still See You?
What About Confidentiality?
How Much Will This Cost?
What about Credit Cards or PayPal?
What About Using My Insurance or Medicare Benefits?
How Long Does Therapy Take?
Shouldn’t I Choose a Therapist with Lots of Online Reviews?
What is an MFT or LMFT?
How Does an LMFT Differ From a Psychologist and Other Therapists?
What is Relational Psychotherapy?
I Have More Questions.

Q.     How Do I Choose the Right Counselor or Psychotherapist?
A.     Determining whether someone is the “right” therapist can be challenging, especially if you are considering therapy during a difficult time in your life. Some things to consider:

  • Do I feel safe with the therapist?
  • Can I trust the therapist and tell her or him the things that are bothering me?
  • Does the therapist respect my confidentiality?
  • Do I feel comfortable with the therapist even if I am discussing uncomfortable feelings?
  • Do I feel like the therapist can help me with the problems I am facing?

The best way to determine whether a therapist is a good fit for you is to talk to the person on the phone and then follow up with a face-to-face meeting. Take some time during and after the call and meeting to consider how it felt to talk to the therapist. If you are not feeling comfortable, you may want to move on and try someone else, but it may also be helpful to think about what feels uncomfortable. Talking about whatever might be going on for you can bring up complicated feelings and can sometimes feel uncomfortable, regardless of the connection you have with the therapist. To help people make an informed decision about therapy, the first page of this website contains links to several articles about finding a therapist. I hope you find them helpful.

Q.     What Can I Expect on the Phone and at the First Session?
    Our initial phone call will give both of us an opportunity to begin to see if working together could be helpful to you. If our phone call feels comfortable, we can schedule an initial face to face meeting. Choosing a therapist can be a difficult decision, often made during stressful times. Take the time to choose someone you think is a good fit for you.

Telehealth Addendum:
If we will be meeting via phone or video conferencing and not in person, I will forward paperwork to you for review and signature. I will provide more information about this during our initial telephone call.

The First Session:
At our first session, I will invite you to talk about what has led you to consider therapy and what you hope to gain from this experience. There will be time for questions and, if we are meeting in person, for completing a small amount of paperwork. The first session will give us a sense of what it will be like to work together.

If working with me does not seem like it will help you to reach your goals, I am happy to offer referrals to other therapists and/or agencies. And if you have any hesitations whatsoever, I strongly encourage you to have an initial session with more than one therapist so that you can feel comfortable that you are making the best possible choice.

Q.     What Happens After the First Session?
Because each person is unique, each person’s experience in therapy will also be unique. In general, however, our focus will be on what is happening for you in the present while weaving in past experiences and family history. Understanding the reasons behind your feelings and actions can give you the insight that helps you to make the changes you want in order to live more fully and authentically. While therapy cannot change your past, it can help you to look at your past differently and to face today’s challenges with a different perspective.

I view psychotherapy as a collaboration between two (or more) people. I am active and engaged during our sessions and regularly invite feedback about our work together. I strive to find the optimal balance between creating a safe and supportive environment and one that challenges you to look at yourself with honesty and compassion.

Also, please note that if we agree to work together, I will ask you to commit to a regularly scheduled weekly (or more frequent) session. I have many reasons for this and I am happy to discuss them with you in our initial phone call or meeting.

Q.     I am a Businesswoman Who Travels Occasionally for Work. Can I Still See You?
A.      To get the most out of therapy, weekly (or more frequent) sessions are strongly advised. However, there are many people who have jobs that require frequent travel. While this can create some challenges for doing therapy, I am happy to speak with you about your situation to see if there still might be ways for us to work together.

Q.     What About Confidentiality?
Everything that is discussed between a client and therapist is legally and ethically considered to be confidential information. However, there are some exceptions to confidentiality. Please see my page Confidentiality for more information.

Q.     How Much Will This Cost?
A.     My current fee is $200. This fee is typical for experienced psychotherapists in the SF Bay Area. Sessions are 50-55 minutes in length.

Q.     Do You Accept Credit Cards or PayPal
A.      In order to keep my fees as low as possible, I do not accept credit cards or PayPal. Payment may be made in the form of check, cash, or agreed-upon electronic means, such as an electronic check sent directly from your bank, Zelle, or similar. Please check with me if you have concerns about payment.

Q.     What About Using My Insurance or Medicare Benefits?
A.     While insurance can be a way to help make therapy more affordable, I encourage you to think carefully before using your insurance for therapy services. Your insurance company will likely require that your therapist provide a diagnosis along with regular updates regarding your progress in therapy. There may be limitations on the number of times we can meet, which may be problematic with respect to obtaining the results you are seeking. You and I do not have control over how the insurance company may use that information, which is especially concerning given that the issues of healthcare and preexisting conditions remain unresolved in the current political environment. Also, therapy is not just for solving problems, but it can offer an opportunity to look at ourselves at a deeper level and create the potential to lead richer, more fulfilling lives. This is not something typically covered by insurance. As a result, I have chosen not to accept insurance directly.

Out of Network
I am happy to provide receipts and “superbills” that you may be able to use to obtain out-of-network reimbursement from your insurance company or flex plan account. Please note that you would be responsible for payment to me at the time of service and you would then submit the “superbill” (provided monthly) for reimbursement to be made directly to you. Please check with your plan administrator and insurance company to make sure that you are able to obtain reimbursement for out-of-network providers and make sure that you are aware of any restrictions and/or deductables. Also, while reimbursement from a flex plan account usually requires just a receipt from a provider, out-of-network reimbursement may require additional information such as a diagnosis. I encourage you to think about the possible downsides of submitting superbills to your insurance company and I am happy to discuss this with you. Please see What About Using My Insurance? above.

For many of the same reasons that I have chosen not to work directly with insurance (Please see What About Using My Insurance? above), like many experienced therapists, I have also elected to opt out of accepting Medicare payments. This means that if you are a Medicare recipient and you decide to work with me, you will be responsible for the full fee and will NOT be able to seek reimbursement from Medicare. In addition, if you are a Medicare recipient, I am legally required to obtain your signed acknowledgement that I have informed you of this. If you are over the age of 60, I will ask you to do this when completing the initial paperwork. Of course, it is your right to seek a therapist who accepts Medicare.

Q.     How Long Does Therapy Take?
A.     The short answer is that it depends on the issues you bring in and on what you would like to get out of this experience. In some cases, people come to therapy because they need help resolving a single issue that they have already thought about and the work can move quickly. In other cases, there may be a great deal of complexity because of the number and types of issues presented, because of the person’s history, or because working on the presenting issues has led to an interest in further exploration.

People often seek therapy because they are dissatisfied with their lives and/or want to take the time to look at themselves deeply. Many people come to therapy without any specific agenda or goals but because they find it helpful to have a safe, confidential, and structured time to focus on themselves, explore their feelings, and think through what might be going on in their lives. Each person and every situation is unique. As a result, it would be misleading for me to offer an estimated timeframe. The decision to continue or end therapy is always yours, although I encourage you to make this decision together with your therapist. Therapy can bring up uncomfortable feelings that we might want to avoid and it is important to distinguish between a desire to avoid something important (which is always up to you) and whether it is a good time to end therapy. Again, unless you are in a crisis situation, the decision is always yours to make at any time.

Q.      Shouldn’t I Choose a Therapist with Lots of Online Reviews?
A.     Psychotherapy is built on a foundation of confidentiality. As a result, in many states, including California, the code of ethics for psychotherapists expressly prohibits the solicitation of reviews. If a therapist has many, many reviews, this may mean that they, e.g.,  conduct classes or workshops, which would be very different from doing psychotherapy. And many people who seek psychotherapy understandably choose to keep their experience private. As a result, many, if not most, therapists, especially therapists who work with people in mid-life or older, may not have much of a social media presence. Of course, people often choose to post something about their experience in therapy on social media; however, it is important to keep in mind that every therapeutic relationship is unique and everyone’s experience will be different, even with the same therapist.

The best way to find out if a therapist is a good fit for you is to: 1) Check out websites or online profiles (Psychology Today, Good Therapy, Therapy Den, etc.) and see if what you read resonates with you–even if your specific issue is not mentioned–therapists often work with many more issues than they can list online; 2) Select a few people who sound good to you and set up times to talk with them on the phone. This call is usually complementary and involves providing the therapist with brief description of why you are seeking therapy (the therapist also wants to be sure they can be helpful to you) and an opportunity to ask some questions you may have about how the therapist works; and 3) Have an initial meeting and see how that feels.

Q.     What is an MFT or LMFT?
A.     MFT, sometimes referred to as LMFT, is the name of the license held by Licensed Marriage and Family Therapists. Although the name “Marriage and Family Therapist” suggests that MFTs only work with couples and families, MFTs are trained to work with individuals, couples, families, and groups and, especially in California, primarily work with individuals and couples. In California, a Licensed MFT is someone who has earned a master’s degree in psychology, counseling psychology, marriage and family therapy, or a related field; completed a minimum of 3,000 hours of supervised post-graduate experience; and has passed two state licensing exams, some of the most rigorous requirements in the nation. In addition passing the California licensing exams administered by the California Board of Behavioral Sciences, I have also successfully passed the National MFT Licensing Exam, administered by the Association of Marriage and Family Therapist Regulatory Boards.

Q.     How Does an LMFT Differ From a Psychologist and Other Therapists?
A.     There are a number of different licenses for mental health practitioners, which can be very confusing. While there is considerable overlap, each license has a slightly different focus: Psychiatrists are also medical doctors, so they may prescribe medication. Psychologists have special training in testing. Social workers are experienced in case management. Licensed Professional Counselors (LPC) may also provide career assessment services. MFTs focus on human relationships. Yes, I realize this is confusing!

Q.     What is Relational Psychotherapy?
A.     Relational Psychotherapy is an approach to therapy that is based on the connection that is created between you and your therapist. Many studies have shown that the theory used by the therapist is far less important than the relationship that is created in the therapy room. As a therapist, I am interactive, involved, and genuine. I don’t hide behind psychobabble. I view my role as that of a trained and experienced facilitator and guide who is committed to helping you look at yourself in new ways and create new meaning in your life.

Q.     I Have More Questions.
A.    No problem! I welcome your questions. Please contact me at 650-383-7654 or at info(at)marlacass(dot)com.