Question 1

HOW DO I KNOW IF I NEED THERAPY?

Accepted Answer

There are not many times that someone would need therapy per se, although I think everyone could use it.  Despite what the social stigma might tell you, psychotherapy is not reserved for those who have gone “crazy” and can be useful for nearly anyone, even relatively healthy individuals.  In fact, given the courage it takes to begin and engage in therapy, I would argue that many of those who are willing to seek help on their journeys are in some ways “healthier” than those who don’t.  Regardless, most of the people who seek therapeutic services are “normal” people just like you and me. 
 
If not for the personal growth experience itself, you might want to consider seeking therapy when:
 
You feel you just need someone to talk to about life’s problems
You feel stuck, trapped, or lost and there seems to be no way out
Your emotional distress is particularly severe, long-lasting, and/or interfering with your ability to function in daily life
You worry all the time and feel like life is out of control
You feel depressed and can’t get out of it
Your coping strategies are hurting yourself or others
You feel like giving up on life and/or are frequently thinking about death
You are having trouble coping with a loss
You are still dealing with the residue of past trauma, violence, or abuse
You are experiencing difficulties in a relationship with your spouse, parent, child, friend, or significant other
You are wrestling with spiritual questioning and need help sorting it out
 
If you can find the courage to give therapy a try, whether out of necessity or desire, I applaud your courage and would be happy to help you in that process in any way I can.

Question 2

WHAT CAN I EXPECT THERAPY TO BE LIKE?

Accepted Answer

The therapeutic process can vary greatly depending on a variety of factors, including--but not limited to--the presenting issues or problems, client personality traits and preferences, as well as therapist personality traits and preferences.  Your experience in therapy with me could be quite different from someone else's. 
 
However, it is always my first priority to demonstrate that you are genuinely valued and to help create a "safe place" so that you can share about your deepest concerns with minimal fear of being judged or criticized.  Many clients find the process enjoyable and even report that the therapeutic bond is among one of their more meaningful relationships. 
 
That being said, it is essential to mention that the therapeutic process can also be very difficult at times.  Therapy typically involves challenging yourself to face some thorny issues head-on and to make some difficult life decisions.  Therefore, it is not uncommon for clients' problems or symptoms to initially get a little worse before they get better.  For those who can find the courage to work through this journey, most will also find the process very helpful and rewarding.

Question 3

WHAT CAN I EXPECT THERAPY NOT TO BE LIKE?

Accepted Answer

Most people’s impression of what therapy is liked is shaped by what they have seen on TV or in the movies.  One typical portrayal is of the client or patient laying down on the couch, divulging dark secrets while the therapist sits behind him or her and is falling asleep or eating lunch.  This is NOT what therapy will be like with me.  You will not be asked to lay down on a couch (though you may if you wish) and you will find that I will be actively engaging in the process with you.  There are not many accurate representations of my style of therapy in popular media, but to give you some reference think of Robin William’s character in “Good Will Hunting.”
 
Another popular myth about therapy is that the therapist will merely sit there and listen to you but not really do anything that helpful.  As a general rule I believe it is important to listen more than I talk in therapy sessions, though I will be doing much more than simply listening.  First of all, I will be actively reflecting back to you what I am hearing you say so as to help ensure that you are feeling accurately understood.  Once this is achieved, I will be working collaboratively with you to develop a plan on how to make changes in your life.
 
One last myth that I often encounter is that the therapist is there to offer you advice or to tell you what to do to make life better.  Some people come to therapy wanting the magic solution to their problem and unfortunately I just don’t have it.  Quite honestly, no one does…except you.  No one knows you better than you do, and I firmly believe that everyone has the unique insight into how best to make positive changes in their life.  I believe it is my job to help facilitate that exploration and to empower you so that you can learn to make those changes on your own without needing someone else (like me) to “tell you what to do.”  Though advice giving can at times be helpful in the short-term, it is ultimately not a viable long-term solution.

Question 4

WHAT IS YOUR THERAPEUTIC ORIENTATION?

Accepted Answer

The foundation of my therapeutic approach is person-centered.  This approach is not a set of pre-prescribed “techniques,” but rather a way of being in the therapeutic relationship that emphasizes the value and uniqueness of each individual.  Starting with the minute that we first make contact with one another you will matter to me, and I anticipate that you will notice this in the way that I interact with you.  From this vantage point, I believe that both the therapeutic relationship and the here-and-now moment are of utmost importance. 
 
As a “fellow journeyer” with you, together we can explore how you are currently experiencing the world and relationships with others.  I will also act as a mirror for you, giving you honest and appropriate feedback so as to help you learn about how others might be experiencing their relationship with you.  It is often through engagement in such a genuine and honest relationship, as you learn to find greater self-awareness and authenticity in a non-judgmental environment, that real healing can occur.
 
I consider myself an integrative therapist, meaning that I have training and experience with a variety of different treatment modalities and will use the approach or interventions that best fit the needs of each individual client.  I tend to borrow from some of the following clinical orientations:
 
Cognitive-Behavioral therapy (CBT)
Gestalt therapy
Existential therapy
Emotion-focused therapy (EFT)
Brief Psychodynamic therapy
Family/Systems therapy
Narrative therapy

Question 5

WHAT WILL YOU EXPECT OF ME?

Accepted Answer

First and foremost, I will be expecting you to participate.  Just with any other acquired skill, the more you practice the better you will get in the shortest amount of time.  Similarly, those who actively engage in the therapeutic process tend to experience better and faster results. So therapy will require an investment of your time and energy.  It will not work for you to merely “show up.” 
 
Therapy is a collaborative effort, meaning that you will be taking an active role in developing and implementing your treatment plan.  Your investment will also need to extend beyond the therapy hour.  You will be encouraged to think about the content of our discussion in your personal time and I will often suggest—or have you suggest—a variety of “homework” activities that can help consolidate what you are learning. 
 
Finally, you will be expected to be honest with me about your thoughts and feelings, as I too will be honest with you.  For instance, it is not necessary for you to always be “gung-ho” in therapy.  Ambivalence is normal when facing difficult changes or decisions.  All I ask is that you are honest with me about your ambivalence.

Question 6

HOW DO I KNOW WHICH THERAPIST IS RIGHT FOR ME?

Accepted Answer

Research has indicated a strong link between the quality of the therapeutic relationship with the effectiveness of therapy.  However, finding a therapist that you feel comfortable with can potentially be very challenging.  It is important to use careful discernment in choosing a mental health professional to trust with your most intimate concerns, and that includes your decision of whether or not to work with me. 
 
Embarking on the therapeutic journey is a significant investment of your time, energy, and money.  Just as with any other important investment, you should make sure that the return from your investment is a right fit for you.  If at any point in the therapeutic process you begin to feel that it is not a right fit, please feel free to share this with me and I would be happy to discuss alternative means for getting your needs met.

Question 7

WILL OUR DISCUSSIONS REMAIN CONFIDENTIAL?

Accepted Answer

Quite simply…yes.  As a psychologist in California, I am ethically and legally obligated to protect clients from the unauthorized disclosure of personal information revealed in the context of our professional relationship.  This includes disclosing whether or not you have seen me for services.  HOWEVER, THERE ARE EXCEPTIONS TO THIS!  The following situations legally allow me to break confidentiality:
 
Third-party reimbursement
If your insurance coverage pays for any of the costs of your therapy, you are giving your consent for information such as your diagnosis and appointment dates to be shared with your insurance company.  I will provide your insurance company with the minimal amount of information required for their administrative needs.
Collection of debt
If you fail to settle an account balance for your therapeutic treatment, your name and the amount you owe can be made known to a collection agency.
Defense of malpractice or professional complaint
If you were to allege that your therapist engaged in malpractice or some other unethical act, the therapist has the right to disclose information from your sessions in their defense of your charges.
Danger to self or others
California legally mandates psychologists to reveal the name of a client to authorities who is deemed a real and present danger to self (e.g., suicide) or others.  Psychologists are even required to warn or attempt to protect the person against whom the threats are being made.
Child or elder/dependent adult abuse
California also legally mandates psychologists to report the known or suspected abuse of children and elder/dependent adults to authorities, which may include physical abuse, sexual abuse, neglect, etc.
Court order or subpoena
If you are involved in a court proceeding, it may be requested that I divulge personal information about you.  In most cases, unless I have your authorization to disclose such information, I will make every effort to protect your legal right to privacy.  However, certain circumstances (e.g. a court order from the judge) may legally mandate me to disclose the requested information.

Question 8

HOW DO I KNOW IF THERAPY WILL HELP?

Accepted Answer

There is no guarantee that therapy will work in the way that you want it to.  I believe everyone has the capacity to gain something from therapy, but the quality of that benefit depends on a number of factors, including your investment in the process and how well you and I work together.  Again, if for some reason you feel that therapy is not helping you in the way you would like it to, please bring this to my attention to see if there is a way to augment the services you are getting to better meet your needs.  These kinds of “road blocks” are common in the therapy process and talking about them openly and honestly often leads to the opening of new doors. 
 
Something to keep in mind is that sometimes you can be experiencing change and growth without noticing it as it is happening.  Just like when a child “all of a sudden grows up,” even though you’ve been with him/her every day, sometimes it’s easier to see how much you have really grown in hindsight.

Question 9

HOW OFTEN SHOULD I GO TO THERAPY?

Accepted Answer

One session per week is the “industry standard” and a good starting place.  Certain situational factors can lead to greater or lesser frequency (e.g. semi-weekly, bi-weekly, etc.), depending on scheduling and clinical indications.

Question 10

HOW LONG IS A THERAPY SESSION?

Accepted Answer

A typical therapy session (therapy hour) is considered to be 50 minutes long.  The initial assessment session may take up to an hour.

Question 11

WILL OUR APPOINTMENTS START ON TIME?

Accepted Answer

I make careful efforts to minimize any lateness on my part to within a 5-minute window from our scheduled start time. There are many challenges that come with managing time in the context of scheduling therapy appointments.  Unfortunately, there doesn’t appear to be a simple or perfectly “fair” solution for those challenges, each strategy coming with different benefits and costs.  One option is to establish strict “start” and “stop” times to minimize risk of my being late to any following appointments.  However, my personal preference is to use a slightly more flexible strategy with time.  Any delay on my part is nearly always the result of my prioritization of finding a more meaningful and natural closure to our sessions rather than an abrupt end that might be in the middle of delicate or valuable moments.  In the event that I am a few minutes late, which admittedly can happen by the end of the workday, I am also careful to make sure we extend the end of our time in equal measure to ensure you get the full agreed-upon session time.  It can be quite a juggling act!  The majority of my clients appear to be pleased with this arrangement (which benefits them too) and I have rarely encountered complaints about it.  However, it is not a perfect system nor am I a perfect human, so if any concerns about my timing arise, please feel free to discuss them with me and I’ll see what we can do to accommodate your preferences.

Question 12

HOW LONG DO I NEED TO BE IN THERAPY?

Accepted Answer

This is entirely up to you.   Some people get the results they are looking for after 6-10 sessions, while some others may choose to stay in therapy for years.  The length of treatment is determined by a number of factors, but mostly depends on the goals you have set for yourself.  After our initial assessment meeting I will be able to offer you a better estimate of how long this might be. 
 
NOTE: If you are planning on using insurance to help with payments, most insurance plans have a limit on the number of sessions they will pay for.  Please make sure to check on the limits of your plan.

Question 13

WHAT IS YOUR FEE?

Accepted Answer

My current rate for individual therapy is $190 per session.  If you are not able to use insurance to help cover the cost and this is too much for you, please let me know and we can discuss your options.  I have reserved spots on my caseload for college students and other low-income clients who cannot afford the full fee and are not able to utilize insurance benefits.  Fees will be determined on a sliding scale basis.
 
In addition to weekly appointments, I charge the above fee for other professional services based on 15-minute increments. Other services include: report writing, telephone conversations lasting longer than 15 minutes, consulting with other professionals as part of your treatment (with your permission), preparation of records or treatment summaries, and the time spent performing any other service you may request of me.
 
If you become involved in legal proceedings that require my participation, you will be expected to pay for all of my professional time, including preparation and transportation costs, even if I am called to testify by another party. Because of the difficulty of legal involvement, I charge $250 per hour for preparation and attendance at any legal proceeding.

Question 14

DO YOU TAKE INSURANCE?

Accepted Answer

For various reasons I discuss below, I have chosen not to maintain a contracted relationship with insurance carriers at this time (please review the "Disadvantages to Using My Insurance Benefits" section).  However, most people with PPO plans will still be able to use their insurance benefits.  Even though I would be considered an out-of-network provider, I can provide assistance in this process.  
 
If you have questions about your coverage, you can call your plan's customer service line.  I would also be happy to discuss your options for using your insurance benefits should you choose to do so.  However, it is ultimately your responsibility to confirm your own coverage and benefits.
 
When checking on your coverage, make sure to ask the following:
  -  Does my plan include mental health coverage?
  -  What is the coverage amount per therapy session for out-of-network providers?
  -  Is there a deductible and, if so, how much of it has it been met?
  -  What is my share of the cost?
  -  Is pre-approval required?
  -  How many sessions per year does my health plan cover?
  -  Are you able to directly reimburse me if I provide a superbill?
 
If you find that your insurance will not cover sessions with me, or if you choose not to use your insurance for any reason, but cannot afford the full rate for therapy, feel free to ask about alternative payment options.  I do care about making therapy accessible to those that seek it out.

Question 15

ARE THERE DISADVANTAGES OF USING MY INSURANCE BENEFITS?

Accepted Answer

There is one clear advantage of using your insurance benefits to help pay for therapy – it helps keeps your costs down!  Admittedly, therapy can be somewhat of an investment, and using your insurance benefits can help make therapy more accessible.
 
However, there are many potential disadvantages of using your insurance benefits that you need to be aware of.  For these reasons, I have intentionally chosen to minimize contracting with insurance companies.  Here are some things for you to consider:
 
By using your insurance benefits, you are allowing managed care reviewers–who don’t know you and have no clinical training–to make important decisions about your health and well-being.  They expect therapists to provide no more than the “minimum of care” and make corresponding decisions about the type of treatment you receive, the number of sessions you are allowed, etc.
Having mental health coverage does not guarantee payment.  In order to qualify for reimbursement, therapists must assign you a mental health diagnosis and disclose this diagnosis to your insurance carrier.  In addition, in order to justify coverage, they often require very detailed information about your personal life and what we do in our sessions together.  This diagnosis must usually be severe enough to warrant “medically necessary” treatment, meaning normal life problems like relationship issues or life transition stress are not likely covered.
This diagnosis will likely be placed on your permanent record at the National Medical Data Bank.  This information can be used to establish a “pre-existing condition,” which could then be used to deny future health, disability, or life insurance, to raise premiums, or even to exclude you from future employment.
Once managed care companies have access to your personal information, you and I both lose control over how that information is secured, who has access to it, and how long it is kept.
By using your insurance benefits, you have limited freedom in choosing whom to work with.  You must choose from a list of their pre-approved providers.  In order for psychotherapists to qualify for insurance panels, they must be willing to:
Accept sub-standard, non-negotiated fees
Agree to short-term care
Agree to share intimate details about you with the managed care company
Be willing to give up control of clinical decisions to individuals who are not mental health professionals

Question 16

HOW CAN I PAY?

Accepted Answer

I require a credit card to be securely kept on file at all times. Your credit card will automatically be charged at the end of each session, unless alternative arrangements are made.  Cash or check payments are also accepted.

Question 17

WHAT IS YOUR CANCELLATION POLICY?

Accepted Answer

Scheduling an appointment involves me reserving time specifically for you.  I am rarely able to make alternative arrangements for your reserved time, especially with short notice.  Therefore, a minimum of 24 business-day hours advance notice is required for rescheduling or cancelling an appointment without penalty (PLEASE NOTE: for Monday appointments, this means cancelling no later than your appointment time on the previous Friday).  This policy includes cancellations due to illness (e.g. cold/flu, etc.), work demands, or other unforeseen events.  Unless we reach a different agreement, the full fee will be charged for sessions missed without such notification.  It is important to note that insurance companies do not provide reimbursement for "no shows" or late cancellation charges.

I do require that you maintain a current credit card on file at all times.  Your credit card will be charged for missed appointment fees, late cancellation fees, and unpaid balances.

Question 18

WHAT IS THE PURPOSE OF THE 30-MINUTE CONSULTATION

Accepted Answer

I offer free 30-min consultation meetings for those interested.  The main goals during this time is for us to get to know one another, to determine if we are a right fit for one another, and to allow you to ask any questions you may have about me or the therapy process itself.  If you choose to, you may share a bit about why it is that you are seeking help and from there we can discuss if therapy is the best choice for you.  If you decide that you would like to continue therapy with me, we can then discuss regular meeting times, fees/insurance, etc. and arrange a time to begin our initial session.

Question 19

WHAT IF I HAVE MORE QUESTIONS?

Accepted Answer

If you have any further questions that are not addressed on here or would like to schedule an appointment, please feel free to call me at (619) 356-0811, email me at kevin@fawcettpsychology.com, or contact me through my website.  I will be happy to answer any questions you may have.  Please allow me one business day to return your call or email.

KEVIN FAWCETT, PH.D.
San Diego-Based Psychologist PSY 24224

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