About Psychotherapy
Psychotherapy has both benefits and risks. Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness and helplessness, because the process of psychotherapy often requires discussing the unpleasant aspects of your life. You may recall unpleasant memories. These feelings or memories may bother you at work or in school. In addition, some people in the community may mistakenly view anyone in therapy as weak, or perhaps as seriously disturbed or even dangerous. Also, clients in therapy may have problems with people important to them. Family secrets may be told. Therapy may disrupt a marital relationship and sometimes may even lead to a divorce. Sometimes, too, a client’s problems may temporarily worsen after the beginning of treatment. Most of these risks are to be expected when people are making important changes in their lives. Finally, even with our best efforts, there is a risk that therapy may not work out well for you. However, psychotherapy has been shown to have benefits for individuals who undertake it. Therapy often leads to a significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness and insight, increased skills for managing stress and resolutions to specific problems. But, there are no guarantees about what will happen. Psychotherapy requires a very active effort on your part and if you work on things we discuss outside of sessions, you will likely enhance its benefits.
Do you take insurance, and how does that work?
Because we value confidentiality and your right to make decisions about your own care, we have chosen not to be affiliated with any insurance or managed care companies, which means we are “out of network” providers. If you choose to use your insurance to pay for therapy services, you will want to find out what they consider to be covered benefits and to what extent they will reimburse you. The following are the types of questions you will want to ask your insurance company:
Do I have mental health benefits?
Does my plan have out of network benefits?
What does the plan consider reasonable and customary for the following codes:90791, 90837, 90846 & 90847?
How much does my plan cover for an out of network mental health provider?
Is approval required from my primary care doctor?
Are there standardized forms I will need to submit for reimbursement and where can I find them?
What is my annual deductible and has it been met for this year?
When does my calendar year begin?
How many sessions per calendar year does my plan cover?
In what preferred form does my insurer prefer I submit my claims (electronically, by mail, etc.)?
Professional services provided by LCSW-C therapists qualify as reimbursable expenses under most insurance plans. However, many of clients choose not to utilize their insurance benefits to pay for their therapy for the following reasons:
Before any reimbursement is allowed, insurance companies require some of your personal information and the use of a psychiatric diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This personal information will become part of the insurance company files and will likely be stored in a computer, which potentially makes it vulnerable to cyber-attacks, as we’ve seen happen recently with a few major insurance companies. Though all insurance companies claim to keep such information confidential, we have no control over what they do with it once it is in their hands. In some cases, they may voluntarily share the information with a national medical information databank.
Having an insurance company involved in your therapy can be like having an invisible third party with you during your sessions because they control many aspects of your care, such as the type of therapy for which they will reimburse you, the length and pace of your care as well as whether they consider your care to be “medically necessary.”
Only you can consider the implications and make a decision that is best for you. We provide clients who wish to seek reimbursement from their insurance company with an invoice that contains the appropriate CPT code, Diagnosis code(s), Service Descriptions and my identifying information. These forms may be stapled to medical claim forms from your insurance company and mailed to the insurance company so they can directly reimbursement you. Often people can write, “see attached” on the claim form. Insurance companies are starting to accept these forms electronically as well so be sure to ask your insurer about their preferred form of receipt.
Does what we talk about in therapy remain confidential?
Maryland state laws and the rules of the NASW (National Association of Social Workers) require us to keep what you tell us confidential (that is, just between us). you can trust us not to tell anyone else what you tell us, except in certain limited situations. We explain in detail what those situations are in our Notice of Privacy Practices and in a handout entitled "What You Should Know About Confidentiality."
How is a therapy relationship different from other relationships?
Psychotherapy is a professional service provided to you. Because of the nature of therapy, the relationship has to be different from most relationships. It may differ in how long it lasts, in the topics discussed, or in the goals of the relationship. It must also be limited to the relationship of therapist and client only. If you and your therapist were to interact in any other ways, it would be a “dual relationship,” which would not be right and may not be legal. The different therapy professions have rules against such relationships to protect both clients and therapists.
Dual relationships can set up conflicts between the therapist’s interests and your best interests, and then your interests might not be put first. In order to offer clients the best care, the therapist’s judgment needs to be unselfish and professional.
The following are examples of dual relationships:
Your therapist being your supervisor, teacher, or evaluator.
Being a therapist to their own relatives, friends (or the relatives of friends), people s/he knows socially, or business contacts.
Providing therapy to people the therapist used to know socially, or to former business contacts.
Having any other kind of business relationship with you besides the therapy itself. For example, your therapist cannot employ you, lend to or borrow from you, or trade or barter your services (things like tutoring, repairing, child care, etc.) or goods for therapy.
Your therapist cannot give legal, medical, financial, or any other type of professional advice.
Therapists cannot have any kind of romantic or sexual relationship with a former or current client, or any other people close to a client.
There are important differences between therapy and friendship. Your therapist cannot be your friend. Friends may see you only from their personal viewpoints and experiences. Friends may want to find quick and easy solutions to your problems so that they can feel helpful. These short-term solutions may not be in your long-term best interest. Friends do not usually follow up on their advice to see whether it was useful. They may need to have you do what they advise. A therapist offers you choices and helps you choose what is best for you. A therapist helps you learn how to solve problems better and make better decisions. A therapist’s responses to your situation are based on tested theories and methods of change. You should also know that therapists are required to keep the identity of their clients secret. Therefore, they may not say hello if you meet or see them in a public place, and they should decline to attend events that are meaningful to you if you invite them. Lastly, when the therapy is completed, they will not be able to be a friend to you like your other friends.
What are my rights in therapy?
Ask that the therapist inform you of your progress.
Know if your therapist will discuss your case with others (for instance, supervisors, consultants, or students).
Refuse to answer any question or give any information you choose not to answer or give.
Refuse audio or video recording of sessions (but you may ask for it if you wish).
Have written information, before entering therapy, about fees, method of payment, insurance coverage, number of sessions the therapist thinks will be needed, substitute therapists (in cases of vacation and emergencies), and cancellation policies.
Ask for and get information about the therapist’s qualifications, including his or her license, education, training, experience, membership in professional groups, special areas of practice, and limits on practice.
Report immoral and illegal behavior by a therapist. You can contact the professional licensing board of the therapist who exhibited immoral and/or illegal behavior. The Maryland Board of Social Work Examiners is the organization that licenses those of us in the independent practice of clinical social work.
Have a safe treatment setting, free from sexual, physical, and emotional abuse.
Get respectful treatment that will be helpful to you