Who should attend the sessions?
How does insurance work?
Why work with a Marriage and Family Therapist?
Why Narrative Therapy?
How to choose a counselor or therapist?
Here are some questions to consider in looking for a therapist or counselor?
- Is the office easily accessible?
- Is the therapist available during a time that works for you?
- Does the counselor have experience working with the issues that you are most concerned with?
- Does the therapist have a short-term or long-term focus and what is your preference? This is largely a matter of you determining your preference. A “big problem” does not always necessitate long term work. Look for a fit between how the therapist typically works and what you are comfortable with.
- Would you feel comfortable sharing your concerns with this person?
- How active or directive is the counselor and how directive do you want your counselor to be?
- Do you feel comfortable in the physical space of the therapist’s office?
- Do you need to use insurance? If so, is the counselor a preferred provider or “in network” for your insurance company and plan?
- What is the therapist’s theoretical orientation or philosophy about problems or problem solving? How does that fit with your own views about problems or problem solving?
Use these questions to guide you; in the end trust yourself. You will be working closely with this person on issues that are important to you. A good fit is an invaluable asset to the work. If you know you are slow-to-warm in new situations, give yourself time to figure out if it is a good fit for you. However be sure to speak up when you need or want something different. Perhaps your therapist or counselor will be able to make adjustments to better suit your needs. If not, ask for a referral to someone else who might be a better fit.
The whole family is affected. How do I know who should attend?
This is an important question. The two things to consider are who is affected by the problem and who is motivated to work on the issues. You want to make sure to include those most affected by the problem and those most motivated to address the concerns. Often times this is the same person or persons. Let me give you two examples:
Scenario #1 Sam is considering counseling. He is unhappy in his marriage and feels increasingly disconnected from his wife since the birth of their second child three years ago. Let’s say his wife Sue thinks that Sam has the problem and just hasn’t adjusted to life with children. In this case either couples counseling or individual counseling could be beneficial. I’d suggest meeting with both Sam and Sue for an initial session to discuss how couples counseling might benefit the relationship. Therapy is generally faster and more effective if all those involved somehow in the problem are also involved in the solution. However Sam and his relationship with Sue could both be helped by his participation in individual therapy. Any changes he makes will impact and hopefully improve the couple relationship.
Scenario #2 Mary wants to send her 14 year old daughter Amber to counseling because she is angry and disruptive at home and having trouble keeping up in school. If Amber is interested in counseling on her own, it could help her learn more about herself and help her develop ways to manage her emotions. Figuring out how to listen to their emotions but not ruled by them is a significant issue for teens. Again let’s assume someone is reluctant, in this case Amber or maybe she just sees the problem differently. She thinks the problem is her mom and the new rules that came along when Mary’s boyfriend Wyatt moved in. Again I’d suggest an initial meeting with Amber and Mary to discuss who should attend. Blending families can be challenging and often the transition is not smooth. Counseling could help Mary, Wyatt and Amber make that transition easier for everyone. A lot is going to depend on who is willing to attend after that first session. If they all attend and each makes a small change it will likely yield big results in terms of household harmony. However it may be more useful to have Mary and Wyatt attend to focus on parenting and step-parenting. Perhaps having Amber and Mary address their changing mother-daughter relationship would be the most beneficial. The focus shifts depending on who is attending and how they see the situation.
If there is a question about who should attend I generally like to have everyone come in one time so we can figure out together how best to proceed. Please give me a call and we can discuss who should attend in your particular situation.
I am an in-network provider for several insurance companies. That means I bill them, they pay me and you pay me only your co-pay and any deductible. If you have out-of network benefits (usually a PPO) and I’m not a provider for your insurance, I can help you get reimbursed.
However I want you to make an informed choice about insurance. One of the most important aspects of therapy or counseling is confidentiality. Clients feel safe to explore their problems or concerns knowing that what they talk about is confidential. There are of course legal exceptions to this right to privacy. Utilizing insurance benefits is one of those exceptions. Protected health information that is shared with health insurance companies includes the client’s name, date of birth, social security number, insurance identification number, mental health diagnosis, dates of service, and other information requested by the health insurance company for payment.
Using your insurance benefit can reduce the cost of therapy or counseling. However, as you can see, using your insurance benefit has some “costs” of its own. When you use your insurance, a psychiatric diagnosis must be assigned and transmitted to your insurance company, detailed clinical information often must be provided by your therapist, and in the case of in-network benefits, total access to patient files must be provided to insurance company employees at their request. This is mandated by your provider’s contract with the network. A diagnosis that demonstrates medical necessity must be assigned in order for insurance to cover the therapy.
Not all concerns that lead people to seek therapy meet the criteria of medical necessity. For example poor self-esteem, grief, or confusion about a relationship, may not. However moderate to severe anxiety or depression does meet the criteria of medical necessity.
Psychiatric diagnoses may affect your ability to obtain health or life insurance in the future and/or the cost of such insurance.
Are Employee Assistance Programs different?
Some employees have EAP (Employee Assistance Program) benefits in addition to medical insurance. EAPs usually do not require a diagnosis and typically require only basic information about your presenting concern, services provided and general outcome. The number of sessions authorized for EAP sessions is more limited, typically 3-6 per incident or per year.
Why Work with a Marriage & Family Therapist?
Marriage and Family Therapists are relationship specialists who treat persons involved in interpersonal relationships. They are trained to assess, diagnose and treat individuals, couples, families and groups to achieve more adequate, satisfying and productive relationships, marriages, family and social interactions.
Marriage and Family Therapists practice early crisis intervention and brief, focused psychotherapy to resolve problems or reduce symptoms in the shortest time possible. They also have the expertise and skills to work with persons for whom more intensive, long-term treatment is necessary to cure or relieve mental or emotional conditions.
A Marriage and Family Therapist helps individuals, couples, families and children explore and solve problems. People who work with Marriage and Family Therapists are more productive at work, visit their doctors less often, and have lower average lengths of stay at in-patient facilities.
Competent therapists do not offer solutions or take sides. They help clients work out solutions according to individual values and lifestyles. Seeking professional assistance is a sign of courage and willingness to effectively address life’s many challenges.
Distress signals for which Marriage and Family Therapists can help
- Emotional stress or anxiety
- Child behavior problems
- Feelings of loneliness, isolation
- Depression
- Moodiness
- Sexual disturbances
- Unexplained fatigue
- Unusual eating patterns
- Excessive alcohol or drug use
- Family conflict or tension
- Divorce or separation
- Difficulty coping with changing lifestyles
- Fear, anger or guilt
- Grief or emotional pain
Content for this section, “Why Work with a Marriage & Family Therapist?” has been condensed and revised from California Association of Marriage and Family Therapists’ website. All other content copyright Carol Harvey MFT, 2011.
I was drawn to the psychotherapy field by a fascination with relationships. I’m drawn in particular to the approach of narrative therapy in part because it takes the unique perspective of exploring the client’s relationship to the problem as well as the impact of the problem on the relationships in the client’s life. This includes the effects of the problem on the client’s relationship with him or herself. Instead of looking at the problem as residing in a person, narrative looks at the problem as separate and examines its influence on the various relationships in that person’s life. Narrative sees the ways people and relationships stand up to problems as equally important as how they are bullied by them.
The term narrative refers to the stories that people have about themselves and others. These stories are powerful and influence how one acts in the world. They can be positive or negative depending on the effects and the meaning they have for the people involved.
Narrative therapy embraces a collaborative, non-blaming approach in which therapists and clients together explore problem stories and find preferred alternatives.
To find out more about Narrative Therapy check out http://www.dulwichcentre.com.au/what-is-narrative-therapy.html