FAQs
Process of Psychotherapy
In psychotherapy, you and your therapist work out strategies for handling problems of daily living. Examples of problems which can be effectively addressed include depression, anxiety and panic, "flashbacks," guilt, low self-esteem, eating disorders, alcohol and drug abuse, couple and family difficulties, and general interpersonal difficulties. Additionally, psychotherapy can lead to personal growth through clarification of your thoughts and feelings about yourself, others, and events in your life.
Techniques
Most of the time you spend in therapy will consist of talking about the issues you bring up with your therapist. In addition to discussion, other therapy tools may be used. These include psychological testing, homework assignments, relaxation training, communication skill training, assertiveness training, anger management, desensitization practice, role playing practice, and guided imagery.
Format
Treatment can involve individual, family, couple, or group formats depending upon the nature of the problem addressed. If it appears that psychiatric medication may be a useful addition to your therapy, your therapist will refer you to a physician or other medical professional for consultation.
Therapeutic Orientation
The specific form of your therapy will depend upon your therapist's specialty, theoretical orientation, and background. While some treatment approaches require examination of the impact of your childhood and past experiences, others emphasize the present. Some treatment approaches focus upon solving specific current day problems while others stress development of the insight needed to solve problems in the future. You may wish to discuss this topic with your therapist, so that you will know what to expect during treatment.
Length of Treatment
The length of treatment varies depending upon you, your therapist, and the nature of the presenting problem. For specific or situational problems, it is typical for psychotherapy to be conducted in 10 to 20 weekly treatment sessions. If your problems are severe, effect many areas of your life, or have persisted for a long period of time, therapy can last as long as several years. Usually, after your first few sessions of psychotherapy, your therapist will be able to give you some idea of the estimated length of treatment.
Frequency & Length of Sessions
Sessions are generally scheduled for once a week and last 45-minutes, giving your therapist the remainder of the hour to make notes which will aid in planning further treatment and assessing progress. Depending upon the problem and treatment format, your therapist may recommend a more or less intensive therapy schedule.
Effectiveness
The success of your treatment depends on a large variety of factors including the nature of your problems, the effort you put into the process, the type and length of treatment, and your therapist's skill. On the average, research has shown that two-thirds of all patients show improvement during psychotherapy.
Risks/Benefits
At times, psychotherapy will involve giving attention to painful and uncomfortable thoughts and feelings. Risks sometimes include experiencing feelings such as sadness, guilt, anxiety, anger and frustration, loneliness and helplessness. Psychotherapy often requires discussing unpleasant aspects of your life. It may also lead indirectly to the end of important relationships, such as when a patient experiencing marital difficulties decides to seek a divorce.
Psychotherapy has also been shown to have benefits for people who undertake it. Therapy often leads to significant reduction in feelings of distress, better relationships, and resolution of specific problems.
Dissatisfaction
Psychotherapy can be a difficult process and it is not unusual to feel angry and upset at times about what happens in therapy. Questions or concerns about the treatment you receive should first be raised with your therapist. Exploring your thoughts and feelings, even when they are negative, is an important part of the treatment process. If, after discussing the issues with your therapist, you are still not satisfied, you have several options. You may seek a second opinion concerning your treatment. Another approach is to end treatment with your therapist and to switch to a new clinician. Competent therapists recognize and accept that they will be able to serve the needs of some patients better than others.
Ethical Issues
Psychotherapists are responsible for adhering to a code of ethical practice which includes the maintenance of high standards of professional skill and knowledge and the prohibition of practices which exploit the therapeutic relationship. Ethical standards specifically prohibit your therapist from using his or her relationship with you for personal advantage, accepting costly gifts from you, being involved in financial or business projects with you, developing a social friendship with you, and engaging in a sexual relationship with you.
Complaints
If you believe that your therapist's behavior is either unethical or does not adhere to professional standards, you have several alternatives. You may wish to bring your concerns to the attention of State of California Board of Behavioral Science at www.bbs.ca.gov. Another option you may choose is to contact the appropriate national professional organization, or its California chapter. Both the American Psychological Association and the National Association of Social Workers may be reached at 750 First Street NE, Washington, D.C., 20002-4242, (202) 336-5970 or (800) 638-8799.
Psychotherapy is a treatment relationship which works in part because of clearly defined rights and responsibilities held by both patient and therapist. This framework helps to create the safety to address difficult issues and the support to make difficult changes. As a patient, it is important that you are conscious of your rights because this is your treatment, the goal of which is you well-being. There are also certain legal limitations to those rights of which you should be aware.
Diagnosis
Diagnoses are technical terms which describe the nature and severity of your symptoms. In North America, the American Psychiatric Association's Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) is generally used as a guide in determining diagnosis. If you are interested, your therapist will discuss your diagnosis with you and a copy of the DSM-IV will be made available for your review.
Decisions Regarding Your Treatment
Your active involvement in identifying goals, selecting approaches, and assessing effectiveness is essential to the success of your therapy.
You have the right to ask questions about anything that happens in therapy. Your therapist will be willing to discuss how and why he or she has decided to take a particular approach, and to look at alternatives which might be more effective.
You have the right to refuse the use of any therapy technique. If your therapist plans to use any unusual technique, its benefits and risks will be explained and discussed with you.
You have a right to ask about your therapist's training for work with your particular concerns. You are free to leave therapy at any time.
You have a right to discuss your therapy with anyone you choose, including seeking the second opinion of another therapist. You have a right to repeat anything your therapist says to you.
The Role of Managed Care Organizations
If your health insurance benefits are administered via a managed care organization, it is important for you to be aware that benefits cannot be used until the managed care organization approves their use. Managed care organizations set limits on choices available to both you and your therapist.
If you use your health insurance to pay for your treatment, you must allow your therapist to inform a managed care reviewer of your problem, the treatment he or she suggests, and how you are functioning in many areas of your life, as well as to provide regular updates. This information will likely be provided to the managed care organization by phone and in writing.
While all insurance companies claim to keep such information private, the laws and other rules that apply to therapist confidentiality are stricter than those which apply to managed care organizations. If you are concerned, you may wish to discuss these issues with your therapist fully before treatment is started and information must be sent to your managed care company.
Managed care reviewers decide how much treatment your therapist can provide to you, based upon the information provided. The managed care organization can refuse to allow the therapist to treat you. It can refuse to pay for any of your treatment, or may pay only a very small part of its cost. It can limit the kinds of treatment options your therapist may make available to you.
Your managed care organization may approve you treatment but limit the number of sessions you may have. While many insurance policies list a maximum number of appointments allowed for psychotherapy, the managed care organization does not have to allow you to use all of these appointments, even if you and your therapist believe that more treatment is needed. If you are dependent upon a managed care program for your health care, it is important that you be aware that you may need to consider treatment choices other than those which you and your therapist would prefer.
Many managed care organizations contract with local general hospitals to provide inpatient mental health services on a per diem--or flat fee per day--basis with the understanding that the hospital is financially responsible for then paying for all required inpatient services, including individual psychotherapy. As a result, local hospitals generally require that their own salaried staff provide all psychotherapy to you while you are hospitalized. Should you need hospitalization, your therapist may be able to offer recommendations to inpatient clinical staff but will not be able to provide direct care to you.
Records of Your Treatment
Both the law and professional standards require your therapist to keep complete and accurate records of your treatment, including notes taken during and after therapy sessions.
Although the Health Insurance Portability and Accountability Act of 1996 specifies that you have the right to inspect and obtain copies of most health information, psychotherapy notes are specifically excluded. Also excluded are information gathered in anticipation of civil, criminal or administrative actions.
Diversified Psychotherapy Inc’s philosophy, however, is that you may obtain a copy of your chart at any time, at a reasonable fee for copying and handling, and with reasonable advance notice. You have the right to request that your therapist correct any errors in your chart. Because professional records can be misinterpreted or upsetting to lay readers, if you request a copy of your chart it is recommended that you review them in the presence or your therapist so that you may discuss the contents.
Treatment records are maintained in a secure location, for a minimum of ten years following completion of therapy.
Treatment of Minors
If you are under eighteen years of age, please be aware that the law may provide your parents with the right to examine your treatment records. Your therapist will request an agreement from parents that they consent to give up access to your records. If they agree, only general information regarding your treatment will be provided to them unless there is reason to believe that you will seriously harm yourself or another, in which case they will be notified.
With the exception of certain specific situations described below, you have the absolute right to confidentiality in your psychotherapy. Your therapist cannot and will not tell anyone else what you have told him or her without your prior permission.
Under the provisions of the federal legislation, your therapist may legally speak to another health care provider or a member of your family about you without your prior consent. It is Diversified Psychotherapy Inc’s policy, however, not to do so unless the situation is an emergency.
You may direct your therapist to share information with whomever you chose, and you can change your mind and revoke that permission at any time.
You may request anyone you wish to attend a therapy session with you.
Confidentiality Exceptions
The following are legal exceptions to your right to confidentiality.
If there is good reason to believe that you will harm another person, your therapist is required to warn that person of your intentions and to notify law enforcement officials to ask that your intended victim be protected.
If there is good reason to believe that you are abusing or neglecting a child or vulnerable adult, or if you provide information about someone else who is doing so, your therapist is required to inform law enforcement officials and/or child welfare officials.
If there is good reason to believe that you are in imminent danger of harming yourself, your therapist may inform law enforcement officials to ask that you be taken into protective custody for your own safety. Your therapist will explore all other options with you prior to resorting to this step.
Privileged Communication
If you are involved in a court case or proceeding, you may prevent your therapist from testifying in court about what you have said in therapy sessions. Called "privilege," this allows you to allow or prevent you therapist from giving testimony, as you see fit. However, there are some situations in which a judge or court may require your therapist to testify. The following are exceptions to privileged communication:
In a civil commitment hearing to decide if you present a danger to yourself or others.
If your fitness as a parent is questioned in a child custody or adoption proceeding.
To authorized federal officials for the purpose of conducting national security investigations.
During a malpractice case or an investigation of your or another therapist by a professional group.
If you are seeing your therapist for court-ordered evaluation or treatment.
If you were to file a complaint or are a plaintiff in a lawsuit in which your therapist or Diversified Psychotherapy, Inc as a practice is named as a defendant.
If you were to file a complaint or are a plaintiff in a lawsuit in which you bring up the question of your mental health, you will have automatically waived your right to the confidentiality of these records in the context of the complaint or lawsuit. It is Diversified Psychotherapy Inc’s policy, however, to release such information only with your written consent or a court order.
If you were to default on payment of your account, your therapist may provide such basic identifying information to collection service representatives or officers of the court as is necessary
to settle your debt.
Relative Confidentiality
While you can expect your therapist to guard your privacy carefully, there are some limits to confidentiality which are an expected part of treatment within a group office practice.
Your therapist may sometimes consult with another health care professional about particulars of your diagnosis or treatment plan, with the goal of ensuring that you receive the best possible care. In such cases, the professional who is consulted shares with your therapist the duty to maintain confidentiality.
If your therapist is active in publishing for professional journals and texts, conducting clinical research, or educating mental health practitioners, he or she may wish to refer to some aspects of your treatment for professional purposes. In such cases, focus will be placed upon symptoms, treatment approach, and treatment outcome rather than individual details of your situation. All information which might identify you will be deleted or modified.
Confidentiality of Insurance Records
If you use health insurance to pay part of you therapy fees, or are a member of a managed care plan, your plan requires you to authorize release of all treatment records to plan representatives whenever you submit a claim for benefits.
Most insurance companies require information regarding diagnosis, session format, date of onset and duration of symptoms, and dates seen in therapy. Managed care organizations, however, ask for much more information about you and your symptoms, as well as a detailed treatment plan. It is common for managed care organizations, and some fee-for-service insurance plans, to require photocopies of individual session treatment records.
In order to protect patient privacy to the extent possible, Diversified Psychotherapy, Inc’s policy is to respond to requests for chart photocopies by instead offering to send a brief summary of symptoms and treatment progress. If this is not acceptable to managed care reviewers, photocopies from your cart will be reviewed by your therapist prior to submission to the managed care organization. When information of a particularly sensitive nature is involved, you will be consulted before any information is released.
If you request, you will be provided with a copy of any report which your therapist submits to your insurance carrier.