I have never done mental health therapy before – what can I expect?

    • The relationship between a client and a clinical mental health therapist differs from personal relationships (i.e. between a client and their partner or a client and their friend) in that the therapeutic relationship is built upon the client’s presenting concerns and goals for therapy and contains strict boundaries to ensure the client benefits from, and is not harmed by, the professional relationship. Ethical codes dictate that clinical mental health therapists do not have personal relationships or interactions with current or former clients in any arena, to include social media. Likewise, the focus of sessions should be on the work the client is doing and not on the therapist’s thoughts, feelings, experiences, etc., as the therapist is there solely to help facilitate the client’s progress towards their goals.

      A standard therapy session is 53 minutes (sessions can be longer or shorter as clinically appropriate) and can be conducted via a secure telehealth platform, in a therapist’s office, or, in some cases, elsewhere in the community as long as there is reasonable expectation that a client’s privacy and confidentiality can be maintained. A client will often meet with a therapist on a weekly basis, though frequency can also be increased or decreased as clinically appropriate. Some therapy modalities, such as Eye Movement Desensitization and Reprocessing (EMDR), posit that less direct communication from a therapist helps a client’s brain process, form connections, and desensitize memories. Others, such as Dialectical Behavior Therapy (DBT), require more verbal engagement from a therapist.

      Mental health therapy is not centered around giving advice and is not a “magic cure” for solving clients’ presenting issues or concerns. For mental health therapy to be beneficial, a client must actively engage to the extent they are able to and work to integrate the work done in sessions into their life outside of therapy. Your feedback about what is helpful and unhelpful in terms of our work together is essential to ensuring therapy continues to be beneficial for you. Some therapeutic work can take years, while other work can be briefer, and more solution focused. I will continually partner with you to determine whether the therapeutic relationship remains beneficial to you and will provide feedback if I think termination of services is clinically appropriate. I will also do my best to provide referrals if you and/or I think it would be helpful for you to work with a different clinician.

How do I start engaging in mental health therapy?

    • The first step is to schedule a free 15-minute consultation with me so that we can briefly discuss your presenting concerns, goals, the modalities I most often use in my work, and any questions you may have to determine if we would be a good fit to work together. At this time, we can discuss whether you would prefer to meet via a HIPAA-compliant telehealth platform or in-person at my office in Old Town, Alexandria. It is important to note that I am an Out of Network provider and my current session rate is $150.00.

      If we decide to move forward in scheduling an initial session (also 53 minutes), I will send you Intake paperwork to review, complete, and sign prior to your first session. This will include an Intake Questionnaire which will allow you to give me information about your biological, psychological, and social history, as well as what brings you to therapy at this time.

      During our first 1-2 sessions, I will review your Intake Questionnaire with you and ask additional questions to learn more about your history and presenting issues. You do not have to share anything you do not feel comfortable sharing and providing me with information will help me better conceptualize your concerns and goals, and whether we will be a good fit to work together.

      I will input your goals and the plan to make progress towards those goals into a Treatment Plan which will guide our work together and will be periodically reviewed and updated as needed. I will also formulate an initial diagnosis(es) and share that with you. Please note that a diagnosis is a label and, as such, cannot provide a full picture of who you are, your history, and your presenting concerns. Diagnoses can help clients better understand and sometimes feel validated in what they are experiencing, but they are only one part of a larger clinical picture. No client should be defined by a diagnosis. As we continue to work together, my conceptualization of your diagnosis(es) may change, and I will share any updates with you.

I am feeling pretty well overall – can I still engage in mental health therapy?

    • Absolutely! It can be helpful to start or continue mental health therapy even when feeling mentally and emotionally well, as this can allow for deeper exploration into past experiences that may still be impacting present-day thoughts, feelings, relationships, etc. It can also allow for reflecting on and working towards building a more meaningful life for oneself. Lastly, it can be helpful for clients to continue to develop and reinforce their strengths, skills, and resources for the maintenance of their overall wellness.

What does it mean to be an Out of Network provider?

    • I am currently an Out of Network provider, meaning I am not in-network with any insurance plans, and I do not submit any information to insurance for payment coverage of clients’ sessions. Clients are required to pay the session cost up-front after every session. I provide clients with a document called a superbill after each session which contains the requisite information that most insurance companies need to determine out of network benefits (reimbursement for a portion of the session cost that the client paid me up-front). It is important to note that most insurance plans have an Out of Network deductible, which is an amount that an individual needs to pay out of pocket before the insurance company starts reimbursing for part of the session cost. I cannot guarantee reimbursement and I strongly encourage clients to contact their insurance providers to obtain information about their Out of Network benefits and how to file an Out of Network claim.


      Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.

      You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

      • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

      • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

      • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

      • Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit http://www.cms.gov/nosurprises.

Why are you an Out of Network provider?

    • That is a very valid question considering the financial barriers to clients needing to pay the full session cost up-front, and the possibility of not receiving any reimbursement from their insurance providers. Firstly, insurance companies often dictate the services a client can/cannot receive, the duration of services, and even the diagnosis(es) a client can/cannot have for the session to be billable. I do not agree with individuals who are not clinicians and may not have much, if any, understanding of mental health treatment dictating parameters of a client’s treatment. Insurance companies in the U.S. are in the business of making a profit – not in prioritizing what is in the best interest of a client’s or patient’s treatment. Secondly, unfortunately, insurance companies can be challenging and time-consuming to work with. There is a lot of bureaucracy and “red tape” to navigate. Thirdly, I want to protect my clients’ private health information (PHI) as much as possible, and insurance companies have access to certain PHI to determine coverage. Lastly, I have found that insurance reimbursement for licensed mental health professionals is generally disproportionately lower than the amount of education, training, and experience we have.

What questions should I ask my health insurance provider to determine Out of Network benefits?

    • Your insurance ID should have a customer service phone number on the back which you can call. When speaking with a representative, here are some ideas of questions to ask:

      • Does the insurance provider reimburse for individual mental health therapy appointments with an Out of Network licensed clinical mental health counselor?
      • What is the reimbursement rate?
      • What is the annual Out of Network deductible that needs to be met before reimbursement can start?
      • Are there any restrictions for meeting with an Out of Network licensed clinical mental health counselor?
      • How does one file an Out of Network claim and submit the corresponding superbill?
      • How long, on average, does it take to receive reimbursement payment after a claim is submitted?

Do you offer a sliding scale for clients who are financially eligible?

    • At times I have limited spots for clients who are financially eligible for a reduced rate; that is, their gross household income is at or below the current U.S. Real Median Household Income as indicated on their tax return from the previous year (or other documentation, if applicable). Potential clients are encouraged to discuss this option with me during the initial 15-minute consultation call.