Questions about therapy

Psychotherapy is not easily described in general statements. It varies with the personalities of the psychologist and the client, and the particular problems you are facing. There are many methods we may use. Therapy is not like a medical visit: it is an interactive process, and we rely on your experience both inside and outside our office to guide us. Therapy should be a safe and comfortable place where you feel understood, and supported to address what has been scaring you and holding you back.

Therapy can feel uncomfortable at first. We work hard not to raise anxiety in a situation that is already uncomfortable for many people, and we believe being an engaged participant is part of that. Be prepared to speak candidly about yourself, and also expect to feel understood. When we notice patterns, we will share them openly. We rely on your experience to guide our focus, and we deliberately show you the insight process so you can continue it yourself.

Psychotherapy has benefits and risks. Because it often involves discussing unpleasant parts of your life, you may feel sadness, guilt, anger, frustration, loneliness or helplessness. It has also been shown to have many benefits: better relationships, solutions to specific problems, and significant reductions in distress. Feeling understood and supported while working through uncomfortable feelings usually eases them, and that is a goal of every session.

Therapy is a large commitment of time, money and energy, so choose carefully. The best way to know is to meet for a consultation, where we discuss your needs, our sense of how we can help, and your comfort in moving ahead. We treat the consultation as much like a typical session as possible, so you get an accurate sense of working with us and ideally leave feeling some benefit. It is normal to feel a first session didn’t cover everything. Research and clinical experience show people benefit most when they feel comfortable with their therapist, so reflect on how it felt to sit with us.

If we decide to move forward, the next few sessions evaluate your needs and history more thoroughly. By the end we can offer first impressions of what our work will include and a treatment plan. Length of therapy varies, depending on the goals we identify and how readily you can apply what you learn to your life outside. Ending therapy is an empowering part of the process, and a goal we work towards. The more you put into therapy, the more you will get out of it.

Research shows that medication combined with psychotherapy gives the greatest long-term relief from mental and emotional problems. Not all symptoms lend themselves to medication, but many do, and it can provide symptom relief that lets a person function and make the most of therapy. It is not necessary for good results, though, and therapy addresses the causes of distress and the patterns that curb progress. Depending on your symptoms, we may recommend you consult your doctor or a psychiatrist about whether a combination is right for you.

For many reasons. Some want help through a major life transition (unemployment, divorce, a new job), especially when they aren’t handling it as well as they’d like. Some need help with low self-esteem, depression, anxiety, relationship problems, career decisions, attention issues or creative blocks. Others are ready to learn more about themselves or to be more effective with their goals. Everyone who seeks therapy shares a desire to meet life’s challenges and make positive changes.

If we begin, we agree on a regular meeting time, and the evaluation continues for another two to four sessions. Usually we meet weekly, though other frequencies can be considered. Sessions are 50 minutes; that hour is your time and won’t be rescheduled or cancelled except with significant notice. If you are late, the time is lost for that session. If we are late, we will make up the time or adjust the fee. Sessions that run over 60 minutes are billed for the extra time.

Because this time cannot be offered to anyone else, we require 48 hours’ notice to cancel. If you do not cancel at least 48 hours before a session, the full fee is charged; insurance companies don’t reimburse cancelled sessions. We will always try to offer another time that week, but cannot guarantee it.

Because of our work schedules we are generally not immediately available by phone. Between appointments you can call the office at (202) 969-2277 and leave a message; that voicemail is confidential and checked regularly. We make every effort to return calls the same day, Monday to Thursday. The office is closed on Fridays, so messages left after Thursday afternoon are heard the following Monday. Current clients with an urgent matter can call Dr. Clark at (202) 625-1313. If you can’t reach her and cannot wait, contact your family physician or the nearest emergency room and ask for the psychiatrist on call, or call or text 988. If we will be away for a while, we will give you the name of a colleague to contact.

Unless otherwise arranged, therapy and coaching sessions run 50 minutes and are scheduled on the hour. Our current rate for individual therapy and coaching is $260 a session, and for couples therapy and coaching $275 a session. Credit cards are preferred; remote sessions are paid by credit card at the time of service.

We do not participate with any insurance companies, so our services are “out of network”. Each month you receive an electronic summary of services and payments with the information insurers need to reimburse you, and we are happy to complete any insurance forms. You, not your insurer, are responsible for full payment. Coaching is not always covered.

Before you start, ask your plan: What are my out-of-network mental health benefits? What is the coverage per therapy session (CPT code 90834)? Is it a percentage of the billed amount or of a “reasonable and customary” amount? How many sessions are covered? What is my deductible, and has it been met? Does my primary care physician need to approve it?

Confidentiality is a cornerstone of the therapist-client relationship. You receive a written copy of our confidentiality disclosures, and what you discuss with us is not shared without your written consent, for example with your physician. There are a few exceptions the law allows or requires, such as information an insurer needs, a court order, health oversight, or a workers’ compensation claim; and situations where we must act to protect someone from harm: suspected abuse or neglect of a child or vulnerable adult, or a substantial risk of imminent serious injury to yourself or someone else. These situations are unusual in our practice, and if one arises we will make every effort to discuss it with you first and limit any disclosure to what is necessary. We are glad to talk through any questions about confidentiality.