Sometimes you need to work on a crisis right away, whether it's a situation or just feeling really bad. In these cases, the assessment might be a brief part of the first session. During the rest of the session and afterward, I can continue to assess based on how you respond to treatment and any questions I work in.

Usually, you want to have a thorough assessment up front so we don't jump to conclusions, and everything important is being considered. Most of the time, the assessment mainly takes place in the first session, unless things are really complicated. Of course, while doing therapy, new information or thoughts may come up, and this helps us decide how to continue and if any changes in our approach are necessary. I'm saying "us" and "our" because you're totally involved in decisions about treatments. That's a key principle in the ethical requirement of "informed consent."

Research on telehealth shows that it is as effective as face-to-face sessions for many people, and it has its own advantages. Here's how it works:

I'll send you a link. When you click, it takes you to the video page. I get notified that you have arrived, and I'll start the session. I use high-quality equipment to make sure we can see and hear each other well.

First, remember that emergencies do not result in a fee. It's an honor system, but emergencies are things like sudden illness, traffic accidents, etc.

One way to handle this is to make the appointment less binding. That means late cancellation or rescheduling does not result in any fee. But the time slot is also not locked in for me. If a different client really needs that time slot, then they get first choice. Then I will notify you that we need to reschedule.

This problem brings a lot of people to see a therapist. There are many things we can do that will make a difference.

First, we must address any safety issues. This includes not just risk of violence, but also making sure that the situation does not stress you out, because you must be able to stay healthy. It's also important that you aren't exposed to legal issues that could come from their behavior.

If you choose to stay in the relationship, then we must understand what drives your partner's behavior. Our plan comes from that understanding. It will help you make decisions like: "Can I really influence and improve my partner's behavior?" and "How do I be myself if they can't handle it?" and, "Where do I draw the line and how do I back that up?"

We will likely work from the idea that you are the more mature person, and you need to learn ways to influence that can guide your partner's behavior. We must make sure that this is a good approach and not just jump into it.

This was a brief overview of an issue that can be complicated, but I hope it gives you an idea of how I work with this type of situation.

I don't accept insurance, but I know the economy is very difficult for many people. I keep some appointment times open for people who truly need a sliding scale fee or one of my packages that lower the cost.

When we start, I will give you an idea of how long I think it may take to get you where you want to be. This is not an exact science, but I have a lot of experience with this. Most people are satisfied in two to ten sessions, but people with complicated family situations or those with childhood trauma may need longer-term treatment.

The methods that I use can, for many problems, result in much faster progress than therapy has a reputation for, because there has been a lot of progress in understanding how to get results. "Trigger-resolution" combined with "body-based therapy" is a perfect example. Sometimes this creates remarkable progress in one session. Of course, that is not possible for everyone.

If you feel we didn't connect well, let me know right away before our second session and you will get a refund. It's a good idea to try to work things out with me because adjusting our approach can be a valuable part of therapy. However, there are situations that might cause you to feel it's not worth it to do that.

Even later on, if you really feel things went in the wrong direction, odds are I would refund the last session that led to the concern. A concern that is not valid would be something unreasonable, like really misinterpreting something I said and not working with me to understand my meaning.

My video platform follows federal law by having various security measures in place. I also follow procedures that are expected of therapists. There are laws and ethical requirements about privacy, such as not telling anyone whether or not someone is my client.

Most often, a couple will sit side-by-side with their cell phone or tablet on a stand or propped up.

EMDR has been shown to work with different types of techniques. Many clients like to tap on two points. Another option is to use stereo sound that I can provide.

The research on this "bilateral stimulation" tells us that at least part of why it works is by creating relaxation and distraction. That way, the memory or issue goes back into your memory without the emotional triggers that cause symptoms (such as panic attacks or over-reacting to social situations).

I have special training in managing these situations. I worked for years under national EAP certification, which specializes in this.

If you feel forced, such as when a spouse demands it, or when an employer or court requires counseling, you are still in charge of your work with me.

Keep this in mind: If counseling is required, you may need to sign a limited release of information. By "limited," I mean I give only the most basic information. That is: 1) Confirmation that you are coming; 2) Whether the assessment is complete; and 3) Whether you are following through on the most important recommendations.

You can cancel that release at any time—not just because it's my policy, it's the law. If you end the release, the only result from me is that the person who referred you will figure it out because I will no longer be able to talk to them. Then it's up to them to decide how to handle that. For an employer referral, this means they will use whatever their discipline policy says. If there's an anger management problem, this may mean other requirements or even losing your job. But that depends on your employer’s policies that are out of my control.

I am not a physician, and I don't prescribe medication. However, if you have a psychiatrist who might prescribe a drug, I can help you understand what your psychiatrist is saying or learn how to get accurate information about prescription drugs. My clients sometimes tell me that they don't really understand their psychiatrist or that they didn't get a good explanation.

Remember that I have worked with prisoners, military, police, doctors, lawyers, violent people, people addicted to drugs, and all sorts of other people. To do this work, I keep a vision of your potential in my mind and heart, looking forward. Rather than harsh judgment, your past helps guide this positive direction. I hope that my way of seeing you will inspire you in a good way.

One thing that will help is that you and I will work together on the plan. This means it must be developed in a way that you understand and choose, or that you can help me improve until you feel that it truly suits you.

Also, I am fully open to discussing anything that you are uncomfortable with, and on your terms. I will not dismiss or avoid anything. You and I know that therapists learn skills of influence, and that such skills can be used badly. I am dedicated to helping you get in whatever state of mind you need to take the next step that you have chosen. A key requirement of ethics for therapists is respecting the free will of the client.

No formal diagnosis needs to be given or written down. The term "mentally ill" is not necessary for our work.

If you are struggling with mental or emotional symptoms, our focus will be on understanding your challenges, strengths, and needs.

There are situations where you might have to deal with labels. Most likely this would happen if you saw a therapist under your insurance. Insurance requires a diagnosis in order to get coverage for the service.

If some situation comes up that involves labels, we can discuss how to avoid it or at least handle it with the least stigma or unfairness.

It is very important for you to build up and heal. There is plenty of work to do without looking into your past. We do that mostly by focusing on overcoming current symptoms, reactions, or limitations.

When the time comes that you are ready to process past trauma, you will know. Also, it is not necessary to experience severe pain in order to process it. Modern therapy has ways to resolve these issues in a more peaceful way. If that doesn't work for you at any point, then we focus on getting you fully back on solid ground and change our focus to present-day progress.

Please call or write with any questions, or schedule a free consultation.