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Information on Services Offered by Daniel Nothmann
& Associates
What is therapy?
What are the
pros and cons of therapy?
How can I tell if I need therapy?
What can I expect?
Will I be able to contact you outside of sessions?
Do you keep records? Can anyone else look at them? May I see
them?
What if I want to quit
therapy?
What are
your fees? Do you take Insurance?
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What is therapy?
Psychotherapy is not easily described in general statements or
in brief paragraphs. A large subsection of psychological
literature is devoted to trying to answer this very question.
The reason it's hard to "pin down" is that "therapy" varies
depending on the personalities of the psychologist and client,
and which particular problems you choose to bring forward.
Psychotherapy is not like a visit to a medical doctor. Instead,
it calls for a very active effort on your part. There are many
different methods I may use to deal with the issues or problems
that you hope to address. Where penicillin may always work for
strep throat in medical settings, in therapy different methods
work for the exact same problem with different people. While one
client may feel that a particular approach works for her/him,
another, completely different, approach may work for another
person. Sometimes we may have to try several styles or
techniques until we find the one that works best for each
individual. What this means is in order for therapy to be most
successful, you will have to work on things we talk about both
during our sessions and outside of our sessions - at home,
work, in the community and elsewhere.
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What are the
pros and cons of therapy?
Psychotherapy can have benefits and risks. Since therapy often
involves discussing unpleasant aspects of your life, you may
experience uncomfortable feelings like sadness, guilt, anger,
frustration, loneliness, and helplessness -- to name a few. On
the other hand, psychotherapy has also been shown to have
benefits for people who proceed through those feelings and
continue to work on their issues. Therapy often leads to better
relationships, solutions to specific problems and significant
reduction in feelings of distress. Symptom management, learned
both through therapy and other methods (groups, worksheets,
"homework," etc.,) has been shown to change the overall
functioning of clients in a very positive way.
But there are no guarantees of what you will experience. Therapy is
different for every individual, and the therapeutic relationship is
different with every client/therapist duo.
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How can I tell if I need therapy or what problems to "bring
forth?"
You must have some concerns, or you wouldn't be reading this
page. Sometimes events bring people to therapy -- life changes,
a traumatic incident, difficulties in work or relationships,
something you "just can't get over," and other times it's a
long-standing pattern of feelings and behaviors that bring
people to therapy. On many occasions the two combined are what
bring someone to consider therapy as an option. Perhaps there is
difficulty, discord, disruptions, new pressures or strange
"differences" in your daily life, feelings of distress, worry or
anxiety, "moodiness," irritability, numbness, unhappiness,
inability to function like your "normal self," odd (for you) or
unhealthy behavior or anything else that bothers you, things
about yourself or your life you'd like to change -- anything is
fair game. There is no set list of problems. Therapy exists to
enrich and make your life healthier, no matter what the issue or
how big or small you or others perceive it to be. The bottom
line: something must be bothering you or causing discomfort for
you to question whether or not therapy is the right path for you
to follow.
Some of these things may be quite normal in small doses for brief
periods of time, so if you're sitting on the question fence about
whether or not therapy is for you, an evaluation is the best first
step.
I normally conduct an evaluation that lasts from two to four
sessions. During this time, you can decide if therapy is for you,
and we can both decide if I am the best person to provide the
services you need in order to meet your treatment goals. Here is how
my evaluation process works:
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We will meet together for the above-mentioned first few
sessions to evaluate your needs.
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You will tell me what brought you to consider therapy, those
difficulties discussed above.
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I will ask questions about your background, your current
life, your relationships, your functioning as well as
questions about other mental health treatment you may have
had.
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I will also ask questions about symptoms that you may or may
not be experiencing or have experienced in the past.
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Come prepared to ask questions.
You are interviewing me
as much as I you. At any time through the process, you
are encouraged to ask questions about my practice and my
therapeutic skills, background etc. You will certainly be
given more than one chance to ask questions of me, so it may
be helpful to jot down thoughts between evaluation sessions
in order to have your questions at hand for the next
session. If you are unsure of questions to ask a therapist
you are interviewing, the
SIDRAN Foundation
offers a handout entitled,
"Therapy for Post-Traumatic
Stress and Dissociative Conditions: What to Look for and How
to Choose a Therapist". It's full of
information and questions. You can print
one out (or take
notes) for every therapist you interview.
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By the end of the evaluation, I will be able to offer you
some first impressions of what our work will include and a
treatment plan to follow, if you decide to continue with
therapy.
You should evaluate this information along with your own opinions of
whether you feel comfortable working with me. Therapy involves a
large commitment of time, money, and energy, so you should be very
careful about the therapist you select. If you have questions about
my procedures, we should discuss them whenever they arise. If
you have persistent doubts, I will be happy to help you set up a
meeting with another mental health professional for a second opinion
and/or a referral.
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In therapy, the time is yours. We will use it to continually work on
the issues brought forth by you and to reevaluate your treatment
plan as well as working on any new topics that arise during the
therapy. Treatment for Post-Traumatic Stress Disorder is a
complicated process. This is not brief psychotherapy directed at one
issue. We will be approaching many areas of your life and reaching
into things far past the "surface." It is important for you to know
this to take into consideration if this type of therapy is correct
for you at this time in your life. You may find that things become
overwhelming at times, that your functioning decreases as opposed to
increases, and while all of these things are horrible, they are
sometimes necessary for growth. At ANY time, you have a
right, and I have the responsibility to point out that we may need
to examine our pacing of treatment. This would include going "too
deep too fast."
Further, you and I both will continue to have other rights and
responsibilities in treatment. Honesty, attendance, timeliness,
respect of my boundaries and other things are important for us to
talk about and do in order to be able to work together to achieve
your overall improvement. In turn, I will be honest, on time and
respect your boundaries as well as continue to work with you to find
the best approach for your particular concerns. If we work together,
we will form a therapeutic bond, and this will be one of the most
helpful factors in your improvement. There is much more to this,
which we will discover together. Many things can threaten the bond,
the biggest being lack of the trust that we will hopefully be able
to build.
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In the meantime, here is another list of rights and responsibilities
in therapy from another source:
A Recovery Bill of Rights for
Trauma Survivors by Thomas V. Maguire, Ph.D.
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Will
I be able to contact you outside of sessions?
I am often not immediately available by telephone. While I am
usually in my office between 9 AM and 5 PM, I will not answer
the phone when I am with a client. When I am unavailable, my
telephone is answered by a machine that I monitor frequently. As
much of my time is also taken up with paperwork or other
responsibilities, it sometimes may take me a while to return
non-emergency phone calls. Given certain limitations (e.g., not
after 10 PM) I will make every effort to return your call as
soon as possible in emergency cases, which I will clearly define
with you. If you are unable to reach me and feel that you can't
wait for me to return your call, contact your family physician,
the nearest emergency room or call 911 and ask for the mental
health specialist on call. If I will be unavailable for an
extended time, I will provide you with the name of a colleague
to contact if necessary.
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Do you keep records? Can anyone else look at them? May I see
them?
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PROFESSIONAL
RECORDS
The laws and standards of my profession require that I keep
treatment records. You are entitled to receive a copy of the
records unless I believe that seeing them would be
emotionally damaging, in which case I will be happy to send
them to a mental health professional of your choice. Because
these are professional records, they can be misinterpreted
and/or upsetting to untrained readers. I recommend that you
review them in my presence so that we can discuss the
contents. Patients will be charged an appropriate fee for
any time spent in preparing information requests.
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CONFIDENTIALITY
In general, the privacy of all communications between a
patient and a psychologist is protected by law, and I can
only release information about our work to others with your
written permission. But there are a few exceptions:
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In most legal proceedings, you have the right to prevent
me from providing any information about your treatment.
In some proceedings involving child custody and those in
which your emotional condition is an important issue, a
judge may order my testimony if he/she determines that
the issues demand it.
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There are some situations in which I am legally
obligated to take action to protect others from harm,
even if I have to reveal some information about a
patient's treatment. For example, if I believe that a
child, elderly person, or disabled person is being
abused, I am mandated by law to file a report with the
appropriate state agency.
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If I believe that a patient is threatening serious
bodily harm to another, I am required to take protective
actions. These actions may include notifying the
potential victim, contacting the police, or seeking
hospitalization for the patient. If the patient
threatens to harm himself/herself, I may be obligated to
seek hospitalization for him/her or to contact family
members or others who can help provide protection.
These situations have rarely occurred in my practice. If a similar
situation occurs, I will make every effort to fully discuss it with
you before taking any action.
I may occasionally find it helpful to consult other professionals
about a case. During a consultation, I make every effort to avoid
revealing the identity of my patient. The consultant is also legally
bound to keep the information confidential. If you don't object, I
will not necessarily tell you about such consultations unless I feel
that it is important to our work together.
While this written summary of exceptions to confidentiality should
prove helpful in informing you about potential problems, it is
important that we discuss any questions or concerns that you may
have in person. I will be happy to discuss these issues with you if
you need specific advice, but formal legal advice may be needed
because the laws governing confidentiality are quite complex, and I
am not an attorney. If you request, I will provide you with relevant
portions or summaries of the state laws regarding these issues.
There are also HIPAA Regulations regarding confidentiality,
record-keeping and disclosure. Please see the sample HIPAA Agreement
here.
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What if I want to
quit therapy?
You always have the right to terminate therapy. As long-term,
psychodynamic psychotherapy tends to raise significant feelings
about the therapeutic relationship, I do strongly suggest that
we discuss the issue of termination before actually terminating
our therapeutic relationship. Should you decide that you desire
continued therapy, I will gladly provide you with contact
information for professionals who may be helpful. Should you
desire, I can also provide you with a variety of other
information resources to help you locate another therapist. It
is always your right to request this.
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What are your
fees? Do you take Insurance? How do you bill and how will I
pay?
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PROFESSIONAL
FEES
My current hourly fee is $160. Please be advised that
cost of living increases may change this fee in the future.
I will clearly discuss any change in fees prior to such an
increase. In addition to weekly appointments, I charge this
amount for other professional services you may need, though
I will break down the hourly cost if I work for periods of
less than one hour.
Other services include:
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report writing
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telephone conversations lasting longer than 10 minutes
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attendance at meetings with other professionals you have
authorized
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preparation of records or treatment summaries
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time spent performing any other service you may request
of me.
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Costs for such services will be made explicit prior to
the provision of services. If you become involved in
legal proceedings that require my participation, you
will be expected to pay for my professional time even if
I am called to testify by another party. Because of the
difficulty of legal involvement (e.g., time to review
documentation, the need to consult my own attorney,
etc.), I charge $350 per hour for preparation and
attendance at any legal proceeding.
In addition once an appointment hour is scheduled, you will be
expected to pay for it unless you provide at least 24 hours advance
notice of cancellation. If insurance (e.g., Medicare) reimburses
for your therapy sessions, please be aware that it will not cover
missed visits and you will be responsible for the fee for the missed
visit.
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BILLING AND
PAYMENTS
You will be expected to pay for each session at the time it
is held, unless we agree otherwise or unless you have
Medicare, which requires another arrangement. Payment
schedules for other professional services will be agreed to
when they are requested. In circumstances of unusual
financial hardship, I may be willing to negotiate a fee
adjustment or payment installment plan.
If your account has not been paid for more than 60 days and
arrangements for payment have not been agreed upon, I have the
option of using legal means to secure the payment. This may involve
hiring a collection agency or going through small claims court. In
most collection situations, the only information I release regarding
a patient's treatment is his/her name, the nature of services
provided, and the amount due. You will be notified in writing prior
to my undertaking this process, and should I need to employ outside
measures, you will be responsible for these additional costs.
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INSURANCE
REIMBURSEMENT
In order for us to set realistic treatment goals and
priorities, it is important to evaluate what resources you
have available to pay for your treatment. If you have a
health insurance policy, it will usually provide some
coverage for mental health treatment. I am not
an In-Network provider for any commercial insurance.
If you are eligible for Out-of-Network services, I
will fill out forms and provide you with whatever assistance
I can in helping you receive the benefits to which you are
entitled; however, you (not your insurance company) are
responsible for full payment of my fees. It is very
important that you find out exactly what mental health
services your insurance policy covers.
You should carefully read the section in your insurance coverage
booklet that describes mental health services. If you have questions
about the coverage, call your plan administrator. Of course I will
provide you with whatever information I can based on my experience
and will be happy to help you in understanding the information you
receive from your insurance company. Unfortunately, due to the
difficulty of reaching an actual person at most insurance companies,
I am not able to help you negotiate or advocate for your benefits
directly with your insurance company.
Due to the rising costs of health care, insurance benefits have
increasingly become more complex. It is sometimes difficult to
determine exactly how much mental health coverage is available.
"Managed Health Care" plans, such as Health Maintenance
Organizations (HMOs) and Preferred Provider Options (PPOs), often
require authorization before they provide reimbursement for mental
health services. These plans are often limited to short-term
treatment approaches designed to work out specific problems that
interfere with a person's usual level of functioning. It may be
necessary to seek approval for more therapy after a certain number
of sessions. While a lot can be accomplished in short-term therapy,
some patients feel that they need more services after insurance
benefits end. Some managed-care plans will not allow me to provide
services to you once your benefits end. For this reason as well as
others, I do not participate in managed-care insurance plans. I feel
decisions about your therapy should be made based on collaboration
between you and I, not by someone whose aim is to conserve money for
an insurance company.
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