Some people meet with me on a weekly basis, while others may decide to meet bi-monthly or every 3 weeks. Meetings will vary on a case by case basis. I often recommend that couples and individuals in distress to start therapy with weekly sessions in the beginning to lay the ground work for achieving your goals. My goal is that you will become the expert of your life and your relationships, but without putting a band-aide over the wound for temporary correction. I want long term change. As we begin to see progress, we can gradually pull therapy sessions further and further apart, as is appropriate for your situation.

Initial assessment sessions are 50-80 minutes. Individual sessions are regularly for 50 minutes each.

I often get people who ask me about how many sessions it will take to achieve the therapy goal. Even though I work from a shorter term of therapy (10-18 sessions), each person and situation is unique. The harder you work in and out of the therapy office, the quicker you will get results. However, if there are traumas or relationship wounds, the therapy may be stretched out and need more in depth focus. Others may respond very well to therapy and need less than 10 sessions. The sessions depend on the issues we are addressing, the client(s), the frequency of the therapy sessions, and the willingness to work through the issues. As a therapist, I will do my best to do whatever I can to help get long term results.

Your first session is important. You and I will assess if we are a good fit for potential therapeutic work. During consultation, feel free to ask questions related to therapy and my background, about the frequency of sessions, fee structure, cancellation policy, payment method, my orientation, my background, treatment method etc. If you are satisfied, we may schedule subsequent sessions. If I feel I may not be able to help you, I will inform you and would be happy to provide you with an appropriate referral to a therapist who can better meet your needs. If we decide to work together, I will go over the therapeutic framework that needs to be maintained throughout the duration of therapy. The framework is for your protection and healing, and I would appreciate your active involvement in the process.

I try to make the therapy appointments that work with your schedule, so I offer appointments both evenings and on weekends.

I can usually schedule an appointment for the same week or for the following week. I do my best to fit my clients in quickly and to get started on therapy right away. Keep in mind that prime time slots get filled quickly, so scheduling the counseling sessions sooner rather than later is encouraged.

My fee schedule is contained under the Fees tab. Click on the word Fees and you will be taken to the Fee Schedule, or click on the Fees tab at the top of the screen to be taken to the Fee Schedule.

Commercial Health Insurance is no longer Accepted
Why It’s So Hard to Find a Therapist Who Takes Insurance (The Wall Street Journal, 2021)
Can't Find a Psychologist Who Accepts Insurance? Here's Why. (Psychology Today, 2019)
Health Insurance Still don’t adequately cover Mental Health Treatment. (National Alliance on Mental Illness, 2020)

• Why It’s So Hard to Find a Therapist Who Takes Insurance Many therapists don’t take insurance. The ones who do are often booked. Here’s why—and what you can do about it.
  Finding a therapist who takes insurance was tough before the pandemic. Now, therapists and patients say, an increase in the need for mental-health care is making the search even harder. When Molly Pratt, a 30-year-old math teacher in Boston, was dealing with depression a few years ago, she says she called several nearby therapists, but they didn’t accept her insurance plan. She tried a few listed as in-network on her insurer’s website. One didn’t call back. Another said she no longer took Ms. Pratt’s insurance. And a third didn’t have room in her schedule. “I was not in a good place. Every day not seeing a therapist felt much more urgent,” says Ms. Pratt. Especially in big cities such as Los Angeles, New York and Washington, D.C., demand for mental-health care is so strong that many experienced therapists don’t accept any insurance plans, they say. They can easily fill their practices with patients who would pay out of pocket, they add. Therapists who do take insurance are often booked up. And in many smaller towns and rural areas, there are few mental-health professionals at all. Finding a provider who takes insurance, or lowering your rates in other ways, is possible but often takes legwork that can be draining when you are already grappling with mental-health issues. Paying out of pocket for individual weekly therapy can add up to thousands of dollars a year. In major cities, the going rate for experienced clinical psychologists can be as much as $300 for a 45-minute session. The typical fee for a session with a licensed clinical social worker is between $120 and $180, says Anna Mangum, deputy director of programs at the National Association of Social Workers. Patients with out-of-network benefits may be able to receive reimbursement for a portion of the bills. But using in-network providers often means patients only have to pay a small copay. Psychologists, social workers and psychiatrists who don’t accept insurance say that insurers’ reimbursement rates are too LOW. Ms. Mangum says insurance companies commonly pay social workers about one-third to one-half the fee they can charge out of pocket. Some therapists also complain about the paperwork and restrictions on the kinds of care that are covered. “If you’re good enough and have good enough marketing and are in demand, then it’s just a financial decision” to not take insurance, says Ken Goodman, a licensed clinical social worker in Los Angeles and board member of the Anxiety & Depression Association of America. Mr. Goodman says he dropped his last insurance provider about a year ago. “I make twice as much if I just accept cash.” Hurdles to Finding a Therapist About 34% of people with private insurance said they had difficulty finding a therapist who would accept their coverage, according to a 2016 survey—the most recent data available—of more than 3,100 participants conducted by the National Alliance on Mental Illness, a national mental-health advocacy group. By comparison, 9% said they had difficulty finding an in-network primary-care provider. Office visits to mental-health providers are more than five times more likely to be out of network than are visits to primary-care providers, according to a 2019 report from Milliman, a consulting firm, which analyzed insurance-claims data. In 2017, 17.2% of mental-health office visits were out of network, compared with 3.2% of primary-care visits, the Milliman report found.
  Petersen, A. (2021, October 5). Why it's so hard to find a therapist who takes insurance. The Wall Street Journal. Retrieved December 9, 2021, from https://www.wsj.com/articles/why-its-so-hard-to-find-a-therapist-who-takes-insurance-11633442400.
• Can't Find a Psychologist Who Accepts Insurance? Here's Why - Insurance payments for psychotherapy do not provide a living wage.
  Prospective clients often tell me that they had a very hard time finding a therapist who accepts payments from their insurance, or that their family members and friends cannot find a therapist who accepts insurance. Many therapists only see patients who pay “out of pocket.” Why? The discrepancy between insurance payments and self-pay is huge. Psychologists in private practice tend to work about 50 hours per week, no matter how many of those hours are paid direct service. Each clinician will have limits to the number of hours they can see clients while maintaining a high level of care, attention, humanity, and application of professional expertise. Reserving a few hours for pro bono activities—such as supervising students, speaking to community groups, writing educational blogs, collecting data, and so on, most clinicians will likely see between 20 and 30 paying clients per week, for one session each. While fixed professional expenses, such as health insurance, malpractice insurance, office rent, etc., do not change, the income discrepancy between therapists who accept insurance payment and those who bill clients directly grows wider with each additional client. At $80/session (about the average paid by commercial or government insurance) working 20 hours per week, psychologists’ gross income is $76,800/year. But remember, private practitioners are part of the gig economy. We do not get any benefits such as health insurance, paid vacation, or sick time—and no perks. Plus, we have plenty of expenses. Conservatively estimated: $1000/month for office rent; $1100/year for malpractice insurance, $6000/year for health insurance; $900/year for internet services; $900/year for phone service; $500/year for CE classes; $5000/year for billing service. (This list does not include any professional memberships, travel expenses for CE courses, office supplies, cleaning services, paper, pens, laptops, postage, printing or even license renewal fees.) I calculated income based on 48 weeks work per year, allowing two weeks vacation, and 10 days that could be used for holidays or sick days. Then I subtracted office expenses. That’s why the actual income for therapists seeing 20 clients per week is $50,400. Compared to $80/hour paid by insurance, self-pay fees are around $200-$250/hour. I calculated based on $200/hour, and the annual income for a clinician who accepts self-pay clients came to $192,000 (after necessary expenses, that would be $165,600).* At 25 hours of direct service per week, clinicians accepting insurance end up with an annual income, after necessary expenses, of just under $70,000, still a far cry from the average income in the San Francisco Bay Area, where I work—about $88,000—or the median of $96,000. Those who accept only direct payment and see 25 client hours per week have an income of about $214,000. For those clinicians who spend 30 hours per week in direct service, seeing clients, the income for those accepting insurance is just at the average level, $88,000/year. For those accepting only fees for service, the income for a psychologist seeing 30 clients/week is $261,600. As psychologists who are trying to provide a decent life for their families switch from accepting insurance to accepting only self-pay clients, it leaves even fewer psychologists available to provide therapy to those who cannot afford $200/week (or close to $10,000 per year), for their therapy. What would constitute an answer that would meet the basic needs of psychologists, while also allowing more people to access services through their insurance? Here are three possibilities: Communities could subsidize community mental health centers, where clinicians could have real jobs, rather than be part of the gig economy. Those real jobs could start at the median income for the area and go up with experience. Full-time clinicians could be expected to do 30 hours of some sort of service, which might include supervision, seminars, community outreach, and clinical direct service, with 5-10 hours reserved for phone calls, notes, and consultation with peers. Another possible answer would be for insurance companies (or perhaps, ultimately, a national single-payer system such as Medicare for All), to increase payment rates. In order for a clinician providing 25 hours of direct clinical service per week to approach the San Francisco median income of $96,000, to give an example, such payments would have to be a minimum of $100/hour for those practicing in that metropolitan area. That would provide an income, after basic expenses, of $93,600, a decent income for a clinician, particularly one who is just starting out. But those rates would have to rise, at least pegged to the rising cost of living in any particular area. There could be a combination of these options, with community centers offering jobs to therapists while demanding decent reimbursement to defray the costs of maintaining the centers.
  LoCiero, A. (2019, May 2). Can't Find a Psychologist Who Accepts Insurance? Here's Why: Insurance payments for psychotherapy do not provide a living wage. Psychology Today. Retrieved December 9, 2021, from https://www.psychologytoday.com/us/blog/paradigm-shift/201905/cant-find-psychologist-who-accepts-insurance-heres-why.
• Health Insurance Still Don't Adequately cover Mental Health Treatment
  Inadequate Provider Networks
  Parity laws mean nothing without “network adequacy;” that is, whether a plan has enough in-network providers to meet the needs of the plan’s members in a geographic area. When health insurance companies have an inadequate network of professionals to provide mental health care in a given area, they effectively discriminate against people needing that care. An inadequate network forces plan members to: Wait for long periods of time before getting treatment Travel great distances to see an in-network provider ​See a professional outside of their network at a high out-of-pocket cost Studies show that network adequacy for mental health treatment is a real issue. A 2019 report found that a behavioral health office visit is over five times more likely to be out-of-network than a primary care appointment. A 2016 NAMI report also found that people had more difficulty finding in-network providers and facilities for mental health care compared to general or specialty medical care. Often, going out of network was the only option for treatment. And individuals reported difficulty finding correct information about the in-network providers for their health plans. Why do so many plans lack in-network providers for mental health and substance use care? A couple of reasons: One, there are shortages of mental health professionals in general, and particularly in certain parts of the country. Two, many mental health and substance use providers do not accept insurance because they do not get paid enough by insurance companies for their services. There is some hope to address network adequacy issues. Under the Affordable Care Act, qualified health plans have to meet network adequacy standards and “maintain a provider network that is ‘sufficient in numbers and types of providers, including providers that specialize in mental health and substance abuse services, to assure that all services will be accessible without unreasonable delay.’” In 2018, a class action lawsuit was brought against companies that sold Ambetter health plans for an inadequate provider network. The lawsuit alleged that fewer doctors or hospitals actually participated in Ambetter’s networks than the companies claimed, people had trouble finding providers who would accept Ambetter insurance and lists of Ambetter’s in-network providers were inaccurate. The lawsuit currently alleges breach of contract claims and violations of the Washington State Consumer Protection Act. Unreasonable Criteria To Qualify For Coverage In addition to inadequate mental health provider networks, health insurance companies also sometimes use restrictive standards to limit coverage for mental health care. These standards often include criteria that plan members must meet in order to qualify for coverage or treatment. Often, these standards make it extremely difficult to get treatment covered unless a plan member is very ill. Another class action lawsuit brought in California has successfully challenged the use of such guidelines in making coverage decisions. In Wit v. United Behavioral Health, individuals sued a plan benefits administrator because they were denied care for outpatient, intensive outpatient, or residential treatment for mental health or substance use. These denials were all based on the plan members’ failure to meet criteria in level of care or coverage determination guidelines. The court found that the guidelines used by United Behavioral Health strayed greatly from the generally accepted standards of care for mental health and substance use treatment. For example, the guidelines: Focused excessively on treating and addressing acute symptoms and stabilizing crises while ignoring effective treatment of underlying conditions Failed to provide for effective treatment of co-occurring conditions Actively sought to move patients to the least restrictive levels of care even if it might be less effective ​Did not meaningfully address different standards that should apply to children and adolescents when treating mental health and substance use The court further concluded that the process for developing these coverage guidelines was influenced by the company’s financial interests. It ruled that United Behavioral Health breached its duties of loyalty, due care, and duty to comply with plan terms. The court also found that United Behavioral Health’s denial of benefits was arbitrary and capricious. Barriers to health insurance coverage for mental health and substance use treatment still exist despite parity laws. But plan members are fighting back in court. If you feel you’ve been unfairly denied coverage for mental health or substance use treatment by your insurance company, you’re not alone. There are resources available to help you appeal coverage denials. And when all else fails, consider calling your friendly neighborhood health insurance coverage lawyer for advice.
  Bogusz, G. (2020, March, 13).Health Insurance Still don’t adequately cover Mental Health Treatment. National Alliance on Mental Illness Retrieved December 9. 2021, from https://www.nami.org/Blogs/ NAMIBlog/March-2020/Health-Insurers-Still-Don-t-Adequately-Cover-Mental-Health-Treatment

Yes

Ideally, it would be great if every couple went through counseling to maintain the quality of their relationship. A marriage is like a garden; it requires regular tending, work, and attention to keep it growing in a healthy way. If it is not routinely maintained, the marital “weeds” will sneak up and spoil the garden of your marriage. It is best to come in even when things seem to be going well, in order to polish up your communication skills, work through unresolved issues, understand each other better, etc. However, many people come into counseling just prior to divorce, when their garden is full of weeds with very little life left. Although coming in earlier is better, we can still work on the problems if you are willing to do the hard work. Marriage counseling is not miraculous; I can’t make everything all better in a few sessions. It took time for your marriage to get the way it is, and it will take time and effort to re-establish your relationship. If you are unsure if you want counseling or if it is worth it for your relationship, come in for an initial session, and I will help you diagnose the problems and determine a plan of action for you to consider.

As your therapist, I take a direct role in marriage counseling. I am not there just to listen; I am there to listen and provide direction, reflection, and clarification. I will be an active participant in your sessions, which involves listening, interrupting, mediating, clarifying, confronting, and providing direction for the session.

If any of the following statements apply to you, you should seek substance abuse counseling.

• You have chronic hangovers, difficulty studying or otherwise question your relationship to alcohol and/or drugs.
• Someone who cares has expressed concern about your use of drugs/alcohol.
• You frequently use drugs or alcohol to a state of intoxication.
• You experience a blackout (a temporary loss of memory), due to the use of alcohol.
• You resist hearing or learning anything about the negative effects of drugs/alcohol.
• You come into conflict with the law, or sustain bodily injury as a consequence of intoxication.
• You were raised in a family where problem drinking or alcoholism was present
• You have friends or loved ones whose use of mood-altering substances is a concern to you.

I am unavailable outside of office hours, I suggest you call an agency listed on the Community Resources page. If you have an emergency situation please call 911 or go to your nearest emergency room.

Because client hours are limited, it is important to make them available to those who need them. I require 24 hours notice of a cancellation or you will be charged the full fee for that appointment. I will work with you if there are unusual extenuating reasons for the shorter notice.