FAQ’s

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?

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 forth. 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 address the issues or problems that you hope to work on. Whereas penicillin may always work for strep throat, in therapy different methods work for the same problem with different people. Therapy is most beneficial and effective when it is tailored to the individual client. While one person 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 approaches 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.

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, among others. On the other hand, psychotherapy has 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.

How can I tell if I need therapy or what problems to “bring forth?”

You may have some concerns since you are 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.” At 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 is this. Something must be bothering you or causing you discomfort for you to be questioning 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:

We will meet together for the above-mentioned first few sessions to evaluate your needs.
You will tell me what brought you to consider therapy, those difficulties discussed above.
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.
I will also ask questions about symptoms that you may or may not be experiencing or have experienced in the past.
Come prepared to ask questions. You are interviewing me as much as I am interviewing 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.
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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What can I expect if I decide to go forth with therapy with you after the evaluation?

If psychotherapy is begun, I will usually schedule one or two 45 to 50-minute sessions (one appointment hour of 45 to 50 minutes duration) per week at a time we agree upon. We will sign a patient contract, an example of which is provided here. 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. It 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 appropriate 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 this can be difficult, it is 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.”

You and I will continue to have other rights and responsibilities in treatment. Honesty, attendance, timeliness, respect of my boundaries among other things are important in order for us 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.

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.

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 (i.e., 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 for 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.

Do you keep records? Can anyone else look at them? May I see them?

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.

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. However, there are a few exceptions:

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.
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 neglected or abused, I am mandated by law to file a report with the appropriate state agency.
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 such a 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 any identifying information regarding 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 necessary because the laws governing confidentiality are quite complex, and I am not an attorney. If you request it, 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 review 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?

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:

report writing
telephone conversations lasting longer than 10 minutes
attendance at meetings with other professionals you have authorized
preparation of records or treatment summaries
time spent performing any other service you may request of me
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.

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 full fee for the missed visit.

BILLING AND PAYMENTS

You will be expected to pay for each session at the time that 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 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.

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.