Intensives

90-min Intensives

MY APPROACH

Couples/family counseling is a special interest of mine. My approach to couples/family counseling focuses on facilitating transparent communication to restore the foundations of trust (identifying wounds), re-assigning personal accountability for self-care, making amends/repairs, identifying steps to rebuilding a friendship, negotiating compromises that feel fair to each person, and learning to speak the other’s love language so that the love you are wanting to send out is actually received and felt. I really work to understand each person’s personality type, values/needs, and fears/difficulties so that I can be a bridge for these differences.

My style pulls from the popular teachings of the Gottman Method, Imago Therapy, renowned psychotherapists Esther Perel, Dr. Irvin Yalom and Dr. Orna Guralnik, non-violent communication teachers Thich Nhat Hanh and Pema Chodron, my years of experience in the field since 2004, my own personal therapy for myself (individual, family, and couples work), as well as my long-term relationships and own divorce. My goal is not to save all relationships at any cost or to decide which relationships are better ended- unless there are issues around safety and abuse. Instead, I wish to help each person see themselves and their partner clearer and to look at what a relationship actually entails in new and wiser ways. Please see my article A Noble Apology to get a better sense of my teaching style. 

It is my general policy to work with the couple/family members together and to not separate anyone for an individual session. Instead, I might focus one session (or a portion of a session) on one person in particular while the other listens so as to witness the process and gain more of an understanding of their loved one as an individual. 

INSURANCE

The great news is that most insurance plans cover couples/family counseling- with one person being identified as my primary client and the other joining to create a conjoint counseling session. 

The downside is that insurances utilize a different code for couples/family counseling than for individual counseling. As a result, the reimbursement rate for couples/family therapy equates to less time (45-minute session) than most counseling sessions (a traditional 60-minute session).

Moreover, insurance allows for sessions only once a week- and that is only if they are considered “medically necessary.” Therefore, you cannot be seen twice (or more) in one week or even weekly if you are not in a crisis or a necessary stabilization phase.  

Thus, therapists have to choose between conducting shorter sessions (often having to stop the session when just arriving to the heart of the work) or to no longer accept insurance. Since neither of these options is appealing, I have come up with a 3rd option – the intensive option. 

OPTIONAL ADD-ON: COUPLE/FAMILY 90-MINUTE INTENSIVES

I have found throughout my years of experience working with couples/families that it can be very useful to engage in extended sessions (longer than 45-minutes) or more frequent sessions (to reduce the intensity sooner than before a week’s time- so as to not frustrate the already fraught process). 

Extended/more frequent sessions can be essential in the beginning as I work to interject myself into an often very raw time. In the first two or so sessions, I am gathering background information and fleshing out goals and can’t provide much needed tools and relief until several more sessions in. More time or frequency is also a huge help during times of intense fighting or during a crisis. Providing this extra support is not possible through insurance under their current practice guidelines. 

The intensive option is essentially:

  • Two back-to-back 45-minute sessions at one time for a total of 90-minutes. One 45-minute session will be billed to your insurance (and you will pay your copay) and the other 45-minute session will be self-pay billed at a discounted rate of $100. This will allow you to still utilize your insurance benefits while also allowing us the extended time that is so essential at the start of therapy and during times of high conflict. 
  • You must book these 90-minute intensives ahead of time when booking your appointment with my office manager Jennifer- they can’t be spontaneously opted for at the end of your session because you want more time. 
  • With the above being said, if you do go over your 45-minute session time without booking a 90-minute session you will still be charged for any time over 45-minutes. There is a bell you will hear at the close of your session and I will also alert you- but you might also want to set your own timer to help you be aware of the time during these often emotional conversations as many continue to talk beyond their time.  If you choose to go over your 45-minute session, you will automatically be charged at $3 per minute over. 
  • Back-to-back sessions are entirely up to you and not meant to be indefinite (unless you want them to be). Once this intensive phase of therapy is complete, single sessions can be booked as needed. 
  • Since extra time is being set aside for these extended sessions, the cancellation policy will also be amended for this time period: 48 hours will need to be given for cancellations, or a $100 late cancellation fee will apply. 

OPTIONAL ADD-ON: INDIVIDUAL 90-MINUTE INTENSIVES

  • Intensives can also be used for individuals who would like more time by booking a double session
  • If a 60-minutes session is considered “medically necessary” by insurance standards, the first 60-minutes will be billed to your insurance (and you will pay your copay) and the other 30-minute session will be self-pay at my discounted rate for individuals at $60.
  • If a 60-minute session is not considered “medically necessary” by insurance standards, the first 45-minutes will be billed to your insurance (and you will pay your copay) and the other 45-minute session will be self-pay billed at a discounted rate of $100.
  • If you don’t have insurance or aren’t using your insurance, the cost for a 90-minute self-pay session is billed at a discounted rate of $180.
  • Since extra time is being set aside for these extended sessions, the cancellation policy will also be amended for this time period: 48 hours will need to be given for cancellations, or a $100 late cancellation fee will apply. 

“MEDICALLY NECESSARY”: INSURANCE STANDARDS

  • Insurances do not allow for generalized supportive counseling (e.g. improve communication, increase intimacy, co-parenting strategies), especially long term. 
  • Instead, they require that the sessions be “medically necessary”: a clear focus (i.e. Treatment Plan with objective/measurable goals that are followed throughout your course in therapy), on a specific mental health issue (i.e. medical diagnosis per the Diagnostic Statistical Manual-5 that is actively impairing your functioning), with acute symptoms documented in each session’s progress notes (i.e. sufficient for an audit review), and working towards some form of resolution (e.g. decrease in frequency of sessions and/or being discharged). 
  • A 45-minute session is meant for routine therapy, whereas a 60-minute session is meant to be utilized for times of crisis or stabilization, complex cases, dual diagnosis, or specialized treatments (e.g. EMDR, Systematic Desensitization, Specialized Trauma Treatments, and DBT protocols).
  • Having already successfully navigated a large audit, I am well aware of how insurances grade care and their readiness to retroactively claw back money they deem was not covered under the “medically necessary” guidelines. 
  • Sadly, their guidelines are very different from how I see the precious work of therapeutic treatment.