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What will happen in the first
meeting?
The first session can take many forms. On rare occasions, I have
had a client who came with a very specific issue that we resolved in a
single session. Usually, though, the first meeting serves several purposes:
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I obtain a personal and family history so that I can better place the
current problems in context. In the case of a child or teen, this helps me get a sense of whether it will be
more effective to work primarily with the entire family, the parents and the
child/teen, or predominantly with just the child/teen in individual
therapy.
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It serves as a time to further define just what you want from therapy. A
common question I ask takes the form of, "When you have accomplished
what you came here to do, how will things be different? What will have
changed in your life?"
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The session gives both of us a chance to begin to confirm that we are a
"good fit." In those rare situations where one or both of
us believes it won't be a good fit, I can often suggest names of some other
therapists that may be a better match based on what I learned about you in
this session.
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What kinds of therapy do
I use?
I once browsed through a textbook that described more than 500 different
kinds of psychotherapy! I find it hard to condense my approaches to
a few terms, though there are some common themes that seem to characterize how
I work. Here are a few, in no particular order.
- I'm a pragmatist: If it
works, do it; don't form a committee.
- I often look at things from a
"family/systems" model. Like two kids on a see-saw, relationships
involve balance. Sometimes life may feel as if you're in the one down
position, sometimes the other way around. Being stuck is often an
illusion.
- I find it much more useful to look
at who can help resolve a problem rather than look at who is to blame for
it.
- I love using stories and metaphors to teach. This
one appeared in Family Circle in late 2001.
- I'm a linguist - I pay
careful attention to the impact of particular words. Many times, disagreements
get started from the same few words. (For a preview, check out
my book Great Ways to Sabotage a Good Conversation.
You can read the first two chapters here on the web site.)
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I value the use of
humor as an antidote to many things such as power struggles and tunnel
vision. (Click here for
one example drawn from the book.)
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Since many people spend a lot of time in trance anyway (ever watch a child
who is watching TV?), I like teaching people how to use self-hypnotic
strategies more effectively.
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Coincidences usually aren't.
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I encourage clients to pay very careful attention to intuitive
hunches. Intuition is usually much more reliable than the other senses. Fear,
worry and anxiety are
never part of an intuition.
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Lastly, I like to work myself out of a job quickly. In
the process, I hope to give you more problem solving tools. To
paraphrase from the philosophy at my undergraduate school, Carnegie-Mellon
University, my job is not to tell you what
to think, but to help you learn strategies for how to think.
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How often are sessions scheduled?
Most of my clients choose to meet once a week. When financial or scheduling
constraints dictate, sessions are scheduled less often. A few meet twice a
week when getting started or during a tough period. Many clients reduce
the frequency of their sessions to once every other week for a few sessions
before their final appointment. I sometimes joke that if I am staying on
top of things well, I'll sense that you're about ready to stop therapy about
five minutes before you tell me.
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How long will therapy take?
I keep several wizards on my desk to remind me that while my (clinical)
hunches are often on target, I don't read minds. Some presenting concerns lend
themselves to brief therapy, defined as 6 - 12 sessions. Acute situations
often respond fairly quickly; long-standing problems (e.g., poor self-worth,
chronic depression) understandably take longer. How much longer? Ask me again
after the fourth session and we'll compare impressions. Those first few
sessions usually tell a lot.
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What are the limits of
confidentiality?
In Georgia, information given to a psychologist is termed
"confidential", a legal term providing even more protection than
"privileged" information. In essence, I am not allowed to share any
information with anyone else without your written consent, with a few
important exceptions:
- suicidal risk -- if I believe that a client is at imminent risk of
harming himself or herself, I am legally and ethically required to intervene. In the unlikely
event that I thought this applied to you, I would tell you before I
contacted anyone else.
- homicidal risk -- if I believe that a client is at imminent risk of
harming someone else, I am required to intervene. Stemming from "duty
to warn" legislation, I would have to notify the person whose life I
believed was at risk. Again, in the unlikely event that I thought this
applied to you, I would tell you before I contacted anyone else.
- abuse of a minor child or an elderly person -- Psychologists are
required to report suspected abuse to DFCS. Again, in the unlikely event that I thought this
applied to you, I would tell you before I contacted DFCS.
- In very rare cases, a judge can order a psychologist to release records.
In 32 years, I have never had this happen.
- Case law is somewhat ambiguous about confidentiality when two or more
people are in the room with a psychologist. For example, assume I am working
with a couple. For billing purposes, only one of them is the "client". Can
the client waive confidentiality for the case file, including things the
spouse told me, without the spouse giving consent? Has confidentiality
already been waived because the spouse was present? Different courts have
ruled differently.
- If parents are involved in child custody litigation, the situation can
arise where one parent waives confidentiality for the child's
psychological records. In such cases, it is important to talk things over
with your attorney.
- For children and teens under age 18, there are two additional
exceptions: If I believe a child/teen is either engaged in criminal
activity (e.g., breaking into homes, stealing cars) or is involved in
drug/alcohol use, it is my policy to tell parents -- after
discussing it with the child/teen first. Technically, this is not a
violation of confidentiality, because with few exceptions, parents have the legal right to
access to their minor children's medical/psychiatric records.
So what about confidentiality for children and teens? The HIPAA
regulations have made some changes that therapists are still sorting out.
Historically, I have worked under the assumption that parents have the
legal right to access everything in my notes. However, the reality is that
teens (and children) are more likely to open up to me if they trust that I
will honor their confidence. So I ask that parents trust that I will alert
them if any of the above exceptions come into play. In practice, only one
parent in 32 years has balked at that. The case involved a change of custody
petition. I refused to share the requested information without a court order
because of how destructive I thought it would be for his son. Before the case
went to court a few weeks later, the boy turned 18, making it a moot point.
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What about psychological testing?
For adults, there are several pencil-and-paper questionnaires I frequently
use. Several are free. The cost for the other major one I use is usually less than $75. Most of the forms can be
completed at home. The information helps me insure I'm not overlooking
something important. I'll discuss the results with you. For
children/teens, I like to have parents complete a couple of questionnaires. If there are
concerns about behavior at school or academic performance I like to have the teacher(s) complete a similar questionnaire. I'll discuss the results with
you. There is usually no charge for these questionnaires. With some older teens
I will administer additional pencil-and-paper tests. Again, the cost is
minimal, usually less than $50-75. Psychoeducational testing to rule out
learning problems falls under a different category. Please see "Evaluation
of Learning Disabilities" for more information about this kind of
testing.
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For family therapy, who will actually come to the sessions?
Years ago I used to push to have everyone in the family come if a
child/teen was the focus of concern. Then I became a parent myself. I'm more
pragmatic now. Sometimes I still like to meet everyone, but I often work with
subsets of the family. Typically, I mix individual sessions with the child,
sessions with the parent(s), and sessions with the child and parent(s). Often
I do this within a single session to facilitate getting critical updates from
a parent.
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