Therapy can be useful for anyone, whether you are struggling with mental health issues or doing well in life but interested in personal exploration. Even if we are able to manage most things on our own, there may be times when what works no longer works. We are able to find more effective or healthier ways to think of or do things when we learn more about ourselves. When there is a willingness and openness to the process, therapy can provide long-lasting benefits and support, tools to manage things, and the awareness to recognize and change unhelpful patterns.

Therapy is able to offer a variety of benefits, including general emotional support, problem-solving skills, enhanced coping strategies, increased self-awareness, and adopting more helpful ways of thinking or living. The work can be focused on self, relationships with others, or the ways we interact or deal with other things.

Therapy cannot change the past, make you stop having difficult thoughts or feelings, or make things exactly the way you want, but it can help manage these inevitable challenges when they arise.

You can learn more about services and the therapy process here.

Online therapy has been shown to be as effective as traditional in-person or face-to-face therapy with higher retention rates as it reduces many common barriers to staying with or committing to therapy. Many enjoy the flexibility, convenience, and ease of access without major disruptions in their lives. However, everyone has different needs and preferences: some may benefit greatly from being seen in person, finding it easier to connect; best practices for severe mental health issues are usually in in-person settings or programs.)

I do not directly take or work with insurance panels but I use teletherapy platforms that do. Octave is contracted with certain insurances and manage everything related to payments and insurance, making things easier for you and me. If you are considering working with me…

Start with Octave if you will be using
• Aetna
• Anthem Blue Cross of California
• Blue Shield of California
• Cigna Health Net
• Managed Health Network (MHN)

Your insurance may also cover a certain amount of out-of-network costs (commonly 50-80% reimbursement for PPO). Contact your insurance to verify if you are eligible.

There are advantages and disadvantages when finding a therapist in private practice versus insurance. If you are not in a financial position to pay privately, getting support in the most viable way is a priority.

If you would you prefer to utilize your insurance first, you can contact your insurance’s member services (often on your insurance card) and request “mental/behavioral health services for therapy and/or psychiatry” (medication). Your insurance carrier’s website may also have an online directory of providers.

Additionally, you can utilize online mental health directories like Psychology Today and filter by insurance type.

Questions to Consider When Using Insurance:

• Do I have mental health benefits

• Do I have to see someone on my insurance panel or can I see a therapist outside of network?

• What is my deductible and has it been met?

• How many sessions per calendar year does my plan cover?

• How much does my plan cover for an out-of-network provider?

• What is the coverage amount per therapy session?

• Is approval required from my primary care physician?

It is important that the investment of therapy should not cause a troubling financial burden in your life, however it is also important to inventory your priorities based on what you are investing in through time, energy, or money.

There are pros and cons to both. Using insurance reduces the cost of therapy making it more affordable and sustainable however also greatly limits your options to therapists contracted with a specific insurance company. It is also common that free services are less valued and therefore less committed to. Therapists are also required to provide a diagnosis and details about therapy to the insurance company to justify coverage of therapy, therefore confidentiality is somewhat limited. When there is trouble with coverage, therapy can also be abruptly terminated. This would not occur with private payment.

The opposite occurs with private payment: when paying the full cost, someone may have higher motivation to commit to change in order to avoid wasting time and money. Additionally, private pay greatly opens up the selection of potential therapists to work with (many therapists avoid insurances because of low reimbursement rates). Confidentiality is full ensured because private therapists are not reporting to anyone (see “Is everything confidential?” below).

There is no “one-size-fits-all” for mental healthier treatment: it depends on a variety of factors. Some of the research generally shows that for:

Depression: combining cognitive-behavioral therapy (CBT) and medications may be more effective than either treatment alone.

Anxiety: while CBT, antidepressant, and anxiolytic medications have all been show to be helpful, therapy like CBT is more effective than medication and adding medication does not significantly improve outcomes from therapy alone.

Substance use: CBT, environment-based therapies, as well as 12-step support groups have been show to be helpful. Severe substance use problems may benefit from certain medications that reduce cravings or intoxication effects.

Eating disorders: CBT, interpersonal therapy, and antidepressant medications have been show to be helpful and that combining may be more effective than either treatment alone. Medical management may be required to maintain physical safety.

Schizophrenia or bipolar disorder: most will require antipsychotic or mood-stabilizing medication. CBT or family therapy can also improve functional outcomes.

Parenting, marriage, or adjustment: therapy is usually the first recommendation to build skills and respond more appropriately to stressors.

I do not prescribe medications because I am not a medical doctor. If you are interested in psychiatric medication, your general/primary care physician may be able to manage basic anti-depressant and anxiolytic medication. For any range of mild to severe mental health issues, a psychiatrist or psychiatric nurse practitioner would focus on managing your mental health treatment (primarily focusing on medicine but likely to make other general recommendations such as therapy, diet, exercise, etc).

If you are interested in a psychiatrist, you can pursue one through insurance or through private pay.

There is a diverse approach to mental health care but the “levels of care” are often organized by severity and need:

Outpatient Therapy
The initial line of mental health care is often psychological “talk” therapy and/or psychiatric medication. Therapy sessions are more frequent when the struggle or need is higher and less frequent when feeling better or things are improving. If there is a lack of improvement after an extended amount of time or things rapidly worsen, a higher level of care may be the next option.

Intensive Outpatient Program (IOP)
IOP focuses on group work to more rapidly develop skills to manage symptoms and issues. IOP may also include individual sessions and/or medication management. It is typically 3-5 days per week, 3 hours per day. The overall duration greatly varies depending on severity, need, and coverage. IOP could be as short as 3-4 weeks or as long as 8-12 weeks.

Partial Hospitalization Program (PHP)
Essentially an IOP but for higher severity or need, typically 5 days per week, 6-8 hours per day. It is a day-program for more intensive stabilization that does not require 24-hour monitoring. PHP durations, often 1-3+ weeks, will vary depending on severity, need, and coverage. A PHP often transitions into an IOP to gradually ease back into life.

Community Integration Program/Extended Care
Clients are living in a shared therapeutic space with other clients but individual/group therapy and support takes place in a separate dedicated space. This allows a certain level of independence, support, and focus on increasing interaction with the community.

Psychiatric Assertive Community Treatment (PACT)
Also known as “hospital without walls”, the goal of this level of care is to keep a person from being hospitalized. It is often used for people who have had multiple psychiatric hospitalizations and are trying to break this pattern. Clients will live at home and the clinician comes to the client’s home.

Residential Treatment Center (RTC)
Essentially “voluntary inpatient”, clients will temporarily live at an RTC while being stabilized or treated after their symptoms have created significant impairment and are no longer able to adequately manage their mental health issues on their own or live at home. 24-hour monitoring and support is available. Duration may last 1-4+ weeks depending on severity and need.

Acute/Inpatient Hospital Care
Commonly associated with “involuntary hospitalization” or “5150”, this level focuses on containment and stabilization when a person is imminently dangerous to themselves or others, requiring 24-hour monitoring and higher restrictions (e.g., hospitalized against will, not able to leave hospital until deemed appropriate by a psychiatrist). A stay usually lasts 3-5 days but may extend when there is a lack of progress or further worsening of symptoms.

Conservatorship
When there is a patten of acute psychiatric hospitalizations a person is unfit to care for themselves, a significant individual or public-guardian may be granted the authority to manage this person’s treatment, also known as a conservatorship.

Assisted Outpatient Treatment (AOT)
When an adult with severe mental illness results in a recognizable and highly concerning pattern of hospitalizations, violence, arrests, incarcerations, or relevant charges, they may be court-ordered to receive constant intensive treatment. In California, it is also known as Laura’s Law.

I am able to work with more specialized issues up to a certain extent. Often times, these more severe issues are the product of something deeper and traumatic. Changing them requires a significant amount of commitment and willingness to lifestyles changes, including habitual use of therapy tools and embracing the temporary discomfort of “letting go” of whatever these issues are holding onto.

It’s common to have some reasonable degree of depression, anxiety, or behavioral addiction (e.g., technology, food, chemicals, social media), but it’s usually not an issue if it’s well regulated or infrequent. When you are completely unable to function as a result of something like addiction, eating disorder, or severe mental illness, meeting 1-2x every week may not be enough. Specialized treatment, psychiatric medication, voluntary inpatient treatment, residential treatment, or other higher levels of care may be more indicated first.

I only work with adults in the state of California at this moment. Occasionally, it can be helpful to include family members (spouse, children, parents) but the focus is still for my patient.

You can inquire with your schools, school’s psychologist or social worker, pediatrician, or simply use the internet. If you intend to use insurance, check their online directory or website. Additionally, insurances are often contracted with online therapy platforms, so you can search “child therapy accepts _ insurance [City, State]”.

Call 911 for emergencies.

Call or text 988 for the suicide hotline.

Once a mental crisis is over, prevention and maintenance is critical. Create a plan ahead of time to be prepared for the possibility of a mental health crisis: recognize your warning signs, known who to talk to, practice things you can do to calm or stay grounded (do this in advance, when you are not in crisis!), and have resources ready to access. Your local community generally has governmental or community clinics with emergency evaluation services to intervene in mental health crises.

Common hotline and warmline resources are listed here. These can be helpful for deescalation.

Confidentiality is one of the most important things I uphold and value. It is important you feel able to share without fear or concern about consequence. Legally and ethically, I protect the confidentiality of all of our communications and will only share or disclose information with your written permission or request.

However, there are some exceptions required by law to this rule. Exceptions are not meant to be punitive but to maintain public and personal safety:

• If a patient is an imminent danger to themselves or others and unwilling to seek help. If all other less restrictive approaches to deescalation are not adequate, I would need to coordinate with local authorities (law enforcement or specialized acute mental health clinicians) and hospitals to ensure safety.

• I am required to notify police if a client is threatening serious bodily harm to another person.

• As a mandated reporter, I am legally required to report information provided to me that makes me reasonably suspicious of current or past abuse or neglect of children, dependent adults, or elder adults (60 years of age or older). Information will be reported to appropriate protective services agencies which will then either take the information without further investigation or pursue further investigation if appropriate.

When using insurance for therapy, a therapist is required to provide a diagnosis as well as details about therapy to justify coverage for the service. Private pay does not require a diagnosis nor for a therapist to provide details about therapy to anyone, therefore you may want to consider this while deciding to go through insurance or not for therapy.

This is dependent on individual needs, requiring self-reflection and trial-and-error. There are times it is clearly beneficial to pursue a therapist that is similar to you or your history and there are times it is valuable to be working with someone opposite of you (often reminding you of someone or something you struggle with).

As a clinician, we are trained and encouraged to maintain awareness of how personal factors may influence the process. This is helpful to stay aware of or discuss to draw parallel real-world applications.

There are situations which are related to these factors (but not because of them) that may limit my ability to support or demand a higher level of care, e.g., dementia in seniors, eating disorders, active suicidality, psychosis, severe substance abuse, physical pain or health problems. Some of these issues would need to include additional health services or require a more intensive mental health treatment service/program to make progress.

If you are still researching potential therapists, it may be worthwhile to reflect on how important these factors are to you. At the same time, be aware of the potential “avoidance” your mind may also attempt to attract you toward.

In the United States:

• 1 in 5 adults (50 million) experience and 1 in 5 children live with a mental illness

• 1 in 25 adults (10 million) live with a serious or debilitating mental illness

• 50% of chronic mental illness begins by the age of 14; 75% by the age of 24

• 18.1% (42 million) adults live with anxiety disorders

• 6.9% (16 million) adults live with major depression

• 2.% (6.1 million) adults live with bipolar disorder

• 1.1% (2.4 million) adults live with schizophrenia.

50-60% of people who have a mental health issue did not receive services to manage them.

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