Is mental health treatment covered by my insurance?

Usually, yes. Every so often we will encounter insurance plans without the mental health benefit so it is important to know your benefits. Most agencies and practitioners bill insurance as a courtesy while some provide the documentation for you to send the claim in on your own, but the responsibility to know what is covered always falls upon the client.

Do I need insurance to seek treatment?

No, sessions can be paid for out of pocket if you so desire.

My deductible is astronomical and I cannot afford the cash fee. Now what?

Some agencies offer what’s known as a reduced-fee, sliding-scale, or negotiated-fee schedule. This looks different everywhere, with some clinicians offering totally free sessions on a limited basis and others dedicating an entire day for reduced-rate sessions. Some ask for income verification while others just take your word for it, all depending upon where their funding stream originates (sometimes grants require certain information). Zephyr hosts graduate students who are accumulating clinical hours for their degrees and, in turn, offers a contribution-based system with a floor of $5 and a ceiling of $30, whatever the client chooses to offer each session. This amount approximates a typical copayment and helps offset the overhead incurred by hosting these students.

When is it time to see a professional?

The Diagnostic and Statistical Manual (DSM) of Mental Disorders is the book that informs the mental health profession how to recognize and diagnose mental illness. In the very beginning of the book it defines a mental disorder as something that creates significant distress or impairment in important areas of functioning. Some of these important areas include relationships, education, work, legal, and physical health. If you are having more than typical struggles in life, that’s a good sign that you can make an appointment to see a professional.

Should I see a therapist when I’m sad?

Emotions are temporary by nature. Whenever an emotion lasts longer than a few seconds, we have to ask what’s keeping it around. Some experiences are more powerful than others and require more time to move through them. If, by your estimation, the emotion is sticking with you longer than you think is necessary or longer than you would like, it might be time for an appointment, if for no other reason than to get a different orientation to your experience.

How long does counseling take?

The sessions are typically 53-55 minutes but the duration of treatment can last anywhere from a handful of sessions to several months. In certain cases, depending on symptom severity, age, development, and recovery environment, treatment can last longer than a year. It all varies but most important is that it should be limited and no one should be in therapy forever. We encourage people to be mindful that they are progressing through treatment with the end goal being to stand on one’s own feet, so to speak, and not become therapist dependent.

What’s the difference between counseling and therapy?

We will assume that we are talking about mental health therapy, as opposed to any other kind. That being said, the terms “counseling” and “therapy,” along with “talk therapy” and “psychotherapy” are often used interchangeably. Some people will split hairs over what the words technically mean, but for general purposes they are all the same thing.

Do I need medication?

This will sound like a cop-out, but that is a conversation to be had between you and your therapist, then you and your doctor. Research has shown that therapy without medication can work, but that therapy with medication also works. Rarely does standalone medication work as well.

How do I find the right therapist for me?

This is tricky, but the best answer is the one whose profile resonates the best with you. Many clinicians have specialties in the kind of treatment you’re seeking but the connection and rapport are what will promote the best growth and healing. And research supports this.

I have an addiction but also trauma, depression, and anxiety. Do I need a therapist for each one?

Ultimately it is the client’s choice what services to obtain but ethics guide our profession to prevent service duplication, inappropriately billing your insurance twice for the same thing, and at minimum, ensure that we are working in the same direction. Typically the recommendation is to seek assistance from one practitioner who can competently address all your symptoms, and go from there, because oftentimes many symptoms are the result of a common problem.

Can I get PTSD without being in the military?

Yes, and it happens all the time. Without going into the diagnostic criteria, extreme psychological disturbance can occur in a variety of ways following a traumatic event. Simply defined, a traumatic event is one that the observer was not emotionally prepared to handle. Not all traumas result in Post Traumatic Stress Disorder, which by diagnostic criteria requires a duration of longer than a month, but we can also have something else: Acute Stress Disorder. Depending on the level of the trauma and the threat that happened during exposure to it, PTSD can result from a variety of events; car accidents, domestic violence, childhood neglect, occupational hazards, and more.

Is it okay to tell others that I am going to counseling?

Not only is it okay, but we actively encourage it. That being said, not everyone in the world yet understands that caring for mental well being is a necessary part of living a full life. Work with your therapist on appropriately navigating the potential hiccups that may occur when dealing with judgmental people who do not appreciate mental wellness.

How do I get past the stigma of going to therapy?

The first thing is believing in it to such a degree that caring what others think no longer matters. Even in physical health care, certain people can be found who discourage treatment, not because of a particularly informed hypothesis or research-backed justification but because they themselves are uncomfortable with it. Try to recognize these potential detractors and avoid letting them influence you away from care.

I once thought about suicide when I was really depressed. Does that mean I’m at risk for it again?

Without a thorough biopsychosocial interview, that is impossible to answer. However, simply thinking about suicide is not, in and of itself, a risk for actual suicide. Research shows that actual risk factors include prior attempts, a family or close acquaintance history of attempts, and several others such as a plan, access to that plan, and means to carry it out. If you are concerned about killing yourself, seek help immediately because no one wants you dead, although sometimes we can convince ourselves of that.

Can I bring someone with me into my sessions?

Usually. Your session is your own time and you can bring in whomever you want, but a few caveats exist. First is that unlike physical health treatment where the identified patient is the only one who will receive the care, in talk therapy the guests will be exposed to concepts that may result in a serious reconsideration of beliefs and which may cause distress that they didn’t expect. Because of this possibility, we require guests to sign consent forms because simply by being in session, they are therefore being “treated.”

If I am in another state, can I still get therapy from you?

State boards license practitioners to practice within their state’s geo-political borders. If a client commutes into that state to receive care and the practitioner stays put, simple logic asserts that the service provided would be appropriate. Whether that commute occurs via automobile, rail, aircraft, boat, or telecommunication seems not to matter if the practitioner practices within the state in which he or she holds a license. State laws vary, however, so check with your provider.

Do I have to choose a therapist before making an appointment?

This varies. Some people like to choose based on a profile that resonates with them, while others are comfortable just getting one assigned. It’s really up to the individual. What’s not recommended is constantly changing therapists without settling in and doing deep work. However, if you don’t get along with your clinician, you can and should change. We work for you and if we’re not doing what you need, you should let us know, have a dialogue about it, and give us a chance to modify our approach.

I have been told in the past that my case is “too complicated” and have been sent elsewhere. Do you ever refer clients out based off of an intake session?

Client health and safety is foremost and if basic needs are not being met, then moving forward with talk therapy could be harmful, which we will avoid. If a medical issue is complicating treatment (e.g., malnourishment due to an eating disorder), we may refer to a medical provider for basic physical care before beginning treatment. However, as long as the presenting issue is treatable within our scope, we will not turn anyone away. Instead we will work hard to train ourselves up in your area of concern and meet you where you are rather than sending you to someone else whom you may not have chosen to go. Referrals to other providers within the same profession are exceptionally rare and should not be the first course of action when facing a “complicated” presentation.

What’s the best way to get help for someone without seeming like I’m attacking them?

One of the more wonderful phrases we have in the counseling world is, “It seems…” and then we remark with our observation. You have to make sure your observation is neutral and not judgmental, and if you can circumvent the person’s fight-or-flight reflex, chances are you will be heard. Be patient and validate.

I don’t know what’s wrong with my kid. The teacher said it’s ADHD, the school nurse suggested a speech therapist, and our neighbor said it’s autism. His pediatrician said we should get him tested by a psychologist and maybe get medication for depression and anxiety. My wife and I are at our wits’ end, what should we do?

Whenever life throws more questions than answers, it’s never a bad idea to make an appointment with a clinician who will take the time to conduct a thorough biopsychosocial interview and give you some appropriate direction. Maybe we can help with family counseling, parenting, or your child individually, but at minimum we should be able to give you a decent hypothesis and some appropriate referrals.

What’s the difference among a CPC (LPC), MFT, LCSW, psychiatrist, psychologist, and substance abuse counselor?

In a nutshell: a lot, and we will try to be brief because this could get even more long-winded than we have here.

Addictions counselors, often referred to as substance abuse (or substance use disorder) counselors, span many categories. In Nevada, the Board of Examiners of Alcohol, Drug, and Gambling Counselors oversees certification and licensing for these clinicians. Their credentials might look like the following: CADC (Certified Alcohol and Drug Counselor - bachelor’s level), LADC (Licensed Alcohol and Drug Counselor - master’s level), LCADC (Licensed Clinical Alcohol and Drug Counselor - master’s level, co-occurring), or CPGC (Certified Problem Gambling Counselor). These practitioners can treat and diagnose what people commonly refer to as “addictions” and the LCADC can also treat other disorders besides addictions, so long as an addiction is also present.

In Nevada, CPCs (Clinical Professional Counselors) and MFTs (Marriage and Family Therapists) have the same practice scope and are licensed by the same board. While their graduate education experiences may be differently themed, they can do the same work within their practice scope. Licensed Clinical Social Workers (different from licensed social workers that don’t have the “C”) can also do everything that MFTs and CPCs can do but are licensed by their own board. Again, their graduate education consists of somewhat different coursework but they are licensed to do the same job.

Clinical psychologists are different in that their graduate education consists of a doctoral-level degree, which entails a research project of some kind. These clinicians will have either Psy.D (doctorate of psychology) or Ph.D (doctorate of philosophy, usually in psychology) after their names. In Nevada, clinical psychologists can do all the same work as MFTs, CPCs, and LCSWs, plus they can perform psychometric tests, which are assessments to determine a variety of human characteristics, including intelligence, neuropsychological functioning, aptitude, development, and much more. They are also licensed by their own board. What can be confusing about the term “psychologist” is that it includes many other disciplines, which are sometimes found within the mental health field, such as educational psychologists (Ed.D, doctorate in education), social psychologists, and sports psychologists. Not all are licensed as psychologists, but can provide mental health treatment. Important to note in seeking appropriate care is that not everyone with a doctoral degree (Ph.D in theology, for example) will possess a license to practice mental health but still might bear the title of “Dr.”

Psychiatrists hold the degree of M.D., or medical doctor, and they can do everything that all of the other practitioners can do, plus they can prescribe medicine. Commonly known as physicians, psychiatrists attend medical school for four years, followed by a residency in psychiatry that usually lasts three years, and then they might do two or three more years of fellowship that further refines their specialty area. These fellowships can include child and adolescent, addiction, forensic, geriatric, hospice, women’s health, and more. Some psychiatrists perform talk therapy in addition to managing medication, while others strictly do medication management and work in conjunction with a master’s-level practitioner to ensure proper care. The general rule with medication is that if you are taking it, you should also be receiving counseling along with it.

A close cousin to the MD psychiatrist is the APRN or APN (Advanced Practice Registered Nurse or Advanced Practice Nurse), who can also prescribe medicine and perform psychotherapy. In Nevada these master’s-level nurses are trained in both medicine and counseling, and can practice either on their own or within a doctor.

What is an intern?

In Nevada, if you see the letter “I” after a person’s credential, such as CADC-I, MFT-I or CSW-I, it means “intern.” In other states these clinicians may be called “associates” or “residents” but it means the same thing. An intern in the mental health world holds a state-issued credential to practice and, often, to bill insurance. Not all insurance companies allow interns to do so, but interns do possess full practice scope under the law. The only difference is that the law requires them to practice under the supervision of a state-credentialed supervisor throughout the duration of their internship. This means that they are getting weekly feedback from their supervisors on how to improve their abilities and strengths and often possess the most current information published in the field.

What’s the difference among “competence,” “specialty,” and “expertise?”

In most professions licensed by the state, two areas exist: scope of practice (what you can do), and scope of competence (what you should do). The law states what licensees can do with their credential, but ethics inform what they can do based on a minimum combination of training, education, or experience. These form our competence. The areas in which a clinician can become competent are literally too many to list here but can include; age demographics, ethnicity, gender, culture (including hobbies), symptom presentation, socioeconomic status, occupation, and health issues. The more time one spends learning something, the more competent one should become.

An area of specialty, more or less, is a different way of saying competence, only much stronger. We should be minimally competent in many things, but likely have only a handful of specialties. With specialization, the clinician has probably spent far more time working on that particular thing (experience) or has attained a certificate of some kind after attending a series of classes (training/education). If your clinician claims to be specialized, you may certainly ask what the path was and how they substantiate their claim.

Legally speaking, expertise is something typically reserved for the courtroom, as judges are usually the only ones who appoint “experts” in testimony. However, as a matter of practicality, people claiming expert status probably only do one thing and they do it really well.

Do therapists go to therapy? How often?

We certainly should, otherwise our authenticity erodes and our credibility suffers.

How do therapists stay healthy after listening to everyone’s problems all day?

Mental health clinicians of all kinds are uniquely trained to leave their work at work when they are done for the day. A simple philosophy that helps is understanding that our clients’ struggles are not ours. To carry them as if they are our own helps no one and hurts only ourselves and our families.

How close of a relationship is too close for someone to receive mental health treatment?

Typically ethics prohibit treating anyone inside of the fourth degree of consanguinity for family members. For others it is up to the practitioner to determine whether the pre-existing social or business relationship would impair professional judgment or increase the risk of exploitation within the clinical relationship.

Who will ever find out about my diagnosis and treatment?

Only the people you choose to tell, just the same as any other medical procedure.

Will you talk to my previous therapist?

We can... but in the spirit of Yield Theory and meeting you where you are (and not where you used to be), typically we like to form our own impression of you on the day we meet and move forward from there. Your story is your own and we would prefer that you tell it to us as opposed to hearing it from someone else.

Can I get a copy of my records?

Yes. Your records are yours, not ours. We are not legally allowed to withhold them from you for any reason except for certain, rare circumstances where doing so could cause harm.

One word of caution here, however. Being that therapy notes are merely snapshots of your work and do not robustly encompass all of who you are or what you have accomplished, the better idea is to request a treatment summary. The notes will also often contain very private, detailed information about things that you may not wish to risk escaping into the public, either through a discovery process in court or by blowing out the window of your car on the way home. With a treatment summary we can create context without the private details and give you greater control over your privacy.

Can my clinician send my records to…

Typically the best practice is for you to deliver your own documents wherever they need to go because this gives you control over your privacy. However, if 1) the medium is secure and/or encrypted, 2) we have reasonable assurance that the recipient is going to be who you say it is, and 3) we have your explicit, written permission, then yes, we can send your stuff. Exceptions to this might include situations where treatment is required for social service compliance, probation, etc., in which case your updates are usually your responsibility. Always check your treatment consent paperwork.

Can you write an evaluation about custody, visitation, or residence for me?

If you or your children are the client and we are treating you, then no, because ethics and law forbid it. If we have never met and we are competently trained to perform the evaluation, then yes. However, after that custody evaluation we are ethically and legally forbidden from treating you.

...okay, but what if I just want a letter of support and not a full-blown evaluation?

Same answer.

Can my employer punish me for seeking mental health treatment?

In a word, no. However, mental fitness for work matters as much as physical fitness for work. Employers should be as accommodating for mental illness treatment as they are for physical illness treatment and make adjustments as necessary. A clean bill of health for a return to duty should be all that is needed and no employer should be overriding a clinician’s determination on such an evaluation. Similarly, if a medical doctor determines that your broken arm is healed and the physical therapist determines that your strength and mobility have returned in full, your boss should not declare otherwise. To do so would be tantamount to practicing medicine without a license.

Where does mental illness come from?

Many theories abound about this, from genetic predisposition to moral failure. What is largely agreed upon though is that origin is minimally useful in resolving the distress that people experience when dealing with mental illness. Similarly, knowing how a person broke his arm is largely irrelevant in fixing it. Most important is knowing that it can be resolved and a full life lived after healing occurs.

What’s the difference between a symptom and a problem?

One idea is that symptoms are the diagnoses that clinicians use to frame a person’s struggles, whereas the problems are much deeper, not necessarily psychologically but systemically. For example, drinking too much alcohol is often referred to as a “drinking problem” but in actuality, the alcohol is just a manifestation of some underlying issue such as poor emotional functioning, lack of self-confidence, uncertainty about life, or attachment issues from childhood. Those problems are not well captured in diagnoses but the symptoms are, which is why we don’t want people grabbing too tightly to their diagnoses.

Can I improve my own mental health without a therapist?

YES! That is why we professionals exist: to get you so healthy that you never have to return. Making simple adjustments in one’s own life to create new habits that ultimately get you what you want is, in fact, how we help people. So of course if you can do this on your own, we would happily go out of business to live in a society full of mentally well people.

Is it true that once you have a mental illness, you have it forever?

If that were true, no one could heal and our profession would cease to exist. Suffering would be unending and recovery would not happen. So, no, it is not true.

What is being done to decrease the stigma of mental health care?

Many organizations fight this on a daily basis, including NAMI and Mental Health America. Zephyr Wellness does its part in normalizing the conversation by breaking out of the traditional silo with its social media presence, podcasts, YouTube videos, and forging multiple community partnerships. The end goal is to make conversation about mental health as commonplace and non-judgmental as conversation about physical health. “How’s your battle with the painkillers going?” and “Is your PTSD getting any better?” should one day be as easy to ask as, “How’s your knee been since the ACL repair?” and “Do you still have that cough?”