Online Counseling Tips for Clients and Therapists

Telehealth is a huge shift for most of us—clients and therapists alike. Here are som tips for you as a client during telehealth sessions:

• change your mindset: online therapy can be equally as helpful as in person sessions. It’s new, and might feel uncomfortable at first, but this doesn’t mean it won’t be useful to you.

• be as close to your internet router as possible to prevent connectivity issues

• find a private space with a closed door

• create a physical environment that feels safe and comfortable

• boundaries--share visually only what you want to share of your home, this can be a little or a lot. You might want your therapist to see your whole living room and meet your dog, or you might want to sit down in a nondescript corner to keep the boundaries more clear and separated. Up to you!

• close other open windows on your computer and put your phone away & on silent to minimize distraction

• put a post-it note over your face if it's distracting to see yourself

• talk with your therapist about what happens if you get disconnected

• know that it might feel different than in person, and that's okay

• get comfortable with silences, they are just like in office; you don't have to always fill space.

• bring up discomfort with the change, process with your therapist how it's impacting your experience

The tips for therapists are really similar, below are the ones that are additional or different:

• change your mindset: online therapy can be equally as helpful. Almost any therapy modality can be adapted to online sessions (I’m speaking from experience here—I’m a somatic therapist and online work for this can be challenging when I can’t see my client’s entire body, can’t feel their breath as I can in office, etc; but I have been able to find ways to adapt it to online. Anything is possible if we get creative).

• find a private space with a closed door, add a sound machine if you can, especially if you're at home

• create a physical environment that feels similar to your office. This can help with getting you into your procedural learning for “therapy session” and get into “therapist mode”. Honestly, I can’t do this if I’m in my PJs or sweatpants. I dress like I’m going to work (which is actually pretty casual), so that I feel as similar to in-person sessions as possible.

• boundaries--share visually only what you want to share of your home. It can be uncomfortable to bring our clients into our homes, even if virtually, because we work hard to “not bring the work home” with us. Figure out a way to set these physical or energetic boundaries with virtual sessions.

• call your clients' insurance to double check coverage. Most carriers have the same coverage for telehealth as in-person sessions, but some process the claims differently. Check with your clients’ carriers so that you can be clear with them about potential cost and coverage changes.

• make sure your clients know what happens if you get disconnected. My rule of thumb is to call them on their cell phone, troubleshoot video issues, and if we can’t resolve them we finish the session by phone. Talk with your clients about what they would prefer if you get disconnected.

• tell your client about what might feel different about online sessions, check in with them about all of the above. If you’re new to doing online sessions, be transparent about the fact that you’re adjusting to this new thing together.

• be ready to process attachment and relationship changes that might come up in session. Clients might feel less connected to you, less seen by you, or on the other side, they might feel TOO see by being on video, or might feel their space being intruded upon. Be mindful of this, name it if it comes up, and be ready to process it.

• give yourself longer breaks between sessions to move your body and to look away from a screen. Please take care of yourself! I’m finding that doing online sessions is more exhausting and my eyes get really tired. Time away from my screen and moving my body, along with longer breaks between sessions and less clients per day (when possible) has been really helpful.

I’d love to hear from you—either as a client or a therapist—how are you adjusting to online sessions? How is it feeling? What did I miss?

Interested in teletherapy during the pandemic? We are taking on new clients! Head to our contact page to reach out, let us know what you’re looking for, and we’ll fit you with one of our fantastic therapists.

How to Recognize a Trauma-Informed Therapist

What the heck is "trauma informed" therapy? You've probably heard this phrase thrown around a lot lately. It's becoming a thing--which is freakin' GREAT! It's also pretty ill-defined, so here's my take.

As a note, ALL THERAPY SHOULD BE TRAUMA INFORMED. So I'm really just describing good therapy here I guess…

Trauma informed therapy co-creates an environment in which you can access a feeling of safety. This doesn't mean you'll feel safe 100% of the time, and that's okay. It just means that safety, feel safe, is a primary goal between you and your therapist.

To me, this means orienting the room so that clients can easily leave if they need to. It means orienting clients to how much time we have. It means using my language intentionally. It means clearly sharing expectations and boundaries of the therapeutic relationship and maintaining them. It means showing up honestly and authentically, being trustworthy and transparent.

Trauma informed therapists understand the impact of trauma on the body, nervous system, emotions and thoughts. They understand trauma on both an individual and systemic level. They acknowledge racism, sexism, ableism, homophobia, etc. as experiences of trauma, and actively work to be allies to marginalized communities and support clients in processing their histories of discrimination and prejudice. They empower clients through choice and collaboration.

Being trauma informed means that we understand that symptoms and behaviors arise as survival mechanisms of trauma, rather than pathologies or problems. We understand that these skills worked at the time of trauma, but are no longer serving you. We work to find your strengths and collaborate to find resources for you to regulate your emotions and body responses so that you can make more life-affirming choices in the present, rather than responding as if you are still in the trauma.

Trauma informed therapy comes primarily from a place of compassion and belief in your resilience. YOU SURVIVED YOUR TRAUMA AND THAT IS A TESTAMENT TO YOU.

How to recognize a trauma informed therapist:

-They won't blame you for what happened to you;

-They will help you understand how your symptoms or behaviors are connected to what happened to you;

-They will explore with you the impacts of systemic oppression, prejudice and discrimination, and be an ally to marginalized communities;

-They will help you find your strengths to cope, soothe and regulate;

-They will be trustworthy, transparent and clear about their boundaries;

-They will collaborate with you, offer you choices, and respect the ones you make;

-They won't define you by your trauma, but will see you as a WHOLE PERSON.

Even if you aren’t going to therapy specifically to work through trauma or PTSD, it’s important to have a trauma-informed therapist. These characteristics enhance and enrich the therapy process regardless of why you’re there.

All of our therapists at Riverbank Therapy are trauma-informed. Fill out our contact form here and we’ll get you booked for a free 20 minute consultation!

Want to hear more on this topic? Listen to the Toni Talks Therapy podcast episode 4!

Health Insurance 101

Does insurance make you want to tear your hair out? When you hear about copays, deductibles, coinsurance--do you want to bolt and run?

I hear ya. That used to be me. Then I started interacting with insurance as a provider, and now I believe it's so empowering for you to understand clearly. When you know what your coverage is and what you will owe for services, you're way more likely to actually get the help you need! I'm all about that.

So here we go. Insurance 101.

You have a PREMIUM. This is what you (or your employer, or a combination of both) pays each month to your insurance company for your plan. Pretty simple. This premium collected by your insurance carrier is how they cover costs for any claims they have to pay out for all of their members.

Unless you have the world's best insurance, you will have a COPAY or COINSURANCE for services. A COPAY is a set rate that you pay (like $20) for services, no matter what the provider's rate is--your insurance covers the rest. COINSURANCE, is a percentage of the provider's fee that you pay (like 20%) and then your insurance pays the rest (80%).

Depending on your plan, you might *only* have to pay a copay or coinsurance for services. Lucky you! However, more and more plans lately have a DEDUCTIBLE. This is an amount your insurance plan sets that you have to pay out of pocket before they cover anything. (Usually, the deductible does not apply to preventative care like your yearly wellness check and sometimes for mental health services like therapy, but check your specific plan for details.) This means you'll pay 100% of the provider's fee until you've paid as much as your deductible, and THEN your copay or coinsurance rates apply.

Example: You have a $1500 deductible that applies to therapy services. After your deductible, your insurance pays for 60% of the providers fee, and you have a 40% coinsurance. Your therapist's rate is $120 a session. You pay the full amount for 12 sessions, and at that point you’ve paid up to your deductible amount of $1500. (A note here: insurance companies don't actually care how quickly you pay your provider, so you can work out a payment plan for this part! Your deductible will still be counted as “met” by your insurance even if you haven’t actually paid that total amount to your provider. Feel free to ask your provider if they offer payment plans for situations like this--most will. I do this all the time for our clients!) Once you’ve met the deductible, then your coinsurance kicks in, and you only owe 40% each session, or $48. Yay! That happens until the plan year resets and you start the deductible over again.

Typically, you will have different coverage for an IN NETWORK provider than an OUT OF NETWORK provider. Insurance companies have a panel of providers that they contract with. When providers contract with insurance, they agree that the insurance carrier can adjust the provider's rates. This insurance-determined rate is called a “contracted rate” or “reimbursement rate”.

Because in-network contracts mean lower reimbursement rates, your out of pocket cost will be slightly lower when you see an in-network provider (also because your in-network benefits typically cover more than your out of network benefits do). Many therapists choose to be out of network because these in-network reimbursement rates are low, rates are not raised often, and insurance companies don’t really negotiate their rates.

Another issue with in-network billing (as well as out of network billing) requires that your provider give you a diagnosis. In addition, when using your in-network benefits, your insurance company has control over how often and how long you see your provider, as well as the approach your provider takes in therapy.

Out of network providers do not have a contract with your insurance company, so their rate will not be adjusted down*, but the services might still be covered by your plan at some level. Typically, with out of network benefits, there's a deductible and then some level of coinsurance. Again, it varies from plan to plan, and also depends on the provider. Out of network services also require a diagnosis, but your insurance company has less control over the therapy process.

Some therapists opt to provide you with superbills for out of network therapy. At Riverbank Therapy, we do courtesy billing because we find it is easier on you as the client. Read more about superbills and courtesy billing here.

*some plans are now implementing an “allowed amount” with out of network providers. This means that if your session fee is $150, the insurance carrier may only apply part of that fee (the “allowed amount”) to your deductible, and you’re still responsible for the rest of the session fee. This means it can take a bit longer for you to meet your deductible. Again, check your specific plan or talk with our admin team to find out if your out of network benefits include an allowed amount for sessions or not.

Read more about how Riverbank Therapy works with insurance on our Investment page.

Your plan will likely also have an OUT OF POCKET MAX for the plan year. This means that you pay your deductible and copays/coinsurance up until you've paid up to the amount of your out of pocket max (ex: $5000) and then you are 100% covered! This is regardless of in or out of network providers for most plans. If you utilize your insurance coverage more frequently, you’re more likely to meet this out of pocket max.

You can pay your copays, coinsurance, and deductible payments with an HSA or FSA account. This is an account that you, and possibly your employer, contribute pre-tax dollars to that are specifically intended for healthcare expenses. You can use an HSA or FSA account for both an in-network and an out of network provider.

Read more about billing insurance for couples counseling here.

This is a BRIEF AND INCOMPLETE overview of insurance policies, based on my experience with insurance in outpatient therapy in the United States. It's complicated, but can be simplified when you know what to look for and what all the words mean. I want to empower you to know what your benefits are so you can get support when you need it, and not be fearful of what it will cost! I encourage you to check your individual plan for specific details.

At Riverbank Therapy, we will be clear with you up front about your insurance coverage, so you don’t have any surprises when it comes to cost. Clarity is important, especially with finances! If you are interested in therapy and want to use your insurance, but aren’t quite sure what your benefits and coverage are, feel free to reach out and we can help you decode your policy documents.

Interested in scheduling a free consultation with one of our providers? Fill out our contact form here and we’ll get you booked!

Want to hear more on this topic? Listen to Toni Talks Therapy episode 2 about starting therapy!

How To Start Therapy

Have you been wanting to start therapy, but aren’t sure how to get started? It can unfortunately be a daunting and anxiety-provoking process. I’m here with some tips to make the process a little bit more clear, so you can go into it empowered!

Step 1: Begin your search.

The easiest way to find a therapist is to do a search online. Go to psychologytoday.com and search for your area (ex: “Seattle, WA” or your zip code “98107”). You can filter by specialty area, therapy style and more.

You can also call your insurance and get their provider list for your area. This is great if you know you need to see someone who is in-network with your insurance. If you go this route, I would still recommend searching through those therapists’ profiles online to see who resonates with you. This way you don’t end up with a random person just because they take your insurance, but actually end up with a therapist who works for what you’re looking for!

Another great option to find a therapist is to ask your doctors, friends or coworkers if they have any recommendations. And, if you happen to be lucky enough to have a therapist as a friend ;) you could ask them for referrals as well. Trust me, I’m giving referrals to friends all the dang time! I love doing it.

You can check out Riverbank’s clinicians profiles as well! Dana and Emily are both accepting new clients.

Step 2: You’ve narrowed down your list to a few therapists that you feel drawn to…now it’s time to schedule consultations.

Most therapists offer a free 20-30 minute consultation either by phone or in office. This helps both you and the therapist decide if it will be a good fit. If it is, great! You’ll schedule an intake session and get going! If it's not a good fit, you can ask that therapist for referrals and they can help point you in a different direction.

When you’re reaching out to schedule consultations, know that a lot of therapists won’t have openings for new clients. This can be frustrating, but I want to acknowledge that it’s a part of the process. Usually when my schedule is full, I’ll still offer referrals to new clients who reach out. I’d encourage you to ask for this, especially if it’s a therapist you really wanted to work for. Likely, the people they know and like who they refer you to are clinicians that are pretty similar to them :)

Step 3: Okay, so you’ve got a consultation scheduled! What the heck do you say?!

Share a bit about why you’re seeking counseling. Keep in mind that you only have 20 minutes, so this is not the time for your entire life story (that comes later!). This is the Cliffsnotes version. Ex: “I’ve been struggling with depression and anxiety since my teen years, and recently it’s gotten worse since I’ve accepted a new job in a new city. I’d like to work on some coping skills for anxiety, and especially around making new friends in Seattle.” Your therapist will likely ask a few more questions about your life and why you’re coming to therapy, but something brief is good for now!

The consultation meeting is a perfect time to ask questions of the therapist, which will help YOU determine if they’re a good fit for you. As a therapist, I don’t want this process to be hidden behind the curtain--I strive for transparency and clarity, because that will make the process that much easier for the both of us! I love these kinds of questions from potential new clients (and current clients for that matter!)

Questions to ask:

-What are your areas of specialty? (Depression, anxiety, trauma, body image, etc).

-What theories do you work from in therapy (CBT, DBT, ACT, somatic, etc.) Ask them to explain what these mean for therapy and how they implement them.

-How often will we meet, and what is your schedule?

-What will a typical session look like?

-What are your fees? Are you covered by my insurance? If not, will you submit out of network bills or provide me a superbill?

Step 4: Check in with yourself.

The most important questions you can ask after a consultation are to yourself. Do I like this person? Do I feel comfortable with them? Do I feel heard and understood? Most of all, get a feel for the therapist's personality and energy. If it resonates with you, they're probably a good fit. If you feel uncomfortable (more than expected when going to therapy for the first time), then it's probably a signal that it's not a great fit.

The therapist will not be offended if you choose not to work with them! Sometimes it takes several consultations to find the right fit. Know that it’s a process of shopping around, and be patient with it. You have the right to choose your provider, and therapy will work best when you work with someone who is a good fit.

After a consultation, you’ll schedule an intake appointment with the therapist you’ve chosen to work with. Prior to or at your intake session, you’ll sign some paperwork with your counselor and then you’ll get started!

Going to therapy is fantastic and will help you grow in big ways, so take the time up front to find a provider that works for you!

Want to schedule a consultation with one of our therapists? Email us to schedule a consultation here!