Summary Outline and Progression of the Therapy Process

1. Review the Intake Documentation

The first step in the process is to complete your intake and orientation to therapy. We will review the following information during the first session:

  • The informed consent to therapy and agreement to treatment
  • The HIPAA notice of privacy practices
  • Confidentiality rules and limitations, interactions outside of our sessions
  • The Vermont statutes annotated regarding licensed mental health practitioners.

2. Review the Information about Electronic Communication

  • Information about telehealth services and your informed consent to telehealth services.
  • Information about electronic communication, client engagement applications, and your informed consent to electronic communication.
  • Information regarding social media.
  • Orientation to the client billing and scheduling portal (Therapy Notes)
  • Based on your consent, an orientation to the therapy plan subscription on my client portal website 
  • Based on your consent, an orientation to the client engagement app and website (Quenza)

3. Review the Information about Health Insurance Policies/Payments

  • Health Insurance company policies: what constitutes medical necessity, diagnosed DSM 5 disorders, and insurance company reimbursement for services, in network, out of network coverage, no guarantee of payment.
  • What are copays, health savings accounts, flexible spending accounts, and healthy dollars accounts?
  • Payment policies, Cash, Venmo, Credit/Debit, HSA, FSA, Therapy Portal
  • Policy about 48 hours cancellations, late cancellations, and no-shows, $75.00
  • My payment policies, and paying me directly for services on the day of services or before your next session.
  • Please do not pay for my services through your insurance comapny’s patient portal.
  • Submitting superbills, out of network claims, on your behalf, and payment types accepted, payment from insurance not guaranteed.
  • The payment authorization form, and your consent to charge a card on file with my autopay service.

4. Complete Surveys and Questionnaires

Beginning therapy assessments measure the onset, frequency, duration, and severity of your symptoms and issues you’re suffering with. Assessments allow us to formulate a set of diagnoses that will inform and influence what approaches we use in therapy. Assessments also justify medical necessity for insurance reimbursement and diagnostic formulation for ethical practice purposes. The folowing assessments and outcome measures will allow us to track your progress in therapy.

Quenza/Website Forms

I may ask you to complete the following assessments and questionnaires through Quenza or my Website:

  • Life Domain Satisfaction Survey
  • Self Care Assessment
  • Values Exploration
  • Strengths, Needs, Abilities, Preferences (SNAP)
  • Health Home Questionnaire (HHQ)

5. Complete Screenings and Assessments

Therapy Portal Forms

The following assessment and outccome measures are sharable and stored in the electronic health records software your therapist uses to also keep track of your other patient data and private and protected health information.

  • Patient Health Questionnaire (PHQ9):
  • Adverse Childhood Experiences Questionnaire (ACE):
  • Generalized Anxiety Disorders (GAD 7 Assessment):
  • Columbia Suicide Severity Rating Scale (CSSR Risk Assessment):
  • PTSD Screening Assesment (PCL 5):
  • Drug and Alcohol Addiction Screening (CAGE ID):

6. Complete Biopsychosocial Assessment (Clinical Interview)

Because mental health care treatment should be holistic and integral, you will also be asked about a number of other correlated life domains:

  • A discussion of your medical problems, medications, physical health, medical history, hospitalizations, previous treatment settings
  • A discussion of your fitness level, pleasurable activities, hobbies, interests, recreation, relaxation, sleep cycles, and stress management.
  • An exploration of your character strengths, values, core beliefs – schemas, internal system of parts of your subconscious mind 
  • A disucssion of nutritional planning, water consumption, eating patterns, appetite, weight management, weight or eating related illnesses.
  • A discussion of addictive behaviors, substance use – past and present, history of rehabs or treatment facilities.
  • A discussion of your social networks; family, community, friends, relationships, coworkers, peers, and other individuals and groups.
  • A discussion of social, cultural, political, religious, spiritual, and environmental factors, intersections of your health and wellness domains.

7. Planning Therapy

  • Psychoeducation and brief overviews for the different types of therapy you may decide on.
  • Discuss and process your problems, and issues that are bringing you to therapy, counseling, and coaching.
  • Define (SMART) Specific, Measurable, Attainable, Realistic, and Timed long-term goals for therapy
  • Determine treatment motivation, desire for change, readiness, openness, capacity, abilities, skills, and self knowledge
  • Create and record the short-term objectives and interventions for your therapy treatment plan in Therapy Notes.
  • Review and sign your interim treatment plan, the plan is dynamic, fluid, and a living document, subject to change, based on many factors.
  • Orientation to the treatment plan and what to expect, as well as frequently asked questions reviewed and discussed.
  • Review, discuss, and process the learning objectives for each of the therapy plan modules, add the relevant ones to your individualized plan.
  • Commit to attendance at regular therapy sessions, and optionally tracking your own progress in therapy (progress tracker) on a regular basis.

8. Adjunct Programs and Coaching

  • Assess whether you would like any adjunct services for developing and implementing a health and wellness plan.
    • I need your permission to share (Strengthening Your Conscious Self) my health and wellness planning program with you.

Without violating ethical boundaries, I can provide health and wellness program planning help in several ways:

  • Assessment: It begins with a comprehensive self-assessment of your current health and wellness status. This includes exploring your physical health, mental well-being, lifestyle habits, stress levels, and any specific areas you want to improve upon. The assessment helps identify your strengths, challenges, and areas for growth.
  • Goal Setting: Collaboratively, we can establish specific, measurable, attainable, relevant, and time-bound (SMART) goals for the health and wellness program. These goals are tailored to your individual needs, preferences, and priorities. Goal setting provides clarity and motivation, giving you a sense of direction and purpose.
  • Education and Resources: I provide educational resources and information about various aspects of health and wellness, including nutrition, exercise, sleep, stress management, and self-care practices. I will provide you with evidence-based information, resources, and strategies to support your understanding and decision-making process. This empowers you to make informed choices regarding your health and well-being.
  • Customized Plan: Based on your assessment and goals, we collaborate to develop a customized health and wellness plan. This plan outlines specific activities, practices, and interventions that align with your goals and preferences. It may include educational material about exercise routines, dietary changes, mindfulness exercises, relaxation techniques, and other relevant strategies.
  • Monitoring and Accountability: I can assist you in monitoring your progress and hold you accountable for your commitments to the health and wellness program. This may involve regular check-ins, tracking progress towards goals, reviewing challenges encountered, and making adjustments to the plan as needed. I provide feedback, support, and encouragement throughout the process, helping you stay motivated and committed.
  • Skill Building: I can help you develop and enhance the skills necessary to implement your health and wellness program effectively. This may involve teaching you stress reduction techniques, behavior change strategies, mindfulness exercises, time management skills, or other relevant skills that support your overall well-being.
  • Collaboration with other professionals: I am not allowed to provide adjunct coaching services, provide fitness training, or prescribe nutritional recommendations, so I collaborate with other health professionals, such as nutritionists, fitness trainers, or medical practitioners, to provide comprehensive care. This interdisciplinary approach ensures that you receive holistic support and guidance for your health and wellness needs.
  • Periodic Evaluation and Adjustments: I can ask you to periodically evaluate your progress and reassesses your goals and needs. I collaborate with you to help you make adjustments to the health and wellness program as necessary, taking into account any changes in circumstances, preferences, or priorities.

By providing health and wellness program planning help, I can assist you in developing sustainable and personalized strategies to enhance your overall well-being. This collaborative approach promotes self-efficacy, self-care, and long-term lifestyle changes, empowering you to take an active role in maintaining and improving your health.

9. Starting Therapy

  • You are invited to engage in some beginning interventions; in order to start on a solid foundation of coping skills
  • Psychoeducation homework will be assigned for in between sessions
    • Most or all of the materials and content will be on this website or in the Quenza App.
  • Completion of the homework assignments and tracking your daily practice is important. However, this option is entirely up to you.
    • The research indicates a correlated positive relationship between therapy outcomes and client engagement in the process.
  • Your therapist will discuss and process the homework in your sessions.
    • We will review challenges, barriers, and blocks to completing homework with you, and reassess your therapy plan if needed.
  • Therapeutic interventions will be discussed and processed with your therapist
    • Homework exercises, and handouts and worksheet pdfs will be located on this website/portal

10. Therapy Sessions

Our sessions will proceed according to your individual needs and preferences within the framework of an organized agenda:

  • A brief check in; sensations, emotions, interactions, experiences since last session.
  • Follow up from last session; process the day after the last session.
  • Review homework (when you complete it, if applicable); homework ambivalence, avoidance, questions, comments, concerns
  • Process the homework (when applicable) or discuss barriers and challenges to doing homework.
  • Subjective reports of positive and negative experiences and events
  • Psychoeducation on disorders and therapeutic approaches
  • Complete any objectives and interventions from your treatment plan.
  • Discussion of important concepts and problems; solution focused problem solving; smart goal setting that is future oriented and goal directed.
  • Processing their experiences in the session; exploring, examining, and making sense of thoughts, emotions, behaviors, memories, or sensations.
  • A brief check out with a brief session evaluation; how they are feeling now versus when they started the session
  • Plan next steps and/or assign homework: videos, lessons, readings, and practice work for in between sessions (when applicable)
  • Process payments, claims, billing questions, copays, deductibles.
  • Confirm or schedule the next session. 

11. Ongoing Work

You can continue learning and practicing new skills in between sessions by completing assignments. I invite you to read books and articles, watch videos, and complete worksheets. I encourage you to keep a journal and track your progress. I recommend developing a formal or informal mindfulness and meditation practice. You can continue to assess achievement of therapy goals, the approach to therapy, and your therapy plan itself. You may be interested in relapse prevention, education, planning, and implementation. You might decide to schedule “booster” or “maintenance” sessions with me or decide to terminate once the goals have been achieved. You might decide you have more goals to reach and wish to continue therapy with me.

Note: Insurance reimbursement for services is predicated on the fact that services provided meet the medical necessity requirement.

There is some overlap of the objectives, interventions, skills, techniques, and knowledge from the approaches listed. Other approaches have an influence on the work but are not described here. The plan outlined above could take 12 weeks, 12 months, or longer. You may also need to switch from treating ADHD symptoms, to treating PTSD symptoms, to alleviating anxiety symptoms, to improving depression symptoms. Each plan is unique and specific to the person in therapy.

12. Relapse Prevention Plan and Crisis Plan

  • Assess whether you would like any adjunct services for developing and implementing a relapse prevention plan.
    • I need your permission to share (Wellness Recovery Action Plan) the adjunct relapse prevention planning model.
  • Assess whether you would like any adjunct services for developing and implementing a crisis plan.
    • I need your permission to share (Wellness Recovery Action Plan) the adjunct crisis plan model.
  • You can gain an understanding of relapse prevention.
    • Learn a rationale for relapse prevention that discusses the risk and introduces strategies for preventing it.
    • Learn the distinction between a lapse and relapse, associating a lapse with a temporary setback and relapse with a return to a sustained unwanted pattern of thinking, feeling, and behaving.
    • Identify and rehearse the management of future situations or circumstances in which lapses could occur.
  • You can learn and implement strategies to prevent relapse of symptoms.
    • Use strategies learned in therapy (e.g., continued everyday exposure, cognitive restructuring, problem-solving), building them into daily life as much as possible.
    • Develop a “coping card” or other reminder on which coping strategies and other important information can be recorded (e.g., steps in problem-solving, positive coping statements, reminders that were helpful to the client during therapy).
    • Schedule periodic maintenance or “booster” sessions to help the client maintain therapeutic gains and problem-solve challenges.

13. Termination Session and Follow Up

A termination session for therapy marks the culmination of a therapeutic journey and sets the stage for a smooth transition towards the client’s independent well-being. Here’s a description of what such a session might look like:

1. Reflecting on progress: We start by reflecting on the progress made during the therapy process. We acknowledge the challenges faced, milestones achieved, and the personal growth you experienced. This allows both of us to appreciate your efforts and celebrate your accomplishments.

2. Reviewing goals: We review the goals established at the beginning of therapy and assess which goals have been met and which may still require further work. This discussion helps you gain a sense of closure and understand the areas where you have made significant strides.

3. Recognizing coping strategies: I highlight the coping strategies and tools you have learned and utilized throughout therapy. I emphasize your resilience and ability to manage difficulties effectively. By acknowledging your newfound skills, it instills confidence and self-belief, empowering you to continue growing beyond therapy.

4. Addressing unresolved issues: If there are any lingering unresolved issues or topics that require additional exploration, we can take the opportunity to discuss them. This ensures that you don’t leave therapy with unresolved concerns or unanswered questions. I will provide guidance, insight, and support to help you navigate these final challenges.

5. Discussing relapse prevention: We will engage in a conversation about strategies to prevent relapse or setbacks. We will explore potential triggers and develop a plan to address them effectively. You will be equipped with the necessary tools and resources to maintain your progress independently. I will be emphasizing the importance of self-care and ongoing personal development.

6. Addressing future support: I offer you availability of future support options, such as community resources, support groups, or periodic check-ins. This ensures you will have a safety net in place and you will know where to turn if you need further assistance. It also helps you feel supported even after therapy has officially ended.

7. Expressing gratitude and closure: We will have the opportunity to express our gratitude for the therapeutic relationship and the work we have done together. We can acknowledge the impact we have had on each other’s life. This expression of gratitude creates a sense of closure and fosters a positive ending to the therapeutic journey.

8. Finalizing paperwork: In the last part of the session, any necessary paperwork or administrative tasks are completed. This may include signing termination forms, discussing records maintenance or disposal, and clarifying confidentiality policies.

Throughout the termination session, I will maintain a warm, supportive, and non-judgmental attitude, creating a safe space for you to express your emotions and concerns. By focusing on reflection, recognition, closure, and empowerment, an ideal termination session honors the progress made in therapy and sets the stage for a successful transition into post-therapy life.