The In-Betweens

People have many associations with the word “psychoanalytic” or “psychodynamic” (same thing, different brandings) that often conjure images of Freud and his many cigars, whatever you may have learned or heard in psych101 about how outdated it is, or a fear that I may ask you to lay down on the couch and not look at me. Here are some basic tenants of a psychoanalytic sensibility that influence how I approach therapy: 

The Unconscious 

Nothing too spooky about this, it basically just means that we are often unaware of why we think, act, or feel the way we do! Sometimes we don’t even know what we’re feeling. In some respects, we are simply strangers to ourselves until we are in the presence of an attentive other who is committed to helping us understand ourselves more fully and deeply. Something is always being communicated–through our actions, our feelings, our dreams, our fantasies, and of course our thoughts…and often we don’t really know what we’re thinking until we’re given the space to free associate in the safe container of the therapeutic frame. Part of my job is helping bring these unconscious dynamics into your awareness so you have more choice and agency in your life–rather than unknowingly running on outdated or old scripts that might not be serving you anymore. Cognitive scientists call it “implicit,” psychoanalysts call it “unconscious”–tomayto, tomahto.

The Therapeutic Relationship

Affect as Primary

Patterns and Themes 

Defenses

Developmental Focus

Ambivalence and Conflict

Many patients understandably want to use their health insurance to cover psychotherapy services. In the past, I have worked with health insurance companies as both a provider and a patient, and appreciate accessibility as a factor in the provision of treatment. However, I have chosen to no longer accept or use insurance for the following reasons: 

–Confidentiality. When using insurance to pay for psychotherapy, disclosure of your diagnosis, treatment notes, and assessment/treatment plan are often required in order to receive payment and continue care. This often gives non-clinical staff access to private health information about you. In my view, this undermines a fundamental tenet of psychotherapy, which is providing the highest standard of privacy and confidentiality possible in order for you to speak as freely as possible.

–Personalized Care. I believe that the frequency, length, methods, and goals of treatment should be mutually and collaboratively decided upon between provider and patient. Common practices such as prior authorization and audits often undermine the therapeutic frame, dictating the terms and parameters of treatment without prioritizing your agency and your provider’s clinical judgment. Health insurance companies are often more interested in managing care in a way that maximizes their profits and minimizes the frequency of sessions rather than supporting a depth and quality of care that is maximally effective. 

–Superbills. I can provide superbills to you upon request if you would like to submit them to your health insurance company for reimbursement for out-of-network services. Your mileage may vary, and this does require a disclosure of a psychiatric diagnosis–but it does offer an alternative route to accessibility and affordability. 

–Continued Commitment to Accessibility. For patients unable to afford my full fee, I offer a limited number of slots at a markedly reduced rate. I offer a reduced rate for veterans, first responders, and college students.

While it’s not possible to discern whether or not I am the right fit for you without meeting and deciding this together, here are some things I choose to embody as a psychotherapist that I believe are important to consider when deciding who to work with: 

–My own time as a patient. When seeking a provider, I would strongly urge you to consider seeking out a psychotherapist who has engaged in their own work as a patient–extensively. Personal therapy used to be mandatory when training to become a psychotherapist; unfortunately this has fallen out of favor. Part of the responsibility of a psychotherapist is being aware of and containing personal dynamics that can and do impact the treatment. For better and worse, therapists are human too! We all have blindspots and neuroses that must be reckoned with to provide quality care. I do not ask things of my patients that I have not asked of myself. 

–I limit my caseload. One of the reasons I have chosen to work in private practice rather than an agency is that many agencies require burdensome caseloads that make it difficult to think and feel deeply with each patient. I reflect on what my own limitations are when considering the depth and quality of care I want to provide each patient, and have chosen a cap that allows me to hold you in mind without overextending myself. I do not carry more than about 15 cases at a time, and I often see patients multiple times a week. 

-I am a forever student. I believe that psychotherapy is both an art and a science that requires years of extensive training, self-reflection, and personal growth to even approach mastery. I am committed to (). Supervision, training, consultation, personal therapy. This is not a casual enterprise nor a 9-5 for me. I believe in this craft and am devoted to it without being dogmatic nor unrealistic about what it can offer. 

–People, not diagnoses. 

-More guidance on how to choose a therapist

Click here for an excellent info sheet/guide on getting started in psychotherapy and what to expect! 

First session(s). 

Assessment phase. 

Treatment. 

How long will this take?