1. What is confidentiality?

Confidentiality involves protecting a client’s private information. The information you share during sessions whether online, by email, by phone, or face to face is private and your therapist will take every measure possible to protect your identity, your e-mail addresses, the content of your e-mail, the therapists responses etc. The information you share will not be disclosed to anyone who does not have a legitimate legal need to know.

There are special circumstances when a therapist MUST legally break a client’s confidentiality. The exceptions are: 1). Therapists are legally bound to notify the authorities in cases of child abuse or elderly abuse 2). Therapists must break confidentiality if a client makes a threat to harm themselves or others 3). In some cases, such as in divorce or child custody hearings, lawyers can subpoena information from therapists.


1. What is meant by Dual Diagnosis? Many treatment programs offer treatment for Co-occurring disorders.

Co-Occurring Disorders or Dual Diagnosis

Individuals who are said to be challenged by problems that involve “dual diagnosis” often face a wide range of psychosocial issues and may experience multiple interacting problems. The term “co-occurring disorders” is a common term used by alcohol and drug rehabilitation centers. When professionals refer to dual diagnosis or co-occurring disorders, they are highlighting the fact that substance abuse is frequently associated with other clinically relevant psychiatric or emotional problems.

Co-Occurring Disorders are said to be present when an individual are challenged by both chemical dependency and an emotional or psychiatric illness. Chemical dependency routinely affects an individual physically, psychologically, socially, and occupationally. Such problems are relevant to substance abuse treatment because they interfere with a person’s ability to function effectively and relate to themselves and others. Co-occurring disorders predisposes one to relapse. At times the symptoms can “overlap” and even mask each other making accurate diagnosis and treatment more difficult.

A person may focus on recovery from one problem, yet, remain unstable because other psychological challenges have not been addressed. Over time, the absence of personal stability is predictive of relapse into substance abuse.

There is no simple solution to challenges involved in the treatment of Co-Occurring Disorders. Each individual is noted for a novel pattern of alcohol or drug abuse. As a result, treatment must be carefully tailored to meet the need of the individual patient

A variety of problems are possible as a result of Co-Occurring Disorders. For example:

•Mental health problems may be covered up or “masked” by alcohol or drug use.

•Alcohol or drug use or withdrawal from alcohol or other drugs can mimic the broad range of mental health diagnoses.

•Untreated chemical dependency can contribute to myriad psychiatric symptoms.

•Untreated psychiatric problems can contribute to an alcohol or drug relapse.

Other problems that are associated with Co-Occurring Disorders include

•Family problems, marital problems, and untold struggles with intimate relationships.

•Isolative behavior and social withdrawal.

•Employment or academic problems.

•Continuation of high-risk behavior despite known risks.

•Multiple admission for chemical dependency due to relapse.

•Increased emergency room and hospital admissions.

•Disorganized behavior and defensive reactions

•Increased need for health care services.

•Legal problems, arrest and incarceration.

The therapists at Positive Start Counseling Services, Inc. are prepared to help you carefully evaluate your specific needs and explore your options for specialized care. It is important to recognize that various psychological challenges must be addressed to reduce the incidence of chemical dependency relapse.

Seeking Help for Co-Occurring Problems?

The challenges implicit with co-occurring problems require careful mental health treatment planning. The impacts of co-occurring disorders are frequently devastating to individuals and families alike. Call Positive Start Counseling Services, Inc. to explore treatment.


1.How do I choose a therapist?

A good fit between you and your therapist is crucial to your having a meaningful and successful experience. There’s no one set criteria that describes great practitioners. The best choice will reflect your specific circumstances, personality, and preferences.

Location, Location:

Proximity is important. Perhaps more so than you think. If your therapist is too far away, you may find yourself not as committed to the process: “I can’t make my appointment today because it’s too far…” Location should not become an obstacle. If there are no therapists in your zip code, try those in a town nearby.

Comfort Level:

As you seek a therapist, ask yourself if you think you’d be comfortable opening up to her. Would you feel better with a male or a female therapist? Would you prefer one who speaks a language other than English?

The Right Stuff:

Find a professional who has treated people with problems similar to those you face. Often a therapist focuses on specific issues such as eating disorders, sexual dysfunction, or mood disorders. Find out what treatment the therapist employs.

Sometimes a therapist works closely with particular populations, such as adolescents, gay couples, or people of particular religious backgrounds.

Psych Basics:

Therapists are usually trained and licensed.  See the “links” page to check a therapist licensure.

The Methods:

Therapists have different methods and orientations. All can be effective, but you may find one or another particularly appealing.

Trial Period:

Contact therapists who seem to be a good fit and schedule initial appointments. You will most likely get voicemail, as therapists are often in session during the day. Don’t hang up; leave your name and number.

On Your First Visit:

Ask yourself, “Do we click?” Do I feel a connection? Do I respect this person?” For you to reveal yourself, you will need to feel safe and at ease. If it doesn’t feel right, move on to the next one.

Sharing Values:

Something to consider during your initial visit is whether the therapist shares your values and beliefs. You are building a relationship, so starting at the core is important. If struggling with a partner in a relationship has brought you to therapy, for example, you certainly want to know how the therapist feels about cohabitation before marriage.

Too Eager?

A therapist shouldn’t be too eager to please. Though you want a connection with a therapist, you don’t want someone who never challenges you. If you suffer from self-esteem problems, for example, you won’t be helped if the therapist does nothing more than flatter you. Improving your mental health is hard work on your part, and you’ll want a therapist who facilitates your efforts.

In The Pocket:

When you do settle on a therapist, you’ll need to agree on a fee. You may want to inquire about whether the therapist offers a sliding-scale arrangement. A flexible fee schedule adjusted to your needs or income.

In- and Out-of-network:

You’ll also want to see if your insurance will cover your therapy. Make a list of questions, including how many visits the insurer will pay for, whether the carrier covers only a percentage of the costs, the difference between providers who are in-network and out-of-network, and whether primary care physician approval is required for you to be covered.


After the carrier has answered all your queries, ask your therapist about coverage, too. Bring up matters such as co-payment, how other patients handle insurance and payment, and whether your diagnosis will go on your record. Arm yourself with information and the therapist can help address all of your monetary concerns.

2. I’ve never seen a therapist. What can I expect in my first session?

While all therapists have their own unique approaches to the initial meeting, your meeting with a therapist will likely consist of a conversation about what made you decide to seek therapy. You will be asked many detailed questions about the nature of your problems, the history of this/these problem(s), the solutions you have attempted on your own and most importantly, your goals for therapy. The meeting will likely be about an hour long. You will have an opportunity to ask your therapist some questions as well. By the end of the session your therapist will likely be able to provide you with a synopsis of how she sees your problem(s) and provide you with a “road map” for how to proceed

3. If I go for therapy, does that mean I am crazy?

No, quit the opposite. It means you are wise enough to take care of your health. How you feel mentally affects every part of your life. Poor mental health can contribute to a number of physical ailments, including heart disease and stroke. For too long there has been a stigma attached to seeking mental health treatment. Thankfully modern living has brought about an acceptance and even encouragement of taking care of your mental and emotional needs.

4. What’s the difference between the terms “counseling, ” “therapy” and “psychotherapy”?

There are no differences since they all imply that you talk to a mental health professional to help solve various problems in your life.


5. Can’t I just talk to someone I know who’s a good listener and get the same help that I would from a therapist?

The following quote answers that question with a resounding “no.” “…the bottom line is that patients want to and need to be listened to. They want a therapist who can listen to them in depth. That is what we offer: We listen to people in depth, over an extended period of time and with great intensity. We listen to what they say and to what they don’t say; to what they say in words and to what they say through their bodies and enactments. And we listen to them by listening to ourselves, to our minds, our reveries, and our own bodily reactions. We listen to their life stories and to the story that they live with us in the room; their past, their present, and future. We listen to what they already know or can see about themselves, and we listen to what they can’t see in themselves. We listen to ourselves listening. Whatever managed care says, and whatever drugs are prescribed, and whatever the research findings, people still want to be listened to in depth and always will.” (Aron, 2009) .

6. How can simply talking about a problem fix it?

The way this commonly asked question is worded tells us a lot about the culture we live in today. We are action-oriented and usually want to know several action steps that we can take in order to solve our problems. The idea of patiently thinking or talking about a given problem seems almost ridiculous and certainly a waste of time. But truly meaningful, significant change has to begin from within and changing from within requires a shift in perspective (a paradigm shift). This in turn usually happens only after contemplating an issue for awhile and after talking to caring others and feeling the strength of their support.

7. How can therapy help me?

Therapy can help you understand and re-frame  your problems and concerns. It can teach you specific emotional and social skills, and can help you reap more satisfaction from your work and your relationships. A therapist’s office can be a sanctuary where you are free to express private thoughts and struggles. Friends and family members can provide excellent emotional support, but a therapist can give you a trained, and more impartial, perspective on your life.

Because subjective feelings and thoughts are involved, therapy’s effectiveness is harder to measure than, say, a cure for a medical ailment. But many studies have shown the effectiveness of therapy in improving quality of life. A landmark 1995 Consumer Reports study concluded that patients benefited very substantially from psychotherapy.

The key to successful therapy is a connected, trusting relationship between client and therapist (taken from Psychology Today).

8. How long does a therapy session last?

Typically therapy sessions are fifty minutes in length

9. How long does therapy last?

Therapy is individualized. For some it may last a couple of session and for others it can last years. It depends on the goals of therapy and the severity of the issues.

10. Will I fall apart if I start talking about upsetting thoughts and feelings?

For most people, the answer is no, at least not in terms of a “nervous breakdown” or crying uncontrollably. It is certainly possible that you may cry or feel anxious or upset. But many people feel relief after letting their feelings out during a session.

INSURANCE – Ins and Outs of Mental Health Insurance

1. In a typical mental health plan, how many visits are covered?

Patients are usually covered for 20 to 30 sessions a year and are expected to pay 20 percent to 50 percent of the bill. Depending on where you live and your therapist’s credentials, a session can cost anywhere from $75 to $175. Medicare, the federal health insurance program for Americans aged 65 and older, covers 50 percent of most outpatient care, with no limit on number of visits.

2. What will my plan cover?

This depends on your provider. Most insurance companies cover problems from anxiety and depression to relationship difficulties and social phobias. However, they are not likely to cover services for weight loss or aromatherapy. IQ tests and screenings for learning disabilities are almost never covered

3. Can I see a therapist of my choosing?

It depends on your insurance plan. If you have a Health Maintenance Organization (HMO) plan or a prepaid health plan, you may choose from a limited pool of health care professionals. These professionals are in-network providers, and it may not be possible to see a therapist of your choice. If you have a Point of Service (POS) plan (also known as a Fee for Service plan), you can see any doctor in the country, and your insurance company will cover your fees. If you have a Preferred Provider Organization (PPO) plan, you must again select from a limited number of providers, but it is possible to have fees partly covered for providers who are out of network. But remember, your out-of-pocket payments will be higher.

4. Will I need a referral from my primary care physician?

Because some insurance companies do require a referral from a primary care physician, be sure to inquire before you start your search for a therapist.

5. What is an Employee Assistance Program, and how can I use one?

Some employers set up company Employee Assistance Programs (EAP) that help workers identify and resolve personal problems, emotional struggles, family difficulties or legal problems. The visits are confidential, so the content is not disclosed to your employer. They are often free, but limited in number of sessions. Check with your employer to see if these services are offered.

6. Will my therapy sessions go on my record? What are the repercussions?

The matters you discuss with your therapist are confidential, with certain legal exceptions: For example, your therapist can release information if she believes you may harm yourself or others. Regardless of the reasons for your therapy, your insurance company has access to your diagnosis and appointment dates