Over the years, I've heard a number of concerns over and over again having to do with the relationship between therapist and client. Sometimes these get expressed early on in therapy and sometimes people wait a long time before asking. Let's clear up some of these worries right away, so they won't interfere with you getting the most out of therapy.
1. You are judging me.
You will be sharing personal and emotional stuff in therapy and there is a natural tendency to wonder if you will be embarrassed or feel weird or that the therapist will be judging you in some negative way. Rest assured that most therapists are really listening with as much objectivity as possible. The orientation of professional, well-trained psychotherapists is to remain non-judgmental. My goal is for you to be comfortable revealing whatever is needed to get results, confident in the fact that I have only your best interest in mind. Rest assured that your story, though unique to you, has elements and events which will be familiar to me.
2. My problem isn't serious enough to take up your time.
Whatever your problem, issue or symptom, if it's important enough for you to make an appointment and come to my office, then it is worth my time and effort. You needn't wait until an issue becomes a major problem to seek help. Really, therapists welcome the opportunity to work on a variety of issues, most of which are not debilitating, such as test anxiety or dealing with a difficult boss. In fact, most of my clients are high functioning people dealing with a troubling life circumstance, symptom or relationship.
3. What are you writing about me and who will see it?
Therapists keep written notes and documentation. Many of us make notes during the session, but some therapists don't like to write during the session. All therapists complete an official note about the session afterward. The notes I make during the session help me to remember what we talked about and what interventions I used and what we need to do at our next session. Sometimes I like to write exact quotes which express an insight, or give me a special understanding. My handwritten notes are kept only for a short time and are then shredded. The note I dictate into your chart becomes part of the record for a number of years. The policy at Hillside has been to keep the chart for 7 years after a case is closed. The official note contains a statement about your current presentation (how you are doing, any symptoms noted), what we talked about during the session, what interventions I used, how you responded to what we did during the session and when you are expected to return. These elements are required to be in the note by insurance providers and accrediting organizations.
Insurance companies rely on the notes to prove that clinicians are doing what they are paying them to do. For this reason, as part of your insurance coverage, you have given permission for your insurance company to audit your record. Now, only a small percentage of charts are actually audited (and some insurance companies never conduct audits), but yours could be one of them. The auditors are looking for specific things, for example, date and time of session or whether all the elements of the required note are there. At Hillside, we also conduct internal audits of a small percentage of charts on a regular basis to make sure clinicians are doing what they are required to do in their documentation. During these audits, strict standards are in place to make sure confidentiality is observed. Feel free to ask more questions about this when you see me, if it is a concern for you. I want you to feel comfortable and confident with our procedures.
4. You are watching the clock.
I won't be watching the clock, but I may check the time occasionally. As you know, you are paying for a portion of my time. I want to make sure we start and end as close to the scheduled time as possible. By doing this, I am respecting your time and that of the next client. It also demonstrates that I am adhering to therapeutic boundaries. The ability to keep good boundaries is an indication of a professional, focused therapist. If I check the clock, it doesn't mean I don't care about you or what you are saying.
5. What is my diagnosis and why do I need one?
Your diagnosis is a shorthand way of describing your symptoms and has a code number attached to it. A diagnosis is made after the initial session. This is required for billing your insurance company. Your diagnosis and treatment plan are usually shared with you after the initial appointment. If you have any questions about the diagnosis, what it means and why I chose it, I am very willing to explain this to you to your satisfaction. Once again, it's important that you feel comfortable with all aspects of therapy. Sometimes, we therapists get so used to these processes and procedures that we forget they are not familiar to clients. It's good to remind us of that occasionally.
6. What if you can't help me?
While I have the skill and experience to help most people with most problems, there are certainly clients who I will not be able to help. If I am not skilled enough in your area of concern, I will let you know and will offer to refer you to someone else. Also, sometimes we may just not 'click' with one another. Since therapy is dependent on a working relationship, it's essential that you find someone with whom you feel comfortable. If that's not me, I can help you find a more suitable match. Don't worry about hurting my feelings. I will not take it personally if you would like to try someone else. In fact, I would prefer you let me know so I can offer a recommendation.
Michele J Gustafson
Hillside Center for Behavioral Services
8435 Holly Rd.
Grand Blanc, MI 48439
810-424-2400
info@michelegustafson.com
