Frequently Asked Questions

Concierge therapy includes:

• Video therapy

• Phone therapy

• HIPAA-secure text-based therapy through secure text-messaging

• Your personalized, private e-library

• Weekly follow-up client care plan

• Weekly quotes cues

• Ability to reach me seven days a week

Your private e-library will contain digital versions of therapy content that targets the treatment goals you tell me you want to work on, including:

• Books

• Workbooks

• Worksheets

• Writing activities

• Journals with prompts

• Interactive lessons

• Role-playing activities

• Micro-learning courses

• Scenario-based practice activities

• Videos

• Podcasts

• Meditations

You can work on your private e-library content when you have the energy and desire to dig in. We will talk about your work in sessions. I will provide feedback, and I encourage you to come armed with questions.

I will build your e-library based on the interests you identify in your intake paperwork, and I will add to it as we go along.

Text-based therapy is therapy delivered via text messaging and will usually be asynchronous. It includes messaging in both directions and is a clinical service. Text-based therapy should not be used as a substitute for therapy via video conferencing or phone; it should be used as a complement to it.

There is a difference between text-based therapy and quick texts for things like setting or changing an appointment.

Examples of text-based therapy:

• You want to share your reaction to content while it’s fresh in your mind.

• You want to check in and let me know how you’re doing, either for accountability or to touch base.

• You have a question about something you’re working on in therapy.

• You want to add a new subject area to your therapy.

• You want to include someone else in your treatment.

• You want records sent to you, a personal support, or another healthcare provider.

• You want me to read or watch material that you'd like to discuss in session.

Please note that Florida law does not allow the provision of telehealth services via email, so if you prefer text-based therapy, we will need to use the secure texting app.

Time for text-based therapy is calculated weekly. Calculations are based on an average reading speed of 200 words per minute. Text-based therapy is billed in 20-minute increments for any portion of 20 minutes used in a week. Twenty minutes covers up to 4,000 words in both directions. That’s 16 pages double-spaced - way more than you’ll probably need!

Freedom and comfort.

If you are able to remain in the comfort of familiar surroundings, treatment for addiction may be less disruptive for you. If you commit to treatment through a treatment center, you are limited to their accommodations, their food, their amenities, their schedule. You are stuck going to whatever support meetings or recreational activities they decide to take you to.

Structure is vital for people in recovery, but you don’t learn to self-monitor when that structure is enforced by someone else. Working with me, you will learn to integrate structure rather than imposing it - right from your own home.

If your current living situation is contributing to your presenting problems, I may recommend that you seek treatment away from home. If that is not desirable or feasible, we will work on building and maintaining your boundaries instead.

I will meet you where you’re at.

In many cases, therapy is goal oriented and focused on finding solutions. But if you’re struggling with addiction, sometimes just the goal of showing up for a therapy session may be all the challenge you can handle right now. If that’s the case, then that’s where you’re at, and we’ll start there. First things first. Maybe we’ll start with talking, and that will be enough at the beginning. Maybe you’ll ask me to read to you, and I’m totally up for that if you find it helpful. Maybe you want to do the work, but you don’t know where to start, so we’ll start it together, in session.

We’ll work on goal-setting when you are ready. You’ll let me know when that is, and if communicating your needs is hard for you, then we’ll work on that. It’s my job to help you start setting and achieving manageable goals one small step at a time. It may sound corny coming from a stranger, but I will always come from a place of love.

When I first came into the recovery rooms, people I barely knew would tell me, "I love you, Michelle." And I would think, "How absurd! You don't even know me!" After a few years, I realized they did not mean that they loved me, Michelle. They meant, "I am loving to you. I give you my love." Coming from a place of love doesn't have to be about the other person, although it certainly can be. It's about honoring others' humanity, and it's about my humanity. It's about being the best kind of person I know how to be. I don't always practice love perfectly, but I always keep it in mind. It's an ideal, and it is always worth the effort.

Variety.

In addition to your therapy sessions, I will provide you with a personalized, private e-library full of content to read and work on between sessions. The material will include readings, videos, interactive e-learning modules, role playing scenarios, and knowledge checks. You will have access to books and activities that are not publicly available.

Your needs are likely to evolve and change throughout the course of your therapy, so we will talk often about the type of content that suits you and the format you feel works best for you (talking, reading, writing, watching, listening, etc.). Occasionally, you may find a shift in format helpful depending on what else is going on in your life in terms of demands on your time and attention. Overwhelm is a natural and common feeling in therapy. If you do find yourself feeling overwhelmed, speak up and we will make adjustments.

Transferable skills.

As a person in recovery, you should be able to write a resume of your recovery skills, experience, and education. If you have nothing to put on it, it's time to get to work. That's what I'm here for. I will help you build that resume. Putting those skills, experience, and knowledge on paper will give you a roadmap for the kind of opportunities you might pursue.

Having that roadmap will help you establish credibility with family and friends, get jobs, get into schools, and feel better about yourself. It’s not something you’d give to prospective employers or loved ones, but writing it will give you the language to use during job interviews and in communications with the people who matter to you.

Sure.

For you:

In addition to working with adults who have problems with substance use, I also work with family members who need a recovery of their own - sometimes for psychoeducation, sometimes to deal with the toll their loved one’s addiction has taken on their lives. In that circumstance, you will be my client rather than the family member who has an addiction.

For them:

If you’re contacting me to work with your family member, they must be over 18 and located in Florida. You are welcome to ask questions about my services if you are looking at different therapists. If you decide to go with me, your family member will need to reach out to me themselves to start the intake process. They can do that on my contact page. If you are financially responsible for them and wish to pay for their therapy, they will need to complete an authorization for disclosure and release of information, and you will need to complete a third party payor agreement prior to scheduling the first session. The client can contact me for the the link to that form.

Depends on what you’re looking for. If that’s your jam, I do. If it’s not, we’ll go in a different direction. I will say that in my experience, 12-step programs work, but only if you’re actually doing the 12-step work. If all you’re doing is going to meetings and filling a chair, you’re missing out on most of the benefits. If you’re turned off by the religious overtones, I can help you compartmentalize that aspect of 12-step recovery so it works for you too. I talk about using 12-step facilitation on my methods page if you want to read more.

Yes.

Sometimes. Each family situation is unique. Timing matters because sometimes family members are ready to hear from each other, and sometimes they are not. I do not offer family therapy where the family is the client. However, I believe it is invaluable for family members to participate in the client’s treatment, and research shows better long term outcomes for clients whose families get involved in supporting their work in therapy.

I will invite a family member to join you for your session if you and I agree that it would be helpful. There are two ways I involve family members or other support persons:

1. Collateral sessions

2. Collateral interviews

“Collateral” is the term we therapists use to refer to anyone in the client’s sphere, such as family, friends, other emotional or recovery supports, other healthcare workers, and legal professionals.

Collateral Sessions

The purpose of a collateral session is to provide insight or assistance with the therapeutic process for the support of the client. As the clinician, my role in a collateral session is to gather information, facilitate communication, and provide educational resources or clinical referrals when beneficial.

It is also my role to discourage triangulation in therapy. Triangulation is when you have three people and one of them pits the other two against each other, one of them tries to control or repair conflicts between the other two, or two of them gang up on the third. Triangulation can increase stress and conflict and stall or prevent conflict resolution. In these cases triangulation is counterproductive to the healing process and can twist therapy sessions from empowering experiences into wearisome and soul-crushing experiences. When triangulation is present, I may advise against collateral sessions at that time.

Collateral Interviews

A collateral interview may be a phone conversation, email, or video session that takes place without the presence of the client. The purpose of a collateral interview is for the collateral to:

• provide background information or another perspective on the client’s history and current struggles.

• receive education and resources regarding the client’s diagnosis and symptoms.

• improve communications with the client.

• set goals for healthy boundaries between the collateral and the client to support the client’s progress.

• discuss the discontinuation of enabling behaviors.

• point out and discourage triangulation.

• refer collaterals to a therapist when appropriate.

Policies for family members and other collaterals:

• I will always consult with a client before agreeing to involve a collateral. A signed release of information from the client is required before a collateral session will be considered.

• Collateral sessions are not therapy sessions for the family member(s). The collateral is a guest, and is there to support the client. Collaterals should not substitute these sessions for their own therapy and recovery. It is important for family members of addicts and alcoholics to have a recovery of their own so they can process how their loved one’s addiction has affected them.

• The family member is there to provide background, insight, or feedback about the issues the client is working on in therapy, or to request resources for their own education and recovery regarding the client’s case.

• Collaterals are not clients and are not protected under HIPAA law. The right to confidentiality is held by the client, not the collateral.

• Collaterals are not entitled to any records resulting from the session or interview.

• Collaterals should be aware that records of a client’s collateral sessions and interviews follow the client’s chart wherever the client authorizes the materials in it to go.

• I will not hold secrets from a client on behalf of a collateral. If someone contacts me about a client, I will notify the client and may discuss the content of that contact.

• Collateral sessions and interviews are billed at my base hourly rates.

• Family and friends of clients should not expect phone, text, or email contact with me outside of sessions or interviews.

Note to family members and other support persons:

If you contact me about a client, and I do not have the client’s consent to speak with you, I will:

• not respond at all unless I have a written release of information from the client.

• respond in a limited manner according to the written release of information the client provided specifically for that contact.

• respond with “Per HIPAA law, I can neither confirm nor deny whether someone is or has been a client, or even if they have contacted me”.

• not respond to voice mail messages from collaterals because it is my policy to limit calls to appointments only.

I do not refer my clients for drug or alcohol testing. If you are recovering from an addiction, you do not need a drug test to tell you whether or not you are using alcohol or other drugs. You know. Generally speaking, I know too. It's pretty easy to tell when someone is still struggling with alcohol or drug use, or is acting out on a behavioral addiction.

Since I do not deal with insurance companies, I am not required to report negative substance screenings to justify continued treatment coverage. I do not think anyone benefits from me asking you to pay for drug or alcohol screenings except for the company that bills you for the labs.

Making someone else responsible for tracking your drug or alcohol use may provide accountability, but it does not improve your personal sense of responsibility and can contribute to your feelings of shame and guilt. You'll benefit a lot more from developing an honest therapeutic relationship in which we can work on your coping skills, relapse prevention skills, and self-monitoring skills.

The following conditions may be a strong indication that telemental health therapy is not a good fit for you at this time.

• If technology causes you so much stress that you avoid logging on to your devices.

• If you are so suspicious of technology/electronics that your suspicion undermines your confidence in HIPAA-secure applications and processes.

• If you are abusing alcohol or other drugs excessively on a daily basis.

• If you are unwilling to identify an appropriate support person in the case of need.

• If you are unwilling to verify your identity, location, and phone number.

• If you are not comfortable submitting payment online.

• If you are suicidal, or have a significant risk of becoming so.

• If you are planning to hurt someone else, are homicidal, or have a significant risk of becoming so.

• If you are currently a victim of domestic abuse and do not have a private location and time in which to receive teletherapy without your abuser’s presence or observation (electronic or otherwise).

There are risks to receiving telemental health services in domestic abuse situations. Some of these risks include compromises to your privacy and security. For example, your abuser may install spyware on your devices, or may insist that you share your passwords and passphrases with them so they can access your therapy records and other protected health information. Your abuser may insist on being present during your sessions or monitor your sessions with electronic listening devices. Because of these risks, teletherapy may not be the safest option for you. If you are living in an abusive situation, please contact one of the crisis resources on my find immediate help page.