Frequently Asked Questions

General

  • Deciding to seek therapy can be a big & positive step. The outcome of treatment depends largely on the right fit between therapist, client, the therapeutic tools for a particular set of issues, and a client’s willingness to engage in the process in an open, honest way while applying what is being discovered into how they live their life. Therapy can lead to better relationships, solutions to specific problems, and an overall increase in well-being. It is a learning process and there are no miracle cures. Therapy can, at times, result in emotional discomfort. Exploring unpleasant aspects of life, and becoming more aware of feelings attached to experiences, can bring on strong feelings of sadness, anger, depression, anxiety, hopelessness. These feelings, and others which you may dislike, are often an essential element in successful therapy. We cannot promise that your behavior or circumstance will change. We can promise to support you and do our very best to understand you, as well as to help you clarify what it is that you want for yourself.

    As therapists, our intention is to support individuals as they overcome personal challenges, identify their values, and start taking steps to live the kind of life they aspire to. Our primary focus is guiding and assisting clients toward greater mindfulness, acceptance, and a value filled life, regardless of the label given to a problem or diagnosis. Our therapeutic orientation is primarily focused around Cognitive Behavioral Therapy (CBT), and Acceptance & Commitment Therapy (ACT). CBT is a structured psychotherapy that identifies and addresses persistent maladaptive thought patterns to change emotions (e.g. - depression/anxiety) and behaviors. It uses strategies such as goal-setting, breathing techniques, visualization, and mindfulness to decrease emotional distress and self-defeating behavior. ACT uses strategies to increase acceptance, mindfulness, and commitment as well as various behavior strategies to increase psychological flexibility. For many, they are both time limited, in that there will be a point when the formal therapy will end. We do not enter the therapeutic relationship with the intent of an open-ended, never-ending process. For some, however, a more extended length of time is required to reach goals.

    Our current practice is currently exclusively online with telehealth sessions. The number of sessions will vary depending on your particular situation. You have the right to question any part of your treatment and to discuss any concerns with us. If you feel you aren’t benefiting from therapy, let’s discuss what’s working, what’s not, and how to best proceed. You have the right to terminate or refuse treatment at any time. It is the client’s right and responsibility to choose a practitioner and/or treatment modality which best suits their needs.

  • PRIVACY AND EXTENT OF CONFIDENTIALITY

    Your right to privacy and confidentiality is of the utmost importance to us, and we do not wish to jeopardize your privacy. Therefore, if we see each other accidentally outside of the therapy office, we will not acknowledge you first. However, if you acknowledge us first, we’ll will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.

    The session content and all relevant materials to a client’s treatment will be held confidential unless health information sharing is allowed under WA State law and/or HIPAA. Limitations of client held privilege of confidentiality exist. These exclusions, along with your privacy rights, are itemized in our Notice of Privacy Practices.

    Occasionally we may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name and disclosing only that which is necessary for consultation, limited to only that information necessary to accomplish the purpose of the consultation. 

    CONTACTING OUR OFFICE

    If you need to contact us between sessions, please call 360-340-9288 or message us within the HIPAA secure client portal system. We are not always available for call or portal messages, and cannot guarantee an immediate response; however, we will attempt to return your message, if requested, within 24 hours, with the exception of weekends and holidays. While you are welcome to call or message anytime, it’s our preference to keep telephone and messaging contact brief when it relates to therapy related issues to discuss with your clinician. We find it better to have an appointment for in depth or extended discussion of therapeutic content so you can receive our full attention with time set aside specifically for you and your current needs. Please do not use either method to request assistance for emergencies.

    Contacting our admin manager for non-therapeutic issues: Please contact our admin manager at our phone number, secure text channel or client portal for scheduling and all non-therapeutic, administrative issues. This includes issues with scheduling, billing, and questions about the client portal.

    Optional Texting for Brief Scheduling & Other Issues: We have a HIPAA secure texting service that clients are welcome to request. This system requires the download of an app and is easy to set up in just a few moments. While we generally keep therapeutic content to scheduled sessions, we offer this external texting service as an easy option for quick cancellations, rescheduling, making an administrative inquiry about paperwork, and similar tasks. This system can also be used on occasion by clients and/or their loved ones in times of crisis. Please remember that this service is for crisis or brief needs. Use the client portal, phone, or a conversation in person for longer messages and more extensive communication. 

    AUTOMATED REMINDERS, CANCELLATIONS, & NO SHOWS

    Reminders: We send automated appointment reminders via email and text message as a courtesy. We will not receive replies if clients respond to these automated messages. (These automated texts are different from the optional texting described under "Optional Texting for Brief Scheduling & Other Issues.") 

    Technology can fail: The client is responsible for their appointment time even if a courtesy reminder from our automated system fails to reach them. If the date or time on the auto-reminder is different from the date or time a client expected to be seen, it is the client’s responsibility to phone the office to clarify.  It is up to the client to keep record of their upcoming appointments.

    Cancellations & No-Shows: Cancellations, “no-shows”, and re-scheduled sessions may be subject to a full charge if not canceled/rescheduled at least 24 hours in advance. As well, if you have booked a full session, but decide during the session to shorten the session or you show up late, you will be billed for the length of session originally booked. This is necessary because a time commitment is made and held exclusively for you, preventing the scheduling of others who we could be seeing. Exceptions to these policies may be made, for reasons such as legitimate emergencies or illnesses. If you are late for a session, you may lose some of that session time. Regular cancellations may result in loss of your recurring time slot or a discontinuation of treatment.

    If it's greater than 2 hours from your session time, you can either call or cancel your appointment within the client portal (www.soundliferecovery.com > Client Portal > sign in > Appointments > click on 3 dots in right upper corner of appt box > cancel appointment.) 

    To cancel within 2 hours of your session time, please call 360-340-9288. 

    CLIENT PORTAL

    Client Email Needed for Portal Access: Our practice is run all electronically, therefore we require all clients to have an email on file to connect with the client portal.

    Joining the Portal: Clients are sent a link, via email, to initiate access to their client portal. In the portal, you can complete documents, access copies of past documents, see & cancel future appointments, access telehealth sessions, message your provider in our HIPAA secure system, see financial/billing information, and update your credit card information to pay your bill.

    Accessing the Client Portal: Simply go online to www.soundliferecovery.com, click the link to the portal, & follow the prompts. Please consider the level of difficulty of your password to best protect the private healthcare information in your account.

    Security Tip: It is recommended that everyone signs out of their client portal after each use to protect their privacy and for their security. Of special note, if others who share or use your computer are also part of our client portal system and you do not want them to see your private information, you must sign out after each use.

    If you are not receiving Client Portal alert messages in your email, check your spam file. If you still have problems, please let us know.

    Portal Based Secure Messaging: We use secure messaging within the portal to keep clients updated on important information related to scheduling, policy changes, and other information as needed. IT IS IMPORTANT THAT CLIENTS KEEP AN EYE ON THEIR EMAIL WHICH WILL ALERT THEM TO NEW SECURE MESSAGES OR CHECK THEIR CLIENT PORTAL FOR MESSAGES. Though we may attempt to connect with you in another way if we don't receive a response from a portal message, clients and 3rd party payers are responsible for the information sent through the secure messaging system within the portal even if: 1) we are not able to contact them another way, 2) they choose to not review and open their email alerts directing them to their portal messages or, 3) they do not read their portal messages.

    Because of its higher level of security, we request client's use the client portal messaging system for ALL written communication (other than brief use of our external texting as described in the section on Optional Texting.)

    SCHEDULING & APPOINTMENT INFORMATION

    Session Length & Scheduling: The standard time scheduled for sessions is 53-60 minutes. Requests to change the session time need to be discussed with your clinician in advance for the time to be scheduled appropriately. Because available appointment times are very limited, we typically schedule clients for the same day and time every week, unless arranged otherwise.

    Occasional Scheduling Conflicts: On an infrequent occasion, Jeff’s position with UW requires him to cancel therapy appointments in order to meet a UW commitment. We often try to find times to reschedule client appointments during the same week, though at times this isn’t possible.

    HOLIDAY SCHEDULE

    Typically, the office is closed on Thanksgiving through the weekend after Thanksgiving, as well as the week of Christmas and New Year’s. Clients will be notified of office closure for other federal holidays, as needed. 

    COURT CASES / DISABILITY & OTHER PAPERWORK

    We do not involve ourselves in court cases unless we are required by law to do so. In order to have a better sense of a client’s needs and levels of function, we generally do not fill out paperwork for work benefits or other benefits such as Social Security Disability unless we have already seen a client for 10 sessions in a 12-week timeframe.

    SOCIAL MEDIA & TELECOMMUNICATION

    Due to the importance of your confidentiality and the importance of minimizing dual relationships, we do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). We believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship.

    GIFTS

    We genuinely appreciate the kindness and generosity behind the wish to offer our office gifts for holidays and other occasions, or simply as an expression of your gratitude. Because gifts can impair the therapeutic relationship, we request that clients consider alternatives. A simple conversation letting us know what we are doing well, sharing our business information as a referral to others, cards, or donations to a local mental health or substance use charity to support our community in lieu of a gift directly to us are all deeply appreciated and less likely to have potential to interfere with the therapeutic process. 

    TERMINATION

    Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. Your therapist may terminate treatment after appropriate discussion with you and a termination process if they determine that the psychotherapy is not being effectively used or if you are in default on payment. We will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating unless conditions are in place, such as multiple missed sessions, with no communication with us. If therapy is terminated for any reason or you request another therapist, we can provide you with a list of other psychotherapists or agencies who may be available to treat you. You may also choose someone on your own or from another referral source. Should you fail to schedule or cancel an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, we will consider the professional relationship discontinued.

    FORM UPDATES

    Scheduled updates of forms and policies, as needed, will occur in December of each year, with review and signature needed by clients by the client’s first appointment of the new calendar year. To stay updated on policies and information we have updated or changed over the course of a year, all clients will have new forms even if it has not been a full year since they last reviewed and signed them.

  • Our practice is exclusively online at this time.

  • Rates to see Jeff Roskelley, LICSW are currently $180 per therapy hour. Nicole’s practice is currently closed. Our therapy hour generally lasts for 53 minutes, but may extend to 60 minutes. Extended session fees beyond that are in proportion to current rates in 15 minute intervals. Assessments are billed at an additional .5 of the session rate. The additional assessment fee allows for time to review & analyze assessment data and create a treatment plan outside of the session.

    CANCELLATIONS & NO-SHOWS

    We ask our clients to cancel or reschedule at least 24 hours in advance. Cancellations, “no-shows”, and re-scheduled sessions may be subject to a full charge if not canceled/rescheduled at least 24 hours in advance. As well, if a client has booked a full session, but decides during the session to shorten the session or the client shows up late, they will be billed for the length of session originally booked. This is necessary because a time commitment is made and held exclusively for a client, preventing the scheduling of others. Exceptions to these policies may be made, for reasons such as legitimate emergencies or illnesses. Excessive late cancellations, late arrivals, and no-shows may result in loss of a recurring time slot or a discontinuation of treatment.

    OTHER FEES

    FAMILY MEETINGS: When scheduled independent of a client session, family meetings are charged at the client's current session rate and in proportion to time spent in the meeting, in 15 minute increments. For instance, if a meeting lasts 15 minutes, an invoice will reflect 1/4 of the hourly rate. If a meeting lasts 25 minutes, an invoice will reflect 30 minutes of time spent. On occasion, often with financial considerations in mind, family meetings are booked within the final 15-30+ minutes of a client session.

    CRISIS TELEPHONE, TEXTING, & SERVICE COORDINATION: We generally do not offer telephone assessment, evaluation, or therapy sessions though if they do occur, they will be billed at your session rate. We do not offer texting therapy as an ongoing practice, however we can arrange for a secure text channel for scheduling communications or crisis on a case by case basis if a client requests. We do not charge for minimal and reasonable crisis text or calls, however if texting, telephone calls, and/or coordination with a client or outside crisis support or services is extensive and takes up significant service time, you may be billed a fee proportionate to your session rate.

    DRAFTING DOCUMENTS: Our regular hourly rate will be charged for drafting of all documents and applies to all requested letters, reports, and communications with 3rd parties.

    LEGAL INVOLVEMENT: Our regular hourly rate will be charged for all preparation, participation, travel, and waiting time if we are requested or required to participate in a legal hearing or other proceeding on a client's behalf.

    INSURANCE, INVOICES, & AUTOPAY

    We aim to invoice clients within 72 hours of our session, though there are sometimes delays. Billing documents are available in the client portal. Clients will receive an email notification when a new invoice is available to them. Clients must have their preferred credit card on file in our secure system, keep that card updated before expiration, and set the card as default for payments. All client accounts are required to be on our AutoPay system. On AutoPay, our system will automatically charge the card on file after we create your invoice. We expect invoices to be paid in full at the time the AutoPay system processes them. Automatic reminders will be sent for overdue balances. If a balance is not paid by 21 days, we can discuss current circumstances to update payment and therapy agreements. This may include termination of services. We only accept online payments.

    We are not contracted with insurance companies and do not bill insurance for you. We are out-of-network for all insurance which means we do not have a contractual relationship to directly bill any insurance company. At your request, we will provide you with a detailed receipt which includes a diagnosis and treatment code and amounts paid for dates of therapy services. You may choose to submit for eligible flex spending purchases, insurance providers, or other potential reimbursement resources to request direct reimbursement to you. We do not offer services intending to comply with insurance reimbursement requirements and do not make any assertions regarding whether or not the services we provide to you will be eligible for reimbursement.


    Medicare recipients: SLR is not a Medicare provider and is opted out of a contractual relationship with Medicare. Client must sign a separate contract required by Medicare acknowledging that they are unable to submit a bill to Medicare will not reimburse either the client or SLR for these services. SLR provides this contract in the intake process.

    Medicaid recipients: SLR is not a contracted Medicaid provider and Medicaid will not reimburse for these services. 

    A note on credit card security: Our practice management system uses  a certified PCI Service Provider Level 1 to store and process transactions. This is the most stringent level of certification available in the payments industry. For more information on Stripe security: https://stripe.com/docs/security

    REFUNDS

    Refunds are not given for payments made for services that fall under the conditions of signed agreements.

    SCHEDULED RATE INCREASES

    To account for rising costs and other factors, we assess our session fees annually with potential rate increases scheduled for January of each year. We offer advance notice of rate increases.

    SESSION PAYMENTS BY A FAMILY MEMBER OR FRIEND

    If a 3rd party such as a parent of an adult child is paying for services, that 3rd party must be in our secure client portal system with a full name, phone number, and email, and listed in the portal as responsible for billing and payment, have an active credit card on file, and sign an authorization to run charges on their credit card through our AutoPay system. Though we aren't legally required to do so, we ask that the client sign a release for us to communicate directly with that 3rd party about information related to billing and payment both verbally and in written form including electronic messaging. The 3rd party will have access to dates & times of upcoming appointments, charges & invoices related to past appointments, and information identifying each session as attended, “no-shows”, or “late-cancels”. They may also see your date of birth and diagnosis depending on what documents they have access to. For instance, if you request the 3rd party to receive a detailed statement of charges for potential reimbursement on your behalf, they may have access to your diagnosis, treatment code, and your provider’s name and other identifying information. The 3rd party will receive information related to our financial policies. The 3rd party will not receive information related to topics discussed in your therapy sessions unless you request we share and authorize us to do so by signing a release specific to that purpose, or as allowed by law in special circumstances if there is a potential for a client to harm themselves or others. Out of respect to all parties' time and financial resources, we discuss repetitive late-cancellation or no-show session charges with the client as well as the 3rd party payer. 

    If a client shares a computer or device with a another person who also has access to our client portal for financial or scheduling reasons, it is recommended that the client sign out of their own account after each use to protect their private information.

    PRIVACY & SAFETY WITH BILLING INFORMATION

    While we try to limit information on invoices and receipts, they may have the client’s name, clinician's name and credentials, the name of the practice, the amount charged, and other information. This information may show up on digital screens depending on your user settings, as well as in such places as subject lines of invoice/receipt emails. As with all non-cash transactions, this information may also appear in your credit card or banking statement. Please consider any risks involved in paying using these methods. A few examples of risks may include: 1) a person other than you may gain access to your bank statements, see your email subject line or gain access to your email, see your digital notifications, and therefore become aware that you are seeing a therapist, and 2) if you are using a work email, your employer seeing evidence of this transaction with a therapist. While the use of this type of invoicing/receipt sending is considered preferred and acceptable to most clients, some wish to keep the limited information potentially exposed during these transactions more secure from a past abuser or for other reasons. Please let me know if you wish to further discuss any concerns about this. If you wish to have another person (ie; a parent or other responsible party) receive these invoices and receipts so they can pay the balance due, you will be asked to sign a form identifying the person and digital address where you’d like this information sent. Please consider your personal safety and risks related to the information above as it relates to a 3rd party receiving your financial documents as they relate to treatment.

Psychosis

  • “Psych-” as a root is defined as “mind”, while the suffix “-osis” is defined as a condition, status, or process, whether typical or atypical. So, the word psychosis points to a condition of mind. It is a broad description of less common or more extreme experiences that we all may have had, or could have. It is only an issue to the degree that the associated experiences are the source of impairment, distress, or harm.

    More people live with psychosis than most of us realize.

    It is common, and it can be manageable.

  • Q1: What is Cognitive Behavioral Therapy for Psychosis?

    A1: CBTp is a form of psychotherapy aimed at helping individuals manage and reduce the symptoms of psychosis, which may include delusions, hallucinations, and disorganized thinking. It involves working collaboratively with a therapist to understand and change negative thought patterns and behaviors. It has been a valuable support for many people in learning how to live a more fulfilling life while living with intermittent or regular psychotic experience.

    Q2: What is the history of CBTp?

    A2: CBTp evolved from Cognitive Behavioral Therapy (CBT), a well-established psychological treatment. The adaptation of CBT for psychosis emerged in the late 20th century as research began to show that psychological therapies could effectively complement medication in treating psychotic disorders.

    Q3: What evidence supports the efficacy of CBTp?

    A3: Numerous studies have shown that CBTp can be effective in reducing the severity of psychotic symptoms, improving functioning, and enhancing quality of life. It is recognized as an evidence-based intervention for psychosis in various clinical guidelines worldwide.

    Q4: What are the phases of therapy in CBTp?

    A4: CBTp typically includes the following phases: Assessment and Engagement, Formulation, Intervention, Relapse Prevention and Maintenance, and Termination. Each phase plays a crucial role in the therapeutic process.

    Q5: Why is the Engagement Phase emphasized in CBTp?

    A5: The Engagement Phase is crucial as it involves building a therapeutic alliance and trust, which is essential for effective therapy. In psychosis, individuals may have mistrust or ambivalence towards therapy due to their symptoms. Hence, more time is often spent in this phase to develop a strong, collaborative relationship.

    Q6: Why is the Engagement Phase typically longer in CBTp?

    A6: The extended duration of the Engagement Phase in CBTp is due to the unique challenges presented by psychotic symptoms. These can include distrust, fear, and a lack of insight into the illness. A longer engagement phase allows for the development of trust, understanding, and a strong therapeutic alliance, which are vital for the success of the therapy.

    Q7: How can families support individuals undergoing CBTp?

    A7: Families can play a supportive role by encouraging the individual's participation in therapy, being understanding of their challenges, and providing a stable and supportive home environment. Educating themselves about psychosis and CBTp can also be beneficial.

    Q8: Is CBTp guaranteed to work?

    While CBTp has been a powerful treatment tool for many people, it isn't the right tool (or the right tool for a particular time) for everyone. We can never guarantee an outcome. What we can guarantee that we'll do what we can with the knowledge base and resources we have to best support you or your loved one in taking steps toward the change that you aspire to. If we don’t have the tools or level of care that you need, we can discuss options for other regional supports who may.

  • This is an excellent question! Not everyone is a good candidate for our program. After you read this, review the question in our FAQ “What are the requirements for your CBTp program?” The information there is a version of the contract we have our clients and their chosen support person sign after we have mutually decided to initiate therapy. Prior to even scheduling, however, there is something that makes someone ready for this type of program, and that is a readiness to engage. We have found that if a client isn’t choosing, from their own readiness and free will, to be part of our program, it is not the right time for them.

    We sometimes use an analogy we call “A Ripe Peach” to describe one of the reasons why this is important. Imagine plucking a peach off of a peach tree. A peach that is ripe drops in the hand with ease. There is limited to no effort. But, if the peach isn’t ready, you might yank, pull, and tug to try to get that peach to come off the branch. In the process, you bruise and damage the peach. Similarly, if someone isn’t ready to engage by their own volition and internal motivations, a resistance or distaste for this kind of support can build. In this way, we may damage the potential they may have had in the future to re-engage at a later time when they may have felt more ready and received benefit.

    Another question that is important to consider is the degree to which someone is experiencing impairment or distress. If an individual is a voice hearer, but the voices are not causing impairment or distress, there may not be a need for therapy, unless the individual seeks it out for other reasons. The level of impairment or distress is key.

  • Cognitive Behavioral Therapy for serious mental illness has better outcomes when it includes three things: 1) therapy 2) support from someone who cares for the person experiencing psychosis , and 3) enough stability to make use of the process (often, for those in early stages, this involves medication).

    Due to our limited resources as a small private practice without the access to the full range of support or menu of services available in a larger agency, our ability to build a team to help our clients achieve their life goals is crucial. Therefore, we ask our clients to have a family member or another loved one involved in their care.

    The following are conditions for initiating and continued therapy with our office:

    1. Family/Support Person Meeting: The client and their chosen support person agrees to having care meetings, as needed. The frequency and duration of these meetings varies from person to person and as their needs fluctuate. During times of stability and maintenance, meetings may be as brief as 15 minutes and be scheduled intermittently throughout the year, or not at all. During other phases of therapy, monthly or more frequent meetings may be important. The intention of these meetings is for everyone on the team to “check in” and stay updated with the progress and plan, or coordinate around crises. Collaboration can help us all as we work together with a shared vision toward a client’s desired therapy goals. This is in addition to weekly private sessions with the client and billed at a rate commensurate with the client’s hourly rate, reflecting the time spent and billed per 15 minute segments. (ie; the fee for a 15 minute meeting would be 1⁄4 of the fee of the client’s regular therapy rate). Often, but not always, these meetings can be tagged onto the final 15-30+ minutes of a client’s session, so no further balance accrues beyond the anticipated therapy session.

    2. Signed Release to Discuss Care: The client agrees to sign a Release of Information allowing us to freely communicate and discuss care with the family/support person, as needed, to more easily coordinate care during a crisis, to minimize crisis risk, or best support the client in meeting their therapy goals. These discussions always have client support at their core and are mostly educational in nature, often in support of deepening the understanding of information learned in the REACH Program (see below for more on REACH). For some clients, these conversations with a support person occur only during crisis.

    3. Crisis plan: Many of our clients find themselves in crisis from time to time. This is a natural part of a more serious or complicated mental health condition, especially in earlier stages, and it's important to prepare prior to a crisis unfolding. Therefore, the client & family/support person agree to both fill out a Crisis Plan before the first family meeting, or as otherwise agreed upon with your therapist. After completion, all parties agree to a family meeting to review and finalize the plan, and to make agreements as to follow through with the plan if a crisis should arise. This is a first draft that will be refined over time. We recognize that some may need this plan more than others, however we can't anticipate who will benefit vs not. Therefore, having a written crisis plan on file is standard policy for all clients in our CBTp program.

    4. Prescriber: The client agrees to have a psychiatrist or APRN in place at the initiation of therapy (or within a timeframe mutually agreed upon with our office) to prescribe & manage appropriate prescription medications, and to have an active Release of Information on file allowing SLR to discuss your care with them.

    5. Attendance: We have some special attendance policies for our CBTp clients. We request that all clients make contact with us if they are going to miss a session. Client agrees to miss no more than 5 sessions without prior notice and a legitimate reason for the cancellation in a 12 month period. All parties agree that if more than 5 sessions occur as described above, or the client has 2 missed sessions in a row without prior notice and a legitimate reason for the cancellation, therapy will be put on hold. If this “hold” status occurs, in order to assess how to move forward, all parties agree to meet to assess continued interest in therapy, assess the therapy plan moving forward, renegotiate agreements for therapy, and make sure all parties continue to be “on board” with involvement. If a client does not make contact with us for 3 consecutive weeks, they are formally discharged from our program. Exceptions may be made for special circumstances. We request that a support person keep us informed in times of crisis and hospitalization.

    6. Family SPIRIT Lab Resources & Completion of REACH Program: The family/support person agrees to familiarize themselves with the resources available through the SPIRIT Lab at the University of Washington. The family agrees to complete the online “on-demand” portion of the REACH Program within 4 weeks of involvement of care, and either the online or in-person half day live portion of the training within 6 months. At the time of writing, the live portion is offered 4 times a year. If the next immediate session is full, one can add their name to a contact/wait list for the following session. This program is offered for free or low cost to families.

    Here are some helpful links to get you started. Use these links as a jumping off point to explore the other related webpages from the SPIRIT Lab:

    • SPIRIT Lab at the University of Washington | Supporting Psychosis Innovation through Research, Implementation, & Training (uwspiritlab.org)

    • Psychosis REACH Training | SPIRIT Lab at the University of Washington (https://www.psychosisreach.org/)

  • We’re dedicated to supporting you or you (or your loved one) through your mental health journey. As we begin our work together, it's important to recognize the limitations of a small independent practice and online telecare services, such as ours, in crisis situations. Our goal is to ensure that you receive the appropriate care and support, especially when facing urgent challenges. As a standard practice for all of our clients with more complex mental health needs, we encourage and require the development of a personalized crisis plan.

    Understanding Our Limitations

    Our Services: As a small private practice with a single practicing therapist, we specialize in providing weekly therapy sessions, hosting intermittent family meetings as needed, and conducting educational groups on topics relevant to our clients and their loved ones. Additionally, we sometimes act as a referral resource, guiding clients and their families to other available supports as their needs evolve. Recognizing the limitations & staffing shortages often found in larger agencies, our clinician(s) also sometimes offer external therapy sessions adjacent to the services an individual might receive from these agencies.

    Note: If you have Medicaid, please bring it to our attention so we can discuss with you the higher level of services that may be more readily available to you and offer a greater level of care.

    Our Expertise: Our clinician is highly skilled in managing complex mental health issues and is widely sought out by clients, families, and fellow professionals for his expertise with psychosis. However, it's crucial to understand that our practice is not a large agency equipped with a diverse array of services. We do not provide access to a multidisciplinary team or comprehensive "wrap-around" services. Our capabilities do not include offering peer support, prescribing medications, or providing 24-hour crisis intervention and vacation coverage. Additionally, we do not have caregivers who travel to clients' homes or other natural settings.

    Our Role in the Community: We acknowledge that our pared down services, without the multidisciplinary resources & programs of larger agencies, offers an imperfect solution to a significant gap in Washington State's mental health care system. This gap predominantly affects individuals with complex mental health needs who are not yet eligible for Medicaid and thus lack access to larger agencies with more extensive resources. By offering our specialized services, we aim to partially bridge this gap and provide much-needed support to this underserved population.

    Crisis Situations: As a practice with only a solo clinician, we may not be as equipped as a larger agency to handle acute crises, such as severe psychotic episodes, grave disability, or situations where there is a high risk of harm to oneself or others.

    Session Flexibility: We do offer flexibility for additional therapy sessions, collaboration, and collateral care coordination during times of crisis, but this may not suffice in every crisis scenario.

    Creating a Crisis Plan

    Early Preparation: It is crucial to have a plan in place before a mental health crisis emerges. Therefore, we encourage and require the development of a personalized crisis plan, in writing, early in our therapeutic relationship. This plan will outline steps and resources to utilize during emergencies.

    Regular Reviews: Your crisis plan should be reviewed and updated regularly to ensure it remains relevant and effective. For instance, as you learn and establish new practices, tools, or resources that improve your ability to engage with your experience, we can add them to your plan.

    Involvement of Family/Loved One: We require a family member or another support person to be involved in crisis planning, to agree to be an active part of the crisis plan, and to follow through with their role in the plan should a mental health crisis arise. This requires participation in crisis planning both outside of and during family meetings.

    Plan Accessibility: Keeping your plan quickly easily accessible for both yourself and your support person can help in times of crisis. Your support person can quickly locate the plan should symptoms escalate so they know who to call and remind themselves what your wishes are. It's also important to consider how your medical team might access your plan if medical care or hospitalization takes place without immediate notification of your support person. Planning ahead to increase your care team's access to your crisis plan during times when symptoms may interfere with the ability for introspection and action can help the care team access the information that reflects your wishes for treatment. There are a variety of ways people manage this, including having their plan on file at your local/regional emergency and crisis services, or wearing a medical alert bracelet or necklace which has information directing the care team to a service that can connect them with their crisis plan. Some choose to keep a flash drive around their neck or in their purse, clearly marked for emergencies.

    Emergency Resources

    Immediate Assistance: In case of an emergency, please contact local emergency services, call 911, or a crisis hotline. We request that clients find & be prepared to share the contact information of their local & regional crisis resources to include in writing on their crisis plan.

    Other crisis contacts include:

    Crisis Line: 988 or text HOME to the number 741741
    Veterans Crisis Line: 988 (press 1) or text 838255
    24 Hour Crisis Line / Peer Support: 1-866-427-4747 (https://www.crisisconnections.org/wa-warm-line)/

    List of Resources: We encourage clients and their loved one/support person to locate regional crisis supports, such as respite programs and inpatient psychiatric care facilities, before they are needed. Keeping contact information for these resources easily accessible on a written crisis plan can minimize stress should an urgent need arise. We ask our clients and their loved ones to gather, at minimum, contact information for crisis emergency services in their preparation for their crisis planning meeting. Please ask us if you have difficulty finding services in your region and we will attempt to support you in that process.

    Additional Information

    Clarifying Terms: Terms like "grave disability" and "acute psychotic episodes" refer to situations where an

    individual is unable to care for themselves or poses a direct threat to their own or others' safety.

    Confidentiality in Crises: Our commitment to your confidentiality remains paramount, even in crisis situations.

    However, please be aware that there are some cases in which we are legally permitted, & in some cases required, to share information about our clients on a limited basis. Examples of some scenarios that fall under these legal disclosures include cases when there is a threat of harm to self or others, life-threatening scenarios, incapacitation, or other emergencies. Even in these cases, we disclose only that which is necessary and to the extent consistent with professional judgment & standards of ethical conduct.

    Feedback and Support

    Your Voice Matters: We welcome your feedback on this policy. If you have questions, need clarification, or have ideas on how we can better support and care for our clients, please feel free to reach out to us. We understand that facing a crisis can be overwhelming. Please know that we are here to support you in creating a safe and effective plan for such situations. Your well-being is our priority.

  • A mental health crisis is any situation in which a person’s actions, feelings, and behaviors could lead to them hurting themselves or others, and/or put them at risk of being unable to care for themselves or function in the community in a healthy manner. 

    Creating a crisis plan during a time of relative calm can help someone continue to experience a greater sense of autonomy should a mental health emergency arise. It's a collaborative plan, largely based on your input, that assists your team in supporting you in your most challenging moments. Some people also like to revisit their plan to help manage symptoms more regularly, even outside of times of crisis. By using this information to create a plan, you & your team can more effectively work to prevent or manage a mental health crisis as it develops, increasing the potential for support measures to be implemented with early signs of difficulty to mitigate potential harm.

    There are 3 steps to crisis planning: 
    1) Planning - during times of calm
    2) Utilizing the crisis plan - during times of need
    3) Modifying the plan - based on new insights that arise throughout therapy and within post-crisis reflection 

    As we progress, it is natural for self-awareness and understanding of behavioral patterns to grow with each experience. This plan is dynamic and meant to evolve, allowing for edits as we gain insights into how your mental health condition affects you and what proves most supportive for you. 

    In our practice, we can use a joint crisis plan to guide and further explore your answers. When complete, both you and your support person should keep a copy of the crisis plan, which will be created from the information, and any other important care documents in a location that is quickly and easily accessible during times of crisis.

  • Yes! Our practice supports a wide range of issues. We include extra information specific to the psychosis community because it’s so unique & specialized. There are limited services in WA State for this population and we want to offer as much as we can that is easily accessible for individuals and their loved ones who may benefit from quick and easy access to information. The training & experience we’ve acquired through working with the more complex mental health conditions only reinforces our skill in working with a multitude of other conditions. Our clients are diverse and bring with them very unique issues related to experiences of anxiety, depression, challenging life transitions, varied addictions, neurodivergence, anger management, general stress and wellness support, support with exploring and identifying values, and other conditions and experience. If we feel we don’t have the skillset for your particular needs, we’ll let you know - and we may be able to put an inquiry to our therapist communities in attempt to help find what you’re looking for.

  • Yes. There is a lot of information on our intake forms. We understand some people have an easier time than others with this, especially with various health conditions. Call us and we can arrange a time to review our forms in detail with you.

  • If you have a crisis plan, this is the perfect time to review it or to ask your support person to help recall what’s in it. You are not alone. If we prepared with a crisis plan, you have someone to be your voice if you can’t find your own.

    For immediate assistance in the case of an emergency, please contact local emergency services, or call 911 or a crisis hotline.

    Other crisis contacts include:

    Crisis Line:
    Call or text 988
    Text the word HOME to the number 741741
    https://988lifeline.org/

    Veterans Crisis Line:
    Dial 988 (press 1)
    Text 838255
    https://www.veteranscrisisline.net/

    Volunteers of America:
    1-800-584-3578
    https://www.voaww.org/behavioralhealth

    Crisis Connections:
    1-866-427-4747
    https://www.crisisconnections.org/wa-warm-line)/

  • Yes. Our approach is an integrated one, where we consider both mental health and substance use issues concurrently. We call it Integrated Recvovery Principles (IRP) for co-occurring disorders. This approach is unlike many other service providers who typically provide sequential or parallel approaches to treatment. In the former, an individual receives treatment for substance use at a different time, and often with a different agency, than they do their care for their mental health. In the latter, an individual receives treatment from two separate agencies at the same time for these two issues.

    In our experience and training, we see that these issues have a strong influence on each other. They aren’t independent of each other. For instance, if someone hears voices they find distressing, they may have developed a habit of using substances as a coping mechanism to alleviate that distress. How can substance use be effectively addressed if the voices are still causing distress? And, how effective will it be if the agency treating substance use has no training in working with more complex mental health experiences? What if the approach taken by the agency treating substance use is at odds with the approach taken by the agency treating mental health?

    Our approach blends the care for substance use and mental health as one integrated approach.

  • We regularly work with loved ones & others who wish to learn more about how to better support someone experiencing psychosis in a general way, or helping learn to navigate their own emotional response and wellness if a loved one is experiencing a serious mental health condition. This support can be a one-time consult or ongoing weekly support, if your loved one is not our client. 

    For loved ones who are formal clients of ours, support meetings are part of our program to the degree that they best support our client. The intention of these meetings is for everyone on the team to “check in” and stay updated with the progress and plan, or coordinate around crises. Collaboration can help us all, as we work together with a shared vision toward a client’s desired therapy goals. These meetings most often occur with our client present, however on some occasions such as during times of crisis (or impending crisis), conversations with a support person may occur independently of our client and are held with the same guiding questions: “How can we best support the person who has put their trust in us as our client?”, “How can we best help them meet their goals?”, and “How do we implement the crisis plan they have created?”

    Another resource for loved ones is The SPIRIT (Supporting Psychosis Innovation through Research, Implementation, & Training) Center at the University of Washington: https://uwspiritcenter.org.

    Psychosis REACH is a training offered through the SPIRIT Center that offers concrete, evidence-based skills for relatives and friends of individuals with psychotic disorders to better care for and relate to their loved ones. Information on the training can be found at https://uwspiritcenter.org/psychosis-reach-overview/. This training is free or low cost, has historically been offered four times a year, and can fill up quickly. If you are interested, you may want to sign up as soon as a session is announced in a timeframe that works for you.

  • There is a range of experience that comes with psychosis, from pleasant to neutral to distressing. For many people (probably more than you may imagine!), it has limited to no impact on their daily function, levels of happiness, or life stability. In other cases, episodes of psychosis can completely reorganize a person’s life and the lives of those around them. There may be losses and uncertainty of many kinds, from roles & responsibilities in employment & education, to large changes or letting go of plans & dreams. There can be a lot of new information and new kinds of experience to navigate. This is true for both the actual internal experience, as well as navigating new systems of healthcare and insurance. We want to offer some reassurance to those of you reading this who are in this more destabilizing stage. By and large, things do get easier over time for most people. 25-30% of people achieve remission after one episode, while 60-80% experience recovery or significant improvement in longitudinal studies worldwide. A majority have no problems related to voices or delusions at a 20 year follow up. For those with ongoing psychotic experience, there is a learning process that happens with each episode. Whether that is learning about the internal experience itself, what triggers it and how to engage it, or learning about the systems that one uses as external supports, these things can feel easier to manage over time. With each episode comes a valuable opportunity to turn into one’s own personal detective to closely examine how it works, and how to work with it. These skills accumulate, leading to more of a sense of capacity to navigate them when they do.

    We have some video resources linked under our “Learning” tab on our website. Some of these videos are of people who have had fairly challenging experiences, just like many of the clients who see us, and who have gone on to learn how to better navigate and find a sense of greater stability and wellness in their lives. The guidance and support of someone who can help you explore and guide the way can be invaluable in this process.

  • While users often report that the use of cannabis (marijuana) alleviates a variety of health conditions, it may not be the best fit for you if you are at risk for or experiencing psychosis. We understand that many people turn to marijuana and other substances to cope with the experiences they’re having. Despite its reputation for low harm and high benefit, cannabis can pose risks in those who experience psychosis. The potential mechanisms for cannabis-induced psychosis are not fully understood. It has been shown to damage white matter, which may lead to psychotic symptoms in people at risk. In multiple studies, early cannabis use, before age 15, has been associated with a high increase in risk of developing schizophrenia, compared to non-use individuals.