Robin Furner, MFT Therapy FAQs
Will therapy be beneficial for me? How do I know what type of therapy to pursue?
There are many reasons why people decide to look for a therapist. In regard to individual therapy, I believe that most people who have a desire to make changes in their life, reduce symptoms like anxiety and depression and/or improve the quality of their relationships with others can benefit from therapy. I primarily work from a psychodynamic perspective and tend to focus on themes and patterns that emerge in the concerns that clients want to work on. I do periodically draw from other theories and therapeutic modalities. A general goal of psychodynamic therapy is to help clients gain greater insight and awareness of underlying issues, themes and patterns that may be contributing to current symptoms and problems. Psychodynamic therapy is conceptually rooted in psychoanalytic theory. One of the reasons I gravitate to psychodynamic therapy is because I believe that relational dynamics have a strong impact on how people think, feel, perceive and behave. We also know that relational dynamics with caregivers have a strong impact on the brain development of children in the zero to five age range. Individual psychodynamic therapy with adults is a great way to help clients gain insight into relational dynamics that impact their symptoms and ultimately shift these relational patterns and dynamics so that symptoms reduce and clients feel greater freedom and a higher level of satisfaction and happiness in the context of their relationships with others. Couples therapy, family therapy and some types of group therapy can also be very effective at addressing the relational dynamics that impact symptoms. For young children, parent-child dyadic therapy and/or parent-child interaction therapy (PCIT) can be very helpful in addressing the relational dynamics that impact symptoms and/or behavioral challenges.
There are other types of individual therapy that are more structured, more behavioral, more supportive and/or more body-oriented. Other common types of therapy include: Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) and various types of existential, somatic and trauma-focused therapies. CBT and DBT tend to be more structured psychotherapy treatments that may include things like teaching new coping skills to manage symptoms and homework assignments for clients to work on between sessions. DBT is particularly helpful for decreasing emotional reactivity and learning emotional regulation skills. Amazon and other online book retailers sell a variety of CBT and DBT skills workbooks. Many of the workbooks available for sale online have a "look inside" feature that may be useful to folks who are interested in better understanding these types of therapies. Behavioral therapies, such as systematic desensitization, are often helpful for phobias and specific types of anxiety (such as anxiety about heights). Exposure & Response Prevention (ERP) is a type of CBT therapy that can be particularly helpful for Obsessive Compulsive Disorder (OCD).
Treatments such as somatic experiencing and EMDR (eye movement desensitization & reprocessing) are usually more trauma-focused and more body-focused. There is some debate in the therapy field about how much therapists should focus on the mind-body connection in the context of working with trauma. Personally, I feel that psychodynamic therapy can be very helpful for folks that have experienced complex trauma and/or developmental trauma. However, this is primarily true for clients that generally stay within a healthy range of emotional regulation and those that are not experiencing current substance addiction. Clients who deal regularly with high levels of dissociation, numbness and/or strongly restricted emotional expression might want to consider addressing those issues first, before delving into their own trauma history. Clients who deal regularly with high levels of emotional reactivity, feeling "flooded" by emotions or significant challenges in managing emotions might benefit from a treatment approach that prioritizes addressing this first. There are various ways of addressing those issues. Some therapists will focus on a more supportive therapy oriented toward building different coping skills. Others might refer folks to various groups and classes that work on teaching and building those skills. Individual DBT and/or DBT skills groups can be helpful for managing emotional overwhelm and emotional regulation challenges. Most therapists will recommend that folks experiencing current challenges with addiction focus on addressing this first, before delving into deeper issues and/or trauma that might be contributing to addiction. This is because the process of delving into painful experiences can be difficult and it is easy for that process to trigger increased substance use and/or relapse.
Mindfulness practices (meditation, yoga, tai chi, etc.) can be helpful for a variety of issues and especially helpful for reducing and managing stress, depression and anxiety. While I don't personally focus on teaching mindfulness practices as a therapist, I often recommend that clients struggling with symptoms of depression and/or anxiety consider incorporating some type of regular mindfulness practice into their life.
Existential therapists tend to focus on helping clients find meaning in their lives and gain clarity about their values and paths they wish to pursue in life. Psychoanalysis is an intensive form of therapy that is often provided several times per week. Psychoanalysts are usually highly educated, with advanced psychoanalytic training pursued after more traditional training as a therapist, psychologist or psychiatrist. Psychoanalysts might have particular theoretical orientations, such as Jungian psychoanalysis or relational psychoanalysis. Psychoanalysis can be very helpful for a wide variety of issues. It is especially useful for folks that want to understand themselves very deeply and gain a greater degree of freedom in their thoughts, feelings, behavior and choices.
There is research attesting to the effectiveness of many types of therapy. If your goal is to focus on symptom management, symptom reduction and/or behavioral change, you might want to start with a more structured form of therapy like DBT or CBT. If your goal is to understand more about yourself, gain insight into underlying issues and patterns, gain more freedom and flexibility in how you perceive yourself and others, then you might want to consider psychodynamic therapy. Sometimes, clients choose to combine approaches by engaging in individual psychodynamic therapy while also participating in a group therapy and/or taking a mindfulness class. Most therapists discourage clients from pursuing two different types of individual therapy at the same time, but there are a few exceptions to this (such as doing EMDR to address trauma reactions while also engaged in another type of individual therapy).
Kaiser members should note that Kaiser typically offers classes and/or educational groups that focus on DBT, CBT, mindfulness, anxiety management, depression management, etc. Some Kaiser classes, such as those offered through the psychiatry department, are limited to members who have been screened and referred for the groups. Other groups, such as those offered under "health education," are often open to the community, including people who are not Kaiser members. There are local therapists that offer groups, though they don't typically bill insurance. Process groups (aka "group therapy") can be very helpful for folks wanting to work on relationships and improve their skills in relating to others and communicating with others. Process groups and/or educational groups that focus on teaching emotional regulation skills, anxiety management skills, mindfulness practices, etc. can be a very helpful adjunct to individual therapy.
I generally recommend that clients who are considering therapy spend some time thinking about what they want from therapy and do some reading about the different types of therapy. Many therapists have websites and it may be helpful to review the websites of a few different therapists. It is often helpful to consult with several therapists. Therapists vary in terms of their experience, focus and how they conceptualize and treat client problems. I strongly encourage all people seeking an individual therapist to spend some time finding a therapist who is a good match. Often, people search for a therapist based on wanting to find someone who accepts their insurance and the availability to see them at a particular time or day. It is important to be aware, however, that research generally shows that the most important factor in client satisfaction with their therapy process relates to the relationship that they have with their therapist.
The following websites are good resources for finding therapists in the Oakland or east bay area:
Psychology Today therapist directory:
www.psychologytoday.com/
CAMFT (California Association of Marriage & Family Therapists), East Bay chapter:
www.eastbaytherapist.org/therapist-finder
Alameda County Psychological Association
http://www.alamedapsych.org/content.aspx?page_id=486&club_id=69704#topcorner
What should I expect when starting therapy?
I generally provide a free phone consultation for all new prospective clients to ensure that my skills and expertise are a good match for the needs and goals of the client. All new clients need to sign a consent form to participate in therapy. I typically will also ask new clients to complete a new client assessment form and a few other informational forms when therapy is started. New client forms can be found on the "Forms" page of my website. I usually focus on assessment during the initial therapy session, understanding current concerns and therapy goals. I tend to be a bit more directive during the initial session with new clients. I typically encourage clients to begin most subsequent sessions with issues and concerns they would like to focus on. I generally expect that clients will attend sessions at least once per week and commit to attending therapy on a weekly basis, with the exception of occasional vacations/holidays. Sessions are typically 50-55 minutes. More information about the therapy process can be found on my "Office Policies and Consent for Treatment" form, which is available on the Forms page of my website:
http://www.robinfurnermft.com/forms.html
Information about health insurance coverage for therapy:
Most health insurance plans cover individual therapy. Health plans vary when it comes to coverage for other types of therapy. Family therapy and parent-child dyadic therapy are often covered for children under the age of 18, when clinically indicated. Couples therapy is more challenging to provide in the context of insurance coverage. This is because therapy generally needs to be a "medically necessary" treatment for a particular mental health diagnosis. Some insurance plans do not consider couples therapy to be a medically necessary treatment. Some plans allow therapists to bill for couples therapy, but they require that at least one member of the couple be diagnosed with a mental health diagnosis and this requires the therapist to develop a treatment plan focused on addressing that diagnosis. Most models of couples therapy conceptualize the relationship as the issue to be addressed in therapy, rather than an illness of one member of the couple. This situation results in ethical challenges and documentation challenges for therapists who try to bill insurance for couples therapy. Therapists who bill insurance are subject to periodic audits of their session notes and treatment plans. It is difficult to conduct and document couples therapy sessions in a manner that is consistent with the billing and documentation requirements of many insurance plans.
If you want your therapist to directly bill your health plan, it is best to contact your health plan and find out what the specific terms of your mental health coverage are. You might have co-pays, deductibles or other coverage limitations. Some health plans require an authorization for behavioral health services. Authorizations typically have an authorization number and/or a date range in which authorized services may be used (usually 6 months to 1 year).
Your health plan representative can provide referrals to therapists in their provider network who can directly bill your health plan. Some health plans will also provide partial reimbursement for "out of network" mental health services. PPO health plans typically have more expansive access to a variety of healthcare providers while HMO plans usually have a more restricted network of healthcare providers. Most health plans have websites that offer listings of therapists that are currently contracted with the insurance plan as behavioral health care providers.
Many clients seek out therapists that will directly bill their health insurance plans. Health plans, however, will generally require periodic documentation from your therapist about your mental health status and most require therapists to submit a mental health diagnosis to the insurance plan to justify the need for mental health treatment. Most health insurance plans require a mental health diagnosis code to be attached to each session that is billed. Many plans also conduct periodic audits of therapist records and they periodically review client progress to ensure that ongoing therapy remains medically necessary.
Some clients like to pursue therapy for personal growth reasons and they might not have a mental health diagnosis. These clients often will choose to pay for therapy on a fee for service basis.
Some clients like to use pre-tax accounts, such as Flexible Spending Accounts to pay for therapy and find there are financial and tax benefits to this. Many employers offer these kinds of pre-tax accounts, though employees usually have to choose to participate in these types of accounts. Pre-tax accounts typically have rules about what kind of health services are covered, so be sure to confirm that therapy is covered and what kind of receipts or documentation may be needed for reimbursement.
Many employers also offer Employee Assistance Plans (EAP) for employees. It is common for EAP plans to offer a limited number of therapy sessions.
Information for folks experiencing difficulty finding a therapist with openings:
Over the last few years, I have spoken with a number of folks reporting difficulty finding a therapist in the Oakland/Berkeley area with current openings. It can be difficult to find therapists with openings that accept insurance and it can be difficult to find therapists with evening appointments open. There is usually a high demand for evening appointments from folks that work traditional business hours and not all therapists are able to work evening hours.
The insurance issue is more complicated. Some of my colleagues report concerns about reimbursement rates for therapy sessions being too low and as a result, they choose not to work with insurance companies. Others have noted concerns about excessive rules and regulations impacting how they provide therapy, what types of therapy can be provided, etc. Therapists individually choose to contract with insurance companies and each insurance company varies in terms of the rates they use to reimburse therapists and they also vary in their policies and rules governing behavioral health care.
It can sometimes be difficult for therapists to contract with an insurance company. The application and contracting process often takes months. Insurance companies will sometimes not accept applications from therapists who wish to join their network if they already have a large roster of therapists in their network. Sometimes, insurance companies only accept applications from therapists with certain types of specialized experience or training. Due to the nature of therapeutic work, many therapists work part-time and/or limit the total number of clients they see per week. This can result in a situation where an insurance company has a large roster of mental health providers, but most of them are full or only have one opening at a specific hour, on a specific day.
It can be very difficult for insurance companies to maintain accurate listings of therapists with openings. When therapists have openings, they often just have one or two hours that are open. They might receive many requests for therapy, especially if they accept insurance. Every insurance company has a different process for reporting openings and/or reporting being closed to new referrals. Some companies make it easy to report openings, while others have more complicated procedures for reporting openings.
Many insurance companies hire case managers and other staff that can assist members with finding health care when they experience difficulty. Sometimes, case managers will assist with the process of calling therapists to find someone with openings. Health plans in California are generally required to ensure that their members can access a mental health appointment for a non-urgent issue within 10 business days. Folks experiencing difficulty finding a therapist with openings should begin by talking with someone at their insurance company about the difficulty they are experiencing and request assistance. The California Department of Managed Healthcare (DMHC) oversees most commercial health plans and also offers assistance to consumers.
Cover My Mental Health:
covermymentalhealth.org/
DMHC website:
https://www.dmhc.ca.gov
DMHC fact sheet about access to behavioral health care:
www.dmhc.ca.gov/Portals/0/Docs/DO/MentalHealthFactSheet.pdf
What insurance plans do you accept? What is your fee? Do you have openings?
I am currently a behavioral health provider with the following insurance plans: Magellan, Anthem Blue Cross, Carelon (formerly Beacon Health Options) and Optum. I am also sometimes able to work with clients that have PPO plans. Health plans periodically merge with other plans and sometimes they "carve out" behavioral health care services to other plans. Currently, the Optum network includes plans like United Health, Sutter, Oxford and others. Some clients with Blue Shield insurance have their behavioral health coverage carved out to Magellan. Kaiser members may be able to receive mental health services through Carelon, but need to receive an authorization from Kaiser first. Usually, a clinician at Kaiser will screen for symptom severity and clients with mild-moderate symptoms might be able to receive an authorization for therapy through Carelon.
I charge $175 for weekly therapy sessions, which are typically 53-55 minutes. I charge $250 for the initial assessment session.
Most insurance companies reimburse therapists at a reduced rate, which is set by a written contract. Clients with a health plan deductible may notice that therapy charges applied to the deductible are lower than the rates published on this page. This is because insurance companies generally prohibit therapists from charging clients a rate that is higher than what has been agreed upon by contract between an insurance company and therapist.
I usually send monthly invoices to clients with co-pays and deductibles and accept payment via credit card, check or cash. Clients with Medicare or Medi-Cal plans through a commercial plan should be aware that there are usually separate rules and regulations for those plans. Usually, a therapist will need to be contracted with and/or approved by Medicare or Medi-Cal in addition to being an approved provider with the commercial plan.
I strive to keep updated information about my openings on the home page of my website (near the bottom of the page). I usually see clients on Mondays, Tuesdays and Wednesdays and offer a few early evening appointments. There is usually a high demand for early evening appointments and openings at those times are rare. When I do have openings, they most frequently occur during late morning or early afternoon hours.
Office location & transit information:
My office is located in a brick and cream-colored building at the corner of Broadway and 40th St. Way in Oakland. There is a black iron gate and brick walkway leading up to the main waiting room. There is a locked gate outside of the main waiting room and you will need a gate code to open this. I provide the front gate code to new clients after scheduling an initial appointment.
There is usually parking available on local streets. Most local streets have a two hour parking limit. Most local commercial areas typically have metered parking while local residential streets do not. Parking can be harder to find on Monday and Tuesday mornings between
9 A.M. and 12 P.M., when most local streets receive street cleaning.
Please note that 40th St. Way runs parallel to 40th St. 40th St. Way is one-way near Broadway. I sometimes recommend that clients looking for parking drive by the office on Broadway, turn right on 41st, turn right on Howe and then right again on 40th St. Way. There are usually parking spots somewhere along that loop, especially on 40th St. Way, which does not receive much through traffic.
Drivers must turn right from 40th St. Way onto Broadway. Drivers on 40th and 40th St. Way are both able to turn right onto Broadway, so be careful when making a right turn there.
My office is about a 15 minute walk from the MacArthur BART station. Kaiser runs a shuttle from the MacArthur BART to nearby Kaiser medical offices. There is an AC Transit bus that stops near my office at Broadway and 4oth. There are also bike share stations located near my office. There are nearby bike racks on the street and people occasionally lock a bike to the fence along the brick walkway leading up to the waiting room.
