How long does counseling take?

This is one of the most frequent questions I encounter and not one that can be answered with certainty.  How long therapy will take depends on the client’s motivation, the seriousness of the problem, and how long the problem has been present.  Some people are only “stuck” and a handful or more of sessions is often sufficient to break free.  Others, however, have long-standing problems that have plagued them (or their relationships) for years and years; these kinds of problems take longer.  Rather than simply hack away at the branches and have clients come back each time a new problem arises, I prefer to dig at the roots so that coming back will be unnecessary.

Why are session just 50 minutes long instead of a full hour?

First, not much can be accomplished in 60 minutes that can’t be covered in 50, so the extra 10 minutes don’t typically make a difference.  Secondly, I need time between appointments to transition from one client to the next, return phone calls, answer emails, and whatever other administrative chores might arise.

Why don’t you take notes?

I do take notes but not during sessions.  Over the years I have learned that listening intently to my clients and not being distracted by writing helps me understand more quickly.  After the session ends, I write notes during the 10-minute interval between appointments.

Why don’t you take insurance and co-pays?

There are two primary reasons why I no longer accept insurance payments.  First, insurance company representatives have a history and (in some cases) a habit of approving sessions and then later changing their minds, meaning I either don’t get paid or have to reimburse the insurance carrier for fees already paid.  Insurance companies are not as quick to change their minds when dealing with a policy holder.  Second, insurance companies frequently “supervise” each case and dictate how many sessions will be allowed, regardless of the seriousness of the problem or how deep the struggle goes.  I prefer to manage my own cases instead of having an unlicensed, non-professional telephone representative determining the course of treatment.  Finally, insurance companies require a diagnosis (for example, depression or anxiety) that becomes a permanent entry into the client’s medical records.  Life insurance companies, courts, and some employers access this information and often make decisions based on a person’s private struggles.

Why can’t we have a friendship outside of your office?

While the nature of the client-therapist relationship is usually quite close, it is a professional relationship and not a personal one.  My licensing board strongly discourages any contact outside the consulting room; more importantly, it is ethically unacceptable.  The therapeutic relationship is heavily one-sided: while every client does get to know me to some extent, the focus on each session should be on the client.  There is also a power differential between the client and therapist, similar to that of a professor and student or pastor and parishioner.  Too many unfortunate violations have occurred when so-called dual relationships are permitted.

Living in a smaller community, of course, it is possible or even probable that I will cross paths with clients outside of my office.  On such occasions I will not acknowledge you or in anyway violate your confidentiality unless you initiate such interactions: too many people in this community know who I am and what I do!

What is “confidentiality” or “privileged information”?

Confidentiality and privileged information are two sides of the same coin, the former being a term employed in the helping professions and the latter being a legal term.  In short, it means that everything that is said or done during sessions belongs to the client, not the therapist.  With few exceptions, the therapist is not free to divulge any information to an outside source without written permission from the client.  This is true regardless of who is paying for therapy (e.g., a parent, employer, or church).  The exceptions include a client being a danger to himself or others (suicide or homicide) or abusing children or the elderly.  For more information, please download the intake forms that address this issue.

Can you prescribe medications if I need them?

Only medical professionals can prescribe medications; psychologists, counselors, social workers, et.al., cannot.  I do work closely with a number of physicians to find an effective and tolerable medication if such a course is indicated.

Have questions not discussed on this page?  Please contact Dr. Russell at drrussell.lpc@gmail.com.  He will either respond to you directly or let you know that he has posted your question (anonymously, of course) and response on this page.