Therapy encourages change by connecting the dots between thoughts, feelings, and behaviors. Even if you think, “I already know what I’m supposed to do differently, I’m just not doing it. Why do I need to pay someone to tell me that?” The truth is there is no perfect objectivity. A caring and trained professional is there to point out your blind spots and blocks at a pace you can manage. Together, we help figure out what you need to get over the hump. If you’ve tried therapy before but didn’t like or didn’t “get it” with the therapist you saw…well, sometimes you have to kiss some frogs. It’s important to communicate to your next therapist what did and did not work for you.

There can be a lot of assumptions about what therapy is if you’ve never tried or found a therapist you connected with. Sometimes I hear people staying away from therapy is because they have the “rent-a-friend” heebie jeebies. Or they’re sure the therapist will be distant, write some mysterious notes down, and offer very little in return. And yet I hear from people all the time who commit to the process who wonder why the hell they didn’t start sooner!

While psychotherapy is an effective treatment (1), all too often the many folks who need mental health services choose not to seek out treatment due to stigma (2, 3). My aim is to keep the environment welcoming as you begin to understand the process better. Learn more about ME, and the way I think about INDIVIDUAL and COUPLES therapy.

This part is like the movies – you come in to an office and have a conversation about what’s going on with you for about an hour every week. The content is based on what’s on your mind and what you’re struggling with. Over time, these conversations weave a greater story about what your life looks like and what it is you need. In couples work, it’s the same principle, but you’re also working toward having meaningful interactions and new ways of communication with your partner.

It can be an unusual and risky experience to open your life to someone unknown to you. It’s normal to feel anxious in the early sessions. When you first come in, you share only what is comfortable, and we get clear about the objectives you’re working toward. The quality of our relationship is key to your successful therapy. While getting to know each other, we start observing patterns in one area that are likely playing out in many areas of your life. The therapy becomes richer the more we continue down this path and gain a shift in perspective.

There’s probably been one or two things that have happened recently that’s got you wondering if you should seek help. The threshold of who does and doesn’t “need” therapy is not as defined as you think. It’s a self-determined decision to invest in your own needs and growth. That’s it. The world (society, families, gender norms) is frequently the complete opposite of supportive when you wonder if you need support. Being stoic and bootstrapping is an idealized way of coping [aside: pulling yourself up from bootstraps is physically impossible]. Nope, you’re not being an overly sensitive snowflake because you’re asking yourself if you need professional guidance. Many of us are living with persistent problems that morph into destructive habits.

Common reasons to get started:

  • Difficulty maintaining stable moods – becoming anxious, depressed, or angry very easily.
  • A vague but haunting discomfort that things aren’t okay.
  • Consistent fighting with your partner that you’re stuck in.
  • That one life event you can’t quite “get over”, or that one life skill you really want to learn.
  • Feedback from others that they’re worried about you.
  • Binging on substances or activities in an unhealthy way.
  • The desire to improve and explore skills you’ve worked on.
  • Experiencing a crisis. Crises are hard enough to get through on your own, and sometimes it’s sending a message. If you’re not in crisis yet and you had the option, would you rather be overwhelmed and feeling out of control when crisis does occur? Or would you rather have tools to manage because you put in the time to have the resources in advance?

So no, things don’t have to be, like, super fucked up already. Therapy is for you, too.

We all want our pain to lessen or go away as soon as possible. It’s part of our DNA to avoid discomfort – even emotionally. There’s no hard and fast rule about length of treatment, and so much depends on the complexity of what you’re bringing into therapy. The way I work is to help clients get to the root of what are likely long-standing issues to find new coping skills. That takes time. I find many clients take at least several months of regular sessions to peel back the onion layers and create lasting change.

Discuss with your therapist your expectations of how long you’d like to work with them up front. Once you choose a therapist, take a temperature of how things are going after about 12 sessions to get a sense of how things are shifting. Just like the gym, consistency in attendance and your commitment to the process yields better outcomes.

First off, it’s a good idea to check out a few therapists. Think about your budget and how far you’re willing to commute. Do some research or ask others for referrals.  Focus on what you’re coming in for. Research shows it’s the relationship between you and your therapist that makes for the most for effective work (4). If you’re looking at their online material (ahem), trust your intuition if you’d like to know more about the therapist. Have a consult call, or go to an in-person appointment to see if it’s a good fit. Your ultimate decision should be the the person that feels comfortable and trustworthy to you.  Here is more about ME.

It’s not unusual that one partner feels more urgent about starting therapy than the other. After completing the consultation call, both partners need to be willing to have an initial session to check it out. I will be listening to both of your wants without shame or blame, and invite questions. After that, its really up to both of you to keep returning. If you’re really aching to start couples work and your partner doesn’t, that is actually a great point to start INDIVIDUAL therapy if you haven’t already.

I see clients during the week with some limited Saturday hours. My office is located in downtown San Francisco at 582 Market St. It is right outside the Montgomery Station and can be easily reached by several public transportation lines including BART. Street parking and paid garage parking is available but often limited. The building is ADA accessible.

Email me or call my voicemail to set up a free consultation. That call consists of talking about the reasons you’re looking for a therapist, assessment that I am the correct professional for you, and scheduling a time to meet at my office. For couples, both partners will need to speak to me.

Therapy is at least one session per week. My rate is $220.00 per 50 minute session and $330.00 for 80 minute sessions. More about rates and contact info HERE.

I am in-network for Anthem Blue Cross of California only. If you have insurance with a different company, please go the next FAQ. I accept HSA/FSA funds.

If Anthem BC is your insurance company, understand that benefits will vary. Be sure to ask your members services and/or your benefits administrator about your outpatient mental health benefits, including your deductible and co-pay. I can assist with gathering that information when we schedule a consultation call.

If you do not have Anthem Blue Cross, many PPO policies will cover a percentage of out-of-network (OON) mental health treatment as part of their benefit – sometimes up to 70%. I can create a monthly Superbill statement for you to submit a claim to your insurance company. You’ll pay my rate in full, and they’ll send you a partial reimbursement directly. I encourage you to research policy coverage in advance. Here are some important questions to ask your member services:

    • Do I have outpatient mental health benefits?
    • Do I have any benefit for out-of-network therapists? (If yes, continue on to next questions.)
    • When is the beginning of my plan year?
    • What is the amount of my deductible and has it been met? Do my out-of-network mental health costs apply toward my deductible?
    • Is there a limit to the number of sessions my plan covers?
    • Are there any prior authorizations required?
    • What is the benefit (percentage and/or amount) for the following CPT codes?
        -Individual therapy: 90834 and 90837
        -Couples therapy: 90847 and add-on code 99354
    • What is the process of submitting my out-of-network claims and receiving reimbursement?

It’s an investment into your own emotional and mental well-being which can pay off dividends. With your session fee, the expertise you’re getting is a professional with graduate education, post-grad intensive internships, ongoing peer and senior therapist consultation, and advanced trainings to continue learning current techniques. There are administrative and advocacy responsibilities outside of the session time for every client included in the fee.

Most private practice therapists are independent contractors, and their client face-to-face is less than 40 hours per week for quality control purposes. Their fee rate must include their overhead, professional development, and self-employment expenses. CONTACT me to talk about your budget.

I like to do therapy with clients in person at my office. I will do occasional video sessions as needed. If you have limited mobility or special circumstances and would like to see me, let’s DISCUSS. Must be a permanent resident of California.

Look at you, overachieving already! I’ve got just the thing. See my RESOURCES page.

“There are no classes in life for beginners; right away you are always asked to deal with what is most difficult.” – Rainer Maria Rilke
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© Deva Segal, SF Therapist. All rights reserved. 2019