Notes For New Patients
From Sherry Cox, Ph.D
My Approach to Therapy
As a clinical social worker, I believe that it is important to address both the individual mental health symptoms which bring patients to treatment, as well as the larger social systems which may contribute to problem development and maintenance. My areas of special training and expertise include working with the effects of exposure to traumatic events and of childhood abuse or neglect.
My approach to treatment is a combination of Psychodynamic (sometimes called Insight-Oriented) and Cognitive psychotherapies. This is a philosophy of psychotherapy which looks at the relationships between a person’s developmental experiences, patterns of thinking and interacting generated during those experiences, and the problems that bring that person to treatment in the current day. If you would like to learn more about this approach, I will be happy to suggest books and other reference materials.
I use a variety of techniques in therapy, with the goal of finding what will work best for you. These techniques are likely to include discussion, self-dialog and negotiation, interpretation, cognitive re-framing, self-monitoring experiments, visualization, journal-keeping, drawing, and reading books. For some specific problems, I may suggest the use of hypnosis or eye movement desensitization and reprocessing (EMDR). I may suggest that you consult with a physician or other health care provider regarding medical treatments that could help your problems. I may suggest that you join a therapy or support group as part of your work with me.
If I propose a specific technique that may have special risks attached, I will inform you of that, and discuss with you the technique’s risks and benefits. You have the right to refuse anything that I suggest without being penalized in any way.
As insurance plans have limited what treatment may be provided on an inpatient basis, I have chosen not to renew my staff privileges with Lincoln hospitals. Should you require hospitalization for mental health reasons, your case will be transferred to the inpatient program of your choice. Currently, only Bryan Health - West Campus offers mental health services in Lincoln.
Some Practical Time Management Considerations
It is important that you be aware that I divide my time among patient treatment, teaching, consultation, and practice administrative tasks. This means that patients who choose to be in treatment with me must be willing and able to work around my often inconvenient, full schedule. If either you or I believe that this arrangement will be unduly stressful to you, it may be necessary to refer you to a more available therapist who is more likely to be able to meet your needs.
I ask office staff to organize my appointment calendar several months in advance with the goal of increasing the chances that all of my patients will be offered the most convenient session schedule possible. Every two months, I provide office staff with a list of session frequency for each patient. They then develop tentative appointment schedules and send them to patients for their approval. If there are particular days and times that work best for you, please let a member of the office staff know.
When I am away from the office to teach or attend a professional conference, I sometimes am able to leave a phone number or e-mail address where I can be reached if you have an urgent problem. This may not always be possible. To take good care of my own mental health, I typically schedule several vacation days every two months or so. During those times, I am not available to return phone calls or help with emergencies. Whenever I am out of the office, there will always be an emergency therapist available.
The Therapeutic Relationship
Psychotherapy is a professional service which I provide to you. Because of the nature of the therapeutic process, the relationship between patient and therapist is different from any other. While it may sometimes seem similar to a friendship or parent-child relationship, it is neither. Unlike any personal relationship, the alliance between patient and therapist is a working relationship based in mutual respect for the importance of the work to be done.
I do not have social or sexual relationships with patients or former patients because to do so would be unethical, illegal, and an abuse of the power I have as a therapist. As your therapist, my duty is to provide you with the best care possible. This requires that I maintain a professional distance, responding to you based upon tested theories and methods of change. It is impossible to be both an effective therapist and a personal friend.
Clinical hypnosis is a method of communication which facilitates the experience of dissociation. This naturally occurring state of consciousness is one in which one’s attention is narrowly focused and relatively free of distractions. Examples of spontaneous self-induced hypnosis are daydreaming, driving “on automatic,” and some forms of meditation.
As an adjunct to psychotherapy, clinical hypnosis may help you enter an alert and receptive state for the purpose of obtaining a specific therapeutic outcome. With hypnosis, suggestions designed to help you become aware of and use specific internal processes (feelings, images, memories, insights) can help you to meet your therapeutic goals.
Hypnosis is not mind control or brainwashing. It tends to neither increase or decrease the accuracy of memory. If hypnosis is an appropriate treatment tool for you, we will discuss these and other myths about hypnosis in detail before developing a hypnosis treatment plan tailored to your needs.
Some individuals are more naturally skilled in using hypnosis than others, and hypnosis may not be the most effective treatment approach for you. Research has shown few serious side effects to hypnosis. Before giving your consent to use of hypnosis, you are encouraged to be aware of the possible adverse effects below.
Some patients have experienced mild feelings of fatigue or disorientation following the hypnotic experience. Please be sure to report such feelings to me since they can easily be resolved.
While research has shown that events recalled during hypnosis are neither more nor less likely to be accurate than those recalled in a usual waking state of consciousness, recollections are sometimes experienced more vividly.
Hypnosis can be a powerful tool for decreasing pain perception and should not be used without prior medical consultation.
Eye Movement Desensitization and Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing (EMDR) is a new treatment approach that has not yet been widely validated by research. Initial studies have shown EMDR has produced promising results in reducing anxiety and in reducing post-traumatic stress symptoms, such as intrusive thoughts, nightmares, and flashbacks.
Although there are currently no known serious side effects to EMDR, there is still minimal data as to its efficacy or safety. Before giving your consent to use of EMDR, you are encouraged to be aware of the possible adverse effects below.
• Distressing, unresolved memories may surface through the use of the EMDR procedure.
• Some patients have experienced reactions during the treatment sessions that neither they nor the administering clinician may have anticipated, including a high level of emotion or physical sensations.
• Subsequent to the treatment session, the processing of incidents/material may continue, and other dreams, memories, flashbacks, feelings, etc., may surface.
Before beginning EMDR treatment, you are urged to thoroughly consider all of the above and obtain whatever additional input and/or professional advice you deem necessary or appropriate to having EMDR treatment.
Trauma and Memory
Individuals experiencing disorders of traumatic stress are often concerned regarding the reliability of their own memories of traumatic events. New research tells us that stress hormones secreted during traumatic events, which have the effect of interfering with transfer of sensory experience into verbal memory and the experience of an “unreal” quality to the event--may explain part of this concern. Research also tells us, however, that all human memory is reconstructive; that is, recalled details of past events tend to be modified to one consistent with more recent life experiences.
Please be assured that I will respect what you tell me of your life, as you recall it. When there is question about the reliability of your memory, I will help you to assess the variables involved in determining meaning and accuracy.
Your Responsibilities as a Patient
You are responsible for coming to your session on time and at the time we have scheduled. If you are late, we will end on time and not run over into the next patient’s session. If you miss a session without canceling, or cancel with less than twenty-four hours’ notice, you must pay for that session at our next regularly scheduled meeting. Our voice mail system has a time and date feature which will keep track of time of cancellation if you call when office staff are not available.
You have the right to decide when therapy will end, with two exceptions: If it is my judgment that I am not able to help you, either because of the kind of problem you have or because my training and skills are not sufficient, my ethics require that I inform you of this fact and refer you to another therapist who can meet your needs. In such a situation, I will assist you to find another therapist and continue to meet with you until you are able to begin the new treatment relationship. If you do violence to or harass me, my office colleagues or staff, or my family, I reserve the right to terminate you unilaterally and immediately from treatment. I will do all that I can to work with you to prevent such an episode from occurring if it appears probable.
You are responsible for paying for your treatment after each session, unless we have made other arrangements in advance. My fee for an individual therapy session, which usually lasts 55 - 60 minutes, is $150.00. Group therapy sessions, which typically meet for 75-90 minutes, are billed at $35 per session. Fees for telephone consultation, other services, or other session lengths, are charged on a prorated basis. My fees may increase as office overhead costs increase. I will notify you several months in advance when a fee increase is anticipated.
If you have insurance, you are responsible for providing office staff with the information needed to submit your claim. You are responsible for paying your deductible and co-payment amounts. If an insurance reimbursement check is mailed to you, you are responsible for paying that amount at the time of our next appointment. If insurance sends overpayment to my office, office staff will credit your account or, at your request, provide you with a refund check.
In cases of financial hardship, I may be willing to accept payment in installments but am unable to allow a sizable balance to accrue. If you find that you are having a hard time paying for your care, please discuss this with me. We may wish to consider meeting less frequently or referring you to a mental health agency with supplemental funding available for individuals in financial difficulty. I am a Medicare participating provider and accept Medicare assignment. I am also able to provide services to Medicaid recipients via the Nebraska Medical Assistance Program and the Magellan managed care program.
Approach to Therapy
Trauma and Memory
In psychotherapy, you and your therapist work out strategies for handling problems of daily living. Examples of problems which can be effectively addressed include depression, anxiety and panic, "flashbacks," guilt, low self-esteem, eating disorders, alcohol and drug abuse, couple and family difficulties, and general interpersonal difficulties. Additionally, psychotherapy can lead to personal growth through clarification of your thoughts and feelings about yourself, others, and events in your life.