A Pre Form

Brief Interactive Information Form (092424)

Hi. Thank you for your interest in my psychotherapy practice. I use this brief interactive form to immediately provide you (any time day or night) relevant information about the fit between my psychotherapy practice and what you are looking for. It takes about 5 minutes to complete. Based on your responses to the questions below, it will provide basic information about my practice e.g., who I am good at helping, my rates and the Employee Assistance Program I work with, my general appointment schedule, how to find out if you have out-of-network benefits, etc. Once I receive the completed form, I will call you -- typically within one business day -- and we can address any remaining questions, and if appropriate, schedule an appointment.

Location(s) of Therapy

· I am doing 100% teletherapy via videoconferencing and phone (with possible occasional single session exceptions)

Whether I am legally permitted to practice teletherapy typically depends on the laws of the state where the client is physically located. However, I have the flexibility to offer teletherapy when clients are located in many states other than Pennsylvania. When we talk on the phone, I will find out the specifics of your situation and verify whether I am able to offer teletherapy when you are physically located in a state other than Pennsylvania.

Please be aware that I will assume that it is ok to share information you include on this and other forms related to couples therapy with your partner and send the same email to both of you given that it is couples therapy unless you clearly indicate otherwise. As a general rule, I am not in a position to keep secrets from your partner when engaging in couples therapy.

Individual Therapy: What I Am Good at Helping With

I am a Cognitive Behavioral Therapist who offers teletherapy to adult clients in Pennsylvania and many other states. I am good at and very much enjoy the process of helping clients:

* feel happier and less depressed, anxious or stressed;

* be successful at doing things they have avoided or found very hard in the past due to anxiety;

* reduce frequency of or eliminate panic attacks;

* free themselves from distress related to intrusive thoughts (or the behaviors they feel compelled to engage in to experience temporary relief from these thoughts);

* decrease the negative impact of their perfectionism;

* liberate themselves from the distress stemming from past traumatic events;

* become more organized and able to follow through and meet their goals;

* decrease bingeing and the amount of brainspace occupied by negative thoughts about eating, shape, and weight;

* reduce anxiety or distress related to illness;

* sleep better;

* ...and if all you know is that you want to feel better but don’t know why you don’t’ feel good, I am also really good at figuring out what the root of the problem is, so that we can work on it to make it better.

* below you will have an opportunity to share specifically what you are seeking help for, and I will be glad to share when we speak whether I believe I am in a good position to help you with that. If not, I am happy to do my best to refer you to a colleague who is in a good position to help you with it!

What My Clients Say about What I Am Good At:

My clients emphasize that not only do they experience me as someone who cares about them, but also as someone who knows her stuff and knows how to help them. My clients tell me that I am good at identifying and addressing the root cause of their distress, which, for some clients, had previously gone unidentified despite years or decades in therapy. They say that they like my semi-structured approach and the effectiveness of the tools I teach them to use (I teach tools and strategies that scientific research has demonstrated to be effective for the specific problems my clients face, often accompanied by handouts which summarize how to use them). Many say they appreciate my ability to follow up on things they have been working on, hold them accountable in a kind way, and help them follow through on the things they set out to do. The vast majority of my clients who committed to engaging in therapy including the home practice between sessions reported a significant reduction and/or elimination of the symptoms that were causing their distress.

Couples Therapy: What I Am Good at Helping With

I am a Certified Gottman Couples Therapist [by the Gottman Institute] and an Integrative Behavioral Couples Therapist (IBCT) who offers teletherapy to adult clients in Pennsylvania and many other states. I am good at and very much enjoy the process of helping clients:

* complete a thorough assessment of their relationship, including, clarifying each partner's concerns, desires, and views of its strengths and weaknesses

* identify next steps for working on their relationship, typically including proposed therapy goals tailored to the specific needs of their relationship as identified by the assessment.

* learn to communicate more effectively and respectfully with each other without saying hurtful words that cannot be taken back.

* when having a conflict, use more effective and time-tested tools to truly listen to and understand each other's perspectives, treat them both as valid, identify a temporary solution that both partners find acceptable, implement it, and tweak it if necessary.

* improve intimacy and closeness as a couple such that both partners feel cared for and safe.

* honor each other's cultural backgrounds and understand each other's perspectives through more deeply understanding each other's cultural lenses.

What My Clients Say about What I Am Good At:

My couples emphasize that they experience me as someone who cares about both partners equally without taking sides.

My Gottman Therapy couples tell me that the specific Gottman techniques I share have helped them change problematic interaction patterns that seemed impossible to change previously -- even if they had engaged in couples therapy before. They say that they like my semi-structured approach and the effectiveness of the tools I teach them to use (In Gottman Therapy, I teach tools and strategies that scientific research has demonstrated to be effective for the specific problems my clients face, often accompanied by handouts which summarize how to use them). They say that they have learned a constructive and respectful way forward for dealing with the differences between them that they had thought might not be possible. They have shared that they understand each other and get along much better than they had when they came in.

Although I have not been offering Integrative Behavioral Couples Therapy (IBCT) as long as Gottman Therapy, my couple clients have shared that I am good at helping them understand the positive and negative interaction dynamics that are the focus of IBCT. Both partners in couples therapy typically reflect that I am able to help them more deeply understand, respect, and validate each of their widely differing perspectives on issues they bring in, without making one partner "wrong." IBCT focuses on increasing both partners' understanding of what contributes to hurtful interaction patterns so they are both well-positioned to better accept their naturally-occurring differences and individual sensitivities and at times, may choose shift how they react to each other in order to better care for each other.

How Will You Pay for Therapy?

My Rates

· I am not “in-network” with any insurance companies and I do not directly bill insurance companies, although I do offer superbills for clients to submit if their insurance offers out-of-network benefits and for some of my clients whose workplaces pay for part or all of their therapy sessions, this is done through their health insurance plans.

· I do, however, contract with Lyra Health Employee Assistance Program (EAP). I think that they provide really good benefits, so if you will be doing teletherapy with me from Pennsylvania, it is worth checking with your Human Resources department and your spouse's or parents (if you get benefits through them) to see if you have access to Lyra Health benefits! Often people receive several sessions for free!

· For Individual Therapy:

For 45-minute sessions:

Intake / First session including therapy initiation costs: $240

All following sessions: $200

For 75-minute sessions:

Intake / First session including therapy initiation costs: $340

All following sessions: $300

· For Couples Therapy:

· I typically schedule 75-minute sessions and my fee for the intake (first) session including therapy initiation fees is $330 and for follow-up sessions is $300 per session [The one-time online Gottman Relationship Checkup assessment costs $39 total for both partners].

· Most insurance companies don't cover "couples therapy" but in some cases we may be able to take an individual therapy approach to couples work that may result in some reimbursement. If you are interested in seeing whether this is an option, make sure to ask me about it during our brief consultation call regarding whether my services are a good fit for you.

· While I have a platform that can accommodate the two partners being in different locations, it is usually far more therapeutic for both partners to be in the same location in front of the same computer. Both partners will both need to be in their home or other designated private location in Pennsylvania or another state that I have approved in advance in order for it not to count as a no-show.

· For Couples Therapy, Both partners should complete this form (by using this link: https://hushforms.com/kathyangellphd-initial) in advance of my calling so that everyone is on the same page when we talk.

Using Out-Of-Network Benefits

Anyone who is hoping to have out-of-network benefits to help pay for sessions should contact the phone number on the back of their insurance card before completing the questionnaire and ask:

· Do I have out-of-network benefits?

· What is my deductible and how much of it have I met so far?

· When does my deductible reset for the year?

· What charges can be applied to my deductible in addition to my mental health charges? my medical charges? charges made by my spouse or other members of my family?

· If I have a qualifying diagnosis:

• How much do you reimburse for sessions with a CPT code of 90834?
• How much do you reimburse for sessions with a CPT code of 90837?
• How much do you reimburse for sessions with a CPT code of 90847?
• Are these reimbursements based on the fee the therapist charges or an “allowed amount?”…if the latter, what is the allowed amount for each of the CPT codes I just asked about?

· Is there a limit to the number of sessions I can get reimbursed for per week?

If a client has out-of-network benefits, they pay me directly for the full fee, and I provide them with a receipt that they can submit to their insurance company for reimbursement.

Please register for Lyra benefits now and then return to filling out this form. Don't close this form or you will lose the work you already did.

Please review your Lyra benefits, ask your Human Resources Department, or contact Lyra at 877-505-7147 to find out how many EAP sessions you have and whether you have Health Plan Integration (HPI) benefits.. If you *only* have HPI benefits (i.e., no EAP sessions where the full cost of sessions you attend is paid by Lyra), then you will need to make sure that you have entered your credit card information AND your health insurance information into the Lyra website to set this up; Otherwise, you will be charged the full fee directly.

Please be aware that before you can use your HPI benefits, you will need to enter your credit card information AND your health insurance information into the Lyra website to set this up; Otherwise, you will be charged the full fee directly. If you need help with this, contact Lyra at 877-505-7147 or care@lyrahealth.com

Make sure that you have entered your credit card information AND your health insurance information into the Lyra website to set this up; Otherwise, you will be charged the full fee directly. If you need help with this, contact Lyra at 877-505-7147

What do you want out of therapy?

I am going to ask you about a number of experiences which you may or may not have had. Answering these questions honestly will help me to figure out how to best help you.

Logistics

My Appointment Schedule (generally)

· I typically schedule clients for one or two appointments per week, but if there is need or desire, am willing to consider a more intensive therapy schedule pending availability. I typically recommend having therapy sessions at least weekly when beginning therapy to have sufficient momentum to create the desired changes in mood, habits, or behaviors. When a client has substantially achieved their goals and is seeking support for maintaining their progress, I often recommend decreasing the frequency of sessions or "fading out" therapy prior to ending.

· I offer 45 minute and 75 minute appointments for Individual Therapy. For Gottman Couples Therapy, I offer 75-minute appointments.

· I only see clients between 8:30AM and 4PM Mondays through Thursdays.

· In order for it to work with my practice, clients need to be able to commit to a regular weekly therapy session time.

Your Availability

What days and times are you available for sessions? I see clients generally between 8:30 or 9AM and 4PM Monday through Thursday, and my schedule is usually pretty full. What time blocks could you make available on each of the following days for a regular weekly appointment?

My Appointment Schedule (generally) for Lyra Clients

· I typically schedule clients for one or two appointments per week. If you desire or need two appointments per week, it requires permission from Lyra (which typically has been given). I often recommend having therapy sessions at least weekly when beginning therapy to have sufficient momentum to create the desired changes in mood, habits, or behaviors. When a client has substantially achieved their goals and is seeking support for maintaining their progress, I often recommend decreasing the frequency of sessions or "fading out" therapy prior to ending.

· I offer 45 minute sessions only.

· I only see clients between 8:30AM and 4PM Mondays through Thursdays.

· Usually I schedule a regular weekly therapy session time with each client but am willing to consider meeting less frequently or scheduling week to week if a client has a very flexible schedule.

Your Availability

What days and times are you available for sessions? I see clients generally between 8:30 or 9AM and 4PM Monday through Thursday, and my schedule is usually pretty full. What time blocks could you make available on each of the following days for a regular weekly appointment?

Providing a Security Question and Answer for use with Hushmail

Next Steps:

Thank you for contacting me and completing this interactive information form. Again, before sending me this form, make sure to:

1) figure out how much of the therapy costs will be covered by your workplace or reimbursed through out-of-network benefits and how much you will need to pay without reimbursement;

2) register for benefits if you need to do so.

When I book an appointment for every new client, I will reserve that time for them, not let anyone else have it, and schedule around it. In return, at the time of booking, I require their credit card information to secure that appointment, with the understanding that if they cancel without the minimum required amount of notice (48 hours), they will be charged for the session. Anyone who chooses to schedule with me will be asked to provide their credit card information at the time of booking. Also, when you book an appointment, you will be asked to complete intake paperwork which will take approximately an hour within 48 hours of booking the appointment. If you [both partners in the case of couples therapy) do not complete this intake paperwork by the agreed upon time, your appointment will be cancelled.

If you did not yet schedule an appointment time for a first session on my connected calendar, once I receive your brief interactive form (from both partners if you are seeking couples therapy), I will review it and be in touch via phone (please watch out for my number, 267-368-2678) or email within a few days. If you are difficult to reach, please provide some good times to reach you in the blank below. I look forward to communicating with you further.

Congratulations on completing the second step in finding the help you are looking for!

Next Steps:

Thank you for contacting me and completing this interactive information form.

Once I receive this form [from both partners if seeking couples therapy], I will review it and be in touch via phone (please watch out for my number, 267-368-2678) or email -- usually within one business day.

When I book an appointment for every new client, I will reserve that time for them, not let anyone else have it, and schedule around it. In return, at the time of booking, I require their credit card information to secure that appointment, with the understanding that if they cancel without the minimum required amount of notice (48 hours), they will be charged for the session. Anyone who chooses to schedule with me will be asked to provide their credit card information at the time of booking. Also, when you book an appointment, you will be asked to complete intake paperwork which will take approximately an hour within 48 hours of booking the appointment. If you [both partners in the case of couples therapy) do not complete this intake paperwork by the agreed upon time, your appointment will be cancelled.

If you are difficult to reach, please provide some good times to reach you in the blank below. I look forward to communicating with you further.

Congratulations on completing the second step in finding the help you are looking for!