What if there is an urgent matter or emergency?
At your very first appointment you are given a electronic (photo) business card that has your clinician's immediate contact information on it (Urgent Care Line). Try not to forget this number and respect it's nature. If you lose the information, simply text (main business line) or email us (Clinician@ChangeTalkLLC.com) and we will supply it as soon as possible. In addition, the number can be found in your "documents" section of your therapy portal online account by signing in (photo). The urgent care line is monitored regularly from 8am-10pm. Of course, if it's something really urgent or emergent, we encourage you to either utilize 911 services (emergency room) for a crisis clinician or 211 for the mobile crisis unit since we routinely check our phone every few hours due to inundated calls. If you are not sure if an issue is between routine and urgent, we typically ask that you attempt to make an appointment with us the next business day.
Unfortunately most insurance companies do not cover regular phone calls with your clinician for standard outpatient care and may hold you as being financially responsible for a second appointment in a seven-day period. Please remember "medical necessity" changes from insurance company and individual policy variations and to call them for specific answers to these related questions. Therapeutically, we want you to establish healthy relationships with support groups, sponsors, therapeutic coaches/mentors, and develop/re-establish relationships with friends and family members. Routine urgent calls to your clinician outside of normal business hours is not considered part of included standard outpatient services.
How do I sign a release of information?
We make it easy to fill out a ROI with us! Simply go to your "therapy portal" under your documents settings and select Release of Information after emailing us a copy of their contact information including full name, address, email, and telephone number. Most clients will have to select "entire treatment record" and select the corresponding boxes below to literally say the same thing twice (full release). Fill out the rest of the document, and your ROI is good for one year. Please be sure to give us a heads up surrounding who the release will be for and their contact information since we have to add them as a "contact" inside your medical file prior to sending you the electronic ROI.
Differences between EdD, PsyD, and PhD?
Although there is a great deal of crossover, an oversimplified explanation of a EdD is as follows: The EdD is focused on individuals who want to apply their knowledge to practice, while the PhD is more focused on research despite all three programs requiring dissertation research and defense. The EdD also typically focuses on counseling, developmental, and educational psychologies. PsyD is a developing behavioral science program that focuses on more practical applications of science which may include clinical psychology, forensics, applied behavior, and business psychology. Since a great deal of counseling includes psychoeducation and learning, an EdD also validates your clinician's ability to impart vital information necessary for maximum benefit while in treatment.
What should I expect with my therapist?
Regularly you will find there are three role-levels of psychotherapists that you will come across which include students, guides, and expert professionals. Despite most therapists surely having favorite predispositions on how to operate, great therapists know that they have to be adaptable to the needs of the client. There are a multitude of social, psychological, environmental, and various other factors that affect our mental health which determine provider-role decisions by your therapist. Clinicians in Connecticut typically either hold a masters and/or doctoral degree in counseling or a related field (e.g., social work, family therapy, etc.) due to developing the knowledge, experience, and abstract thinking that takes years for a provider to ascertain.
Do you offer free consultations?
We ask that you treat our service as you would most other providers/professionals and suitability/treatment questions be made during the time of your in-person intake appointment where your provider can take their time assessing the systemic nature of your current situation. This decision is also largely due to HIPAA constraints surrounding responsible record keeping and the enormous amount of time it takes to understand the nature of any situation. Signing our intake packet is not indicative of treatment obligation (you do not have to continue seeing us). This also means that until you sign a consent to treatment, we are not your therapist meaning that we cannot offer feedback or interventions until we are. We also understand that there are some therapists that offer this service with more open availability.
How do appointments work?
Appointment times, frequency, and format sometimes differ based on your insurance benefits. The least frequency observed by this office is twice per month while the more frequent clients see us twice per week. Most clients see Adam in the beginning weekly until a full grasp of what is going on is achieved by both parties. Unfortunately, both weekly and biweekly frequencies are dependent on appointment availability. Make sure you check out our appointments tab for more information on our locality we serve (Connecticut), see our next seven day availability, and other important commentary/videos. Appointment times are generally 53 minutes depending on your insurance eligibility. Our operating hours are Monday-Friday 9am to 6pm. Your initial intake appointment will be virtual (12 and older) where you will see intake paperwork roughly within 24 hours after making your intake appointment (documents tab of your therapy portal). We also require a credit card to be placed on file for private insurances for copay, coinsurance, deductibles, and/or operating fees (e.g., case management).
Appointment reminders are automatic via text and still occur if you cancel that day with us since physical appointments get canceled on the day you miss it due to A) preventing online intakes from taking your recurring spot, B) documentation purposes to track your absences where a full note is generated when you actually miss your appointment, and C) not to generate double the effort if the cancellation is rescinded. We choose only a seven day window for new appointments due to the high no-show rate that begins escalating due to a large portion of intake populations choosing to book several intake appointments with multiple providers and often making their actual appointment on the basis of the first provider who is actually able to see them. As always, all medical, mental health, and financial information shared with us will be respected and is protected under state and federal law.
Do you offer weekend or late night appointments?
Due to our recurring appointment business model, missed appointments mean a disruption in your treatment plan and of course loss of income for us. We have attempted weekend appointments during two separate previous careers in counseling and experienced problems facing clients sleeping past their appointment times and of course the justified family event that usually happens on the weekends. As for late night appointments, we also love spending time with our family during this time as well! We do offer late afternoon appointments, however, client turnover during these times are extremely rare. Most individuals that work conduct therapy during their lunch break or approved company time via teletherapy. Please remember that after hours communications are for extremely urgent matters only.
What if I do not see an opening in your schedule?
It is quite common that our availability changes from week to week along with sometimes unpredictable highs and lows when it comes to client census. Until you are one of our regular clients there is little we can do if there is not an opening that suites your needs. Unfortunately, most of our prospecting client phone calls revolve around unsuccessfully attempting to negotiate or influence future availability. Change Talk LLC does not have waiting lists due to insurance and legislative restrictions that discourages this practice and we do not schedule intakes more than a week in advance. You are welcome to still check our online availability weekly. Unfortunately, we do not condone pulling children from their classes for psychotherapy due the lack of educational sustainability, the child falling further behind, and the unnecessary high pressure it places on the clinician towards creating availability.
What do I have to do if I have to miss an appointment?
Please note that your clinician purposely repeats all client appointments. If you are able to successfully reschedule within seven days with an opening we have, this absence does not count against our cancellation policy. We also strongly encourage you to consider treatment alternatives such as using your cell phone in a convenient location when deciding to cancel your recurring appointment. Other missed appointments generally cannot be filled and consequently may likely incur a no-show fee with a cancellation frequency of two or more missed appointments every 90 (weekly) or 180 (biweekly) days. The first cancellation fee waiver may be extended for second absence with proof of illness or grouped vacations. Every effort should also be made to cancel the appointment during regular business hours, explore the possibility of a remote teletherapy session, or to send an email to firstname.lastname@example.org after hours since our urgent care phone is constantly monitored for urgent matters -only-.
A weekly client is allowed three normal absences every ninety days and biweekly clients are only allowed to miss ONE appointment in a 90 day period of time prior to your chart being reviewed for possible administrative discharge. Such is the price of treatment consistency and this practice choosing not to double book clients or schedule clients on a week-to-week basis. Please keep in mind that if you "no-show" for a single missed appointment, not arrive for two appointments in a row with communicating to us intent to reschedule, or violate our attendance policy, we reserve the right to cancel all recurring future appointments which may lead to eventual termination. Recurring appointments only recur if you make them or exhibit communicated mutual intent on making the next one.
What does insurance not cover?
Outpatient clinical services are the lowest level of mental healthcare. Even when you are paying towards your deductible, psychotherapy rates are already reduced due to negotiating prices with your individual insurance company. This means if you are using your insurance, that you have close to most basic services we can provide. Consequently, case management/forensic services are not included in MOST insurance plans! Nor are these services an extension of the limited amount we receive for an hour of our time. If you feel like your child needs more care, intensive outpatient, in-home, clinical day schools, or residential facilities might be your better option. Most people don't realize that most provisions for Court, Department of Children and Families, Drug Testing, Social Security, Social Security Disability, Guardian Ad Litem, School, and various other exchanges typically are not considered medical necessity by most insurance providers for standard outpatient treatment. The unfortunate reality is that in many cases either the family is responsible for these charges and/or your clinician attempts to be as efficient with their time as they can be in order not to charge you.
Unfortunately, beginning in 2015 a certain online therapy provider convoluted this process by offering "unlimited texting" to your therapist at "anytime" for additional fees where your therapist had 24 hours to respond. This à la carte style of therapy typically is not supported by your insurance providers since it can create a codependency with your therapist and insinuates that a client cannot function without them. In fact, a good majority of insurance companies require prior authorization just for you to see your therapist a second time in a seven day period and most certainly don't write "blank checks" for additional services. Therapists generally get paid only when you conduct a psychotherapy appointment with them. Any additional services that are offered by your clinician should be deemed as a rare and hopefully a appreciated courtesy only. As an example, if you worked a 40 hour week and your boss asked you to work an additional 30-60minutes that week, most people would not only expect to be paid, but to be compensated for the additional work (overtime). Your therapist is no different than you are!
Can I see two therapists at the same time?
The short answer is "it depends." The safe answer is to always check with your clinician first since they are in charge of your treatment. Most insurances do not cover redundant services that have the same billing codes. However, couples counseling, EMDR, medication management, group psychotherapy, and other modalities MAY be accepted treatment opportunities by both your insurance company and provider. However, this is as much an insurance thing as it is a liability thing. Always consult with your primary therapist. Historically, concealing seeing another provider leads to automatic discharge in most psychotherapy practices due to liability concerns (e.g., who's treatment plan do I follow?), it being a treatment plan violation, and of course the disruption in the therapeutic alliance (e.g., trusting each other). Don't forget, in any great relationship, both individuals answer to one another.
Virtual therapy requires a phone/computer/tablet with a quad-core processor with a minimum usable and consistent 1.5 mbps UPLOAD (not download) speeds or greater. We generally see much better results with 5 mbps constantly accessible upload speeds via an ethernet or fiber connection (wired). The faster your device and upload speeds the better the experience (resolution). Teletherapy sessions will be conducted in private with the exception of asking your clinician permission to bring other individuals into your psychotherapy session. Please do not conceal members of the family during psychotherapy sessions, record your psychotherapy session, and make sure to always let us know when your geographic location changes for billing, state license limitations, and emergency purposes.
Can I call, text, or visit my therapist?
Currently, there are very few provisions for very select insurance plans that even cover any and all phone calls (synchronous technology) or texts, emails (asynchronous) with your therapist (scheduled therapy portal teletherapy does not apply). Your clinician will be there to support you during URGENT matters and in times of need. Not for routine matters, or issues that can wait until the next business day when you can schedule an online/in-person appointment with your clinician. This includes anxiety provoking matters that may be routinely encountered by a reasonable person (e.g., traffic ticket, etc.). This is typically a very hard notion to convey considering the nature of the work we do and this being an relationship-driven business. This is just as much as a fee-for-service related decision as it is a boundary related decision that promotes autonomy and repels codependency with our clients since we are trying to teach you how to manage uncomfortable feelings vs. avoiding them. This practice also prevents practitioner burnout and compassion fatigue since therapists also need to focus on their mental health and family.
As a general rule of thumb, if we have to ask ourselves "is this an urgent matter?" that it typically means it likely can wait. 211 or your local emergency department are a great resource for emergency/urgent matters where a professional may either actually show up to your home (mobile crisis unit) or a crisis clinician will perform an initial evaluation in a hospital setting that we will collaborate with. We ask that cancellations be emailed to email@example.com with at least 48 hours notice for routine matters. Texts are permitted during regular business hours to both of our urgent/nonurgent business lines. Urgent communications will be responded to within 1-8 hours which means if you need someone right that very moment to choose either 211 or 911 options. Texts should not be used as a "check-in" and are usually logistical or administrative (e.g., late, last-minute openings, etc.). Even our Urgent private line is inundated with telemarketing, prospecting client, and other nonurgent communications which is why we limit our cell phone exposure. Telemarketers alone constitute thousands of calls annually originating outside of the country and we cannot place blockers on these calls in the remote chance that they block your call. Most board and professional associations prohibit and/or strongly discourage clients showing up to a place of residence. However, under extremely rare and exigent circumstances, we will meet you in a public location with a private room (e.g., library conference room, etc.). Showing up to a clinician's residence is strictly prohibited and violates the autonomy, privacy, and ethical conduct associated of a professional counselor.
Does Adam treat Adolescents?
YES! We do see 12+ years old children and young adults. Problem is that 3-6pm availability rarely has any openings and there seldom is a remedy for that! So please, do not make intake appointments for children that are not sustainable (school, sports, etc.) understanding that the intake time you are choosing is the continuing appointment time you will likely be offered. Lastly, everything is included in your child's one hour session. This includes updates from parents or brief case management opportunities that will be conducting during your child's appointment. These processes does not "interrupt" your child's session and is very much a part of it. Checking in to see how your child is doing in front of your son or daughter exhibits investment in their well-being that generally heightens your relationship with them. If you want additional time, please schedule a separate appointment. For children over the age of 12 we generally require your child to be present in the immediate vicinity of your son/daughter in case of exigent circumstances.
Are there other treatment options?
There are a multitude of factors that either lead to successful or unsuccessful treatment plan terminations. Typically, if you are on-time with your payments, followed the rules of this office, and showed up to your scheduled appointments most of these clients remain in "good standing" with this office and can return to this practice outside of ninety-day period of time upon discharge. After your termination we are no longer your therapist. This means if there is a urgent mental health care item you would like resolved you can either schedule another intake appointment with us, find another therapist, speak to your primary care physician, dial 211 (mobile crisis unit), or go to the emergency room/dial 911. If we believe you need a higher level of care (e.g., intensive outpatient, etc.) we will let you know during your discharge or in writing. Future referrals and/or brief phone calls after discharge constitutes a level of post-psychotherapy influence that is discouraged by most governing bodies we follow (implies active treatment).
How do therapist vacations/cancellations work?
We love our vacations as much as you do! With that said, vacations/holiday/absences will be posted on our "home" or "landing" website page three months to a year in advance. We also typically observe most major holidays or choose days that are frequently missed by our clients (e.g., Black Friday). During our absence, we would like you to utilize either 211 or 911 for most urgent/emergent needs and ask that you respect our well-earned days to ourselves although we will monitor all communications for safety purposes. This includes cancellations, case-management, and most other routine matters. If it really can't wait ore be sent by a scheduled text/email feel free to text us, however, it might be some time before we can respond due to geographical limitations.
When it comes to storms, we do our best to predict safety, communications, and power grid obstacles that effect telehealth services. This means if we don't think that we will have cell service for the following day, we will try to be proactive and cancel in advance of losing this capability (communicating) which includes teletherapy options. Thusly, we also attempt to reasonably predict our client's behaviors as well, and if we believe that four or more clients have/will cancel on us, typically take the stance of taking the whole day off much like the four hour work stipulations of most agencies regarding storms. In inclement weather or if you conduct frequent business trips, we ask you also consider teletherapy options in a private setting to limit distractions and confidentiality concerns.
Professional Boundaries and Client Expectations
We are honored that you think of us for your important occasions and events in your life. Unfortunately, with our well over 50 client caseload, this means our time is already strapped with all the outside work logistics systemic care requires. This often takes the form of speaking to state officials, lawyers, other mental health providers, continuing education professors, physicians, and of course your insurance company. Just like we are discouraged (professional boundaries) to connect with you on our nonprofessional social media page, if we were to attend such an unlikely event please keep in mind it would be as a official capacity ONLY where we cannot relax and have a good time. When it comes to asking us to contribute to whatever cause you are currently supporting, please keep in mind we conduct our own charitable efforts for our adolescent clients in the form of positive reinforcement gifts and food, and also gifts for our adult client's birthdays, special accomplishments, and/or Christmas once per year.
Please also note that we see roughly 40 clients per week! Between our clients, their family, and associates (e.g., probation, physicians, etc.) sometimes the name of a pet or family member might elude us. Due to this overwhelming caseload and case management, the preferred method of psychotherapy is virtual therapy only, were texting or cell phone communication may be permitted during emergency circumstances. Please remember that we frequently see clients back to back with no respite meaning that if you text us and we give you a partial response, it does not mean that we did not fully read the text or are indifferent towards what is transpiring. Due to these and other very important reasons, if you need to see us let us know, and we will book an appointment where you will have our full and undivided attention. Like mentioned previously texts or emails are not a substitute for psychotherapy and are meant to be for logistics or information-gathering purposes only and not to get our opinion, seek feedback, or expect empathetic responses when we are juggling throughout the day already.
How do I make payments? (No third-party payments please)
Payments are required during time of service. For private insurances, a credit card will be required to be kept in your file for all incurred fees.
For outstanding balances please send cash, check, or credit card information to:
Change Talk LLC
P.O. Box 185
Old Lyme CT, 06371
Checks: Should be made out to "Change Talk LLC"
Credit Cards: Information should include Card Holder Name, Account Number, Expiration Date, three digit security code, and billing zip code.
AUTO PAY: The standard option. We accept all major credit cards that will be placed securely and encrypted in your electronic file.
THIRD PARTY PAYMENTS: Both violate our "payment due at time of service" policy, your consent to treatment agreement, and greatly complicate/delay the reimbursement process and will not be accepted at the practice. This is even further confused by insurance companies offering third-party provider payment options.