Frequently Asked Questions

Effectively, these terms can be used interchangeably. More important to note is the particular type of licensure a provider holds and what that means about their education and what they are able to provide. For example, a licensed mental health counselor (LMHC) and a licensed marriage and family therapist (LMFT) are both qualified to provide counseling/therapy services, however, an LMFT typically would be expected to have specialized training working within family systems or with couples and an LMHC may not.

Generally, Cognitive Behavior Therapy, aka CBT, is an approach that focuses on unhelpful patterns of thoughts, feelings, and actions that a person may feel stuck in. When working through CBT, the goal is to identify these unhelpful patterns, help you build skills for difficult experiences, and challenge thoughts that are keeping you from accomplishing your goals. CBT has been proven to be effective with several populations and in reaching a variety of goals around depression, anxiety, self-esteem, motivation, and more.

CBT can also be beneficial for people who have experienced trauma. Traumatic experiences can naturally reinforce patterns of thinking and responding to different triggers (events, places, sounds, etc.) that are often helpful at the time but become unhelpful or distressing later. CBT can help us challenge these patterns and find helpful ways to move toward the life you want to live.

Generally, Dialectical Behavior Therapy, aka DBT, is an approach that focuses on the core concept of dialectics. Dialectics is the idea that two seemingly opposing things can be true at the same time. For instance, acceptance and working toward change. The therapy focuses on skill-building around four core areas: emotion regulation, distress tolerance, effective communication in interpersonal relationships, and mindfulness. Originally created for those struggling with intense emotional experiences, DBT has been shown to be effective to accomplish a broad range of goals.

At Lycan Counseling, I use the term creative therapy to encompass several things including art therapy, music therapy, and any other intervention that uses creativity as a tool for change. Research shows that using creativity in practice can help people express difficult emotions, process their experiences, identify difficult or stuck points, engage in problem-solving, and more. I often use creative therapy techniques in conjunction with other approaches.

In counseling, your first 3-4 sessions will focus on getting to know you, evaluating your needs, and evaluating our ability to meet those needs. The first session will focus entirely on history and the current situation. You may be asked a series of questions to that end. You may also be asked to complete several evidence-based assessments ahead of this session if a diagnosis is needed. You may also have time to dive deeper into coping strategies you have tried and what you have found helpful to get a good understanding of your starting point. 

In your next sessions, your provider will discuss your goals with you and will communicate a proposed treatment plan to achieve your goals. This plan may include the proposed frequency of visits and modality to be used as well as a plan if safety is a concern for you. You may experience uncomfortable feelings at times. Experiencing these feelings and learning to tolerate distress can have long-term benefits and can result in overall reductions in levels of distress.

It is important to note that Lycan Counseling PLLC does not provide crisis services or same-day services. This may mean that if your needs exceed the capacity of this practice, your care will need to be transferred/referred out, or other services will be required in conjunction with this treatment, to ensure the safety of all clients. Providers with Lycan Counseling PLLC return messages and calls as soon as possible (usually within 48 business hours). 

If an emergency or crisis requires immediate attention, you can call a crisis hotline, or go to an emergency room. The local Tri-Cities, WA community crisis response number is 509-783-0500. The National Suicide Hotline number is 800-784-2433.

If you identify as trans or non-binary and would like a safe space to get support from other trans individuals, Trans Lifeline offers their own hotline for those in crisis. The number in the U.S. is (877) 565-8860. They are available from 8AM – 2AM PST daily. Closed 2AM – 8AM PST daily.

If you are a teen seeking support, Teen Link is a great resource where you can speak to other teens in the event of distress. Find more information about Teen Link on the Organizations page under the Resources tab. Teen Link can be contacted via call, online chat, or text. Their number is 1-866-833-6546.

It is important to understand that many methods of counseling and many assessments for mental health are shown to be effective in meeting a variety of needs. However, in some cases, this treatment, or any other healthcare treatment, may be ineffective, unhelpful, or in rare cases increase symptoms. At times, another treatment in conjunction with these services is necessary. Any particular result cannot be guaranteed.

That said, I tend to believe that everyone can benefit from support and a safe space to express themselves and work to develop more helpful strategies to meet goals. In our sessions, we may use tools to facilitate this process to help you move toward your goals and none are inherently harmful. It is MORE likely that you will experience uncomfortable feelings at times. Experiencing these feelings and learning to tolerate distress or work our way through hard things can have long-term benefits and can result in overall reductions in levels of distress.

There are several things to consider here, and the most basic answer is yes. Online or in-person, children under 12 are required to have parental involvement. This is because a young child is not able to remember everything discussed, implement strategies in the home, and remember to complete homework all on their own. This isn’t a realistic expectation and is going to set kiddos up for failure and more frustration for the parents. Additionally, success in therapy does NOT happen in just the 1-hour session a person is in the office. Implementation in real life and in the home is ESSENTIAL for building new habits, new skills, and new ways of thinking about things. 

Lastly, and though we may not like to hear it, it is often the case that adult choices, habits, and ways we model dealing with different situations are having an impact on the children in our lives. They really lean on us to learn how to manage emotions, how to communicate difficult things, and how to solve problems. Sometimes we don’t even notice what they are picking up. Maybe they go between homes and we cannot control what happens there. 

So, does that make it our fault if things don’t go well? Not always, but if we exclude our own adult behaviors or feel that we cannot make helpful changes, we are likely missing a big piece of the puzzle. Involving parents is a great way for everyone to be on the same page and make sure that we are working toward success for your child together.

The best answer to this is to invite you to think about a time when you were able to perfectly learn a new skill or make a big lifestyle change after hearing about it just one time. If you are like most, this is difficult to do. Similarly, success in therapy does NOT happen in just the 1-hour session a person is in the office. Generally, a therapist’s job can be described as providing support. Many times, this looks like things such as helping you identify your goals, barriers you are facing, strengths you can lean on, and new strategies to reach your goals. Sometimes we need help processing things or thinking about different sides of things. Regardless, all of these things take time and are difficult. Remember, it is normal to need support, AND taking what you gain from the session and implementing it in real life outside of the session is ESSENTIAL. Homework is designed to give you concrete ways that you can practice these new skills and habits to reach your goals.

Feeling comfortable and safe with your provider is important. Research shows that the connection between a client and therapist is the most important factor to success in counseling. It is also very common for styles and ways of thinking about things to differ between two people. It is normal and okay to have these feelings. 

You may wish to see someone else for various reasons. You are encouraged to discuss this with your provider so that they can make changes, if possible, or have a better understanding of your needs to provide an adequate referral. If you don’t feel comfortable, that is okay too. If you would rather not work with your provider, you have the option of informing them or another provider, and receiving names of other mental health professionals that may be a better fit. 

If your provider feels that you would be better served by someone else, or at any time feels you would be better served with an alternate level of care, they will discuss this with you in session as soon as this becomes apparent. They will provide recommendations and a referral as needed.

Absolutely! There are many alternative types of services than counseling and other types of counseling than what you may receive here. You have the choice to seek these alternatives rather than obtaining our services. You may also choose that treatment of any kind is not right for you. To the extent that you are interested in alternatives, you can and should discuss the benefits and risks of these with your provider or other healthcare professional.

It is my belief that therapy works best when there is buy-in from those involved. A provider is able to work on engagement and building a relationship of trust, but the nature of therapy requires participation from those involved. 

Legally a child under the age of 13 can be enrolled in therapy with parental consent. Someone over the age of 13 legally has the right to consent or refuse consent for their treatment. However, in Washington State, a minor can be enrolled for a set number of sessions by a parent or guardian, even without their consent, to assess if there is a safety issue or need for further involuntary treatment. After these sessions, and assuming there is no precedent for involuntary treatment, the teen may opt-out of further sessions.

Legally, anyone aged 13+ has the right to consent, or refuse to consent, to treatment. However, there is a law in Washington State that allows a parent to force a teen to attend treatment without consent for a set number of sessions to determine if there is a need for further involuntary treatment. Personally, you may also be in a situation where a parent “forces” you to consent, e.g. taking away a phone until you agree. These are parenting decisions that are allowed and not related to your legal right to refuse treatment. 

If this is the case, you will be obviously be faced with a difficult decision. Letting your provider know you feel pressured to attend, and being open to talking about this, may help them to better understand where you are coming from and what your goals are. Often, participating in sessions in this small way helps things move forward more quickly and can get your goals met sooner.

The biggest change is likely that your decision to consent to treatment or not looks a little different. When a client is court-ordered to therapy, it usually means that they must attend and participate in treatment in order to avoid a less desirable option such as spending time in jail. Courts may attempt to offer a less restrictive option that includes mental health treatment so that a person can continue with other aspects of their life (e.g. school or work). 

Another change is likely that the court will require you to give consent for your provider to give updates on your attendance. Usually, this looks like writing a letter or filling out a form regularly with the dates you attended and may include other things such as progress, goals, and diagnosis. However, it may look different for each person. 

Lastly, insurance billing for sessions that are court-ordered does not change. However, additional time spent on updating a PO, writing a report, filling out forms, or speaking with court officials is not covered and is a time expense that you will be billed for out of pocket. 

It is important to note that, at an outpatient level of care, your consent is still required for these things. However, failure to consent can result in the court implementing a consequence, such as an arrest or other alternatives such as involuntary treatment at a higher level of care. It may be better to agree to the terms and participate fully to work through the requirements with no issues. After your required time is completed, you will be able to decide freely whether you wish to continue or not.

If you are over 13, sessions with your therapist are confidential which means that they cannot be shared with another person without your permission. This includes parents, teachers, family members, other healthcare professionals, or anyone else that may ask. 

It is often true that providers will ask a teen to consent for certain things to be shared with a parent such as scheduling, billing, and treatment summary. You can always refuse and take responsibility for these things yourself and/or specify which things you are not comfortable having shared. 

There are legal exceptions to this rule because therapists are what are called “mandated reporters.” This means that we are legally required to report to the appropriate authority (the police or CPS) if we feel there is abuse happening in the home toward any minor child or other vulnerable people. Therapists may also choose to disclose to a parent or other adult if they feel it is necessary to prevent serious or life-threatening harm to you or another person. In general, self-harm that is not causing serious or life-threatening injury is not reported or disclosed.

The short answer to this is, it depends. Most of this discussion that I have found has to do a lot with therapist and client preference and what they feel comfortable with and are used to. Some people feel more comfortable online than others, and comfort and trust in a session are important factors to success. 

Our providers are trained and supervised for interventions that work effectively online. For example, research has consistently demonstrated that Cognitive Behavior Therapy (CBT) is as effective online as it is in person for a variety of needs including PTSD, anxiety, depression, and more. Research has also shown that several other approaches are just as effective online as well. There may be some types of therapy that work better in person, and the research doesn’t cover all techniques at this time. I can say that I screen providers to ensure they are using techniques that can be successful online. 

Another benefit to online sessions is that they can offer a more accessible solution to people who may have otherwise delayed or dismissed seeking support. Things like stigma, busy schedules, disability, chronic illness, and lack of transportation are big barriers. I notice that my online clients are able to consistently attend their appointments and make progress.

Again, it all comes down to what is comfortable for you. Online therapy may not be for you, and that is okay! Do what feels comfortable to you!

Again, the answer to this is, it depends. In-person a client may attempt to hide self-harm or their true feelings, and they may be successful in this. A counselor cannot guarantee always getting honesty from someone in person or always getting an accurate read on a client. Likewise, they cannot guarantee the safety of a client outside of session, or even in session. This is not a realistic expectation in person or online. Our providers are trained in appropriate online therapy techniques to ensure they provide the same interventions online as they do in person.

Does it go perfectly online? For me, the answer is no, however it goes similarly to when I worked in an office and saw people face-to-face. Additionally, the way I manage this is quite similar to how I would in person. For instance, I require video connection and the ability to see a certain amount of a client’s face and body with certain lighting for sessions, especially if I don’t know a client well. I also am open to receiving information from parents about their concerns and directly following up in session. If I know self-harm is an issue or has occurred, I may ask to be shown if it is in an appropriate location. Just as I would in person. 

Another big factor is the relationship between the therapist and the client. Research shows that therapeutic relationship is the single biggest indicator of success in therapy. I have found that people who are comfortable with online work are just as able to form a connection with their therapist as those who work in person.

Each provider chooses which insurances they would like to accept. Each provider has listed their insurance contracts under the Therapists tab. In your initial screening call, it is your responsibility to know which
insurance you would like to bill so that we can work to match you with an in-network provider. If your current provider changes their insurance contracts, you will be informed by a letter in the mail, or verbally in
session, with a minimum of 30-day notice.

If you wish to see a provider out of network, you may do so, but are not guaranteed to receive coverage. See “What if I have an Out of Network Insurance” below.

It is your responsibility to know your coverage ahead of your first appointment. If you are unsure, we are happy to bill your in-network insurance and wait for payment, however, you will be responsible for any back co-pays or deductible payments owed at that point. Insurances can take up to 6-8 weeks to send a payment for a session initially, so this could add up. It is better for you to have the following information ahead of time: 

1. What is your annual deductible and how much have you paid toward it? 

A deductible is an out-of-pocket expense that you have to pay prior to your coverage kicking in. For example, if you have an $800 deductible and have not seen any other healthcare providers this year, you will be responsible for the full contracted fee for service until you or a family member have paid $800. After that point, you will only have to pay your co-pay.

2. What is your co-pay after the deductible is met? 

A co-pay or coinsurance is the out-of-pocket portion of the fee for service that you are responsible for paying. Your insurance will cover the rest. Some insurances state-specific dollar amounts for an office visit (e.g., $15) and some will state a percentage (e.g., 20%). Sometimes this number can be found on the front of your card under office visit. If your card doesn’t have this information, you can typically go online to your insurance client portal and figure this out. You can also call your insurance and ask. If you are asked, our sessions bill as an office visit for behavioral health and more specifically as a 60-minute psychotherapy session.

3. What is your out-of-pocket maximum for the year? 

Most insurances have a stated maximum amount that you will be responsible for in a given year, for instance, $2500. After this amount, they should cover any services you receive 100%. Your deductible payments and copay payments usually go toward this. It is possible that you will not meet this amount within the year, but it is a good idea to know to avoid overpaying for services. In the event that you overpay, it could take time to get that money back.

If you wish to see a provider that does not accept your insurance in-network, you may choose to do so. As we do not bill out of network, you will be responsible for paying the full rate at the time of service. See our Services/Rates page under the For Clients tab for more on rates. 

You are responsible for submitting a claim to your insurance if you wish to receive reimbursement. To help you get coverage, we will send you a monthly superbill that you can submit. You should note that a Superbill does not guarantee coverage for out-of-network providers. You are responsible for knowing your coverage and should check if you have out-of-network coverage prior to your first appointment.

A superbill is a document that has pertinent information about services that you have received and paid for from an out-of-network provider. It typically includes things like provider information, date of service, client name and date of birth, billing code, description of service, diagnosis, length of service, and amount paid. Essentially, it looks like a very detailed invoice/receipt. 

You will receive this superbill via mail or email monthly, and at your request, for all services received in the past 30 days. You can then submit this document with a claim to your insurance to receive reimbursement. Keep in mind that if you do not have out-of-network coverage, this will likely be rejected, and you will still be responsible for the fee. Each company may have additional forms they want you to fill out with your request for reimbursement. 

Many have client portals with this information, but you can also call the number on your card to learn how they prefer you submit your information. When you reach out, it is a good idea to ask them how to submit a claim for services you received and paid for out of network, what forms you need in addition to a superbill, where you need to send the forms, and how long you can expect to wait. If your claim is rejected due to not having all the pertinent information on the superbill, please contact our main number and we will see this is corrected for you.

Many insurances only cover group therapy on a case-by-case basis. We do not work on insurance approvals or insurance billing for group sessions and only accept cash for groups. If you wish to receive a superbill for your group sessions, we are happy to provide one at the completion of all group sessions and after you have paid for them in full. However, this does not guarantee your insurance will reimburse you for any group sessions.

Insurance companies do not typically contract with student counselors, or cover sessions completed by a student counselor. Therefore, we cannot bill insurance for your session or offer a superbill. However, we do offer a reduced rate to you for these sessions.

First, this is a boundary that allows me to value both my time and the time of my clients. It is important to me to be able to fit everyone in while maintaining a manageable schedule. Setting clear boundaries like this is one way to make sure they get scheduled and that you will have your provider’s undivided attention.

Second, my goal is to provide support so that you feel that you are empowered to manage challenges on your own. Of course, this may not be true right away and I do want to make myself available if you need a quick question answered or to follow up on something. I am available for brief phone calls for free for this reason. However, if either of us feels you need more support between sessions, we may need to discuss increased frequency or, in some cases, a higher level of care. 

Third, I have noticed that sessions tend to be more productive if we are not having smaller check-ins throughout the time between sessions. It may seem counter-intuitive, but when we both are able to value the time spent in the session, while you work to implement strategies between sessions, we can more productively discuss what worked and what didn’t for you while you were on your own. This will allow us to ultimately make progress more quickly.

Beginning Jan 2022, healthcare facilities are required by law to provide information about client rights under the No Surprises Act and are required to provide a Good Faith Estimate of cost of services to all clients that are not using insurance to cover their services. Here is what you need to know about these:

The No Surprises Act is intended to protect the consumer, you, from receiving bills for services that are in excess of what you were expecting to pay. It requires healthcare facilities to provide you with an estimate of service costs, kind of like what you get when you to a mechanic or other service provider, prior to receiving care. Of course, there are times when you may not be able to receive this in advance, such as when you go for emergency services. In this case, the law protects you from “balance billing.” This means that if a doctor at a hospital you are taken to is out of network, the facility cannot charge you more than you would have paid in-network without your permission. If you are unable to give consent, you cannot be billed more than you would have paid in-network. You will still have to pay your copays, deductibles, and coinsurance as you would with an in-network provider. An out-of-network provider may ask you to sign a waiver giving up your rights under this law. You may choose to do this if you would like to see this provider out of network or if you do not have insurance. You are NEVER required to sign this. However, if you choose not to give up these rights, and the facility does not have an in-network provider that can see you, the facility may choose to refer you to an in-network provider.

The Good Faith Estimate is a document that you should be given IF you are receiving services out of network, are not billing insurance, and/or do not have insurance coverage for the service being provided. This document should have services that are going to be provided and the cost of these services. If your final bill exceeds the estimate by an excessive amount, you have the right to dispute the charges.

Lycan Counseling provides Good Faith Estimates to all clients seeing student counselors, associate providers, and those who are out of network with insurances. Your provider will also discuss this with you in your free phone consultation and provide you with this information via email ahead of your session. Our session fees are also listed in the policies and informed consent documents each client must sign to initiate services.

For more information, you can go to
https://www.cms.gov/nosurprises/consumers.