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What is Tele-Mental Healthcare?

The word "tele" is greek for "far off."  Essentially it is mental healthcare at a distance.  Some literature has started using the abbreviation "CV" or "clinical video-conferencing" which is more specific.  Tele-mental healthcare is an umbrella term that could mean services provided by phone, email or video-conferencing.  I do not use e-mail to communicate with patients, however I will use the phone on occasion.

 

The vast majority of sessions are held via clinical video-conferencing software.  I use Zoom because it is HIPAA compliant, has a record of being reliable and uses less bandwidth than other companies.

 

Although tele-mental health has been around since the 1950's, the vast majority of publications have appeared in the last 20 years.  An increasing number of controlled trials are demonstrating the effectiveness of tele-mental health to treat a multitude of mental health disorders. 

 

Legal precedents have been made to such an extent that many states have parity laws that mandate insurance companies reimburse tele-mental health visits the same as in-person visits, Virginia is one of these states.  For more information on billing see the Fees page.

 

Preparing for Tele-Mental Health visits:

This is a picture of the office where I conduct tele-mental health sessions.  My office demonstrates several things which help when video-conferencing:

  • Note the light source is behind the computer.  Overhead lights create shadows and lights behind the computer create glare, all of which would make it more difficult for you to see me.

  • Notice the blue curtain as a backdrop.  The less busy the background the better and neutral colors (such as blue) help by not absorbing or reflecting too much light.

  • Similarly, dressing in solid neutral colors helps by requiring less bandwidth.

  • If bandwidth is an issue (frozen images or distorted sound) ensure that other computers and devices are turned off.  You may need to ask other members of your home to not download or stream while we are in session.  VSee (the video-conferencing software we will be using) advertises that it can operate on 4G networks and uses less bandwidth than other companies.  Some patients have even attended sessions with me via their smart phones.

  • The most important thing about the space you choose is privacy.  My office has a door that locks and everyone knows not to knock when the door is closed.  Remove distractions from the space you choose and inform other members of the home about the importance of having uninterrupted time.

Hopefully these recommendations help "set the stage" so that you can get the most from your tele-mental health visit.  See Informed Consent for more information.

 

Psychopharmacology:

Some people see me primarily for management of medication.  New medications are constantly being developed and today there is an unprecedented number to choose from, many with fewer hazards and side-effects than their predecessors. 
 
Many view psychiatrists as the “pill pushers” of the mental health system - perhaps with justification.  You will find that I do not follow this pattern.  Rarely do I consider medication “mandatory” and rarely will I tell you that there is no medication which could possibly help.  The question of medication generally falls between these two extremes. 
 
Once a BioPsychoSocial formulation has been established, I will likely describe which medications may help, and why.  I will provide you with information about the pros and cons of specific medications, and answer any questions you have.  At this point, your personal preferences will largely guide the decision. 

 

I will offer opinions, based on my experience and knowledge, but decisions about medications will always be mutual.

 

Psychotherapy:

I am trained in several forms of psychotherapy, and enjoy using my training to your benefit.  I have particular interest in psychodynamic therapy but also find a cognitive-behavioral approach useful at times.  ACT (acceptance and commitment therapy) has also informed my work.   
 
Every therapist is different, and most seek to modify their approach depending on a patients situation.   

 

In general my job is to see what you cannot see, suspect what you do not suspect, and return this information to you in a way that you can use, in short, to improve your understanding of yourself.  

 

I am not a purely “supportive” therapist.  While there can be value in venting or getting things off your chest, this alone does not constitute psychotherapy as I practice.  The process of therapy will likely induce anxiety, discomfort, and anger.  However, I will also help to guide you through these experiences.   
 
Although the process of therapy is complex, it is not magical or mysterious.  We know that the mind, at the most basic, is a complex system of shifting electro-chemical patterns.  We also know that these patterns can be changed through experience over time.  This process takes many forms, however, the common theme in psychotherapy is a shift in thoughts and feelings which literally change electro-chemical patterns.  Over time this can alter patterns that have led to unhappiness, anxiety, and unwanted behaviors.  For these reasons I do not view therapy as being inherently opposed to medication treatment.

 

Privacy:

Privacy is critical to treatment.  Unless you are confident that the information you share is confidential, you will be held back from achieving your goals.  Operating as a solo private practitioner affords my patients the highest level of privacy protection.  At larger clinics or agencies your personal information may be seen by receptionists, administrative assistants, dictation typists, billing clerks, etc.  This is not the case in my practice; I am the only person with access to your file. 

 

As a rule, unless you provide specific authorization, I will not release information about you to anyone. 
 
For details, including emergency exceptions to confidentiality, and potential limitations due to technology please see Informed Consent and Preparing Space pages.

 

Fees:

Current fees are listed under the scheduling page and subject to change at anytime.

 
Please see Cancellation page for fees related to late cancellations and no-shows. 
 
TMHC operates on a fee-for-service basis and payment must be made at time of scheduling appointment.  I do not accept insurance of any kind.  This policy protects your privacy to the highest degree, allows greater flexibility in developing a treatment plan with you, and allows me to spend more time with each patient.  
 
However, people who do have insurance are often able to obtain partial "out-of-network" reimbursement for fees paid.  An invoice containing procedure (CPT) codes and diagnostic codes are available upon request and can be submitted to your insurance for reimbursement.  Every company and plan has different policies and reimbursement rates, use this checklist to help determine how much your insurance will reimburse.  If you cannot open the above link you can copy and paste the information from here.

 

Cancellation:

Your appointment is time that I reserve for you.  Barring emergencies, I will be ready to see you at our scheduled time.  I do not over-book or double-book my schedule.  I  prepare for our sessions by reviewing past notes and reading the latest literature that may be pertinent to your case so that we can make the most of our time together.
 
Because of this, I ask that you provide me with as much notice as possible when cancelling or rescheduling.  Please call me at: 757-404-6592 to make the request. 

 

My cancellation policy is as follows: 
 

  • > 24 hours:  No charge. 

  • < 24 hours:  50% refund.

  • No notice (no-show):  No refund.

 

Refilling Medication:

If you are low on medication, please contact me at least several days before you run out.  You may leave a message at: 757-404-6592.

Because I may be out of the office when I call in your refill, it is important to leave the following information in your message:

 

  1. Your full name, date of birth and address.

  2. Exact medication name (including suffixes such as "ER" or "CR").

  3. Medication strength (mg).

  4. Medication frequency (how many tablets, how many times per day).

  5. Name & phone # of your pharmacy.

  6. Your phone #, in case of problems.

 

Emergency:

If you are a current patient in an emergency situation, and I am not available at 757-404-6592, please leave a message.  If you do not hear back from me right away, please do one of the following:


1)  Contact 911
2)  Go to your nearest hospital Emergency Department for assistance.

3)  Contact your local CSB (Community Services Board).