So, tell me about this whole therapy business..

• Sexuality (gender identity, intimacy, desire discrepancy, sexual orientation, changes in libido, etc.) 
• Culture and Family Dynamics (values, beliefs, challenges, adjustment, etc.) 
• Life Transitions (childhood, adolescence, identity formation, marriage, parenting, empty nesting, menopause/andropause, aging, grief and loss, etc.) 
• Traumatic Experiences (psychological trauma, natural disasters, domestic violence, abuse and neglect, sexual abuse, violence, motor vehicle accidents, victim of or witness to a crime, experiencing war, secondary trauma, mass shootings, etc.) 
• Expectations of Therapy (frequency, style, approach, timeline, etc.) 
• Self-Harm (risk, severity, assessment, coping skills, etc.) 
• School and Work Challenges (school struggles, transitioning jobs, exploring interests, etc.) 
• Current Symptoms (depressive episodes, anxiety responses, triggers, difficulties with focus and impulsiveness, insomnia and fatigue, ruminating thoughts, triggered responses, etc.) 
• Relational Experiences (communication, dating, marriage, breakups, infidelity, lack of trust, attachment wounds, friendships, etc.) 
• Feelings and Emotions (regulation, identification and awareness, healthy expression)  
• Spirituality and Religion (impact, importance, meaning, etc.) 
• Progress and Barriers (in life and in the therapeutic process) 
• Past, Present, and Future (perceptions, goals, expectations, meaning, purpose, etc.) 

Clients are entitled to the privacy rule under HIPAA, which states all “individually identifiable health information” held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information “protected health information (PHI).” PHI covers: 

• The individual’s past, present, or future physical or mental health or condition, 
• The provision of health care to the individual, or 
• The past, present, or future payment for the provision of health care to the individual 
• Also includes identifiable client information (name, address, birth date, social security number) 

Permitted Use and Disclosures 

• To the individual – A covered entity may disclose PHI to the individual who is the subject of the information (may require written request) 
• Treatment, payment, and health care operations  - information may be utilized for treatment and billing circumstances in order to provide for the maintenance and continuity of treatment. (Circumstances might include submission of a prior authorization request for services or submitting diagnosis, codes, and notes for billing and reimbursement.) 

Additional Circumstances in which PHI may be disclosed: 

• As required by law – some statutes, regulations, or court orders may require treatment notes or information and therapists will protect client privacy as much as they can and provide the minimum necessary information). Some notes may be required to be submitted in legal proceedings 
• Victims of abuse, neglect, or domestic violence – Therapists are mandated reporters, which requires them to prioritize health and public safety, so they will often report incidences of child, elder, and vulnerable population abuse as well as seek additional help for suicidal and homicidal ideation 
• Health oversight – information may be utilized for treatment and service evaluation in order to oversee integrity of services 
• Law enforcement purposes – in very limited situations, law enforcement may provide necessary documentation which subpoenas information. 
• https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html#:~:text=The%20Privacy%20Rule%20protects%20all,health%20information%20(PHI).%22 

Early 

• Prior to attending your first session, you might expect to fill out informed consent paperwork as well as providing insurance and billing information, if applicable.  
• During the initial session, the therapist will often introduce themselves and review the informed consent and answer any questions. The therapist will also complete a mental health assessment, which is utilized to gain an understanding of current symptoms, relevant context and experiences, and establish goals for treatment. 
• The mental health assessment does address topics such as suicidal ideation, past trauma, drug use, family history, and exploration of current circumstances. These are utilized to help provide insight into potential risk factors, consideration of diagnostic criteria, and influences therapeutic approaches that would be a fit for the client.  

Middle 

• The therapist will consider your therapeutic goals, influential factors affecting your circumstances, and provide some theoretical interventions and approaches to processing these presenting concerns and help to identify coping skills and insight. 

Late 

• The therapist will ensure that you are working toward goals and able to implement coping skills and effective techniques to allow you to feel more confident in managing these concerns on your own. They will also help plan for potential challenges that might come up in order to prepare you to handle future challenges. 

• The course of therapy will often be unique to each client and what their specific goals are from therapy. 
• Some clients aim to identify new coping skills, others might aim to process childhood experiences in order to become aware of cycles and patterns of interactions, while others might hope to gain insight and understanding into their experiences. 
• Dependent upon these expectations and goals, therapists will aim to utilize an approach that best fits your goals. 
• If you feel you have reached or are approaching your goals, please feel free to discuss this with your therapists as there can be a variety of approaches during the later stage of therapy including, but not limited to: 
• Reducing frequency – potentially from once per week to every two weeks, then once per month, then to as needed 
• Reviewing initial therapy goals together to determine if they have been achieved 
• Identifying areas that may still present as challenges or contributing factors to presenting concerns 
• Strengthening the use of coping skills and healthy responses to increase the ability to respond and cope with distressing situations/thoughts/etc. 
• Discussing how to respond to future stressors or creating future templates of how one would like to respond 
• Discussing plans for when one might feel “done” with therapy (for now) and, if applicable, factors in which someone may want to return to therapy 
• Explore possible referrals if additional or increased care might be necessary or beneficial 
• For some, therapy might be more of a lifelong practice (to continue processing chronic stressors and systemic factors affecting someone) and others might seek out therapy on a more situational or circumstantial basis (processing a recent loss, exploring ways of adjusting to a new life stage, processing through a traumatic event, or seeking out therapy when one notices something new or unfamiliar that is difficult to work through independently). Therapy is not a one-size-fits-all and clinicians will be considerate of individual and unique goals, expectations, and commitments to therapy to consider the best treatment approach and timelines. 

• If I live in another state, but my insurance and/or primary residence is in Nevada, can I still be seen? 

Clinicians are limited to only practicing and providing services to clients actively residing and present in the state they are licensed in. Unfortunately, this means that our therapists are unable to provide therapy to clients who are out of the state of Nevada (unless the clinician is dually licensed).  

• Do you offer emergency or crisis services? 

We provide outpatient services on a scheduled basis. This means that we often cannot accommodate emergency or crisis services. We often provide the crisis line contact information in case of emergency situations – Call 988 or text HOME to 741741.  

• My friend or family member already sees a therapist at Next Chapter Therapy. Can I schedule with the same therapist? 

Due to conflict of interest and ethical limitations, therapists will often choose not to work with family members or friends of a current client to maintain privacy and integrity of the therapeutic relationship.  

• I’m currently seeing a therapist outside of this agency. Can I also see a therapist at Next Chapter Therapy? 

Dependent on insurance and billing restrictions, it is often a standard practice for clients to only be seeing one therapist at a time. Some exceptions to this might be if a client is seeing one therapist for their primary mental health concerns (depression, anxiety, stress management, etc.) and another for more specialized treatment (i.e. addiction, eating disorders, family counseling separate from individual counseling). 

• What happens if I lose eligibility with my insurance? 

If you lose insurance eligibility, we encourage you to discuss this change with your therapist or with the front desk. Many therapists are able to find alternatives or accommodations (adjusting frequency, temporarily providing a sliding fee scale, or transferring to a more affordable student therapist). Our hope is to not let finances and lack of insurance be a barrier to accessing treatment.  

• Do you offer in-person or telehealth sessions? (And why might I choose one or the other?) 

We have clinicians who provide in-person sessions, teletherapy options, or a combination of the two. Some prefer in-person therapy as it can provide a more tradition feel and a confidential environment for healing. Others prefer teletherapy as it can allow for more flexibility and may be preferential if transportation might be a limitation.  

• What are the risks and benefits of therapy? 

The benefits of therapy are often discussed in terms of healing, identifying coping skills, and processing experiences to allow for healthier ways of interacting, but the risks and challenges are often not talked about. Therapy can often bring about conversations regarding past traumas, unconscious and unidentified concerns and feelings, and may feel emotionally activating as therapists explore various topics. Occasionally, it can feel like “things get worse before they get better”, which can often feel like therapy might be unproductive and unhelpful. In many circumstances, this may be a reflection of changing dynamics and interactional patterns that are affecting the “status quo”, therefore it can feel uncomfortable and unfamiliar. It is encouraged to discuss any of these concerns or experiences with your therapist if they are bothersome.