Hi you guys.  So sometimes I get asked a few questions about the work I do, who I am, what not.  I thought I'd compile and go over some information about how I work with folks and what could be expected in therapy.  I had some fun writing up the info for you to peruse at your leisure-and if your question isn’t on here click here to

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Q: Do I need therapy?

A: YES.  But not for the reasons that you may think.  I am of the thought that everyone benefits from having an objective 3rd party to work things through with.

No one makes it this far without some kind of negative cognitive beliefs that cloud their judgment from time to time; and we are all exposed to trauma on some level (I will be posting a new mind-blowing article about the concept of trauma soon).  Therapy can be a great space to work through some of that stuff.  Also here is an article I co-authored which talks about Maslow’s Hierarchy of Needs.  Therapy can support personal growth and self-fulfillment throughout the entire pyramid.  You may not always need therapy, but it can be a great resource to utilize to check in with yourself.   

Q: Will therapy make me feel better?

A: Maybe?  No, but also yes.  This is a complicated question for a complicated human being. We avoid talking about what brings us distress, which in the short term makes things better; but increases distress over the long term.  Therapy often creates an opposite effect, increasing distress in the short term and then decreasing distress over the long term.  I have also observed that it is amplified in the beginning of treatment, many people experience that beginning to talk about difficult experiences is more challenging at first, and desensitized to the process (meaning it gets less upsetting) as we practice it more.  I believe there are a number of things about therapy that are super helpful which is why I feel so passionate about the work we do. At a base level, everyone needs a place to safely talk about what is going on in their lives.  Having a therapist can be containing, meaning that therapy provides a space for the traumatic content to go; like you’re saying “here brain, this is the place we talk about this”.  We are giving your brain a special specific place to hold space for whatever is going on; instead of your brain reminding you about it during your weekly staff meeting, or while you’re eating lunch, or trying to go to sleep, for example.       

Q: How often and how many weeks/months/years/decades do I need to be in therapy?

A: Incredible question.  This is another complicated one that will vary case by case.  Generally, I will see people more frequently to start (usually weekly), and as symptoms reduce we will reduce the frequency of sessions.  Some folks come to work on specific traumas, and some people use therapy as a maintenance tool (for example coming every other week to debrief and have a safe container to work on daily/weekly struggles).  Frequency is something that can be adjusted throughout your treatment, and we will definitely discuss more as we progress.  

When working with children and teens, I tend to utilize a short-term therapy model.  To start with I plan on seeing them from 4-10 sessions and then reducing to bi-weekly, then monthly, and then discontinuing treatment once symptoms appear to stabilize.  Children and families are always welcome to check back in should symptoms recur, which is not unusual (for) with the growth and development that occurs throughout adolescence.  When working with kids, I require frequent family engagement, starting with weekly for the first several sessions, then moving to a family session every 3-4 sessions.  

Q: I saw you at Costco…what do I do?

A: Definitely try the sample of the artichoke dip they are giving away in aisle 19!   We live in a small community (and really small world), and I don’t just exist inside the box of my office.  It is probable that you will see me from time to time in different settings.  What we talk about in session is confidential INCLUDING the fact that you come to a session with me.  So if we cross paths in public, I leave it up to you if you want to say hello or not.  In reality, I am pretty involved in a lot of different areas of our community, so there are a lot of ways that we may have met, so saying hello to me does not necessarily “out” you as a client.  It is important to note that when outside the box of my office I don’t have your “file” in the forefront of my mind; so I just see you, a human being, grabbing a jumbo size bag of carrots on a Sunday afternoon.  Getting into a therapy session in the freezer section at Costco is the last thing on my mind; I’m just here for my year supply of garlic, dude.

**There are certain settings or situations that do require further discussion, however.  Our relationship is a professional one, and if our paths are intersecting (for example our friend groups begin to overlap) in a way that changes and challenges that relationship for either of us, we can talk about the best step to take for your wellness.  I have and uphold an ethical obligation to maintain our professional boundary; so there are times where I can’t take or continue to see certain clients due to having a dual relationship.  

Q: Are you psychoanalyzing me right now?

A: Aaaah, no.  I often get this question when people find out what I do.  I think its pretty funny when people start squirming like I’m seeing through all of their defenses.  It is not X-RAY Vision, don’t worry.  When I am out doing stuff day-to-day, I am doing just that.  Getting coffee, thinking about how polar bears and band-aids are related, writing something in my head, or reading some science fiction; you know, normal nerd stuff.  For YEARS I adjusted how I talked about my career in order to squash these conversations and the experience of making people squirm.  These days I’m way more transparent about what I do because I think it is awesome and important work; because I think that everyone needs to be thinking and talking about personal growth and mental wellness.

Q: How much are sessions, and how do I pay for them?

A: Sessions are typically 50-55 minutes in length, and are $150.  There are lots of ways to pay for them; I take cash, check, and credit card.  I also bill some insurance companies (UHA, HMSA, HMSA Quest, HMAA, HMA) for services, if you meet criteria for certain DSM-5 diagnoses.  I do have a limited number of spaces in my schedule that are available for insurance clients.   

Q: What happens if I can’t come to my session or I am late?

A: When you book a session with me, I reserve that time block for you; as well as a certain amount of administrative time before and after your appointment during which I write and review notes on our session, submit any billing, etc.  When you cancel within 24 hours, I still bill you for the appointment.  If you typically use insurance, please be advised that insurance does not pay for missed sessions, and you will be billed directly for the full rate of the appointment.  When you are running late or don’t come to your session several things happen.  

1. I worry about you!  What happened that kept you from getting to our appointment?  I will call you to make sure that you are not lying dead on the side of the road somewhere, which would make me very sad.  I realize this is a very “mom” reaction, but it is what happens for me.  Rule #1 is don't get dead. 

2. I will be concerned that you are not valuing our time together.  I understand that there are times where unforeseeable situations may arise, you may want to factor the cost of the session into your decision.  as I value my time, I will bill you directly for the session.    

If you are late to your appointment you are drastically reducing the amount of time we are able to work on your goals!  You still pay for the portion of the appointment that you have missed; (,) and insurance will only pay for the portion that you have attended which means that you will have to pay out of pocket for the portion that you did not attend.

 As a convenience, I have multiple systems set up to help you remember your appointment time (like text reminders 24 hours in advance), and technology these days is so good there are additional ways you can help yourself remember your appointment (like using a reminder or calendar on your phone).

Q:  Where is your office and where do I park?  

A:  After our initial phone consultation, I will send you a link to my electronic health record and all of the important info such as address and directions.  My office is located downtown Kapaa.  I see clients by appointment only, so if you drop by the office you can expect that I will be either in session, or not there...call/schedule an appointment first please!  

As for parking, we have labeled our 3 available parking spots using orange buckets and signs that state “HFK & Kauai Behavioral Health”.  If you arrive to your session and those spots are full, please use street parking.  If you park in a space in the lot that is NOT one of our spots, you may be towed, your car may be sneered at, and someone in my building may take a picture of your vehicle in their spot and send a nasty e-mail to me and the landlord complaining.  Be kind, park in an HFK space.    
 

Q: My mom (substitute other family member/co-worker/boyfriend/girlfriend/spouse/friend) sees you, can I see you too?

A: Part of being a therapist is having a clear unbiased relationship with my clients.  There are ethical guidelines for professionals regarding this that prohibit dual relationships (for example; if you are my friend that is one relationship, and if we are working together in therapy that is a second).  There are exceptions to the prohibition because, well, living in a rural community if no one was allowed to see anyone they knew outside of therapy there would be no therapists left to counsel clients, and no clients left.  I have seen that there are as many different ways to manage this as there are therapists; so I’ve resolved to really think and talk through the situation on a case-by-case basis.  If our professional relationship is affected by the secondary relationship (such as in the friend/client situation), then one must go.  There are some cases in which a previous relationship does not impact, and some for which it does-for example I have an extremely difficult time seeing multiple family members, or close friends because my brain meshes together information in family groups so I can’t remember what you told me vs. what your sister told me (come on brain!).  This can be tricky because of confidentiality, I may not be able to disclose the specific reason or conflict that requires me to refer you to another provider!  Please know that I am working hard to support you in accessing the best treatment options available.

 Q: You seem amazing and I want to book a session; what next?

 A: Great!  I always want to do a quick 5-10 minute phone consultation prior to meeting with someone in person.  During this time, we want to make sure that what you are wanting to work on is within my scope of practice and answer any additional questions you might have about therapy and the type of work I do.  If it feels like we may be a good fit we can look at scheduling our first appointment.  The best way to book a consultation is by clicking the SCHEDULE A CONSULTATION button at the bottom of the page which will take you to my secure electronic health record.  Please enter your name and a phone number and I will call you at the time of our consultation.

Q: You seem cool, but I don’t know if your style is for me, who else can I see?

A: The therapeutic relationship is a very personal one, and it is important that you find a therapist that you feel is a good fit.  I would suggest checking out Psychology Today and entering in your zip code to see a list of therapists who are in your area.  I also highly suggest asking trusted friends who they are seeing (you’ll be surprised to find out how common it is for people to go to therapy), and if they would recommend a therapist.  Everyone is different, so sometimes it takes trying out a few different therapists before you find one that fits.

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Thanks for reading party people, and special thanks to Matt the cat who covered my post while I was writing...good talk and more soon.  Love always, 

-HFK

4569 Kukui Street, Suite 201

Kapaa, Hi 96746

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