Greetings

Greetings and Welcome!
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Introduction/Purpose: We realize that it is a big deal to reach out for therapy, even if it is your first time or you have been doing this for a while. We recognize that not everyone knows about this process so we have created this landing page to help guide you or we now have an Orientation Class (TBA) that you can attend to cover all of this. What we do is somewhat different than what you might expect, so this landing page or class outlines generalities but more specific information can be discussed when we first meet or the class is another option. 

*If you prefer to just make a consultation appointment and have us walk you through this process, please let us know. But please still review this page as best as you can and keep it for reference as it pertains important information relating to your care and we do not always go over all of it in-person. If you are looking for general mental health services, our position is that a lot of our symptoms can be accounted through a trauma lens because trauma (PTSD and Dissociation) are transdiagnostic. We do general mental health services as well. 


Choose your clinical path…  We realize that choosing a therapist or therapy can be challenging. For this purpose, we created a path system where you can choose the path of your treatment but first you have to choose what type of intake is right for you. We may have given you guidance on this when you first contact us, but this outlines our transparency. Each option is similar but the timing is arranged differently, depending on your need and which path is right for you. You may not know what is right for you right now so in that case, we would recommend doing an initial 1-hour initial consultation. This session would be paid at the hourly rate listed below.

Typically there are three reasons why people are reaching out for services. 

1) they are in crisis (If you are in a medical emergency then call 911.) 

2) they know they need therapy but have been waiting for the right time. 

3) want therapy to improve their quality of life. Due to this we offer an intake process that can meet your need. 


Is the 1-hour initial consultation, or 2-intake (w/o qEEG), or 3-hour intake session (w/ qEEG) more appropriate for me? Typically, we can assess and treat the most immediate needs (intrusive PTSD/dissociative symptoms) in the first intake session (2-hour w/o qEEG or 3-hour intake w/ qEEG). For this reason, we are giving you the option of choosing your treatment path. If you prefer to discuss in person or meet us first to see if it is a good fit for you, then we suggest doing the hour intake consultation. If you want to know more about the process, continue on…

Initial 1-hour Consultation: Choose this option if you are unsure about the therapeutic and you have questions about us or the process. After this meeting, you will know what path is right for you…

 

PATH ONE (Most common): Unresolved trauma from childhood or recent events are triggering something and you are not sure what, you not have been attending directly to your needs over the years, have untreated medical conditions, are having symptoms that are pronounced, have had multiple diagnoses, been on various psych medications or used substances abusively, complications in intimate relationships, or issues in professional relationships. OR despite having all of these, you are over excelling in your life to the point of exhaustion and for the same underlying reasons. 

INTAKE SUGGESTION FOR PATH ONEDo 2 or 3-hour intake to help stabilize and start your treatment and follow PATH ONE. SEE TYPICAL COURSE OF TREATMENT BELOW.

Typically Course of Treatment and Recommendations for PATH ONE: Following the 3-Hour intake you would start weekly Neurofeedback (2x a week if possible for 4-5 weeks). This would infused with intensive trauma resolution sessions and then the maintenance phase of your treatment. Typical diagnoses: Acute Stress Disorder, anxiety, depression, OCD, PTSD, Dissociative Disorders, Addictions, Adjustment Disorders, Bi-polar. (Meets medical necessity for treatment and is mostly covered by insurances). Combined with the mindful use of cannabis, this path also is how we address autoimmune conditions.

PATH TWO (Common Enough): You probably have been working on yourself and have seen improvements over the years, but something still feels stuck. This course of treatment and the intensive model would fit well here. (Meets medical necessity for treatment and is mostly covered by insurances.) (Typical diagnoses: PTSD, Adjustment Disorders, Anxieties, Depression). 

Do either 1-hour consultation or dive in with the intensive models of treatments and if you need continuing care we would transition you to Neurofeedback, Meditation, and other supportive therapy.

Typically Course of Treatment and Recommendations for PATH TWOHybrid Intensive Model: 4-Hour intensive followed by weekly Neurofeedback and supportive therapies.

PATH THREE: You are probably coming in for performance enhancement or current stresses/changes in your life that you are dealing with and you probably are looking for support. This is more of a maintenance stage. (Insurance companies may not reimburse for this phase of treatment.) Because of this, we currently creating more of a supportive maintenance model where you can take classes through our wellness programming. 

Typically Course of Treatment and Recommendations for PATH THREE: Hybrid Intensive Model followed by weekly Neurofeedback and then supportive therapies. 

*All can be done adjunctively with other supports/therapists.


Starting the process…

  1. If you are comfortable with it, do the initial paperwork. Please review this whole page before filling out the paperwork. It is organized in a way that may answer a lot of your questions. If anything comes up for you while doing it, we have provided some grounding and coping skills for you to try.
  2. With respect to scheduling, currently a lot of people are reaching out for support. Our mental health system is taxed with the demand. Our schedule is booked a few weeks out due to this need. However, as we work through the waiting list, people are dropping out so it can be sooner. (IF YOU FIND ANOTHER THERAPIST IN THE MEANTIME PLEASE LET ME KNOW ASAP SO I CAN TAKE YOU OFF THE LIST AND MAKE ROOM FOR SOMEONE ELSE.) We schedule according to need, location, and based on your and our availability. Depending on your need will depend on what service is right for you. If this is not the appropriate level of care, we will tell you that. (We probably have discussed this our initial phone/email contact.) There are times when I need to hear more about you and will perform an initial consultation/intake session. This will be a paid session. We work on first come first serve basis. If I reach out and do not hear back from you by the end of business the day that I reached out to you, the appt that I offered may not be available. If I do not hear back from you at all, we will see if you want to stay on the waitlist or not. If you do not respond to that, I will assume that you not wanting services anymore. Please feel free to reach out in the future if the need arises.

INITIAL PAPERWORK

There are 4 steps that you must fill out prior to your first session. 1) Informed Consent. 2) Intake. 3) PCP/ Emergency Contact consent. 4) Good Faith Estimate. If we have not done it during the first contact, after doing these 4 steps, we will schedule a 2-3 hour intake session (hourly rate applies and this intake is also treatment at the same time). If you prefer you can do a consultation session before signing up for the full course of treatment, we can do that.

  1. Click HERE for the informed consent. Please review and sign it if you are comfortable with it. If not, ask me any questions.

2. Click HERE for Google Form Intake (For CHILDREN HERE and review down below for more details regarding children.* Laptop instead of mobile device is better). If you can do the intake before our first session, it would save time in the initial session. If you are triggered while doing it, please refer to the grounding skills below or reach back out to me. You can also fill it out before the session in the waiting room as well, just let me know if you need me to leave you a copy.

3a) If you are comfortable with it, please fill out a consent HERE for your primary care physician (PCP). If not, there will be an initial consultation so we can explore why. (Please enter the full practice name and contact information into the allotted slot). For psychedelic clients, your PCP and prescriber must fill out this form: HERE and you must fill out: initial inquiry, Emergency Contact consent (below), and Agreement and Legal Waiver.

3b) Emergency contact consent form: HERE

4) Right to Receive a Good Faith Estimate of Expected Charges: Good Faith Estimate (GFE): By law, No Surprises Act of 2022, I am providing you with a Good Faith Estimate of your therapy. We discussed this in your original contact but here is the form: HERE. *Remember, the amounts are an overestimation* (Most people will choose number 7 or 11)

**When communicating via email or text please don’t use your full name in either the subject heading or in the body of the email. Do not send any photos. Do not send Protected Health Information (PHI). I only use texting for scheduling.** **If you need to communicate securely with me, I can send you an encrypted email.


LOCATIONS AND DIRECTIONS

Home office is 160 Loomis Rd. Chatham NY 12037. It is a dirt road so PLEASE DRIVE SLOW (15 mph max)EVEN IF YOU ARE RUNNING LATE! because children and law enforcement live on the road). (In winter and wet months consider going from 203 to Rt.9 to Raup and then left on Loomis.)

From 90, take the Taconic southbound down to Exit 99 (Chatham – Rt. 203) Head East on Rt. 203 and take a left on Rt. 9. Take second left on Raup Rd. Then second left onto Loomis Road.

We are at the top of the hill of Loomis Road on the left and there is a black mailbox and a rock marked 160. Enter the property and please go straight (No turning left or right) and park in the front of the house on the stone parking lot (leave enough space for others). Looking straight at the house it looks like there are 3 of them, follow the stone path to the right to where the waiting room is. Please enter at your designated time.


The Hudson Office (Monday’s ONLY) is at 84 Green St. Suite 4 – Hudson N.Y. 12534 Please park in parking spot labelled: SUITE 4 Parking) near the wooden ramp, as that is where the entrance is. Also, there is the sign “Karuna Grief Counseling.” The suite is on the second floor.


Albany Office (Friday’s Mostly) is at 255 Lark St Suite 4 Albany N.Y. Enter the main building and go upstairs to the back office: Suite 4. Parking is available behind main building at the designated signs (MAMHC). Entry to the parking is right along side of the building (not through the Trinity Church parking lot, however, if you do go through Trinity Church – you may be able to get there if cars are not blocking it).

*Acknowledging that this location/building has a particular history in our community, we understand how and why it may be triggering. If this location is triggering you, please let us know and we can work something else out. We are trauma specialists and are looking to help everyone heal and can help connect you to other services, if necessary. We have long worked with victims of crime and NYS Office of Victim Services (OVS). Also, there is a detached space on the same property where we could meet or we have other office locations in the area. *We will make special considerations if this location is an issue for you.*

255 Lark St Albany NY Building Photo 1 HighDefinition


HELPFUL SKILLS TO REVIEW BEFORE FIRST SESSION

Click here for Grounding and Coping Skills Please review and keep on file. (you may have to request it when clicking on it)

This link is helpful too for skills: Mindful Living Coping Skills and on Dissociation and Addiction

I also offer a meditation class preview that utilizes Mindfulness Based Stress Reduction (MBSR) for those on the waitlist. At your own risk, if interested, Click: HERE


Scheduling and Hours: We work on a first come first serve basis, depending on clinical need. If we reach out to you and don’t hear from you then the time slot that I originally offered may not be available. Currently, we have a 1-2 month waitlist. We will also be opening more NFB hours in the summer…

Hours: 7am-4pm M-F and limited Saturday mornings (7-12pm). Wednesday’s are the day that I do Intensives and Psychedelic Sessions.

Intake sessions: Wednesday’s, Thursday’s, and Friday’s, typically from 9-12.

Neurofeedback Clinic Hours: Monday (Hudson/Chatham), Tuesday (10-2 in Chatham), Wednesday (10-2 in Albany), Thursday (10-2 in Chatham) and Friday’s (10-2 in Albany).

Fee Schedule for Neurofeedback (NFB) Clinic:
  • 3x a week: 75$ per 25-30 min session (CPT:90832) for 3-6 weeks (225$ a week).
  • 2x a week: 75$ per 25-30-minute sessions (CPT: 90832) for 4-6 weeks ($150 a week).
  • 1x a week: 100$ per 30-minute sessions (CPT: 90832) ($100 a week) (usually in conjunction with another therapist).
  • 1x a week at 30 min and 1x a week at 45 min: ($175 a week)
  • Every other week: Full rate of 150 an hour, 45 min ($125), 30 min ($100).
  • Monthly: Full rate of 150 an hour, 45 min ($125), 30 min ($100)
For those who want/need to have more time to check-in or have more to talk about…
  • 1x a week: 125$ per 39-45 min sessions (CPT: 90834) Neurofeedback ($125 a week).
  • 1x a week: 150$ per 53-60 min session (CPT: 90837) ($150 a week)
  • 2x week: 150$ per 53-60 min session (CPT: 90837) ($300 a week).
Because families sometimes want to combine their care…
  • 2 persons per 30 min = 150$
  • 2 persons per 45 min = 200$
  • 3 persons per 1 hour = 225$
  • 4 persons per 1 hour = 250$

PAYMENT

Depending on the service, but generally my fee is $150 an hour (psychedelic sessions are $200 an hour), unless otherwise arranged. (IN ORDER TO HOLD THE FIRST SESSION MUST BE PREPAID (I will send you a link unless it is in person and you want to pay cash, then a credit card will be held on file.) I do not offer a sliding scale but depending on your situation and need, you may be able to do prorated sessions. Once transitioning to every other week, the full rate will be resumed. 

Insurance: *We do not take any insurance, mostly because they do not cover a lot of what we do and the overhead is too much. Our fee is what we would get if the insurance companies were not involved. Barter is also a possibility for payment, depending if it is right for you. At your request, we can provide “superbills” for you to give to your insurance for reimbursement. Reimbursement is health plan dependent and you will want to check with them about their out-of-network reimbursement rates and you must meet your deductible first before they will cover you. You will be diagnosed in order to do this. See information below regarding diagnosing. (*Some services are not eligible for a superbill but a receipt can be provided.) *If you ask retroactively, you may be charged a case management fee* Let us know which method of payment you are choosing to do and I will send you a link to pay. There is a 48-hour cancelation policy. The full session is charged for missed sessions without 48-hours notice. Emergencies are considered. In regards to payment: Cash is the best way to protect your identity and minimizes HIPAA responsibility. Check and Credit Card are accepted with the understanding that your PHI information is more at risk. (See info regarding Self-pay vs. Insurance below.)

It is also my responsibility to make sure that you get connected to services that you are looking for. If you do not think that we are a good fit for you, we can provide you with other options that may be a better fit for you. Lastly, if you have read anything here that is making you concerned about signing up for therapy, it would be helpful for me to understand your personal reasons but you are obviously not obliged to share them. However, as we have worked with others, sometimes it is about addressing the issues head on, which produces anxiety that we try to avoid feeling, sometimes anxiety comes up over the idea of longer sessions which is why we offer a hybrid model or the more week to week model. Whatever the reason may be, by letting us understand your reasons for not signing up for therapy, we may be able to connect you to someone who could meet your needs. 


Clinical Decision Tree

Trauma is a subjective term, meaning that it is defined relative to the person defining it. However, some experiences are traumatic by default because they make a lasting impression on the body, of which, the mind (society/culturally) does not always see or recognize these as traumas or they are normalized to such a point that they are considered everyday life. The conscious answer is not the most informed answer because it does not always account for the unconscious mind or emotional world. As the body is our unconscious and it speaks through our illnesses, disease, and disorders. This is mainly why people are seeking therapy and support.

We made this decision tree to help inform you about the length of treatment that you can expect when working with me. However, we have to recognize that healing is a lifelong endeavor and daily maintenance is needed to maintain the health (*physically, psychologically, and spiritually) that you do have. 

Traumatic factors to consider: Type of traumas, when they occurred, by whom, and are they resolved are all factors in how long your care will last. Most people are coming to therapy because the past is unresolved in some way and is pouring into their life today effecting their abilities to navigate their lives.

If you experienced traumas during the ages of 0-5 or 5-10 and the traumas are still unresolved (often looks like difficult in relationships/attachments/addictions), then go to Phase 1. If not, go to number 2.

Diagnoses: If you have been diagnosed with or are on or have ever been on medications for these disorders (addictions, dissociative disorders, PTSD, ADD/ADHD, Panic, Schizophrenia, Bi-polar, anxiety, depression, personality disorders), if parents had these diagnoses, if there was illness in your family of origin, then go to number 1. If not, go to Phase 2.

If you have a history of medical procedures or are on or have taken any pharmacological medications, then go to Phase 1. If not, go to Phase 2.

Healing Factors: If you have been working on yourself over the years, ask yourself, do the memories relating to the topics that you have been working on feel resolved? (Pain/SUDS 0-10 scale), if not, then go to Phase 1. If yes, then go to Phase 3.


Typically Course of Treatment and Recommendations and reference:

Phase 1) There is a good chance that weekly (2x a week for 4-5 weeks, if possible) Neurofeedback would be the first round of treatment (Length of treatment: 6 months-1 year) followed by intensive trauma resolution sessions (Length: 6 months – 2 years) and then the maintenance phase of your treatment (Length of treatment: lifelong). (Meets medical necessity and is mostly reimbursed by most insurances (out of network). (Typical diagnoses: PTSD, Adjustment Disorders)

Phase 2) You probably have been working on yourself and have seen improvements over the years, but something still feels stuck. This course of treatment and the intensive model would fit well here. (Meets medical necessity and is mostly reimbursed by insurances (out of network). (Typical diagnoses: PTSD, Adjustment Disorders).

Phase 3) You are probably coming in for performance enhancement or current stresses/changes in your life that you are dealing with and you probably are looking for support. This is more of a maintenance stage. (Insurance companies may not reimburse for this phase of treatment.)


Typical Course of Treatment

Some of the services that we do are very specialized but have general and widespread effects. Below is general/typical course of treatments. We believe in treating the source of the symptoms and not only the symptoms themselves.

Phase 1: Stabilization/Preparation/Assessment.

Includes: Brain scan with qEEG, Integrative Medicine, Awareness skills like Mindfulness/Brainspotting (Resource/Expansion model)/Psychedelic Sessions, EMDR (Phase 2), and Expressive Arts. (Can be done in a 4-hour intensive format or this phase can take years depending on level of awareness and where you are at in the therapeutic progress).

If staying in the present moment is difficult or you have physical ailments related to your trauma/stress: Neurofeedback is used because it helps the body regulate. (can take 20-40 weeks to establish physical stability) Or one can create the same by creating a mindfulness practice (5-7 days a week, 1-2 hours a day) for several years to gain the same level of physical stability.

Phase 2: Memory resolution/Trauma resolution phase.

Includes: EMDR (phase 4-8), Brainspotting, Psychedelic sessions, Deep Brain Reorienting (DBR), Progressive Counting (PC), and Mindfulness interventions.

Phase 3: Integration, Maintenance, Recovery, Posttraumatic Growth phase

Includes: Mindfulness-based practices, psychedelic sessions, EMDR (phase 8), Brainspotting (expansion resource model), Neurofeedback (20-60 wks), and Expressive Arts.


Typical length of treatment

Typically: 6 months – 1-2 years for most presentations.

For more extensive cases could be 2 years + (depending on age and trauma/treatment history/treatment style you choose e.g., intensives). (2nd year is usually monthly and 3rd year is usually monthly/quarterly)

For addictions, we recommend 5 years because recovery research shows after that point, people are more than likely to stay sustained recovery (3-5 years are quarterly, semi-annually, or annually).

Extensive cases include: addictions, dissociative presentations, bi-polar, eating disorders, panic, chronic illness, personality disorders, complex PTSD with unresolved trauma history.

*Other things to consider on length of treatment: exercise, diet (caffeine, sugar, additives), medications, social supports, willingness to make changes, and time in play/creative outlets.

Retreat/Hybrid Model: Because of the therapies that we do are more procedural/protocol oriented (and evidence-based), doing a retreat/intensive cuts down on your length of time in treatment.

2-5 days for Phases 1-2.

1-2 years for Phase 3

Check-ups

We also believe that once you hit a maintenance phase of treatment, that yearly or bi-annual check-ups are a good idea. We can set this up if you like. Let us know.

* Please be aware that it is New York State Law (Educational Law and Regents Rules) requires that you have a medical evaluation (yearly physical) as a part of your care, particularly if you are have been medically diagnosed with schizophrenia, schizo-affective disorder, bi-polar, major depression disorder, panic disorder, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, or autism.


Information about my specialties and intensive services: Click HERE for more details

Trauma resolution therapies that I do are EMDRProgressive CountingDeep Brain ReorientingCannabis-assisted sessions, and Brainspotting. Trauma resolution is basically moving memories that feel like they are still happening today, to this thing that happened. It is more of a procedure than other therapies. Because of this, the weekly session format does not make sense when you are ready for trauma resolution. “Intensive sessions” trauma resolution methods can be done in bulk. The idea is that if you are cleaning house, you could do it for an hour a week, but you could also make a day of it to get it done. The benefits are that you can get better fasterstabilizes you, and is more cost-effective in the long-run. Insurances companies can cover this service with out-of-network. Neurofeedback (NFB) may be used as maintenance or start with to help you get ready for this deeper work.


Using Insurance vs. Self-Pay

Paying for psychotherapy out of pocket minimizes the exposure of your protected health information (PHI). Please see the informed consent for Notice of Privacy Practices for how we use your PHI. Whenever you use insurance benefits to cover psychotherapy, the provider, with your consent, has to release certain types of information to the insurance entities in order to a) verify your eligibility for coverage, b) pre-authorize services (if applicable), and c) to process claims to obtain payment. As a result, the provider informs the insurance companies of the nature of the issues you struggle with, diagnosis, treatment plan, and prognosis. In the event of Self-pay, your therapy remains completely private (with the exceptions to confidentiality such as in suicidal or homicidal ideation, etc.). Once such diagnosis code is recorded by the insurance, it becomes part of your permanent healthcare record. Self-pay means no reports of your treatment are shared with your insurance and all records remain with the provider. **If you are on psychiatric medications or have ever been then you already have or had a diagnosis but you should be aware of this information when using insurance.**

Since there are certain types of therapy that may not be covered by your insurance, I have decided to not take health insurance. A lot of what I do is outside the realm of what insurance companies are willing to reimburse, even though they are evidence-based treatments. Self-Pay allows you to stay in control of your treatment. Self-pay allows you to also determine the length of your treatment based on your needs.

Furthermore, the advantage of Self-Pay includes the fact that no records of therapy exist in the Medical Information Bureau (MIB). MIB records of your therapy could potentially compromise your ability to get a current or future life, health, disability, or long-term care insurance. Self-Pay, thus, involves no psychiatric diagnosis code. If, however, you were using your insurance benefits (i.e., “superbills” that you would submit for out of network coverage), you would have to be assigned a psychiatric diagnosis in order for the provider to justify the medical necessity for the services provided.

As it relates to medical necessity and superbills, the use of health insurance companies require that clients meet medical necessity. (See more information HERE.) In order to submit claims or superbills clients must be diagnosed and the relevant treatment has to be applied to the diagnosis.


* Regarding Children

If you are a parent reaching out for your child for therapy (any age really), particularly EMDR, PTSD, or for Substance Use, please know that a child in therapy often involves the family dynamics. Children, or their symptoms/disorder, are often identified as the main issue but that is usually a symptom of the family system/parenting. Additional support is often needed, which is why we offer NFB family style.


*Regarding Medications

While we respect people’s right to be on whatever medications they are on when they first start therapy, there are some medications that can limit your response to the therapies that we do. We also respect that medications are a norm in our society and is often prescribed as a first response to mental health. As therapists, we also experience clients desire to come off of medication or often explore the regret of clients having gone on them in the first place because of the social stigma and societal/familial pressures. We are not prescribers. We can work with you and your prescriber to come off of your medications if that is your goal. But please know that they can limit outcomes or prolong results.