Frequently Asked Questions

  • Where are you located?

    I’m online only at this time which means that I can provide services statewide, to anyone anywhere in North Carolina! I have offices in Mooresville and Winston-Salem & collaborate with multiple farm locations in Mooresville for equine-assisted sessions.

  • Do you offer evening or weekend appointments?

    Appointments are generally offered 10:30am through 6:30pm Monday-Friday. I do at times offer some limited weekday early evening and Saturday spots that are reserved for those with true need due to their work or school schedule – you can always inquire about availability of these times, but they do tend to stay booked. Ways to problem solve attending sessions could include online sessions during days off, lunch breaks, commutes, or discussing an adjustment to schedule with your employer to maintain a standing appointment time.

 

  • How much do office/online/equine-assisted sessions cost?

Rates and options for payment are described on the Investment page. If you are using insurance, your actual out-of-pocket payment responsibility is determined by your plan. Insurance information and your date of birth, as well as that of the primary policy holder if different, are required prior to your first session so cost can be determined. If you have financial hardship or no insurance contact me and we can discuss options.

  • Do you take insurance?

    I am in-network with most Cigna and BCBS plans including BCBS State Health Plan (some limited network plans including but not limited to value, local, medicare plans are excluded). If you have an in-network plan I will submit claims for you and you will be responsible for paying whatever your plan dictates as your responsibility based on copays, coinsurance, and/or deductibles while insurance covers the rest of the fee.

    If you have an insurance I am out-of-network with, I am happy to provide a superbill upon request for sessions so that you can submit claims based on your out-of-network benefits. The Reimbursify App makes it easy to submit out-of-network claims on your own

    I also take self-pay, sometimes called private pay.  In addition to those that may have to pay out of pocket due to not having mental health benefits through insurance, self-pay also allows more flexibility and privacy for your sessions without risking insurance dictating treatment or later “clawing back” payment for claims that you would be responsible for.

    See the Investment page for more info on rates, self-pay, and insurance options. Contact me with any questions.

  • Will a diagnosis go on my “permanent record?” Will this reflect negatively on me in the eyes of my professional organization?

  • When you engage in therapy services a diagnosis is used to help ensure effective treatment planning and it is required if you plan to use insurance. Your diagnosis is a confidential part of your treatment, but diagnoses are required to be shared with insurance companies to justify “medical need” for claims to be paid. We must acknowledge our history to learn & grow from it – the medical & mental health professions did start out using the “illness model” and illness related language to discuss physical & mental health. Counseling as a profession has recognized the problems with this, no longer agrees with the “illness model” & has been approaching therapy from a “wellness model” with focus on highlighting client strengths for a while now. As providers we are constantly striving to improve the language that we use to discuss mental health.  However, it is also a priority that our clients be able to afford services. Insurance companies generally have a goal of trying to get out of paying out on benefits –  the more premiums they take in & the less claims they pay out the better for their profit margins. Insurances continue to necessitate use of “illness model” language in order to justify payment on benefits – they require a diagnosis & progress notes that show that enough is “wrong” to fit the definition of medical necessity and without some compliance with a majority of clients would be unable to afford services.In reality a diagnosis is not an indication of someone being  broken or something shameful. Every person could probably meet criteria for some diagnosis at some point in their lives.  A diagnosis is just a collection of symptoms or attributes that give us a way to best conceptualize treatment according to the DSM-5  & to let insurance know that what specific things we are addressing. Anyone and everyone can benefit from going to therapy and learning additional life, reasoning, self-inquiry, and communication skills regardless of their diagnosis or their perceived level of functionality. The most high-functioning, successful individuals can still at times meet criteria for an adjustment disorder, trauma or stress related disorder, anxiety, depression, etc., especially when facing life stressors or engaged in high-stress jobs.
  • To my knowledge, no professional organization should have access to your mental health or medical records unless you sign a release of information for them to have access or if it were to be part of a court order. Professional organizations may ask you to self-disclose certain mental health issues which may impact job performance such as substance use disorders. Employers and professional organizations most likely want to see that you have a plan for addressing the issue to keep it from negatively impacting your work performance. In fact, not seeking mental health services is more likely to negatively impact your functionality at work. I believe the view on seeking mental health care is shifting, particularly for veterinarians and other professions with high rates of suicidality, and it is being seen more often as an appropriate, necessary, and responsible preventative measure. If concerned you could ask a for a hypothetical clarification on policies around this from your board, professional organizations, employer, or supervisor.Please don’t let fear of a diagnosis stop you from getting necessary help. If you would like to further increase privacy of your mental health diagnosis, you may consider paying out of pocket, or what’s known as “self-pay”, without the use of insurance. This helps ensure that your mental health files remain confidential and will not be shared with insurance companies. Some people may not meet criteria for a mental health diagnosis, just want help with life planning and goal setting, or they may have a mental health diagnosis that some insurance plans may not deem “medically necessary” – these situations would also be appropriate for self-pay in order to access mental health treatment without the need for a diagnosis. Discuss your concerns with me and I will be happy to answer any questions you may have and work out a reasonable solution that will help you feel more comfortable with coming to therapy.

  • Do you have experience offering services to diverse clients? Are you affirming/an ally of LGBTQIA, Non-binary,  Poly, BIPOC, Vegan, Secular/ Atheist/Agnostic, Sex/Kink Positive, and Body Positive clients?

            Yes, I strive to offer a culturally competent practice and a non-judgmental space to be yourself.  I help ensure support for diverse clients by using evidence based, client centered, & validating approaches to therapy, working to educate myself, & seeking to have awareness of my own privileges & bias in different situations.  I am a member of the Secular Therapy Project and am committed to providing secular (not faith-based) counseling services. Ethical veganism, vegetarianism, environmental issues, & animal advocacy are a big part of my life outside the office. I know the pain, frustration, & barriers that can come up when we encounter family, community, or society being unaware, dismissive, or anti-.

Therapy should be a safe space for you to discuss any aspect of your identity without judgement. I operate from an existential philosophy that we each create our own meaning/”purpose” in life. I believe each person’s life and experience is unique, so I encourage you to inform me about yourself and I may ask questions to better understand what is important to you.

            *While I assist many clients that are transgender or non-binary in coping with depression or anxiety, I am not a gender specialist & do not feel that I have adequate specialized training in that area to provide the level of support, advocacy, or documentation needed during the medical process of gender transitioning. I recommend having a specialized gender therapist and medical provider who are informed on all the details of the medical process and what to expect during that time.

Equine-assisted psychotherapy is an experiential approach to therapy that incorporates evidence based practices like Cognitive Behavioral Therapy, Narrative Therapy, Motivational Interviewing, Dialectical Behavior Therapy, etc. with in the moment interactions with a herd of horses in a natural environment. The herd and outdoor area provide us with a space to create external representations of our emotions, stressors, and relationships. These external representations allow us to have internal distance from an issue to more easily discuss, process, and cope through it, as well as a hands on, concrete way to practice new behaviors and problem solving. Horses are prey animals with complex social systems making them very sensitive to their surroundings including nonverbal communication, body language, and space/boundaries.  Their reactions, behaviors, and interactions with you can be used to illustrate in the moment issues and interactions that also occur for you outside of session and to build metaphors and narratives that can be applied to daily life, stressors, and relationships. Check out the EAP specailty page for more info.

Yes, these sessions are still covered by insurance because the primary focus of these sessions is providing a mental health office session (typically billed as codes like 90834, 90837, etc) to address an established diagnosis and treatment plan goals with evidence based interventions, all of which is reflected in the progress notes which documents for insurance that appropriate, evidence based mental health practices are being used in session. Our office just happens to be outside for these sessions.  In this way equine-assisted psychotherapy differs from other hippotherapy & equine therapies whose primary focus is on physical issues, riding, or horsemanship without training or use of mental health based diagnoses, treatment plans, or evidence based practices. For example, even though you might do “walk & talk therapy”, play ice breaker games, or use a sandtray, worksheets, or other activities in some therapy sessions, those sessions wouldn’t be billed to insurance differently because of those activities – equine-assisted psychotherapy is the same concept.

  • Can I visit the farm/horses outside of my scheduled session time? Can I work/volunteer in the stables? Can I participate in riding at the farm?

No.  Due to safety and privacy concerns, appropriate therapeutic boundaries, and out of respect to the farm owners, we ask that you please do not present to the farm or office outside of your scheduled appointment time. Please do not enter the fenced areas without myself or an equine specialist present. Violation of this will be considered trespassing onto private property and may impact your ability to continue sessions. See the EAP specailty page for more info.

  • Do you offer letters or recommendations for Emotional Support Animals (ESA)?

            No, I do not provide recommendations or letters for Emotional Support Animals (ESA). While I recognize the mental health benefits animals can provide for anyone, I have not received formal training on this and consider this to be outside my scope of practice at this time for many reasons. This article discusses some of the role conflicts that can arise with providing expert opinion or recommendations for therapy clients.  Most importantly in my opinion, there is no way for me to verify through our therapeutic interactions the quality of care you will provide to a support animal or the safety or stability the animal will or will not have in the environment you are seeking to keep it in. Not only are there liability implications if the support animal were to physically harm someone or damage property, there is also the personal moral liability of responsibility that I feel to the animal if care is not maintained or if it is taken into an environment not set up to appropriately accommodate animals and their space and environmental needs.

There are several online entities that claim to assist with obtaining ESA letters – I have heard positive feeback about  https://americanservicepets.com/ – I am not affiliated with the website, so of course I can’t guarantee or speak for their services. You may also try checking with your Primary Care doctor (PCP) or Psychiatrist as sometimes these providers may be willing to provide documentation for ESAs.

I also do not provide recommendation or letters in regards to service animals or determinations of disability. Service animals and support animals have different rights and legal protections, for more information please see the ADA’s explanation.

  • Are Emotional Support Animals (ESA) allowed in session?

            I love animals and really enjoy when service animals, support animals, or pets are able to join you for office or virtual sessions! Support animals or pets are welcome to accompany you to office or virtual sessions if they are potty trained, will stay with you and within your control, and will not be a distraction to you or other clients receiving services. If they become a distraction I may ask that you discontinue bringing them to session in the future. You are responsible for cleaning, replacing, or paying for any damages that occur as a result of your pet’s behavior, so please be mindful of knowing limitations prior to deciding to bring them.

Support animals are generally not allowed in group sessions due to distraction and potential allergies or discomfort of other clients. Support animals are not allowed in Equine-assisted Psychotherapy sessions for the safety and comfort of your pet and the other animals involved in session.

Service animals are different from “support animals” and have different protections that are governed by the ADA, for more information please see the ADA’s explanation of differences.

 

If you still have additional questions about concerns not answered here please email and I will be happy to provide more information!

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