As you can imagine, the COVID-19 crisis has impacted many in-person businesses and many people's ability to maintain physical office space; sadly PST is no exception. In a rather sudden and bittersweet turn of events, PST will be closing both of its current locations and moving to one new space on July 1st, 2020. Unfortunately, the leases at both the North and West Portland locations are expiring and continuing in either office was untenable under the circumstances.
So what does this mean?
PST will continue as is well into June. Those of you who have requested to see me in person with the appropriate social distancing precautions will be able to do so at the N Williams office until I move. I will continue seeing clients online at present, during the move, and indefinitely once I am in the new space.
On July 1st, PST will be located at:
1017 SW Morrison St.
Portland, OR 97205
At that time I will begin developing and implementing policies based on the recommendations from the CDC and the Oregon Health Authority regarding seeing people in person. I am in the process of determining the conditions under which I will begin seeing clients in-person again and will inform you of all the required precautions as we move forward. If you are a current client who cannot see me in-person at this new location nor do you wish to see me via telehealth, please let me know so we can make a plan for your continued care and growth.
Please let me know if you have any questions or concerns. I look forward to continuing my work with all of you in the safest and most effective way possible.
Wishing you all good health and security in these uncertain times,
In light of the severity of the coronavirus pandemic, I am announcing some changes PST is making to better support everyone's health at this time. Know that I will provide updates here and via email to current clients as they arise.
For Current Clients:
Some Further Precautions:
For Prospective Clients:
Yes, I am still open at this time and I am both adding new folks to my wait list and letting people know when I have a spot open in my practice.
Due to the CDC's recommendation that we practice social distancing, I would prefer to see potential new clients via video. When a spot opens up in my practice I will provide you with instructions on how we can access the video platform that we will use to connect. I understand that for some this is not the ideal situation and meeting a therapist over video may feel strange, but these are strange times.
I would much prefer to see if I can be the right therapist for you, while protecting our community from the exponential spread of the coronavirus, than to contribute to the pandemic or to not see you at all!
When a client comes to see me for a free consultation, inevitably the question gets asked:
Do you take my insurance?
I understand why I get asked the question, only paying a co-pay and having your insurance foot the rest of the bill sounds like an amazing deal, like it's too good to be true!
The truth is, sometimes it is too good to be true and there are a couple of reasons why my answer to the question is "no."
Many people don't realize that in order to use your mental health insurance benefits you have to be diagnosed with an illness. Insurance companies call this "medical necessity" and if you and I can't prove to the insurance company that you need the treatment you are seeking, they can deny your request to use your insurance.
Even if you made it past the initial request, I would have to consistently prove to your insurance company that it was important for me to continue to see you, otherwise they may deny you further sessions.
Beyond that, all diagnoses go on your medical record and could be considered pre-existing conditions in the years to come.
Pre-existing conditions can have a significant impact on your ability to secure any health insurance coverage in the future. And even if you are able to obtain insurance with a diagnosis on your record, your insurance premiums, deductibles, and co-pays are likely to be much higher, as protections for pre-existing conditions have been, to say the least, scaled back.
I don't want to take that kind of risk with your well-being.
Say Goodbye to Privacy
Did you know the average insurance claim passes through fourteen people on its way to being approved?
Now remember, in order to use your insurance, I have to diagnose you with a condition relevant to the treatment you would receive from me. That means upwards of fourteen people could find out that you're suffering from a sexual dysfunction, are struggling with a sexual concern, or have a problem in your marriage or partnership.
It's embarrassing enough to have to reach out and talk to someone about your concerns, and the last thing I want is for everyone at your insurance company to know your problems and be the judge of when you should stop seeing me.
And ultimately, if I take your insurance directly, that's what we would do.
Talk about a lack of control over your own situation.
More often than not, couples and relationship counseling is not covered when you use your insurance.
I know a lot of insurance companies say they cover couples or relationship therapy, but there is no such thing as a couple's therapy code for insurance claims, nor is there a diagnosis I could give a couple that would qualify for mental health treatment.
What insurance companies really mean is the person who gets a diagnosis for an individual mental health concern can have their partner present in session while we work on their diagnosis.
But sometimes, even if you meet all the criteria to have your partner present while we work on your depression, low libido, or erectile dysfunction, having your partner in session may not be considered "medically necessary" and so your claim for couples therapy would be denied.
Alana, You Are Killing Me...
I get that you're frustrated, and until I feel that the insurance companies I might contract with are safeguarding your mental health and allowing us to do the work we need to do, I won't be taking your insurance directly.
But let's look at the positives! Not a lot of people realize that, because I don't take insurance right now, I can do a lot of amazing things like:
Ok, So What Are My Options For Seeing You?
Right now, I do not take insurance plans directly, but you have options if you want to see me and possibly use your insurance benefits:
I take cash, cards and checks for all services.
I am able to take Flexible Spending Account cards and Health Savings Account cards.
While being an out-of-network provider for all insurance plans means I do not file with your insurance directly, I can provide you with what is called a superbill, which you can submit to your insurance for potential out-of-network reimbursement.
But be warned that:
If you want to try to use some of your insurance benefits for my services, the best thing you can do is call your health insurance company and ask about reimbursement for outpatient mental health services with out-of-network therapists.
I hope that spending some time explaining why I do not take insurance right now was helpful and informative. If you have any questions about it, please feel free to email or call me with further questions. I would also recommend checking out my Fees & Insurance page for my current rates.
If you think you may be ready to take the leap into therapy with me, head on over to my Contact page.
I would love to hear from you!
What are the secrets to a long-term relationship, not only lasting but, being exciting and fulfilling?
Sadly, I don’t think it’s magic, which means there is some work involved, but there are things that people in relationships do to keep their relationship going strong for many years.
Here are four habits/ attitudes I’ve found in my clinical work that help to keep relationships running like a well-oiled machine:
Do things together
Having shared interests, values and experiences with your partner creates a solid foundation for your relationship.
Doing things together like taking walks to get coffee in your neighborhood, waking up and discussing your plans for the day or attending a class together expands your intimacy.
Couples who have been together for a long time know the importance of having these experiences in their everyday life.
Do things apart
While doing things together is good for building intimacy and showing investment in your partner, you have to balance that out with doing your own thing.
This is because seeing your partner as someone separate and independent from you often injects mystery into your relationship; that mystery breeds curiosity and being curious about your partner is what keeps you going back for more.
When you both consistently do things for yourself, it creates opportunities to get to know your partner all over again.
For many people, the trick to staying together happily is getting to see their partner with fresh eyes from time to time.
It's tempting to think that when you get married or pass a certain milestone in your relationship that all the work is over.
But relationships will change over time, because people change over time.
Practicing flexibility around what comes next for your and your S.O. is another way that long-term couples keep their relationship going strong.
It also makes it easier to be excited about a job opportunity your partner gets that could take you someplace new, or to spice up your sex life in a way you never thought you would have with your partner because your interests changed.
Couples that are excited to be around one another feel a certain sense of closeness.
That kind of closeness only comes when you are consistently connecting with your partner, showing your vulnerability to them, and recognizing their vulnerability when they show it to you.
I know it's strange to think of honesty, trust and safety as things that you do, but the truth is that these larger concepts in relationships are only maintained through small actions every day.
Couples that are still in love, years later, know how important it is to be open and show that you're still there for your significant other in small moments over time.
If you want to show yourself and your partner that you’re in it for the long haul, investing some time and energy into these principles is absolutely worth it. And if you find that some of these areas are hard for you (because something is blocking you mentally, you and your partner have different ways of thinking, etc.), couple’s therapy might be worth considering!
Until next time,
You’re having trouble maintaining an erection or you don’t feel lubricated enough to make penetration pleasurable and it’s starting to kill your desire for sex.
Before you throw in the towel, it could be helpful to check out some contributing factors to a lack of arousal and some things you can do about it:
Consider an organic cause first
If your body has trouble getting physically ready for sex there are a few organic causes you need to check for first.
Hormonal imbalances, nerve damage, low blood pressure, disease or illness; all of these things can interfere with your ability to get and maintain an erection, lubricate the vaginal walls and get your heart rate going in preparation for physical activity.
if you’re concerned that your body isn’t going through the physiological process of arousal, and you’re not sure why, it’s important to see your doctor and get some things checked out. If something is going on, treatments can include hormone therapy, physical therapy and medications, among other things.
There’s also a reason I put this one first; if you don’t get checked out before pursuing other options, like sex therapy, you could be headed further and further away from the solution to the problem.
So if you think this is the reason, talk to your doctor and/or find a qualified medical professional to help you determine if there is something going on physically.
Maybe it's what you're putting in your body
This is going to be another one that is best addressed with a medical professional, but it’s worth considering that what you’re putting in your body is having an impact on your ability to be physiologically aroused.
Substances like alcohol, marijuana and even prescription medications have varying side effects that can absolutely wreak havoc on your body.
As an example, the use of alcohol and/or antidepressants* can result in inadequate vaginal lubrication and an inability to maintain an erection. Other substances can do this too when used daily or to excess.
If you’re suffering from inadequate arousal during sex, it could be worth looking at your habits.
If you’re on prescription medications, perhaps changes can be made to your regimen to address the issue. If you’re having 3-4 alcoholic drinks a night, perhaps it’s time to figure out how to cut back.
Talking to your doctor about the drugs you’re taking and the substances you’re using is going to be your best bet going forward.
Stress? Anxiety? Fear? Oh my...
I know I said that stress interferes with desire, but it also interferes with your body’s physical responses too.
If you’re afraid of getting an infection, getting pregnant, you have a looming deadline at work, you and your partner have been fighting, whatever, your body is going to be expending precious time and energy on these problems over getting you physically ready for sex.
Some would describe it as an evolutionary mechanism we developed to keep us alive.
Think about it, our ancestors had to prioritize running away from that lion over having sex (in order to keep having more sex…).
We may not have to worry about lions anymore, but chronic stress and anxiety produce the same physical reactions in people. Your adrenaline and cortisol levels go up when you start fighting with your partner or realize that your big project is due at 8am tomorrow morning.
As mentioned in the previous post, if stress is impacting your physiological ability to become aroused you should consider:
While addressing these areas might be all you need to feel re-energized around sex, for some there are more complicated issues such as anorgasmia, erectile dysfunction with no physical cause and genito-pelvic pain disorder.
While these issues are scary and can feel hopeless to try and address, seeing a competent urologist or gynecologist and working with a qualified sex therapist or sexual health provider can be an amazing step in the right direction.
Be sure to check out previous posts on the subject: Arousal & Desire: Defining Our Terms and Addressing a Lack of Desire
*Kennedy, S. & Rizvi, S. (2009) Sexual dysfunction, depression and the impact of antidepressants. Journal of Clinical Psychopharmacology, 29(2), 157-164.