I’m a therapist who is transparent about seeking therapy for myself, and who believes both teletherapy and therapy is helpful for almost all people, regardless of the circumstances. Throughout my years, I have undergone my own therapy for different reasons, from wanting support for the trauma I experienced, to learning how to gain the self-esteem needed for me to break free from domestic violence, for simple advice about navigating through transitions, as well as for a means to cope as a caregiver for two parents who both were terminal. Sometimes, too, it felt cathartic just to be able to “vent” to a nonjudgmental, compassionate individual.
Unfortunately, as I’m sure you’ve noticed, it isn’t easy to get a therapist! I’ve had to leave voicemails, emails, and private messages for many local therapists – quite a few who never got back to me, and most who said, “sorry, I’d love to help you but I’m full” without any advice about who I could go to instead. Alternatively, for the therapists who did respond, there were issues with the commute (I require public transportation due to a neurodevelopmental disability) or with timing. For part of my treatment saga, I was also in graduate school and working a full-time job on top of balancing a mandatory field placement, which made it seemingly impossible to fit in self-care for myself.
Talk about irony! I remember it so vividly. I was a social work student learning how to be a therapist, employed at a community mental health agency while also interning at a private practice. I made the time to be there for my clients at the expense of ignoring my own needs. I desperately wanted a therapist of my own, but with the transportation issue, an unforgiving schedule, and the lack of available therapists in the area, how could I?
Then the pandemic happened. The world shut down. Overnight, I had to change meeting with clients face-to-face to going online. I will admit I came with a bias. Years before, during orientation for my social work undergraduate program, a rather old-fashioned professor rambled about why online therapy is a “threat” to the field. Mainly it was that she assumed HIPAA could not be honored or that the relationship was not as “real and organic.” However, now after being exclusively a remote-based therapist since the pandemic to the present, I must admit I respectfully disagree with her. Some of my most intimate, heart-to-heart conversations have been over a video screen. I have shared in my client’s sorrows, hopes, fears, joys, celebrations, and hardships. And I have seen glimpses into the very environment where they spend most of their time – their homes. There is something so powerful, insightful, and raw about seeing one’s home which cannot be captured through the spoken word while in a therapy office. It is truly a privilege to be trusted with seeing the private spaces of my clients, and in turn they get to see mine. Furthermore, teletherapy allows for me to work with anyone if their primary residence is New York State, going far beyond the borders of Suffolk County. This means the people who choose me as their therapist do so because they want to work with me, not because of just location. This arrangement has allowed me to blossom as a specialist in turn, having clients who all fit into my niches (grief/bereavement, complex trauma or C-PTSD, caregiving stress, and/or people with debilitating disease).
Thanks to teletherapy, I too got to have my own weekly therapy. After a somber event happened, I needed a therapist to process my emotions. One therapist who replied to me in a timely fashion offered teletherapy to anyone in the state. She offered everything I needed – experience, knowledge, efficiency, she even liked the challenge of having other therapists as her clients! Perfect! Yet best of all, the flexibility of being online allowed me the flexibility I required to remain efficient in my own role as a therapist to the people I serve. It was simple: I only needed to log in to the teleconference platform right before the session start time. This allowed me to never miss a scheduled session, be proactive about my recovery, and let my “therapy time” truly be 45 minutes (rather than adding in commuting time, which of course could be delayed due to an accident or inclement weather!). Plus, this also meant I got to have more time for other commitments in my life.
Still feeling unsure about teletherapy? Here’s some perks.
There are numerous reasons why teletherapy is beneficial. Here are a few in summary.
Privacy (the BIG one!)
Have you ever ran into someone you know while in the waiting room? Worse, was it someone you have difficulty with because you two do not get along? Yep, talk about awkward. Back in high school, I remember being in the waiting room at a therapist’s office when suddenly a girl I knew came in to pick up her younger sibling. She was best friends with a bully who absolutely loved to torment me. Yep… awkward.
Want to hear another unsettling story? That practice was so disorganized with communication that there was always competition for rooms. One time while I was there, one of the therapists came into the waiting room to ask if any of us would be willing to have our session in the kitchen – the public kitchen, where staff and clients alike could come and go to get coffee. Yeah, I’m not kidding. Talk about a HIPAA violation!
Or maybe you have been spared such severe examples, but most of us can relate to at least this experience: Have you ever overheard the entire conversation between the patient and the clinician while at a doctor or therapist’s office? Or have attempts to soundproof the rooms still proven impossible? I’ve been there, too.
Fortunately, with teletherapy you do not need to be concerned about coming across someone you know in the waiting room, parking lot, or restroom. You can schedule your session for a time where you will have optimal privacy and confidentiality, whether that be in your home, your car, or even in your backyard.
Flexibility
Going to a session is easy when you do not have to drive to and from the therapy office! Clients can schedule their session during lunch break, before work or class, during their baby’s naptime or when the toddler is watching Sesame Street, or any other gap. In turn, it allows me to offer a wider schedule to also suit my clients’ needs.
Flexibility is especially important for clients who otherwise would not be able to fit therapy into their schedules at all. For example, for my clients who are caregivers, it would be impossible for them to commit to in-person therapy because they would need to arrange for care for both the session and the commute. However, with teletherapy, they are only “away” from their loved one for 45 minutes, and they also have the option to step away from the computer to care for them, if needed. Or as another example, say the client has a serious medical issue. They can prioritize their doctors’ appointments without having to suffer from a late cancelation fee because chances are, I can fit them into another time slot for that week. This is not always the case for in-person therapists because they tend to have stricter “on the clock” hours.
Accessibility for People with Illness or Disability
Sadly, although therapists tend to think they are sensitive to those with medical issues, this is often not the case. Their hearts may be in the right place, but they simply do not understand why going to an appointment in-person can be a great challenge. It is one thing for an office to be “ADA-friendly” by having an elevator. But what if the elevator fails? What if the parking lot is full of potholes? What if there is no ramp at the entrance or no automatic door? What if the restroom door is very heavy? What if the person needs their caregiver to help ambulate them but the only appointment times available do not work for the caregiver?
What if the person has IBS or Crohn’s disease? Or maybe they are pregnant? The fear of waiting in line for the restroom is a legitimate concern for such people, in addition to the embarrassment that comes with nosy strangers.
If you have limitations due to an illness, disability, or medical procedure, you may be unable to make it into the office, which will hinder treatment during when it is most needed. Teletherapy removes these barriers by allowing you to “log in” from the comfort of your bed.
Continuity of Treatment for College Students
For some youth, their connection with their therapist is one of the healthiest, strongest relationships they have with an adult. They make great progress, tackling the core beliefs or issues or whatever it is that is hurting them… until they must discontinue therapy because they are moving away for college. In the best-case scenario, the therapist may just happen to know another therapist who is in that area and can take on the referral – but that is almost never the reality. Usually, the treatment is terminated, and the client is left floating, just waiting to hopefully get some help through the counseling center at their college. These colleges may not have enough counselors available to assist every student, lack the training needed for issues that go beyond “typical college stuff,” or other limitations.
On the flip side, with teletherapy, college students can keep their therapist, even those going to a college outside of their home state! In my case, I can keep every student who began with me in high school and has since left for a college that is far away. The only requirement is that their primary address must still be in New York, which usually is the case for college students as they tend to “go home” during breaks.
Reduced Wait-Times
In an in-person setting, there may be a considerable wait time to get an appointment with a particular therapist. However, remote-based therapists tend to have more time slots open and allow themselves to be more available. For instance, if someone needs to reschedule a session with me, that is much easier to accommodate because I can log on during a time when I usually do not work. On the other hand, an in-person therapist may only be able to offer times that are bad for the client, or say they are completely unavailable because otherwise they may have to drive to the office for just one session.
Effectiveness (yes, teletherapy is just as good as in-person therapy!)
Evidence-based research supports that teletherapy is highly-effective for most clients, issues, and modalities – and generally, teletherapy is just as useful as in-person therapy. Sometimes it is even more effective since clients may feel more relaxed being in their homes.
It is only a myth that teletherapy is a “diluted” version of in-person therapy. In truth, most modalities (i.e., EMDR, DBT) can be easily adapted to an online version. For instance, there is a website I use for the bilateral stimulation used with my EMDR clients.
For more reasons as to why teletherapy may be the right option for you or your child, click here.
Are you struggling to get to your therapy sessions consistently?
It is common for busy people, or just everyday people, to miss therapy from time to time. Sometimes it’s a child’s game or event, double-booking for doctors appointments, or you have no energy to engage that day, there are many reasons why therapy may need to be canceled.
You may have noticed that even when you cancel your appointment you continue to be charged, even though you were not seen. Is this normal or should you be worried?
Is It Normal to Charge For Canceled Therapy Sessions?
Yes! It is completely normal and common practice for therapists to charge the full session cost if an appointment is missed.
If you are being charged a late cancelation fee, it is likely because you canceled your session on short notice. For us here at Long Island EMDR, we consider “short notice” anything less than 24 hours in advance. This is common practice for most therapy offices and other medical professionals . We list this policy in our intake paperwork in multiple locations and do our best to review with you during your initial session.
You may be thinking “Okay I get it you charge but why do you charge”? Below I will go over some of the main reasons why we charge for missed appointments.
Your Progress in Therapy Slows
The number one reason we charge is because client’s ultimately lose out when they are not showing up consistently to their appointments. Therapy is not easy- it takes commitment and hard-work. As a practice that specializes in trauma and anxiety, I can tell you avoiding therapy will only serve to maintain your current anxiety and trauma symptoms.
The truth is- the more you avoid facing your difficulties the worse your symptoms will get. We charge to motivate you to face those fears. We believe in the power of therapy and in your ability to overcome your challenges. You deserve to feel better.
As someone who has been in therapy, I know all too well there are many reasons to cancel your session. While your reasons for canceling may be entirely valid, the truth is something can always come up. Many of our client’s late cancel because they are in a bad place emotionally, or are “too drained/anxious/overwhelmed” to deal right now. Canceling really just keeps you stuck in that cycle. Underlying your cancelation is likely a feeling that not attending is the easier option in that moment- and it may be easier in that moment- but it is not what is best for you long term.
Showing up even when it is uncomfortable allows you to work through those difficult feelings and ultimately receive the help you need to reach your goals. Therapy provides you with the support you need to feel better about your life and begin to make changes. Avoiding your sessions will only serve to make your anxiety about attending worse- not better.
Our goal is to help give you every excuse to make your mental health a priority.
We strive to make being consistent with therapy as easy as possible (which is why we always offer to switch to virtual for the day) and to make neglecting your mental health or placing it at the bottom of your priority list more difficult. This is because we believe in your ability to grow and change. Because we know you deserve to make progress towards your goals so you can start living the life you want.
We charge a cancelation fee for the session, because we want you to come. Not just for us- but for you. Because there is a reason you chose to enter into therapy and sometimes in our busy lives we forget that our needs and priorities are important too. Consistently attending ensures you get the most out of your treatment, you are honoring your needs and feelings and you are putting yourself first! Showing up is an investment in you and your future- and we want to encourage that.
Note for Trauma Clients...
Long Island EMDR is known for trauma counseling. Clients seek us out specifically because we specialize in EMDR and are truly trauma-informed clinicians. I founded Long Island EMDR because as a trauma kid I know what the struggle is like. That one cannot simply just “stop being anxious” and that you may not fully understand why certain things trigger you- they just do.
Staff are trained continuously so you can move from past to present. A present unencumbered by the bombardment of triggers and negative self-talk that can take over your life. To help you end that constant “whack-a-mole” of thoughts popping up in your head even though you know they are not rational- which is so very emotionally draining. I believe so deeply in the work that we do and in our client’s ability to find relief- because I have seen therapy work over and over again. Our work and the results and relief we get with our wonderful, truly awe-inspiring clients is what continues to motivate me as a therapist and as the owner of Long Island EMDR.
But as trauma specialists- we also tend to push our client’s out of their comfort zones. We are not “uh huh” or “how was your week” therapists. We really dive deep into underlying issues that cause our clients to feel stuck and work through old patterns and make lasting change!
This can make wanting to come to therapy really hard at times. It can bring up unwanted memories, thoughts and feelings. It is oh so easy to just say- I don’t want to do it any more. Many client’s want to quit therapy at some point- because it often gets worse before it gets better. These feelings, thoughts, unwanted memories, flashbacks and nightmares- may very well trigger you to avoid coming to your sessions.
Trauma kids are really great at problem-solving and avoiding pain. So your brain will very easily come up with tons of reason to cancel. They are all likely valid. What is also valid is the need for you to face your trauma and anxiety head on so your past stops replaying in your present. And to do this you need to come to therapy- consistently.
For EMDR Clients
EMDR clients in particular. Avoiding an EMDR session on an uncompleted memory or “target” is not going to make all the thoughts and feelings that came up with that target go away. You cannot just push it back down- it’s not likely to work. Finishing processing of that target/memory, however will. The more you do it the more memories you work through. And the less true those thoughts of “I’m unlovable” “I’m not good enough” “I’m responsible” will feel. And, the less distressing the memory and its associated triggers will be.
That is why, we are doing you a disservice by not holding you accountable when you late-cancel. Every time you cancel late and we do not charge a cancelation fee, your brain gets a wave of release. Because you successfully avoided the anxiety that week. This makes it more likely you will come up with more excuses in the future. By charging the fee, we are holding you accountable (for my neglected folx this is even more important.) And we are saying to you that your mental health matters. Hopefully this will help you to avoid the avoidance and come consistently. Research shows us consistency will truly help when you are being treated for trauma.
It Affects Your Therapist
For our fee-for-service therapist, if you do not show and are not charged they just lost out on income for that week. If you give them notice, they may be able to move you to another time during the week and not lose out on that income, as well as ensure your consistency. If the practice does not get paid, we cannot pay those therapists. These therapists do rely on you coming consistently to pay their bills.
Most of our therapists are full-time salaried W-2 employees. In order to maintain full-time status they need to meet certain quotas and when clients cancel their appointment it puts those numbers in jeopardy. Though it may not affect their weekly paycheck, if they lose full-time status it does mean they lose all the benefits associated with that- including health insurance and retirement plan. While we would love to offer health insurance and other benefits to all our clinicians, the cost associated with doing so is just not possible unless they meet certain minimum standards.
We understand that most clients are not thinking of how their cancellations affect their therapist. But when client’s consistently miss appointments it is not just employees pay that can be affected- but their lives outside of work as well.
Late-Cancelations Affect Other Clients
As stated above, most of our clinicians are full-time. Many clinicians have little flexibility, especially after school hours to move appointments. If client’s need an additional parent session, couples session, or emergency session and we have notice you won’t be there- we can offer your time slot to those clients. When we have less than 24-hours notice there is not enough time to schedule in those clients who really could’ve used that time-slot that week.
When you just have to Cancel…
We understand there are just some times you will just need to cancel. Maybe it’s a family vacation, a night out with friends, or a big exam. That’s okay. We understand entirely.
We do however need to know in advance. As soon as you know you cannot make it- let your therapist or the front office staff know. We won’t make you feel bad or encourage you to change your plans. We will likely just offer you whatever other time-slots (if we have any) that are available that week.
If you cancel before the 24 hour mark, we will not charge you a cancelation fee. You won’t be hurting us or other clients. And hopefully we can squeeze you in some other time so it’s not interfering with your progress either. As long as you are coming consistently, canceling when absolutely necessary is okay.
If you do cancel within less than 24 hours, we will charge you a cancelation fee of the full fee. For all the reasons I stated above. Please still let your therapist know so they do not worry about you. Hopefully we can reschedule your appointment to another time and waive the fee. But this is not a guarantee as most of our therapists have very full schedules.
Looking for a Therapist?
Our counselors at Long Island EMDR would love to help you on your journey. We have clinicians with a variety of specialties including trauma, EMDR, TF-CBT, LGBTQIA+ issues, grief & loss, teen counseling, caregiver issues, anxiety & depression. Contact our office today to schedule with a therapist and take the first step towards wellness.
Sending Love & Light,