Frequently Asked Questions About Counseling in General

You know your child better than anyone. Trust your gut! When you notice a struggle that creates more difficulty or lasts longer than what seems normal or more than one life area is affected, it is time to seek assistance. Success is determined by the outcome of reaching your goal(s). Don't delay success any longer. Call today!

Counseling is more about the relationship than anything else. Therefore, it is so important to find a counselor that you and your child feel good about seeing and trust. Even paying $20 for therapy when the relationship is not right is a waste. The counseling relationship models a healthy relationship. In this supportive relationship, your child and you will experience, maybe for the first time, being validated, accepted, and listened to. This atmosphere opens you up to explore, express and gain new insight. Your child can better understand all those BIG feelings, such as anxiety, that can easily get jumbled up. Your child and you will gain healthy skills to assist you without therapy to get you through future difficult times.

Even when seeking services for your child, I also work with the parent(s). Sometimes this will be with the child and sometimes without. The child lives in a family system. Unless the family system changes also, the changes the child makes cannot last on their own. I do not work with children younger than 3 years old

Children, individually, or with their family, will engage in play-based therapy and art-based interventions. Play is the language of children and their vocabulary toys. It may look like we are just playing in therapy, but your child is learning much more. They learn how to facilitate communication, foster emotional wellness, enhance social relationships, and increase personal strengths. Art-based interventions provide a way to express without words. After the art is created, processing prompts will be discussed allowing for better understanding of what is going on inside. Another modality within play-based therapy that I use is Sandtray Therapy. With the use of sand and miniatures, both children and adults, create a world in the sand either with a prompt or without. After the world is created, I will direct processing questions to explore further. Processing continues after the session that can provide insight to the client. Sandtray is powerful because of it being a creative medium. This uses the right brain where unconscious things are stored without any language and yet can heavily affect behaviors. 

Upon completion of your FREE 15-minute consultation, you will receive an intake packet with the forms required for registration via our secure Electronic Management System (EMS). Once those forms are returned electronically, you will be assigned a private portal link to book your appointment. 

Appointments can be cancelled through your private portal or you can always call. Sessions that are not cancelled with a 24-hour notice, will be charged a missed session fee. If arriving later than 10-minutes of your scheduled appointment, you will be charged for a missed session. 

Sessions may be changed to a virtual appointment from an in-person to avoid missed session fees. You will just need to notify your therapist that you would like to change it to a virtual session. 

Not at this time. On Mondays, I have appointments until 6pm. On Tuesday - Thursday, my latest appointment is at 4pm.  Late appointment times may be difficult to secure due to clients booking in advance through their client portal. Once registered you'll find available times in your portal on the appointment calendar.

Sessions work best when scheduled weekly. You don't want to be in therapy forever. This keeps momentum up of the things learned and practiced in therapy.

The duration of therapy depends on the goals that you want to reach. Success rates vary with each individual client or their family. Other factors to consider are finances, insurance approval, and necessity. Typically, clients stay in therapy on average 9 months. 

The first session is where we get to know a little about one another, go over some important aspects of the therapeutic relationship from the intake paperwork submitted online, gather background history, and develop the treatment plan. This session lasts 1.25 hours.

Your investment in therapy will be determined by the way services are delivered. You're very first appointment will be $140 and for 1.25 hours. This intake provides insight of what is being experienced and the history behind the experience. A customized treatment plan will be created to address specific issues. Individual sessions are $100 for 45-minutes to 1 hour. Interventions will be selected based on the issue presented. Family sessions are $110 for 50-minutes to 1 hour. This investment fee is charged anytime more that 2 are present in the session for more than 10 minutes and engage in interventions. Parents and guardians are allowed to update progress without being charged the fee if they do not engage in the intervention. 

You may pay when you book your session through your private portal; however, you will be charged the full rate. If using insurance, please do not pay through the portal. At the end of session, you will be able to pay your adjusted invoice based on your co-pay. If the session is virtual, you will receive an adjusted invoice where you can pay it directly through the portal or you can provide your therapist with the card information while in the session.

This depends on your insurance plan. Insurance requires a "medical necessity" for them to pay or reimburse you. Depending on the presenting issue and the effect on quality of life "medical necessity" may not be determined. To gain "medical necessity" a diagnosis is required from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). I do not take assigning a diagnosis lightly, nor should you. I will only provide a diagnosis if criteria is truly met. If it is determined that there is not a "medical necessity," insurance will not pay or reimburse. If insurance does pay and I am filing your claim, you will be responsible for your co-pay amount.  If seeking virtual sessions (online), your insurance plan may cover. You will need to verify with member services of your plan prior to scheduling to ensure they will cover virtual sessions.

If you are using an insurance plan that I am a part of their network, I will file the insurance for you and you will be responsible for the co-payment amount determined by your insurance. If you have a deductible that needs to be met prior to the insurance paying, you will pay the full investment fee. Please see the Investment Fee on Services page.  If I am out-of-network and you are seeking reimbursement, I will provide you with a superbill (receipt) that will have all the required information on it for you to submit for reimbursement. Please see the section above "Are sessions covered by my insurance?" regarding "medical necessity." 

Each session will be different for each individual child and family; however, there are some similarities. For in-person sessions, the first few minutes is usually checking in to see how things have been between sessions. We will review any changes either improving or worsening the situation and make any necessary changes to your treatment plan. An intervention will be introduced. Depending on the age of the child, it may be play-based therapy. This could be non-directed play, a directed family activity, talking out your situation, a handout / worksheet, reading, art, or game. After the intervention is completed, or during if we are talking, we will discuss about what was learned, the feelings felt from the intervention, etc.

Virtual sessions will be similar to above but online. Activities may require caregivers to gather certain items prior to the session or your therapist may send you the items necessary to engage. If your child is receiving virtual counseling services, a parent / legal guardian / authorized additional participant will be required to be present at the same location as the child. If the parent / legal guardian / authorized additional participant is unable to be present, you will need to reschedule.

These sessions last approximately 45 - 50 minutes. Before leaving, I will assign some practice work to be done in between sessions. Therapy will only be successful when practiced outside of the therapy room and when all is calm. Practicing when not aroused is a must, so your body and brain know what to do when aroused. Just like practicing those fire drills in school when there is not a fire. You are creating what is called procedural memories that will automatically kick in when necessary. 

A new law was recently passed called the No Surprises Act (NSA). With the passage of this law, I am required to provide a diagnosis on a Good Faith Estimate (GFE) for clients utilizing self-pay or out-of-network providers. The GFE provides you with an estimated cost of services. Using your insurance also requires a diagnosis; however, the diagnosis given must be medically necessary. You may benefit from counseling, but it may not be medically necessary; therefore, insurance will not pay. I am not one for just providing a diagnosis. These become labels and stick with you for life. We will meet for more than one session before receiving a mental health disorder, if applicable. You will receive a diagnosis, but it may not be for a mental health disorder. In this case either a V-code (used in the Diagnostic and Statistical Manual of Mental Disorders [DSM-5]) or a Z-code (used in the International Classification of Diseases [ICD-10]) known as other conditions that may be a focus of clinical attention that affect mental health but is not a mental health disorder.

While what is said in therapy is confidential, there are some limitations to confidentiality. We will discuss them in detail in your first session. I do not release any information without your approval unless it is noted under the limitations. You may request records at any time. I am always willing to discuss progress with you. I will not go into the specifics of what is discussed with your child though, unless it is one of the limitations. I would ask you to allow your child to tell you what they want about their play-based therapy session rather than you inquiring. There are times when your child will be assigned practice work. This is where they will learn a skill during therapy and they need to practice it at home. They may require assistance to either help do or to remind them to do their practice work. This is the building blocks of therapy. What we do in the therapy room will not help unless put into practice in the real world. I will inform you when practice work has been assigned.

Counseling is a subjective process. Only you will truly know if it is working. This requires honesty with your therapist. You and your therapist will periodically exchange feedback on your progress during sessions and every 90 days, the treatment plan will be updated to reflect the treatment goal’s progress. If you ever feel that counseling is not working for you, please let your therapist know. 

You have the right to request the termination of services should you feel that effectiveness has diminished or that the goals, as listed in the Treatment Plan, have been reached. Your therapist may terminate as well. Reasons for termination include: diminishment of outcome effectiveness; the therapist is no longer suited to assist with your presented concern once receiving more information; a conflict of interest arises where an individual’s interests may not be consistent with the interests of the unit (family or couple) being treated; if not sharing information is contrary to the client’s (family or couple unit) goals; goals listed on treatment plan have been accomplished; or client / parent / legal guardian chooses not to engage in therapy sessions.

Upon either of these instances, discharge must be completed. Just discontinuing to attend appointments is not the proper way to discharge. Please notify your therapist of your decision and they will assist in the process to ensure that you have the proper resources necessary for your care, including finding another therapist.

If you feel that you are in crisis and need immediate attention, call 9-1-1 or go to the nearest emergency room.

If you do not need immediate attention, you may contact your therapist at 830-444-5064. If you happen to get voice mail, please leave a message stating it is an emergency. I will return your call as soon as possible. If during sleeping hours, realize your therapist may not reach the phone immediately but will respond as soon as possible. If the crisis occurs during normal business hours (weekdays 9a.m. - 5p.m.), please call your therapist at the number listed above. If it is deemed that an appointment is necessary, arrangements may be made for a same day crisis appointment.  

If crisis occurs during an in-person session, your therapist will do an assessment to see what the next step will be. If it is determined that you need further evaluation, you will be referred to one of the behavioral hospitals (in San Antonio, TX) for an assessment.

If crisis occurs during a virtual session, our virtual platform restricts intervention for life threatening crisis and / or non-suicidal self-injury episodes. If the therapist thinks you / the child are / is at risk, TKR COUNSELING SERVICES PLLC will call 9-1-1 or refer you to your local emergency room for treatment.  If 9-1-1 is contacted, general circumstances will be provided of situation, unless client is showing suicidal / homicidal threats. The client’s parents / legal guardian / authorized additional participant, if under 18, will be notified by phone of the situation that precipitated that 9-1-1 to be contacted.

TKR Counseling Services PLLC uses the telehealth platform within Power Diary, our electronic medical records software. This platform is an end-to-end encrypted connection between yours and your therapist's computer. This system meets the HIPAA requirements to be fully compliant. Your therapist will share your personal static link to your appointment room with you via the client portal in your chosen preferred communication you authorized in the intake packet. The link will be used for the duration of services. The link should not be shared with anyone.

You may use a computer, a tablet or phone. You will need to grant access to your microphone and camera. 

Browser requirements for each operating system are as follows: Windows can utilize Chrome or Firefox; macOS can utilize Chrome or Firefox; iOS (iPhone or iPad) can only utilize Safari; and Android can only utilize Chrome. Please make sure you are using the most up-to-date version of the necessary browser. 

A reliable internet connection is necessary for optimal performance. Power Diary does not require a fast internet connection to work - connections with a download speed of 5Mbps and upload speeds of 2Mbps are normally ok. If your internet connection is slower than this then you might notice that Power Diary is slower to navigate and use. You can use the website www.speedtest.net to test your internet connection. A hard-wired internet connection will provide the best picture and voice quality.

You will need to be in a place or designate a place for your child that can provide privacy and use a private secure connection rather than a public one. Using an employer’s computer is highly discouraged. Privacy may include meeting alone in your vehicle; however, it cannot be moving. For Children: Either a parent / legal guardian / or authorized additional participant (form must be on file prior to appointment) will need to be close by, although not in the same room, to assist the child should they experience any dysregulation or have technology issues.

In the event of a technology failure or the virtual connection is not adequate, the therapist will take immediate steps to reconnect. The therapist will ask you to disconnect and then attempt reconnection. If this does not resolve the issue, a phone call will be placed to your / the parent's / legal guardian's / additional authorized participant's phone as the backup step to a failed virtual reconnection. The therapist will make multiple attempts to reconnect. IF RECONNECTION DOES NOT HAPPEN OR IS NOT POSSIBLE, THE SESSION WILL BE BILLED AT THE FULL RATE UNLESS RESCHEDULING ARRANGEMENTS ARE MADE WITHIN 24 HOURS OF THE FAILED VIRTUAL SESSION. It is incumbent upon you / the parent / legal guardian / additional authorized participant, if under 18, to initiate the rescheduling process. NOTE: INSURANCE WILL NOT COVER TECHNOLOGY FAILURE AND THEREFORE, YOU WILL BE RESPONSIBLE FOR PAYMENT IF NOT RESCHEDULED.

If you can click on a link, you can have a virtual session. When booking your appointment, you have the option to select a virtual session. You will receive a personal static link to your appointment room via the client portal in your chosen preferred communication you authorize in the intake packet. The link will be used for the duration of services. The link should not be shared with anyone.

When asked to grant permission to your camera and microphone, say yes.

Research has found virtual sessions to be just as effective as face-to-face when appropriate.

There are some situations when virtual sessions are not appropriate. The following issues / conditions do not lend themselves well to virtual treatment: Clients in acute psychiatric / medical emergency, severe substance use disorders, or eating disorders. Suicidal, psychotic and serious self-harm may need referral for higher level of care. Children may also have a difficult time remaining focused on a screen for the necessary amount of time required. 

Yes, the computer, tablet or phone would just need to be far enough away from clients to have everyone in view.

Unless your therapist holds a license in the state that you live in, you would not be eligible for services. Licenses are state specific.

If you are vacationing in Texas, yes. If you are out of state, the therapist would need to be licensed in the state that you are in at the time of your session. It would be better to not hold a session while you are on vacation, unless it is an emergency, but even then, you would need to be in Texas. You need your time away to be restored not having a counseling session.