Frequently Asked Questions

Will substance use counseling with you work? I need it to work.

In an ideal world, I would ask you how you define “work.” We’d use your answers to co-create treatment plan goals. When clients are aware of what they need and want, the likelihood is increased that counselors can offer therapeutic methods and support that will be helpful.

In the real world, the question “Will it work?” usually means, “Will counseling work to make me abstain?” Most people with substance use issues are required to abstain from banned, illegal, or non-prescribed substances, or to cut back on, or abstain from, legal or prescribed substances. While counseling /= abstention, counseling can help. After medical care – which may or may not include medications, based on your medical providers’ recommendations for your individual case – individual counseling is the first line of care recommended by Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Since 80% of people with substance use issues do not get care, including counseling, we’re increasing the odds of abstention simply by engaging in individual counseling.

On the individual level, no one can pinpoint the causes of individual substance overuse or misuse, nor the causes of reduction in, or abstention from, substances. Even if we could go back in time and watch the story of the person’s substance use unfold, we wouldn’t be able to still the frame with an “Aha!” We would be unable to do the same for someone able to abstain, although he or she might attribute the difference to a particular moment when “the lightbulb went on.” The brain is too complex, and life is too complex, to know for sure. However, beautiful, complex human brains have devised experimental methods that let us generalize about what’s true for large groups of people. Research conclusions mean: “Most people, most of the time, do better with these methods, better than with those methods, and better than with nothing.”

According to the Surgeon General’s report, medical care, including medications, is first-line care for substance use disorders. Counseling is recommended in support of medical care. I offer counseling methods that research suggests helps people abstain. I offer no guarantees. But I think we increase the odds of people with substance use issues feeling better and doing better when offered evidence-based methods rather than belief-based, or theory-based practices.

Do you require me to abstain while I’m in counseling with you?

No. If during our sessions, you and/I or determine you would not be able to benefit from counseling, we will end the session.

Do you do drug screens?

Absolutely not.

What if I relapse while I’m in counseling with you?

In an ideal world, with kindness and without judgment, we would create a timeline of the past few weeks, then seek clarity on what you were feeling and thinking, and what was going on around you and in your relations with others, prior to an unintended return to use. We would co-create next steps based on your wants and needs.

In the real world, if your return to use is without consequence, we would do the same. If an outside entity detects substances in a urine screen, or your behavior results in involvement of authorities or employers, sanctions are to be expected. In this context, we will co-create next steps.

Why don’t you take insurance?

I created a business plan prior to launching a small, part-time, private practice. Based on my analysis of overhead expenses – office rental, electronic health record software, liability insurance, etc. – and the few hours I’m able to offer counseling sessions, I could not see a way to cover expenses and generate an income with the discounts required by insurance, nor with the expense of paying a billing service. Many people with substance use issues want to receive care in private as well, with no third-party payers notified. I may take insurance in the future but, for now, clients self-pay for sessions online.

Why do you charge the full fee for missed sessions?

My time is precious to me and cannot be replaced. While the value I offer clients is the service they pay for, the cost to me is my time. For an exchange of value to occur, I need to receive payment for the time I set aside specially for each client.

Why is Handshake Media, Incorporated listed on my credit care/debit card statement for counseling sessions with you?

I founded Handshake Media, Incorporated in 2008. It has served as the umbrella corporation for multiple enterprises, including a behavioral health software platform, and an addiction recovery mobile application. It is the business entity through which I offer counseling services.

What is your view on medications?

I am not a medical professional and would not presume to, nor am I qualified to, offer opinions on which medications you should and should not take. If you are denied access to medical care, and wish my assistance, I will advocate for you. Based on your wishes, I will work closely with your medical providers to support the medical care you receive.

What is your view on 12-step recovery?

Spiritual and/or religious beliefs, practices, rituals and gatherings may be personally helpful to people. In and of themselves, spiritual or religious beliefs, such as those of 12-step recovery, are not supported by research as necessary or sufficient to help people abstain from problematic substances. Clients of all faiths and no faith are welcome. Clients are welcome to hold beliefs of all kinds that give them strength and comfort. The evidence-based therapeutic modalities I offer do not include 12-step recovery.

Are you in recovery?

I am in remission from alcohol use disorder. I have abstained from drinking alcoholic beverages since December 28, 2012. The opinion of professionals, including my own, is that I developed alcoholism after traumas experienced in 2007 when I was near the age of 50. I use evidence-based treatment protocols to support my current state of remission. I chronicle my evolving understanding of my personal recovery story here.

Can my partner/parent/child attend sessions with me?

They can. This may or may not be helpful to you, however. Let’s talk first about your treatment goals and go from there. Sessions with more than one person present are billed at the couples/partners rate.

What do you expect from me?

If you have substance use issues and you make it to my office, you’ve exceeded expectations already. If you’ve even shown up, you’re ready and willing enough for counseling to be helpful. I honor your arrival. Welcome.

What can I expect from you?

Kindness. Respect. Attention. Focus. As much skill, knowledge and expertise as I can bring to the moment, moment after moment. Good grooming. A nice office. This approach. Desire to understand. Willingness to be told I don’t understand and to listen harder. Willingness to recognize when I’m wrong, say so, and apologize. Directness vs. directiveness.  Getting done what I say I’ll do. Energy. Determination. Respect. Kindness.

What might I expect from you and not get?

Abstinence. Given that the primary symptom of the illness is use, mandated abstinence illogically – and, in my opinion, unjustly – requires people to be symptom-free on demand, without treatment. Abstinence is society’s requirement, not medical science’s goal. Most people with substance issues have received no treatment, incorrect treatment, or been subjected to harmful practices. That means many of us have had a tough illness for a long time. We may need to unlearn misinformation and rethink some things we thought were true. This all takes time. However, we’re pioneers using evidence-based treatment that is more likely to result in intended outcomes than other methods.

Friendship. It’s natural, humane, and generous to want to become friends with one’s counselor. This is especially true in a small town, and even more true among people with substance issues who may be part of a local recovery community. We are likely to see each other outside of sessions, whether at the grocery store or a recovery event. The beauty of having a counselor – I have one as well – is that the interactions are intentionally all about you. Friendships are mutual and naturally require taking turns. In a counseling relationship, it always is, and should be, your turn. If we see each other in public, I will follow your lead on whether you want to acknowledge knowing each other. This may be challenging to navigate at times, but with awareness and openness, we will do it.

A sparring partner. If you want to debate issues related to addiction treatment and policy, I am not the counselor for you. I do attempt to change hearts and minds in favor of humanity and science, but I limit my activism and advocacy efforts to writing and speaking. I treasure spending counseling sessions in counseling.

What will counseling sessions be like?

Even the room for skills-focused counseling is set up differently from traditional counseling. Instead of counselor and client sitting in soft chairs, exploring possibilities, we’ll sit at a round table in chairs with rollers. At the first session, we’ll talk about your situation, your needs and wants, and co-derive a treatment plan. At subsequent sessions, you’ll check in and share what’s going on with you, then we’ll work at the table on a skill specific to your plan. As the end of the session nears, we’ll gather together our observations and your gains. I’ll ask you to make a statement of your progress for your notes, and we’ll plan next steps.

I’ll meet you in the waiting room, then bring you down the hall to the fourth door on the left. My office is one of four in a suite with other practitioners. My office has been newly painted and carpeted by the owners of Colony Park. All the office furniture is new. The bathroom is at the end of the hall, the last door on the left.

Group therapy sessions will be like this.

Can I stop going to counseling? Will you tell me when I’m ready to stop?

Unless you are mandated to treatment, your decision to engage in counseling is voluntary. Therefore, you may choose to stop at any time. If this should happen, you are asked to attend a final session to discuss concerns before terminating. If you are mandated to treatment, but are not finding working with me to be a fit, I will help you find another counselor if you wish, or you can search for your own. Virginia Tech maintains a database of local counselors here.

My experience is that both client and counselor become aware at about the same time that treatment goals are being met. Either party can bring up the subject at any time, and both clients and counselors can find it useful to discuss when and how counseling might end. The client is the expert on his or her own treatment, however, and is always the decider – and rightly so – on the continuation or discontinuation of counseling.

How can I contact you in case of emergencies?

In case of emergency, call 911, or go to the nearest emergency room.

If you live in the New River Valley of Virginia and are experiencing a mental health emergency, call ACCESS, 540-961-8400.

Please text me. Unless I notify clients I am out of town, I intend to respond within 24 hours. If you do not hear from me, again, call 911 or ACCESS.

Last updated 9/13/18