FAQs | Kramer Counseling

Frequently Asked Questions

How do I know if telehealth is right for me?

Telehealth can be a fantastic option for many people, but like anything, it has its pros and cons. You will want to make sure that you have the appropriate technology to participate in a telehealth session, which means a camera, microphone, and access to strong wifi. You will also want to ensure that you have a private space to participate in a telehealth session. It will be hard to be vulnerable and engaged if you are concerned that someone can hear you in the next room. Another factor to consider is whether the intensity of the issue you are seeking services for can be adequately treated through outpatient telehealth therapy; this is something I am happy to help you sort out during the initial consultation and will continue to revisit if safety issues arise during the course of treatment. Some people prefer in person sessions and benefit from the commute to and from therapy to think about what they want to say and consider what they're taking away from the session. Other people prefer participating in therapy from the comfort of their own space and benefit from the added convenience of eliminating a commute. Joining therapy from your own environment also allows me to get a different sense of what your world is like and allows you to use the resources you have at hand to practice therapeutic skills in session.

Do I have to turn my video on to participate?

Short answer, yes. Long answer, yes for a variety of reasons. The most fundamental and non-negotiable of those reasons is that it is a safety issue. During the time that we are meeting, you are in my care, and I need to know that you are safe. If your camera is off and you, for example, pass out, all I know is that the sound cut out or there was a large "thud," I can't see that you have passed out and access appropriate resources to follow up and make sure that you are safe. The other reason it is important to turn your camera on for sessions is that a significant portion of communication is non-verbal. Having your camera on improves my ability to understand your experience and how the content of the session may be impacting you. There may be times where we experience technological difficulties or other barriers that result in us meeting with video off or via the telephone; however, this would be an outlier due to unforeseen circumstances rather than a regular or planned occurrence.

What happens during the initial 15-minute phone consult?

The initial phone consult is designed to allow us to briefly connect and see if we may be a good fit to work together. I will ask for more information about why you are seeking services and do a brief assessment to determine whether I feel I can safely treat you in an outpatient telehealth setting. You will have an opportunity to ask any questions you may have about me, my approach, my policies, and/or the therapeutic process in general. If we both feel ready to proceed, we can use this time to schedule your first session. If either of us needs additional time to consider whether this is a good fit, we can set a timeline to follow up via phone or e-mail or leave it open-ended if that's more comfortable for you.

What do the different types of modalities you mention mean?

The world of therapy comes with a lot of different acronyms! Below I provide a brief overview of the modalities mentioned in the "My Approach" section to give you more information as you consider what kinds of therapy you might be interested in. These are all established theories and modalities that I have learned about through my training as a therapist. If you were to ask someone else about these same approaches, they may highlight different underlying principles, concepts, or ways that they apply the theory/modality. I provide this overview to give you an idea of how I think about these approaches and incorporate them in my work with clients.

Acceptance and Commitment Therapy (ACT): This modality focuses more on the process of identifying your values and living your life according to those values rather than the outcome of meeting a specific behavioral goal. For instance, if your overall reason for entering therapy is to improve your relationship with food and body, the goals you set through an ACT lens may be more focused on spending time with friends and family, engaging in more leisure activities, setting stronger boundaries, etc. The idea is that the more you are living your life according to your values, the less you will tend to engage in behaviors that pull you away from the things that are important to you.

Attachment Theory: Attachment theory focuses on how our relationships with primary caregivers as children impact our sense of security in relationships with others into adulthood. When someone is raised in a household with consistent, present caregivers, they are more likely to develop what's called a "secure attachment," meaning they have an underlying sense of security in themselves and their relationships and can feel comfortable giving and receiving affection and space. Alternatively, if someone grows up in a household with inconsistent caregivers, they are more likely to develop what's called an "insecure attachment." This can show up as either anxiety - an intense drive to know one is connected to the important people in their lives - or avoidance - an intense fear of being overly reliant/connected to others and thus a tendency to withdraw from relationships when they get too close. Using the example of working on a relationship with food and body through the lens of attachment, we might explore how early childhood experiences impact your sense of security in the world and how this shows up in your relationship with food and body, working on increasing your ability to trust and care for yourself.

Biopsychosocial Theory: Biopsychosocial theory looks at how multiple factors can contribute to a person's challenges, specifically biological, psychological, and social factors. In addressing difficulties with food and body, one might apply this lens by looking at any biological vulnerabilities (e.g., family history of disordered eating, other health conditions, etc.), identifying any underlying psychological factors that may be contributing (e.g., a tendency toward perfectionism, co-occurring depression or anxiety, trauma history, etc.), and exploring social factors that may predispose one toward these struggles (e.g., experiences of being bullied, family messages around food and body, being involved in activities that emphasize specific body types, etc.). Better understanding the various contributing factors that underlie and reinforce a problem can help identify strategies for addressing that problem.

Cognitive Behavioral Therapy (CBT): This approach focuses on the way we think and how this influences our emotional experience and the choices we make. Once we identify ways of thinking that contribute to difficult emotions or limit our choices, we can learn strategies to challenge, reframe, or otherwise shift that thinking in ways that better serve us. Using the same example of seeking therapy for improving your relationship with food and body, goals you set through a CBT lens may address things like identifying and challenging thought distortions that contribute to your difficulty with food, practicing affirmations, or identifying and addressing core beliefs that form a basis for your difficulty with food and body.

Dialectical Behavioral Therapy (DBT): DBT was originally designed to treat folks who experience borderline personality disorder; however, it has since been effectively used to treat people who experience all kinds of difficulties, including eating disorders, substance use disorders, and trauma. Many DBT skills are widely useful even for folks who don't experience significant emotional distress. DBT skills are broken down into four categories: mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. Using the example of working on one's relationship with food and body, DBT skills could be used to help you manage behavioral urges, to tolerate moments of intensified body image distress, and/or to support you in more effectively communicating your needs.

Existential Theory: Existential theory approaches challenges from a combined lens of philosophy and psychology. It tends to focus on asking the bigger questions, such as exploring purpose and meaning. Using the example above, through this lens we might explore what you want your life to mean and how your current relationship with food and body allows or interferes with your ability to show up in the world in a way that feels meaningful to you.

Person-Centered Therapy: The underlying assumption of person-centered therapy is that we all want to be our best selves and that when we are met with the appropriate conditions for change, people will generally move in the direction of healing and growth. Person-Centered Therapy highlights the importance of autonomy and self-determination, putting the client in the driver's seat of their care.