I’m new to therapy.  What should I expect?  Is it a lot of laying on a couch and you asking me how I feel?
People who are new to therapy have a bit of fear and concern about entering the process.  Much of what they know about going to a therapist is either from word of mouth or by watching shows on television.  You should expect a brief period of getting to know one another and determining what you would like to work on followed by at least weekly sessions (some clients can benefit from more sessions per week).  During these sessions, we’ll likely talk about what has happened since our last meeting, any concerns, recent developments, dreams, relationships, changes or anything else you want to bring into the session.  Although I may be interested in how you feel about something, there are other questions and observations that are likely to come up for me that I’ll want to check out with you.

I’m scared of what might come up in therapy.  Is there a way to avoid anything scary?
Totally understandable.  Few of us seek out opportunities to be scared on a regular basis.  And yes, some of the material and memories that may surface can be scary to remember and re-experience.  I’m there to help you through that process in a way that feels natural, gradual, safe and avoids a “retraumatization” of the scary stuff.  Therapy is your journey.  You are the driver.  I’m simply holding the map and suggesting the safest route for us.  Sometimes, that means driving right into the fear.  But not always.  We may be able to address your issue(s) in a gentle and slow way, so by the time it’s becoming resolved, you find you weren’t nearly as scared as you thought you would be when we started.

If I need medications or more intensive treatment, can you do that?
I’m not a physician, psychiatrist or nurse practitioner so I cannot prescribe medication or advise you about medical treatment.  However, if either or both of us feel that medication or a medical consultation is indicated, we’ll hope to arrive at that decision together.  Should this be the case, I will do my best to provide you with a referral to a competent practitioner with whom I can communicate regularly to provide you a comprehensive treatment plan.  Should a crisis come up that I feel cannot be managed safely in my office, you and I will work on a plan to help you feel safe and stabilized so we can continue our work together.

What if I can’t afford your fee?  Do I have to stop coming?
These economic times leave all of us feeling at least financially insecure, at some point.  Therapy is a great place to explore these anxieties and figure out how to best manage them.  That being said, therapy is designed to help, not hinder, your growth, and, if finances become an issue, please bring it up in therapy.  Money carries a lot of power in our lives and it can be a worthwhile and deepening discussion to have with your therapist.  There are several provisions and options to ensure you can continue necessary therapy and not have the “money issue” stand in the way.

What if I really am not liking you, or therapy?  Can I just stop coming?
This is your journey.  We start where and when you like and we can always discuss finishing when you feel you are ready or the therapy is no longer working for you.  Similarly, if I feel that another therapist might be a better fit for you or that therapy is no longer benefiting you, we should have a conversation about the next step.  In either case, I would ask that we have at least a session or two before terminating therapy.  Abrupt terminations can be jarring and destabilizing for many clients and can often be replicating patterns in other relationships.  If we are to part company, I suggest doing so in a positive, mutually-decided way that makes you feel you got something out of the process.

What is your cancellation policy?
I ask for at least 24 hours notice to cancel or change an appointment to avoid being charged for the session.  By giving me notice, I can not only make the time available for someone who might need an extra session but also look at my schedule to make time to see you at another slot in the week.

How confidential is my information with you?  Can you just talk about me with anyone?
I hold what you tell me in the strictest of confidence.  Federal and state laws prohibit me from breaching confidentiality in all but a few circumstances.  If I need to collaborate with someone, like your psychiatrist, medical doctor, acupuncturist, etc., I will ask you to sign a written release allowing for such communication.  In session, I will be happy to review the very few exceptions to maintaining confidentiality.  I want you to feel comfortable in disclosing as much or as little as you feel comfortable so you can get the most out of your treatment with me.  I may consult with a colleague about a case, but, rest assured, the specifics of who you are and any identifying information will never be shared.

I’m interested in couples or family therapy.  What if I have a secret that I don’t want my spouse or family to know?  Will you keep that confidential?
Couples and family therapy works, in my opinion, by opening up channels of communication between members.    If you have something you need to tell me and don’t feel comfortable having your partner or family know, we need to talk about the impact of holding such a secret on you, your partner or family, and the therapy.  We want to reduce indirect communication and “triangulation” in the treatment, and I feel secrets can contribute significantly to the problem rather than a solution.  I’m happy to discuss my policy about this with you in session.

What days do you work?
I am in the office Mondays, Tuesdays and Fridays.  I take some later appointments to accommodate work schedules and have times throughout the day, including the lunch hour.  Sadly, I am currently not available on Saturdays and Sundays.

Where is your office?
My office is located on Divisadero Street at Oak Street, close to the 24 Divisadero, 6 Parnassus, 71 Haight/Noriega, 21 Hayes and 5 Fulton MUNI lines.  There is parking available in the lot and street parking in the immediate vicinity.

Ok.  I’m ready.  How do I take the first step?
I’m happy you’re ready to investigate and will be pleased to talk with you about the process.  Simply give me a call at (415) 820-9640.  Leave me a message about when you can be reached and I’ll be glad to call you back so we can chat.  If you prefer to send me an email, please do so.  My email is mrappaport.lmft@gmail.com.  However, I discourage from putting too much information in an email; but your name, phone number, how you have heard about me and what you are looking for is a great start.

I’m an MFT Intern or ASW and I’m looking for supervision.  Can you be my supervisor?
Certainly.  Please call or email me and we can discuss developing an agreement, fee and schedule for both individual and group supervision so you can get those hours towards licensure.

I work for an agency or group and would love to have you do some trainings and in-services.  Can you do that?
Absolutely, I have conducted trainings on a variety of topics, including: severe and persistent mental illness, mood disorders, psychotic disorders, navigating the mental health system, Axis II disorders and treatment, substance use/abuse and mental health, developing a therapeutic alliance and many others for various groups throughout the city.  Please call or email me for more information.