For Patients

The Therapy: ISTDP

The therapy I practice, ISTDP, is probably different from any other therapy that you might have had, that friends or family have described to you, that you have read about, or seen on TV or in movies. While it is “talk therapy,” and while insight is an important component of the work, ISTDP recognizes that insight alone often does not bring lasting therapeutic change. As a result, a central focus of ISTDP therapy is on helping patients face aspects of their inner lives that they avoid, including a visceral experience of avoided feelings. Without this key component, the talking  of “talk therapy” runs the risk of being a form of intellectualized avoidance.

Changing longstanding habitual patterns of thought, feeling, and behavior is not comfortable.  It does not need to involve excruciating pain or overwhelming anxiety—in fact, those get in the way—but ISTDP recognizes that change will inevitably have uncomfortable aspects. If your goal in therapy is to have a soothing “time out” from your difficulties, this is probably not the therapy for you. If your goal is to face your difficulties and move beyond them sooner rather than later, it is probably worth a try.

In most forms of therapy, the first session is primarily focused on gathering history and perhaps making a diagnosis.  The initial ISTDP session, known as a “trial therapy,” lasts 2-3 hours and is focused less on history and more on doing the therapy. This means that in the initial session you can try out ISTDP and often get a sense of whether it may be helpful for your difficulties. Subsequent sessions are typically 45 minutes once a week, though some patients benefit from longer sessions, usually 60-75 minutes.

“Short-term” does not refer to specific number of sessions, but to a commitment to bring meaningful change as rapidly as possible. ISTDP therapies tend to run about 20 to 60 sessions, though some are shorter and some are longer.

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Video Recording

For patients who give permission, I generally make video recording of sessions. This can provide a number of benefits, all depending on what you give me permission to do:

  • Many patients have reported that watching video of sessions has been very helpful to them. Patients who watch the video generally only watch a small number of sessions, but some watch almost every session. Some report that it is like having another session of therapy for free.
  • I sometimes review the video myself, or with one or more therapist colleagues, which helps me improve the therapy I give both to you and to others.
  • I sometimes use video recordings for research, or for the training I give to other therapists, which in turn helps other patients.

For more information, see my “Authorization to Record Psychotherapy” form (link below).

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Insurance

I am an in-network provider for Tufts Health Plans. This means that I can take Tufts HMO and PPO plans, but I am not a provider for Tufts “Network Health” plans. I am also a Medicare provider, though I have unfortunately had to limit the number of slots available for Medicare patients. If I am in-network for you insurance, I issue a bill at the beginning of each month for copays from previous sessions. I can also collect copays at the time of the session if you prefer.

I am not in-network for any other providers (e.g., MassHealth, Harvard Pilgrim, Aetna, Cigna, United HealthCare), and as of June 1, 2019, I am no longer in-network for any Blue Cross/Blue Shield plan. However, if your insurance has an out-of-network benefit (e.g., a PPO plan), it should cover a significant portion of the cost.

For patients with out-of-network benefits:

  • I will have you pay my fee at each session.
  • I can provide you with a monthly “superbill” (receipt) that you can submit to your insurer to receive reimbursement from them.
  • In considering this option, please be aware that if your insurer says that they will “pay 80%,” they are referring to 80% of what they deem “usual and customary” for the services I provide, which is generally significantly less than what I charge; you will be responsible for 100% of my fees above whatever their number is.

If you are using insurance, you should check with your insurer before the first session to find out whether you need prior authorization or referral; typically there will be a “mental health” phone number on your insurance card. You will need to track how many sessions are authorized before re-authorization is required. When necessary, I can work with you around obtaining re-authorization. In general this is fairly straightforward and I do not charge for it. With certain insurers it has proved to be very time-consuming, and in that case I do bill at my clinical rate for administrative time, which is not covered by insurance.

Please note that some insurers have incorrectly told patients that I am “in-network” because of my affiliation with Beth Israel Deaconess Medical Center (BIDMC), where I periodically do consultation work. To be in-network for treatment in my practice, I must be listed under my office address, 68 Leonard St in Belmont, MA (or my previous address, 5 Watson Road in Belmont).

The full ISTDP initial psychotherapy evaluation session last from 2-3 hours. In-network insurance plans does not cover as session of that length, so that there is an additional charge of $250. This is a one-time charge since in-network insurance typically does cover weekly session.

Some patients with insurance choose to pay out of pocket either because they prefer to avoid using insurance to cover mental health care, or because they’re not able to find someone in their provider network that seems like a “good fit.”

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Fees

As of June 1, 2019, for patients paying out of pocket, I charge $275 for a 45 minute session (usually either CPT code 90834 or 99213+90836), and $375 for a 60-75″ session (usually 90837 or 99213+90838).  For the initial ISTDP trial therapy, I charge $650 (usually 99204, sometimes with 90838).  For medication follow-ups, which generally last 10-20 minutes, I charge $150 (usually 99213 or 99214).

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Cancelations and Lateness

For cancelations with less than 24 hours notice, I charge my full fee, generally with exceptions for significant illness, family emergencies, and weather that makes travel dangerous. If you contact me before your appointment time and we are able to reschedule, I generally do not charge even if it is within 24 hours.  Insurance only pays for the time a patient is with me; it does not cover missed sessions.

For patients who arrive late, I still charge my full fee. In terms of insurance, in some cases of significant delay, I can only bill for a shorter appointment, resulting in lower reimbursement. If the reimbursement is coming to me, I bill the patient for the difference between what the insurance pays for the shorter appointment and what they would have paid for the full-length appointment.

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Patient Portal

My Electronic Health Record (EHR) system offer patients the option of using a secure “patient portal.” This is optional, but it allows for things like secure payment of bills on line via credit card. For patients who have enrolled, the patient portal can be accessed at https://natkuhnmd.clientsecure.me.

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Intake and Other Forms

New patients can fill out intake forms through my secure patient web portal. If you wish to do so, please provide me with your email address and I will have the portal email instructions to you. Filling out the forms, whether on paper or on line, is not a guarantee that we will do therapy together. That is a decision that we make at the end of an initial evaluation (“trial therapy”) session.

The following forms are not included in portal intake. I generally provide these at the office, but they are also available here:

If you do not wish to enroll through the portal, you can come early to their first appointment and fill out the forms in the waiting room (I recommend allowing half an hour). You can also print out my nine-page packet for new patients. This packet includes both of the forms linked to above. If you need more than one copy of the Authorization to Release Information form to cover various treaters (e.g. primary care doctor, former therapists and psychiatrists, etc.), use the link above.

In addition to the links above, these two forms are also included in the packet:

  • A two-page summary of my policies on Privacy, E-mail and Phone Calls,Cancellation and Lateness, Payment and Outstanding Balances, Pharmacy Renewals, Incidental Contact, and Ancillary Work
  • My four-page New Patient Information form

My full three-page Notice of Privacy Practices is available here.

When a third party is taking financial responsibility for a patient’s treatment, they should fill out this form, which is not included in the new patient packet.

If you are not able to open these documents, you may need to download the Adobe Acrobat Reader.

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