Frequently Asked Questions

There are thousands of therapists in Colorado to work with. Some are outstanding, but many are not. It can be frustrating when a therapist just nods and listens, or doesn’t deeply know their craft. We focus on what helps and we bring our care, our knowledge, and our commitment to each session.

We return phone calls. Almost always within 24 hours. Sometimes we even answer the phone when you call! Don’t you hate when you’re trying to take care of something important with a professional and you can’t even get a call back? We don’t leave you waiting.

We show up on time. Having been in the field a while, we’ve heard the stories about the therapists who continually show up 15, 20, or even 30 minutes late. We find this tremendously disrespectful, and we should almost never be late (even by 5 minutes).

We care more about you than about our theories. The psychotherapy profession is full of passionate and committed partisans about the best ways to help people change. While we share the passion, decades of research to find the ‘magic bullets’ for psychological problems consistently show that different approaches help different people. This drives psychologists crazy and we even have a name for it: “The Dodo Bird Verdict” (it’s from Alice in Wonderland if you’re curious). We are not wedded to a single approach that may be in vogue this year (or decade) only to be replaced by the next miracle cure.

We want you to fire us. Sure, we want to be stunningly helpful. But the very best therapists (“supershrinks”) have about a 70-80% success rate with their clients. In comparison to a lot of fields (including medicine), that’s fantastic. But not if you’re in the other 20-30%. So we make sure that we’re heading in the right direction and the fit feels just right to you.

If it doesn’t, we don’t call you a “difficult patient.” Sometimes, the problem is your therapist. If it’s just not working out, we get it; and we invite you to try another therapist at The Colorado Center any time you want a fresh perspective–even just for a second opinion or to experiment with the process. We don’t take it personally–it’s how we operate.

Or we will try to find a colleague outside our practice if that might be a better fit. We’re committed to being the most helpful psychotherapists you can find anywhere…even if that means getting you connected elsewhere.

We talk with each other. The Colorado Center is committed to the highest standards of confidentiality and privacy. This is part of the reason we refuse to submit clinical information to insurance companies (beyond a diagnosis, and even that happens only if you request it). Yet, we also know (and some research backs this up) that collaborative group practices like The Colorado Center often provide better therapy than therapists in solo practices do.

We respectfully consult with each other as needed to improve our effectiveness with our clients and keep ourselves from getting locked into theories or habits that may get in the way of helping you. Rest assured that when we do consult with each other, we do so with a deep reverence for client dignity and privacy; never in the cavalier and disrespectful way that we have seen in the hallways of some doctors’ offices.

We focus more on what we get wrong. Research on top performers in every field shows that the best in their fields focus more on what they do wrong (and fix it) rather than trying to repeat what they do right. We’re about clinical excellence. Excellence requires an extreme devotion to working on our failures and weaknesses so we can build our strengths. We truly want to be the best therapists in Colorado.

No. Our data are scientifically valid. Consumer ratings on sites such as Google, Yelp, and Healthgrades rely on people who are motivated to register and write about their experiences: often fewer than 1% of those who received a service. That’s too small a number to accurately reflect quality. Our outcome data are based on almost all the clients who walk through our doors (coded to protect privacy). So we have a remarkably accurate picture of our effectiveness.

Just as importantly, we measure levels of client well-being, not “satisfaction.” Satisfaction ratings are not ratings of effectiveness because most people are highly satisfied with their therapist even when they feel significantly worse! We are interested in your life satisfaction, not just how much you like working with your therapist!

It depends on which one of us you ask. We all have a somewhat conservative approach to the use of medication, and we differ on the particulars. We’re all familiar with the controversies about long-term effectiveness and the aggressive selling of meds to the American public. Many clients are interested or curious about medications. Others are worried because medications haven’t worked, they don’t want the side effects, and they don’t know what to do next.

We want you to know that we respect our clients’ views on whatever approach to change they are interested in–as long as it’s actually effective. So, one question we would ask you is: “What’s your position on using medications?”

Maybe. We are often using pieces of these treatments without labeling it as such (or perhaps even being aware of it). Similar to our position on medications, the hyping and popularity of specific approaches to therapy rarely stand up to scientific scrutiny or real-world experience. After various biases are taken into account, comparisons between therapies don’t show any of them to be superior to others (see the “Dodo Bird Verdict” in the first FAQ section, above). They are all better than nothing, and that’s about it (that doesn’t keep practitioners of these different approaches from cherry-picking studies that “prove” their method is best).

Like the old saying about “a distinction without a difference,” the several hundred existing psychotherapies are like Coke vs. Pepsi: much of the differences are in packaging and personal preference. Having said that, a factor that does influence effectiveness is a strong allegiance toward the approach to treatment. So if a therapist feels very strongly about their method (and so does the client), this is likely to have a positive impact on the outcome–more so than the particular method that is actually chosen! Again, we are more interested in the outcome: Is whatever we’re doing actually helping? And if you are particularly interested in a certain approach to treatment, by all means please discuss it with your therapist.

Anyone who answers this is just guessing. Researchers on therapy outcomes have been trying to accurately answer this in every possible way for many decades. But the answer depends on so many factors that any estimate is really just a wild guess. Some research shows that the longer a person has struggled with a problem, the longer therapy is likely to last. But this may not be true for you. Some people have a very particular goal in mind, reach it quickly and leave. This may not be true for you. The average client might stay for 7 sessions or 17 sessions, but maybe not you. Clients’ well-being tends to improve the longer they are in therapy. Yet your “trajectory of change” may be quite different than what’s average.

You may be finished and satisfied after a single consultation. Or you may want to work with your therapist for many years in a process of continual development and creative exploration. You might move out of state, start a new relationship or end one, or have an unexpected life event that interrupts therapy, resolves your issues in a surprising way, or plunges you into a new level of deeper work. So one answer to this question is that therapy should take as long as it serves you. And no longer.

First, let’s talk about Medicaid and Medicare: If you are on Medicaid or are “Medicaid Eligible” (called “Health First Colorado” in our state), we are not allowed to bill you or Medicaid for psychotherapy services. You must work with a Medicaid provider if you are on Medicaid, even if you have a family member or someone else willing to pay out-of-pocket. It’s just not allowed.

For Medicare: We can work with you if you are on Medicare but neither you nor we can bill Medicare for our services. We have “opted out” of the Medicare system. When you obtain therapy with us, you pay us directly, and you cannot be reimbursed for these services by Medicare.

For HSA and FSA accounts: Psychotherapy is a covered service under FSA and HSA plans. We will just need your debit card and a backup method of payment (in case your HSA or FSA account runs out during treatment).

For regular PPO/POS health insurance: We are out-of-network for all health insurers. If you have out-of-network benefits, you may be able to submit our statements with a claim to get reimbursement from your insurance company. However, we don’t directly contract with insurance companies or bill them. Insurance companies can be detrimental to the process of therapy by abruptly cutting off treatment, pressuring us to provide certain kinds of treatment, and denying or delaying payment. There are also instances when client confidentiality or obtaining other kinds of insurance can be compromised when health insurance is used to pay for therapy (including difficulty getting disability, long-term care, life, or malpractice insurance after receiving a psychiatric diagnosis). And, to practice psychotherapy at insurance rates, we would be so burnt out and have to see such a large number of clients that it would erode the quality of the therapy we provide.

Please also keep in mind that on rare occasions insurance companies ask us for an “outpatient treatment report” or other clinical information about your treatment. We will not provide this private health information as a matter of policy. If you have requested it, we are happy to provide a diagnosis, dates of service, and all charges on the statement, but will not divulge more detail than that about our clients unless you insist (please see our privacy page for detailed information about this). Please check with your insurance company about whether they require this information.

Finally, you may also be able to deduct the cost of therapy as part of your medical expense deduction on your income tax. Whatever your circumstances, we know that psychotherapy out-of-pocket is expensive, and we take your investment in therapy with us very seriously. That’s why we are so focused on making sure that what we are doing is actually helping.

We actually want you to! Normally, people feel very awkward about breakups: “It’s not you; it’s me.” That sort of thing. We have a very different attitude at The Colorado Center. Rather than feeling hurt or insulted if you don’t feel that you are working with the best possible therapist, we want you to find the best alternative. We know that sounds strange. Imagine your cardiologist, auto mechanic, or attorney doing that! But we know how critical it is in psychotherapy to get just the right fit, and that no one therapist is “perfect” for everyone. It can be difficult to start over and say, “I think I want to see how things go if I try a different therapist.” But your life is too precious to accept professional care that isn’t working for you. When you demand more, it causes all of us to ‘up our game.’ We think that’s how it should be, and we are grateful for the feedback.

Therapy can be very challenging, and conflicts can arise with your therapist which may be critically important to resolve with your therapist. Often, expressing and sorting out the emotions (anger, fear, frustration, disappointment) with the therapist who is triggering them can be incredibly empowering and create a massive shift in your progress, especially if conflicts with others have been a continual problem in your life. But a problem in therapy that can’t be adequately addressed (assuming you’ve tried to bring it up, and that it even feels safe to do so) may signal a need for a change. And a stagnant process that doesn’t seem to go anywhere fresh or new may be a sign that it’s time to go.

At times, we may refer our clients to other therapists in our practice or outside of our practice who might be an even better fit. When we refer you to other therapists, we do so with the same expectation: if it’s not working out, fire us. We don’t take it personally except as a possible indication that we may need to improve the quality of our care. Life is short and therapy is expensive. We want you to get the outcome you desire.

Our practice uses a secure electronic health record system. In addition to your therapist, a small number of non-clinical staff may have limited, role-based access to parts of your record for operational purposes such as billing, IT support, and practice administration. Some of these individuals work within our practice and some work for ARC Health Partners, a management services organization that provides administrative support to our practice. Access is limited to what is necessary for each person’s specific function and is governed by federal law (HIPAA), Colorado law, and written confidentiality agreements. A more detailed explanation of how your information is handled, including who may have access and what safeguards are in place, is available below.

We use secure, encrypted communication and document systems, including platforms such as Google Workspace, Zoom, and Paubox for end-to-end email encryption. We use an internet-based (VoIP) phone system. We do NOT use artificial intelligence products/services to record or transcribe any psychotherapy sessions.

These tools are used for:

• email or phone communication with you, internally as needed, or with those who are legally authorized (e.g., if you sign a release)
• document storage and sharing with those authorized to have access (as explained above) such as for clinical or billing purposes.
• scheduling or administrative coordination

Protections typically include:

• encryption in transit from our mailservers
• account-level security (passwords, multi-factor authentication)
• hardware system-level security (i.e., computer login)
• administrative controls over access (e.g., director of CCCE or IT administrator at ARC)

From time to time, trained IT professionals (e.g., from ARC Health Partners or from the phone or EHR company) may need limited access to maintain, troubleshoot, or secure the systems we use.

This may include:

• fixing technical issues
• updating software
• maintaining security protections
• restoring access if systems fail

Their access is typically:

• temporary
• purpose-specific
• limited to system-level functions rather than clinical review

We all are required, by contract and by federal law (HIPAA, HITECH), and licensees are required by state law (e.g., CO Rev Stat § 12-245-220 and § 12-245-224) to follow strict confidentiality and privacy rules.

These requirements come from:

• federal law (HIPAA, HITECH)
• state confidentiality laws
• written agreements such as Business Associate Agreements (BAAs)
• internal confidentiality policies

These rules typically require:

• protecting your information from unauthorized use or disclosure
• using information only for specific, approved purposes
• reporting any potential breaches

Access is limited to what is necessary for each person’s role.

This is often called the “minimum necessary” standard and may involve:

• role-based permissions (people only see what they need) for accounting, etc.
• restrictions on downloading or copying data
• time-limited access for certain tasks
• monitoring and audit logs
• work is sometimes done remotely (e.g., work-from-home) and on personal computers, in which casehardware and software logins and multifactor authentication are required for all devices using CCCE-based accounts, and all information is kept using the secure methods as described above.

We follow both federal and state laws and only share the minimum necessary information for administrative and operational purposes.

In practice, this means:

• Information is not broadly shared or accessed.
• Only the specific data needed for a task is used.
• Most non-clinical personnel do not review full clinical records.

More detail:

• What does “minimum necessary” mean, and what does it look like in real situations?
  • The main idea is to limit access, limit use, and limit disclosure to the least amount of information and the fewest people needed to accomplish a specific, legitimate task. It applies to payment and operations, and most non-treatment uses. Many organizations, including ours, also apply it to treatment as a best practice even though HIPAA does not require it.
• How it plays out in common scenarios
  1. Treatment (clinician-to-clinician at The Colorado Center)
     • Share information relevant to diagnosis, risk, treatment improvement, and continuity of care.
     • Avoid oversharing unnecessary historical or unrelated personal details.
  2. Internal administrative staff (scheduling, billing)
     • Access only what is needed to perform logistics.
     • Name, contact information, appointment times, and provider.
     • Insurance status, forms, or paperwork may only be seen if required for a task.
  3. Billing and revenue cycle
     • Access to information required to submit and defend claims or provide superbills.
     • CPT codes, dates of service, and provider information.
     • Diagnosis codes, as required by the payer.
     • Limited clinical summaries in workers’ compensation cases for audits or medical necessity.
  4. IT support and system maintenance
     • Access to systems and limited identifying information, not clinical content.
     • User accounts, system logs, and configurations.
     • Occasionally, limited record visibility for troubleshooting.
     • Controls typically used:
       • Masking tools.
       • Supervised or logged access.
       • Temporary permissions.
  5. Quality assurance, supervision, and training
     • Access to records for improving care or oversight.
     • Selected cases or de-identified data when possible.
     • Full records only when necessary for clinical supervision.
     • Use the smallest sample or least identifiable version possible.
  6. External providers or referrals
     • Share what the receiving provider needs to treat the patient, if allowed.
     • Referral reason, diagnosis, medications, and risk factors.
     • Brief clinical summary.
  7. Legal, insurance, or third-party requests
     • Disclose only what is specifically authorized or legally required.
     • Narrow responses to:
       • Date ranges.
       • Specific issues.
       • Defined record sets.
         • Colorado usually requires more restriction than HIPAA alone.
         • Colorado tends to favor targeted disclosures over full records.
  8. Research and data analysis
     • Use de-identified or limited datasets.
     • Remove direct identifiers.
     • Use coded data.
  9. MSOs, contractors, and vendors
     • Access is tied strictly to the contractual role.
     • Billing vendor: billing data only.
     • IT vendor: system-level access.
     • Administrative support: scheduling or document handling.

You are always welcome to ask questions about how your information is handled. You can also request clarification at any time, not just at the start of treatment.