Frequently Asked Questions

The first step is your reading my website and getting a feel for me and my practice. There are a few indicators that I would NOT be a good fit. These are self harming or suicidal thoughts or behaviors, a personality disorder, an active addiction, or an active eating disorder. For a more specially trained therapist, you can search on Psychology Today by your city/zip code and then select the specific clinical issues you are facing to narrow the search. You could also check out Evidence Based Treatment Centers of Seattle.

If you think I might be a good fit for your wants and needs, let's arrange a free 20 minute consultation by phone or video for me to learn more about what you are looking for support with, you can ask me any questions, and we can gauge if we are a good fit. If we decide to arrange a first session together, I will first send you some intake paperwork to fill out and sign online.

1. Our first 3-4 sessions will be an assessment and goal setting phase, in which I’ll be getting to know you, assessing your needs, and together we'll be identifying your goals for counseling. Towards the end of the assessment phase, we will discuss and arrive at two or three top goals for our work together, which we can always revisit and revise as we go. If at the end of 3-4 sessions I do not feel I am the best clinician to serve you, I will talk to you about this and give you three referrals for therapists I believe would be a better fit.

Counseling is a broader term, meaning using any therapeutic technique that assists with someone's mental, emotional or behavioral problems. Psychotherapy is a more specific term that means diagnosing and treating a person with a mental health disorder. Although I can and do sometimes assess clients for disorders to gain clarity on your clinical picture and ensure I am providing you the best treatment or referring you to the appropriate provider, it's not integral to my approach. You may or may not meet "criteria" for a diagnosis, and I prefer to see you as a whole, complex person rather than summed up in any way by a diagnosis.

My standard session length is 55 minutes.

55 mins/$170

80 mins/$260

I accept cash, check, Visa, MasterCard, American Express, Discover, Health Savings Account (HSA) Cards, and Flexible Spending Account (FSA) Cards.

I am also contracted with Lyra, the Employee Assistance Plan. If your employer uses Lyra, please contact your HR department to access this benefit and working with me. Your plan will have a maximum number of sessions covered per calendar year.

Yes, I have a a limited number of sliding scale spots available.

I find that although insurance can mitigate the cost of counseling, it can also bring major limitations around kind or duration of your care. For these reasons I have chosen to not be listed as a preferred provider with any insurance carriers. However, I am considered an Out of Network provider, and some insurance plans offer considerable or full reimbursement for counseling with Out of Network providers, depending on your benefits.

I can provide you with a monthly "superbill" (a kind of receipt) for you to submit to your insurance carrier or employer for possible reimbursement and/or flex spending purposes. Insurance carriers can ask/require that you meet criteria for a mental health disorder in order to reimburse.

I am contracted with Lyra, the Employee Assistance Plan. If your employer uses Lyra, please contact your HR department to access this benefit and working with me. Your plan will have a maximum number of sessions covered per calendar year.

I suggest calling the customer service # on the back of your insurance card and asking:

- What are my mental health benefits, if any?

- Do I have out-of-network coverage?

- What is the coverage amount per session?

- How many therapy sessions does my plan cover?

- Do you only reimburse for certain diagnoses, procedure codes, and/or session lengths?

- How do I obtain insurance reimbursement?

- Is approval required from my primary care physician prior to receiving therapy services?

- Do I have coverage for telehealth ( video) appointments?

You have a right to a Good Faith Estimate (GFE) that outlines an estimate of what your psychological services may cost. Because I am an out-of-network provider and as my client you would be paying for my services out of pocket rather than directly through your insurance, you are entitled to a GFE to protect you from unanticipated "surprise" health care bills secondary to non-emergency care. While I will discuss fees and payment with you before you schedule services, you can request a GFE and review the expected costs at any time. If you receive a bill that is $400 in excess of your GFE, you are allowed to file a dispute. Please learn more at https://www.cms.gov/nosurprises

My standard session length is 55 minutes, however depending on my availability and your needs we may decide to meet for 80 minute-long sessions.

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With most clients we start meeting at a standing weekly time for 55 minutes, and as they are feeling better we may agree to move to biweekly or monthly, before we terminate our work together. I am also open to starting off biweekly. Another option, if my schedule allows, is a biweekly session for 80 minutes, in order to go a little deeper.

The length of counseling can really vary depending on your interest and needs. Individual counseling can be anywhere from five sessions to years of working together weekly, depending on what you’re looking for. We will periodically check in on how counseling is going, whether you are making progress to your goals, and tweaking my approach if necessary to better fit your needs and desires.

I do! I have a couple of video session slots on Wednesdays for regular sessions. Video sessions can also be a helpful fall-back if we have an in-person arrangement but you have a last minute challenge with illness, childcare, etc and still want to meet.

I use a HIPAA-compliant platform for video sessions.

Yes! Pre-crawling babies are always welcome to office sessions. Babies and toddlers who can ride in a carrier or stroller are also welcome to walk and talk sessions.

I require at least 48 hours notice (by email or phone) for session cancellation, unless it is due to illness in which case I waive the cost. If you give less than 48 hours notice and it is not due to illness, I charge the full session fee.

Please note if you are using your benefit through Lyra, the Employee Assistance Plan, to access counseling with me, your employer may have their own cancellation/no-show policy that we will follow instead.

If you are unhappy with your counseling for any reason, please talk to me about your concerns as soon as possible so that I can respond to them appropriately. I assure you that I will take such criticism seriously, and that I will work to treat your concerns with care and respect. If you believe I have behaved in an unprofessional or unethical manner, please advise me so that the problem can be clarified or resolved. You may contact me at:

Email: sarah@madronacounseling.info

Phone: (206) 339-3641

If such discussion proves to be ineffective, or if you feel that I’ve been unwilling to listen and respond, you can contact the Department of Health, Health Systems Quality Assurance, P.O. Box 47877, Olympia, WA 98504-7877, ph: (360) 236-4700.

If you need to talk to someone right away, please call 988, the new national crisis and suicide lifeline. You can also go to any nearby emergency room.

Please note I do not offer phone or e-mail clinical support to clients between sessions. If you'd like to schedule an additional session, please inquire about my availability. Because my practice is often full and I only work part-time, it's often difficult for me to find available additional sessions.