Counseling/Psychotherapy
What is Counseling?
The word counseling means several different things. In a mental health context, it refers to a service that can also be referred to as therapy or psychotherapy. While some make a distinction between counseling and therapy, for purposes of providing information to assist a prospective client decide to pursue counseling at Alamo Heights Counseling, the terms may be used interchangeably. Generally, counseling doesn’t involve advice-giving; instead, counselors are trained in a variety of skills that allow them to help an individual reach their own unique answers to questions and solutions to situations that may be perceived as problems. Instead of telling you what to do, a counselor helps a person explore options and find the one that is best for that person.
What to Expect in a Counseling Session
Your first appointment at Alamo Heights Counseling will be with the counselor you have chosen; you don’t ever have to have a separate “intake appointment” with a non-clinician or an intake-coordinator. At your intake appointment, your counselor will ask you what issues have come up in your life that led you to seek counseling. Your counselor may ask you more questions to gather a complete history. Your counselor will talk to you about confidentiality and it’s limits as well as about HIPAA and our specific privacy practices. Your counselor will share with you information about his or her therapeutic approach and the benefits and risks of seeking treatment. This process of providing information is called informed consent. Depending on the counselor’s approach, your therapy may be structured or unstructured. It may involve primarily talk or other types of experiences. Your counselor will let you know what approaches may be used in your counseling experience during your first appointment. You will have the option to guide your own therapeutic experience and confront challenging situations at your own pace.
Types of Counseling/Therapy
Rogerian/Person-Centered
Developed by Carl Rogers, person-centered therapy begins with the idea that each person is the expert on him or herself and that the solutions to any problem are deeply personal. Each person will arrive at the best solutions for that person, and the counselor’s role is to facilitate that process. Rogerian psychotherapy is a non-directive approach; your counselor will encourage you to take the lead in what issues to address and at what pace you are comfortable proceeding. Person-centered therapy takes place in an accepting, non-judgmental atmosphere. Although many of our counselors utilize other approaches at various times in therapy, we all start from a person-centered approach, with respect for our clients and appreciation of the journey that is the counseling process. All of our counselors begin with a Rogerian approach to counseling, although other techniques may also be applied based on each provider’s individual training
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy is a well-researched, structured form of therapy originally developed by Aaron Beck in the 1960s. Cognitive Behavioral Therapy, or “CBT” may involve addressing cognitive distortions in a person’s thinking patterns and learning new ways of thinking. CBT is founded on the principles that patterns of thinking influence behaviors and emotions therefore learning new patterns of thinking changes both behaviors and emotions. CBT is generally a time-limited approach, focusing on finding solutions to problems, addressing cognitive distortions, learning new coping skills, and ultimately becoming one’s own source for solving future problems. CBT may involve homework between sessions. Although a client history is taken before getting started, CBT generally focuses on the “here and now” rather than on past events in a person’s life. Counselors at Alamo Heights Counseling who operate from a CBT perspective or who used CBT as one of their primary modalities are Norma Arshad, Nicole Bowker, Daisy Nieto, Heather Perez, Chatoné Strickland, Bianca Vincent, and Richard Zello.
Cognitive Processing Therapy
Cognitive Processing Therapy (CPT) is a form of CBT that was developed to address symptoms of PTSD with an aim toward educating a person about the relationship between thoughts and emotions and provide specific skills for reducing symptoms. CPT takes place over 12 structured sessions beginning with becoming aware of automatic thoughts followed by writing a detailed account of the traumatic experience, then reviewing the traumatic experience while practicing skills for breaking the thought patterns that contribute to or result in the harmful automatic thoughts. Therapy may focused on specific issues such as power and control, safety and security, or trust and belonging. Counselors at Alamo Heights Counseling who operate from a CPT perspective or who use CPT as one of their primary modalities are Daisy Nieto, Heather Perez, Chatoné Strickland, and Richard Zello.
Dialectical Behavioral Therapy
Dialectical Behavioral Therapy (DBT) is another structured approach, also arising out of the history of CBT and related research. The main goals of DBT are to teach an individual how to live in the moment, cope with stress, regulate emotions, and improve relationships. Although DBT is often recommended to treat specific conditions, many of the tenets of DBT are practical and beneficial for everyone. DBT is founded on core skills including mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. Counselors at Alamo Heights Counseling who emphasize DBT skills in their work with their clients are Nicole Bowker, Heather Perez, and Bianca Vincent.
Narrative Therapy
Developed in the 1980s, Narrative Therapy is a non-pathologizing form of therapy that seeks to separate people from their from their problems. From a narrative therapy perspective, each person is the expert on that person’s own life as well as the author of that person’s own story. Narrative therapy may be entirely oral or may be enhanced through journaling and other written communication of the person’s story. Counselors at Alamo Heights Counseling who regularly or primarily use narrative therapy interventions in their work with clients are Lauri Berkman, Cherie Shulter, Bianca Vincent, and Rick Zello.
Solution Focused (Brief) Therapy
Solution Focused Therapy, also known as Solution-focused Brief Therapy, is a short-term, goal focused approach grounded in the positive psychology movement. It is a strengths-based model, focuses on solutions rather than problems, and operates in the here and now moving toward the future rather than focusing on the past. Counselors at Alamo Heights Counseling who operate from a SFTB perspective or who use SFT as one of their primary modalities are Marcia Castañón, Daisy Nieto, Heather Perez, and Rick Zello.
Play Therapy
Play therapy is a form of psychotherapy commonly used with children, although adolescents and adults can benefit from play as well. Like other forms of psychotherapy, there are a number of therapeutic models, and the training and therapeutic orientation of the therapist determines the type of therapy being offered. Although the specific toys used vary from therapist to therapist, generally speaking, most play therapists have a variety of toys from each of several specific categories for children to choose from. Categories include nurturing toys, toys for artistic expression, power and aggression toys, interactive toys, and toys related to control and safety. Counselors at Alamo Heights Counseling who regularly work with children and use play therapy techniques as a primary modality are Norma Arshad, Marcia Castanon, and Daisy Nieto.
Sand Tray Therapy, Sandplay therapy
Sand Tray and Sandplay therapy are forms of psychotherapy that involve the use of a sand box or sand “tray” and miniature toys. A variety of different theoretical approaches, some of which are described above, can be applied to sand tray therapy. Sandplay is a specific type of Sand Tray therapy that is grounded in Jungian psychology. Whether the play is directive of non-directive, as well as whether clients and counselors are verbal or non-verbal during their use of the sand tray, depends on the theoretical orientation and training of the counselor. While most counselors who are trained in play therapy techniques have some sand tray experience, certification as a Certified Sand Tray Therapist or a Certified Sandplay Therapist requires extensive training and continuing education. Marcia Castañón is a Certified Clinical Sandtray Therapist.
What does it cost? Can I use my health insurance?
Generally speaking, health insurance covers the cost of counseling. The Affordable Care Act, signed into law in 2010, provides that health plans generally must cover mental health care, with a few exceptions. In order to use health insurance for anything, the service must be considered “medically necessary.” For a service to be considered medically necessary, it must meet certain requirements set forth by the health insurance company. Generally speaking, a diagnosed mental health condition (such as Major Depressive Disorder or Bipolar I Disorder) is a condition which meets medical necessity, whereas some situations that counseling benefits are not deemed to be medically necessary by health insurance (for example, counseling to improve communication in a marriage is not considered “medically necessary” under most health insurance guidelines. For that reason, many mental health professionals choose not to accept health insurance, and many individuals choose not to use their health insurance to obtain care. The decision to use your health care plan (or not) to obtain services is an important and personal one. At Alamo Heights Counseling, we choose to join all health insurance companies plans and to credential all our providers to be “in network” in all plans that we are eligible to join. Choosing an in-network provider at Alamo Heights Counseling means that if you have a condition that meets the requirements of your health plan and if treatment is medically necessary, then you will be able to use your health insurance to pay for your services. It is important to remember, however, that if you are seeking treatment that is not medically necessary, it may be necessary to pay out of pocket. You also have the option to pay out of pocket if you prefer not to have your health insurance involved in your treatment. The full fee at Alamo Heights Counseling is $175.00 per hour if you will not be using health insurance, and a sliding scale is available for families that qualify. We also have Associates (recently licensed counselors and therapists who are practicing under supervision of a seasoned counselor) who charge less. Finally, we have practicum students/interns who provide services at a still further reduced rate. See our “payments” page for more information about our rates and discounts.
EMDR
What is EMDR?
EMDR is a form of psychotherapy that was developed in the early 1980s by Francine Shapiro. The acronym stands for Eye Movement Desensitization and Reprocessing. The reference to ‘eye movements’ refers to the moving of the eyes back and forth (left and right) during the processing of a traumatic memory. While eye movements were the first form of bilateral stimulation to be studied, there are other forms that may be as effective, or more effective with some individuals. Although relatively new (when compared with psychoanalysis for example) EMDR is well-researched, efficacious, and is considered by most health insurance companies to be a “best practice” for the treatment of trauma, including those associated with a diagnosis of PTSD
Common Misconceptions
EMDR is not hypnosis. Although the two treatments may have a few things in common (they both are effective in treatment the effects of trauma, they both require additional training and skills beyond the basics, they both are structured and directive modalities) they are distinct treatment modalities with separate histories and research. (In fact, despite being portrayed that way by Hollywood, hypnosis generally doesn’t involve moving the eyes back and forth at all)
The most common misconception about EMDR, however, may be that trauma can be cured or cleared in as little as one session. While there have been instances in which a traumatic memory can be cleared this quickly, it is not the norm, and it’s important that client’s expectations are commensurate with the condition to be treated. If you select an AHC therapist with EMDR training, your therapist will ensure that you understand the benefits and limitations of EMDR before beginning treatment.
What To Expect In an EMDR session
EMDR is a structured approach that consists of eight phases and begins with a detailed history. Although ‘eye movement’ is present in the name (Eye Movement Desensitization and Reprocessing) not all EMDR sessions include eye movements, and eye movements are not the only form of bilateral stimulation used in EMDR. Generally speaking, a client will not be asked to engage in processing using eye movements (or other bilateral stimulation) at the first session. This is because it is important that the therapist have a complete understanding of the client’s history, including traumatic events in the recent and distant past. It’s also important that the therapist get to know the client in terms of what coping skills the client already has, what types of events trigger strong emotions in the client, and how the client is able to recover after a difficult session. The first session (or two) will be used to gather information about the client’s history and assess whether it is safe and effective to use eye movements (or other bilateral stimulation) with the client. Not every EMDR session will include eye movements, but this doesn’t mean that a client isn’t “doing EMDR. “ EMDR is a complete approach to therapy, not a mere tool that a therapist uses occasionally. Some clients may require extensive therapy in the earlier phases before beginning “processing” using eye movements of other bilateral stimulation.
What does it cost? Can I use my health insurance?
Although the ideal EMDR session lasts 90 minutes, it is possible for a therapist trained in EMDR to utilize this effective approach in session lengths that meet the requirements of most health insurance plans. Generally speaking, health insurance permits sessions that are 45 minutes in length or 53-60 minutes in length. If your therapist determines that you are capable of processing traumatic material and then returning to a calm and safe state within the 53-60 minute time frame, it will be possible to use health insurance for EMDR sessions. When health insurance is used, the health insurance company sets the rate for the session as well as the client’s portion of that payment, in the form of a copayment, coinsurance payment, or payment toward deductible. While a single traumatic event may be processed in just a few sessions, clients who experienced prolonged trauma or repeated trauma may require much longer treatment. Clients should expect a minimum of eight sessions, but many clients continue treatment for a year or more.
Hypnoanalysis
What is Hypnosis?
Most people’s ideas of what hypnosis—and even hypnotherapy—comes from Hollywood portrayals, many of which could not be more wrong. Hollywood tends to not only sensationalize hypnosis, but also portray it as something shrouded in mystery rather than a very natural occurrence. If you’ve ever gotten so engrossed in an activity that you lost track of time, or if you’ve ever driven a familiar route on “auto-pilot” and didn’t really remember the drive at all, you’ve been in a hypnotic state. Hypnosis is a state of combined relaxation and focus. It is often achieved with the eyes closed, which allows greater focus on a person’s own internal experience without outside distractions.
What is Hypnotherapy?
Hypnotherapy refers to the use of hypnosis for therapeutic purposes. While the use of hypnosis is unregulated in Texas, hypnotherapy may only be performed by someone holding a clinical license to perform therapy. Many therapists can and do use hypnosis, either directly or indirectly through relaxation exercises, meditations, visualization exercises, and positive affirmations. There are so many different approaches to hypnotherapy that the experiences can be as unique as the therapists who provide the services. Even if a person has been to hypnotherapy before, each experience is completely different; even if a person has had a hypnotherapy experience that was not as effective as they had hoped, this does not automatically rule out hypnotherapy at a later time, over different subject matter, or by a different hypnotherapist.
Common Misconceptions
Common misconceptions about hypnosis include that a person can be “made” to do something they would not ordinarily do, that a hypnotist has the ability to control another person, and that some people cannot be hypnotized. In reality, any person can reach a relaxed but focused state with a little practice, and the purpose of hypnosis is to become more connected with one’s own thoughts and feelings, to become even more yourself, so to speak. For that reason, hypnosis and psychotherapy have long been partners.
Most people who are aware of the therapeutic benefits of hypnosis are familiar with smoking session programs and weight loss programs. Those who have had success with these types of programs swear by them, and those who tried one of these programs and did not experience success quitting smoking or losing weight may reach the conclusion that hypnosis “doesn’t work” or that they are one of those people who “cannot be hypnotized.” Most likely, though, there is an underlying, subconscious reason for the person’s behavior that cannot be sufficiently addressed with mere hypnosis, and this is why hypnoanalysis is used, rather than mere hypnosis or hypnotherapy.
What is Hypnoanalysis?
Hypnoanalysis involves a thorough examination of a person’s unconscious thought processes, needs, and desires, which are influenced by their history, including childhood memories, and oftentimes childhood events that occurred when they were so young that they don’t even realize that they can remember it. Like conscious forms of psychotherapy, hypnoanalysis addresses early trauma, unresolved loss, attachment and abandonment, hopes, dreams, and fears. Unlike conscious forms of psychotherapy, however, it can also address parts of the personality that the conscious mind desires to avoid or reject. Hypnoanalysis is also effective the examining the symbolic content of dreams and working with spirit/angel guides that are part of a person’s belief system.
What To Expect In a Hypnoanalysis Session
When you call the office to schedule a hypnoanalysis session, you will not need to provide any information to the person you speak to on the telephone; this information will be shared the first time with the hypnoanalyst. Hypnoanalysis is a structured approach as taught by the American Academy of Medical Hypnoanalysts (AAMH). While your problem and your history are unique to you, the protocol that will be followed in your treatment will follow the researched protocol. Your first appointment, ideally, will be scheduled for 1.5 hours rather than 1 hour. Your analyst will take a complete and thorough history using a standardized set of questions that will cover all aspects of your life. The first session is solely for your analyst to gather information about you and about the problem you wish to solve. At the second session, you will experience an introduction to hypnosis, relaxation exercises, and protective suggestions. Another structured exercise is part of the third session, and the fourth and subsequent sessions will continue to follow the AAMH protocol, including age regressions. Hypnoanalysis is intended to be a short-term approach which has a conclusion after the issue at hand has been resolved.
What does it cost? Can I use my health insurance?
Please note that due to the nature of hypnoanalysis and the scheduling needed for an effective analysis session, Cherie is not accepting health insurance for new hypnoanalysis clients. Hypnoanalysis sessions are $225 for a 1.5 hour session and may be discounted to $200 for clients paying with cash. Clients should anticipate a minimum of 8-10 sessions of the structured protocol before reevaluating the need for continued hypnoanalysis.
Court-related Services
What are Court Related Services?
Court-related services is a blanket term that refers to a number of services provided by mental health professionals for purposes of supporting individuals involved in legal matters. As they cover a wide range of types of services, each service will be described thoroughly below. If you already have been to court and the judge ordered a specific service, that it is a court-related service. If you have an attorney working for you and the attorney recommended that you seek a service, it’s very likely that service is a court-related service.
What does it cost? Can I use my health insurance?
Generally speaking, Court Related Services are not covered by health insurance as they are usually not health care. Services such as custody evaluations, supervised visitation, mediation, and parent facilitation are not medically necessary, do not require a diagnosis to be performed, and they do not even have an ICD 10 code assigned to the service to bill the insurance company.
Sometimes, however, the line between Counseling and Court Related Services is a little blurry, such as when a judge orders a person to go to counseling or when a judge orders a family to participate in family counseling. In those cases, we as mental health professionals must be very careful as to which service we are providing. When a judge orders counseling, the person or persons ordered must participate in counseling in order to comply with the court order—but that doesn’t mean the counseling is medically necessary. Sometimes, the reason a judge is ordering counseling is because it is evident that there is some not-yet-diagnosed condition that is making it difficult for a person to follow laws or comply with court orders. In those cases, it’s possible that counseling might be covered by health insurance. Oftentimes, however, services are ordered by a judge to improve a family situation or help a person cope with an issue and the criteria aren’t met to diagnose the person or persons with a mental health condition. In that case, the court-related services are not covered by health insurance.
Attorneys and judges are not experts in the mental health field, so sometimes there are misconceptions about what can and cannot be billed to health insurance. For example, a judge may order “Family therapy visits” or “therapeutic family visits” in an attempt to provide an opportunity for a family to use their health plan to pay for supervised visits. As ethical mental health providers, we strive to help those in the legal profession understand the differences and make clear distinctions to avoid fraud and possible malpractice allegations. We do provide supervised visitation, and we do provide family therapy, but these are two separate services. We strongly recommend that instead of ordering the counseling be paid with insurance, they instead order that individuals come to counseling for an assessment to determine whether a condition exists, or to order counseling to be billed as private pay or through insurance, as determined by medical necessity.
What to Expect in Court Services
What to expect when requesting court-related services largely depends on what service you will need, so each service will be described thoroughly below. Generally speaking, it’s a good idea to anticipate paying out-of-pocket for court-related services; as use of health insurance requires medical necessity, court-related services are usually not covered.
Types of Court Services
Custody Evaluations
Custody evaluation is defined by the Texas Family Code as “an evaluative process in a contested case through which information, opinions, recommendations, and answers to specific questions asked by the court made by made regarding conservatorship of a child, including the terms and conditions of conservatorship, possession of or access to the child, including the terms and conditions of possession or access or any other issue affecting the best interest of a child and made to the court, the parties to the suit, the parties attorneys, and any other person appointed under this chapter by the court in the suit. [Texas Family Code Section 107.101(1)].
Custody evaluations are ordered by the Court in connection with a divorce, request to change conservatorship, or other suit affecting a parent-child relationship. A custody evaluation involves home visits, interviews of parents, interviews of children (both the subjects of the suit and other children living in the home) observation of parents and children interacting with one another, background checks, and many other elements that are defined by law. Custody evaluations can be requested a party but can also be ordered by a judge without a request from either party. If you have questions about the legal issues involved, consult an attorney who practices family law.
While the Texas Family Code outlines the requirements for an evaluation and the qualifications of an evaluator, In Bexar County, the Domestic Relations Office, located on the third floor of the Bexar County Courthouse, maintains a list of custody evaluators who have already been determined to have met the qualifications and are therefore approved to provide services in the Bexar County Courts. The surrounding counties may or may not maintain a specific list, but those who are listed on the Bexar County Evaluators List meet (or exceed) the criteria outlined in the Texas Family Code and are qualified to provide custody evaluations in any county in Texas. Cherie Shulter provides custody evaluations in Bexar and surrounding counties on a limited basis. She also provides oversight for the following providers who are also on the Bexar County Evaluators List: Corrina Espinosa Herrera, LPC-S, Bexar County Evaluator Number 1134; Lillian Little, LMSW Bexar County Evaluator Number 1634; and Elvira Marquez, LPC Bexar County Evaluator Number 1419. Those interested in having Cherie, Corrina, Lillian, or Elvira ordered to provide a custody evaluation may contact our office directly at 210-822-2600 or may contact the Bexar County Domestic Relations office at 210-335-1242 or visit their website at: https://www.bexar.org/3186/Domestic-Relations-Office
A copy of the Bexar County Domestic Relations Office’s list of custody evaluators can be accessed here: https://www.bexar.org/DocumentCenter/View/23558/Child-Custody-Evaluators-List-PDF?bidld=
Private Adoption Home Studies
An Adoption Evaluation, sometimes informally called a “social study” is defined by the Texas Family Code as “a pre-placement or post-placement evaluative process through which information and recommendations regarding adoption of a child may be made to the court, the parties, and the parties’ attorneys” [Texas Family Code, Subchapter E, Section 107.151(1)].
Adoption evaluations are ordered by the Court in connection with adoptions, including private adoptions and step-parent adoptions. An adoption evaluation involves home visits, interviews of parents and children (both those to be adopted and any others living in the home) observation of the prospective adoptive parent and the child interacting with one another, background checks, and other elements that are defined by law. Adoption evaluations when the Department of Family and Protective Services are different than the evaluations performed for private adoption and are not a service we provide at this time. If you have questions about what type of adoption evaluation applies in your situation, you may need to consult an attorney who practices family law.
All Evaluators on the Bexar County Domestic Relations Office Evaluators List who are able to provide Custody Evaluations as described above also meet the qualifications outlined in the Texas Family Code for providing Adoption Evaluations. Cherie Shulter provides adoption studies in Bexar and surrounding counties on a limited basis. She also provides oversight for the following providers who are also on the Bexar County Evaluators List: Corrina Espinosa Herrera, LPC-S; Lillian Little, LMSW; and Elvira Marquez, LPC. Those interested in having Cherie, Corrina, Lillian, or Elvira ordered to provide an adoption study may contact our office directly at 210-822-2600 or may contact the Bexar County Domestic Relations office at 210-335-1242 or visit their website at: https://www.bexar.org/3186/Domestic-Relations-Office
Evaluators listed on the Bexar County Domestic Relations Office’s list of evaluators have already been determined to meet the qualifications required by law. Those that provide adoption evaluations have indicated so and may have provided a starting estimate of costs: https://www.bexar.org/DocumentCenter/View/23558/Child-Custody-Evaluators-List-PDF?bidld=
Parent Facilitation
After a divorce or separation, or in situations where parents have always lived separately, Parent Facilitation is sometimes ordered by the court to reduce conflict between parents and avoid potential court battles which can be both financially and emotionally draining.
Generally speaking, the court order will specify the Parent Facilitator by name and will provide a specific requirement for contacting the Parent Facilitator.
A Parenting Facilitator is defined by the Texas Family Code as “an impartial third party who… performs any fuction described by Section 153.6061… and is appointed…to assist parties in resolving parenting issues through procedures that are not confidential.” The Texas Family Code distinguishes a Parenting Facilitator from a Parenting Coordinator in that a Parenting Coordinator assists parties in resolving parenting issues through confidential procedures. [Texas Family Code, Subchapter K, Section 153.601(3- through 3-a)]. Cheryl Shulter, MA LPC-S meets the qualifications for these roles and provides Parenting Facilitation Services on a limited basis in Bexar County. (Please note that for professional reasons Cherie chooses not to act in the Parenting Coordinator role and will not accept an assignment in which information is confidential even from the Court.)
Occasionally, Parent Facilitation is recommended by a social service organization or is entered into voluntarily by two parents who wish to avoid going to court. Each situation is unique; when a court order is not present, Cherie will evaluate the situation and will let both parents know whether it will be possible to provide this service. If you think that Parent Facilitation might be right for you and your child’s other parent, or if someone has recommended you pursue Parent Facilitation, please feel free to contact our office for more information about Cherie’s services.
Link: https://www.bexar.org/DocumentCenter/View/25683/Parent-CoordinatorParent-Facilitator-List-
Supervised Visitation
Supervised Visitation refers to any visit between a child and an adult or adults in that child’s life that is supervised for whatever reason (such as to ensure the safety of the child, to document behaviors of the child and parent such as in a reunification situation, or to protect the parent from being falsely accused of hurting the child when there have been false allegations by another adult in the past). Alamo Heights Counseling has a contract with the Department of Family and Protective Services to provide independent objective observers to observe interactions between children in DFPS legal cases (see below under DFPS Services) and can, when sufficient staff are available, provide observers for visits that are ordered by judges outside children’s court as well (such as when ordered by a District Court judge in a family law matter).
Alamo Heights Counseling provides supervised visitation on a limited basis when other resources in Bexar County are inaccessible or have been deemed not to be a good fit. While we are generally able to provide services on relatively short notice, it is imperative that we have a copy of the Court Order and that both parties sign our contract and pay all fees in full before visitation can begin. In rare instances when there is no court order but parties agree that one party’s time with the children will be supervised, we may be able to provide an independent observer, but will need documentation of the agreement between the parties.
Parties or their attorneys may contact our office for additional information, or may contact the Bexar County Domestic Relations Office for a reference.
Collaborative Divorce MHP/facilitator
Cherie Shulter is trained as a mental health professional/facilitator to provide services in Collaborative Law matters, including Collaborative Divorce. Collaborative Law is a non-adversarial legal process that takes place outside the court system. Both parties are represented by attorneys, but the parties and attorneys have signed a collaborative agreement which requires, in part, that if they decide to change to the adversarial process and take the matter to court that both attorneys are relieved of their representation and the parties will find new attorneys and start the process again. When parties commit to the collaborative process, they emphasize that the two of them know what is best for them (and for their children if children are a part of their family). By committing to the collaborative process, the parties remove the “wild card” aspects of going to court such as to which judge will they be assigned, how much testimony the judge will be willing to hear, and whether the judge will order outside professionals such as a visitation observer, a parenting facilitators, and custody evaluator. By engaging in the collaborative process, parties ensure that the decision-makers for their case will be themselves. In addition to the parties and their attorneys, most collaborative law cases also include a financial professional and a mental health professional. Financial professionals help the parties to explore how divorce will affect wealth preservation and how division of assets may affect
DFPS Services
What are DFPS Services?
The term “DFPS Services” refers to services performed under a contract between Alamo Heights Counseling, Inc and the State of Texas Department of Family and Protective Services. A service is not necessarily a DFPS service just because the service is recommended by an employee of DFPS. Only when they services are required by DFPS to complete a Family Plan of Service or when the services are being paid for by DFPS is the service truly considered to be a “DFPS Service.” These services may have additional requirements beyond HIPAA, informed consent, or insurance guidelines. DFPS Services may have additional requirements in terms of required paperwork, releases of information.
Below is a comprehensive list of the DFPS Services that Alamo Heights Counseling offers.
Evaluation and Treatment Services
Evaluation and Treatment Services is the name given to the DFPS contract for Child Protective Services (CPS) cases for providing what is generally referred to as counseling or psychotherapy. Clients referred to Alamo Heights Counseling by DFPS for Evaluation and Treatment Services will complete a psychosocial evaluation (different from a psychological evaluation, which we do not provide) and will receive counseling, usually on a weekly basis, but no less than two times per month. These services are usually considered by DFPS to be required for the successful completion of a Family Service Plan. Alamo Heights Counseling providers are required by this contract to share information with the referring DFPS caseworker. Information that will be automatically shared includes cancelled or no-showed appointments, psychosocial evaluation reports, and monthly reports. Other information such as progress notes and treatment plans are not automatically shared, but DFPS may request them. CPS caseworkers can refer families to Alamo Heights Counseling for Evaluation and Treatment Services by creating a 2036 referral form and a 2054 authorization providing 4 units of 86U and a minimum of 16 units of 86C to get started. Other units, such as 86F may also be used if needed. Caseworkers with questions may contact our offices by calling 210-822-2600.
Supervised Visitation
The Supervised Visitation Services contract with DFPS is a contract that allows parents and other adults who are involved in Child Protective Services legal case in which children have been removed from the home and placed with another adult, such as a family member or foster parent. Supervised visitation services may be provided in a CPS office, in AHC’s office, or in a public place but are most often provided at the main CPS office in rooms specialize designed to accommodate supervised visits. Although rooms with a “one-way mirror” do exist at the CPS office, these are rarely used. Generally speaking the visitation observer will be in the room with the child and the visiting adult, or will sit in the doorway or right outside the doorway where they can observe interactions and hear conversations. Visit observers take notes on the interactions between the observed adults and children and complete a report which is sent to the CPS caseworker. Visit observers are not licensed individuals but have been background checked and trained to provide this valuable service. CPS caseworkers can refer families to Alamo Heights Counseling for Supervised Visitation Services by creating a 3101 referral form and a 2054 authorization providing a minimum of 16 units of 92L to get started. Caseworkers with questions may contact our offices by calling 210-822-2600.
Supplemental Caregiver Services for Children Without Placement
Supplemental Caregiver Services are a service to Child Protective Services for children who have been removed from their homes but do not have access to a safe home with another family member and have not been placed for foster care. At one time, these services were provided in CPS offices, but after a change in the law, these services are now provided in hotels or in houses that are rented by the State of Texas. CPS caseworkers are present on site as is law enforcement. Supplemental caregivers round out the child to adult ratio, provide additional observation, assist caseworkers when needed, and interact with the children as needed. Alamo Heights Counseling subcontractors sign up for shifts with the various teams on a monthly basis. Caseworkers needing emergency coverage or additional assistance may contact our offices by calling 210-822-2600.
Substance Abuse Services (groups and individual)
**This service is temporarily unavailable at this time. Please check back in February 2023**
The Substance Abuse Services contract with DFPS is a contract that provides primarily group counseling related to abuse of a substance or dependence on a substance. This is an out-patient only group provided to those who have already completed detox as well as those who do not require detox to get clean and sober. Substance Abuse Services groups have a rolling admission, so a newly referred client does not need to wait until the next group begins. Referred clients will be required to complete a total of 12 sessions of group services. If a group is missed, it may need to be made up either by waiting for the next time that group covers that subject material, or by attending a different group if another group is available at that time. A certificate of completion is issued at the end of completion of all required sessions. CPS caseworkers can refer families to Alamo Heights Counseling for Supervised Visitation Services by creating a ____ referral form and a 2054 authorization providing a minimum of 32 units of ___ to get started. Caseworkers with questions may contact our offices by calling 210-822-2600.
When a Child Protective Services (CPS) case is opened, substance use is often a challenge that a parent must overcome in order to be reunified with his or her child permanently. Substance Abuse Services refers to both individual counseling and group counseling services provided by a Licensed Chemical Dependency Counselor (LCDC). This includes wide range of information including educating individuals on the biological actions of a variety of substances, understanding personal triggers that result in temptation to use substances, the mechanisms of addiction, understanding how and why addiction occurs, identifying a variety of treatments and which ones work for each individual, lifestyle changes to increase the likelihood of sobriety,
Substance Abuse Services are provided at Alamo Heights Counseling on evenings and weekends, both individually and in a group setting by Jasmyn Contreras, LCDC.
Hospital Sitting Services
**This service is temporarily unavailable at this time. Please check back in February 2023**
From time to time, Alamo Heights Counseling enters into a contract with DFPS for Hospital Sitting Services. When a child in foster care is hospitalized, an adult must remain with the child at all times. Given staffing shortages at hospitals and at DFPS, it is often not possible for either the hospital or the Department to provide an employee to remain in the child’s room at all times with no other duties. When this happens, DFPS contracts with local companies and social services agencies to provide contractors to sit with the child and ensure their safety.
If you are a DFPS caseworker who needs a hospital sitter, please contact the Contracts Department at DFPS to find out whether our contract is active at the time you are asking for the service.
How to set up DFPS Services
For Clients
If you are parent or other caregiver and you want to receive counseling and have it count for your service plan, your caseworker must set up counseling for you under the Evaluation and Treatment Services contract. You may ask your caseworker to refer you specifically to Alamo Heights Counseling. If you do not have Medicaid, your caseworker will need to create an authorization and a referral form before we can set up an appointment for you. If you do have Medicaid, you can come to our office using Medicaid either on your own or under the Evaluation and Treatment Services contract. If your caseworker wants access to your information, your caseworker will need to create a referral and an authorization for you. Your caseworker can contact our office at 210-822-2600. Without valid referrals and authorizations, your services may not count towards your Service Plan, so be sure to communicate with your caseworker.
Supervised Visitation Services can only be initiated by a DFPS caseworker. If you are a parent or other adult who has been ordered or permitted to have supervised visits with a child in CPS case and you would like your visitation observation to be provided by Alamo Heights Counseling, the first step is to ask your caseworker. Your caseworker can fill out the appropriate forms and send them to our office. The majority of visits we observe take place at the DFPS office located at 3635 SE Military Drive, south of San Antonio. If your visits are at another location, or if you are requesting that your visit take place at Alamo Heights Counseling, availability of observers may be limited.
Substance Abuse Services can only be initiated by a DFPS caseworker. If your service plan includes Substance Abuse Services (usually group counseling and education around substance use) feel free to ask your caseworker to provide a referral to Alamo Heights Counseling for this service. Group schedules are set by the counselors who provide them. While these services are not available every day of the week, there will generally be an evening or weekend group offered each week. Your caseworker can obtain the schedule by calling our office. *Note: Substance Abuse Services refers to group counseling, usually for approximately two hours once per week over a period of 12 or more weeks. We do NOT provide in-patient services, partial hospitalization, or intensive outpatient services. If your service plan requires admission to a treatment facility, we are unable to provide that service or any resources related to that service. Your CPS caseworker will provide an appropriate referral for those services. You may be eligible to utilize our Substance Abuse Services groups after completion of another program, however.
Supplemental Caregiver Services and Hospital Sitting Services can only be initiated by a DFPS caseworker and only when those contracts are active.
For Caseworkers
Caseworkers who desire to refer a client for Evaluation and Treatment Services (including individual counseling not related specifically to substance abuse) must create a 2036 referral form and a 2054 authorization and send it to our counseling email inbox. If you do not know our email address, please contact our office at 210-822-2600. When creating the 2054 authorization, please make sure to provide four units of 86U and a minimum of 16 units of 86C with a date span of four months. (If you will provide a longer date span, please increase the number of units of 86C by at least 4 units per month).
Caseworkers making referrals for Supervised Visitation Services must create a 3101 referral form and a 2054 authorization and send it to us at our visitation email inbox. If you do not have this email address, please contact our office at 210-822-2600. When creating the 2054 authorization, please make sure to 1) include a date span of three months or longer 2) include enough units of 92L greater than the number of hours the parent will visit each week times the number of weeks the date span covers, and 3) include at least 1 additional unit that can be utilized for going over the rules with the parent before the first visit. In addition, please let your clients know that for the first visit they will be instructed to arrive prior to when the visit is scheduled to start to go over the rules. If the parent does not arrive until the time that the children arrive, the children will be made to wait while the parent goes over the rules with the visit observer and signs a form indicating that they understand the rules and agree to abide by them. If this is not completed, the visit will not take place and you will be notified.
Supplemental Caregiver Services are scheduled differently than services that are scheduled through the contracts department. Your Team Lead will send your schedule link to our coordinator who will either sign up our subcontractors for shifts or disseminate the link to our subcontractors to allow them to sign up for their own shifts independently. If you have a shift that needs to be covered on short notice, call our office during regular business hours (Monday through Friday 8 AM to 5 PM except federal holidays). To reach us in the evening or on weekends, obtain our director’s cell phone number from your chain of command and reach out with a text message.
Caseworkers making referrals for Substance Abuse Services should call the office first to find out what days and times groups are available to avoid a situation where their client is unable to attend on the days that groups are available. To create a valid referral to AHC, caseworkers must create a 2062 referral form, a 2063 release form and a 2054 authorization and send it to us at our Substance Abuse email inbox. If you do not have this email address, please contact our office at 210-822-2600. When creating the 2054 authorization, please make sure to 1) include a date span of approximately six months 2) include 1 unit of 83F 3) include 32 units of 83H 4) include at least 4 units of 86G.
Because Hospital Sitting Services are a rarely-used service by DFPS, the subcontractors who provide this service work regularly under our SVS and SCS contracts. To ensure that we have a subcontractor or staff member available for the shift you need, please call our office first at 210-822-2600. To make a valid referral to AHC, caseworkers must create a 5612 referral form and a 2054 authorization that spans the period of time the child is anticipated to be hospitalized and sufficient number of units of 87D to cover the shifts that are requested. Caseworkers are asked to provide 6-8 units of 87D above and beyond what is requested to account for early arrival to receive report and to cover times when subcontractors are not permitted to leave because relief did not arrive.
**Caseworkers making referrals for Substance Abuse Services or Supervised Visitation should call our office first to confirm that we are accepting referrals and have adequate staff available to provide services immediately.**
New Clinician Supervision
LPC Associates and LMFT Associates
Cherie Shulter LPC-S, Lauri Berkman LPC-S, and Bianca Vincent LMFT-S are all approved supervisors approved by their respective boards to provide supervision services to individuals who are newly licensed as LPC Associates or LMFT Associates. Both Cherie and Bianca are currently accepting new associates. If you are an Associate looking to change supervisors, or if you are a new graduate looking for a supervisor so that you can apply for your clinical license, please contact our office to schedule an initial appointment to meet Cherie or Bianca or to find out if Lauri is accepting Associates at that time.
Practicum Students and Student Interns
Alamo Heights Counseling, Inc. is an approved practicum site for Our Lady of the Lake University in San Antonio, Texas; Texas A & M San Antonio in San Antonio, Texas; and the online program at Northwestern University in Chicago, Illinois.
For more information, visit our internships page.
