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Clinical Services


This page provides an overview of Dr. Garber's direct clinical services.

"Clinical service" describes any evaluation or intervention intended to assist one or more individual to better understand or modify a specific goal aspect of thinking, feeling and/or behaving.

Clinical services are distinct from forensic (court-related) services. Forensic services intend to help the court to answer questions about a person, relationship or family system. These answers may be relevant to legal decision-making. Read more here read more here

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back to top Thank you for inquiring about Dr. Garber's clinical services.
Getting here is an important first step. For many people, it means that a problem has grown, and may feel out of control, that other efforts to change have failed, or that other helpers have not been helpful.

For some, seeking psychotherapy may be a relief. For others, its an embarrassment. For still others, it seems like a waste of time.

This page and the rest of HealthyParent.com is intended to help you make well-informed, forward-thinking and child-centered decisions.

  • Read below to learn about psychotherapy in general and about Dr. Garber's specific psychotherapy services.
  • Take the time to understand your rights and the limitations of confidentiality as they apply to psychotherapy read more here
  • Its important to understand the costs associated with psychotherapy, how Dr. Garber accepts payment, and the limitations associated with third party (health insurance) reimbursement read more here
  • There are many different approaches to psychotherapy. Its important that you understand these differences and advocate for the service that is best suited to your specific needs read more here

Dr. Garber has advanced degrees in child development and clinical psychology. He provides psychotherapeutic services to individual children and adults, couples, co-parents, and .families. In every role, in both clinical and forensic processes, Dr. Garber is child-focused and an ardent child advocate.

Dr. Garber's expertise in family law, family systems and divorce make him uniquely qualified to provide psychotherapeutic supports to conflicted co-parents, families in transition, and children enduring adult conflict.

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top of page  What is psychotherapy?
Psychotherapy is a unique relationship established in support of specific cognitive (thinking), emotional (feeling) and/or behavioral goals.
  • The psychotherapeutic relationship is not a two-way street. The client or patient shares his or her experience, expectations, thoughts, and feelings.
    The therapist listens, provides feedback, perspective ad alternative ways of thinking, feeling and behaving. The therapist provides the setting, expressive tools, and education in support of the client's expression.
  • Psychotherapy occurs within the confines of this specific relationship and usually only in the psychotherapist's office.

There are many distinct kinds of psychotherapy. Dr. Garber provides cognitive-behavioral, dynamic and family systems interventions as best suits each unique client's needs.

  • Cognitive-behavioral therapy (CBT) asks the client to closely examine his or her thinking as it affects behavior and emotion. By changing expectations and interpretations, unsuccessful behavior patterns and relationships can be changed.
  • Dynamic psychotherapies examine relationship patterns, including how the relationship within the therapy emerges over time. Recognizing and understanding these patterns can create opportunities to develop new and more successful and rewarding relationships.
  • Family systems therapies focus on how roles and rules, limits and boundaries function within a family system. Conflict can often be reduced or eliminated by clarifying or redefining each family member's responsibilities and privileges within the group.

Psychotherapy with children incorporates each of these methods in the context of creative, entertaining, and expressive interactions. Play therapy, for example, provides opportunities to address impulsivity, frustration management, pro-social skills (e.g., turn taking, sportsmanship), and delay of gratification. Drawing and similar expressive arts and crafts can help children to share fears and hopes, anger and grief when face-to-face and verbal interactions fail.

Psychotherapy with children whose parents are highly conflicted, divorcing or divorced incorporates all of this into a very specialized process intended to 'keep the kid out of the middle.' Read more in Dr. Garber's book, featured at right, and below read more here




























read more here










top of page Is psychotherapy confidential?
Your choice to engage in psychotherapy,  the contents of what you share in psychotherapy, and the record of your psychotherapy are all protected under the law and by the ethics of the profession. This means that Dr. Garber cannot acknowledge who his clients are, what they say, or the records of their services without the client's (or the client's legal representative's) written informed consent.

However, the ethics of the profession and the law allow for certain loopholes. Dr. Garber will alert you to these exceptions to confidentiality when you first meet together. As the client, you have a responsibility to remain informed and alert to these exceptions. They include:
  • Safety always comes first. Dr. Garber will alert the police, child protective services or similar agencies any time he believes that an individual's safety is in danger. This includes instances of child abuse and neglect and threats of suicide and homicide.
  • Dr. Garber's records are subject to demand under court order and subpoena. Although some such demands can and will be resisted, in general the court will receive records.
  • Dr. Garber's records are subject to exposure under administrative review. Credentialing agencies can demand access to otherwise protected information.

In addition, the client (or the client's legal representative) can provide written informed consent allowing Dr. Garber to disclose otherwise confidential information to specific others and/or to obtain information from others.

Above and beyond these legalities, it is important to recognize the practical limitations of confidentiality in the digital age. These include:

  • Electronic communications (e.g., email) and digitally stored records are vulnerable to exposure even when properly password protected, anonymized, firewalled and encrypted. Your choice to share confidential information in any digital medium constitutes tacit acknowledgement and acceptance of this risk.
  • Digital payment media (e.g., PayPal, SquareUp) leave a trail that can lead to exposure of otherwise confidential information. Your choice to use these media constitutes tacit acknowledgement and acceptance of this risk.












top of page How is psychotherapy paid for?
  • Clinical services are billed on the basis of a 50-minute hour. 
  • Most psychotherapies are conducted for one 50-minute hour once per week, once every two weeks or once per month. The frequency of meetings will depend upon the urgency of the need.
  • Payment is due in full at the time of service.
  • Payment is accepted as cash, personal check, credit card and via PayPal

  About insurance and insurance reimbursement
Dr. Garber will not bill your third party health insurance or managed care company. Payment is due in full at the time of service unless otherwise agreed in advance. Read more here read more here

  • Dr. Garber withdrew from participation with all third party (health insurance and managed care) payors in 1999 in the belief that such organizations needlessly compromise clients' autonomy and privacy. In addition, third party payors' expectations that an individual be identified as the "client" or "patient" and be diagnosed with a mental illness can create far more problems than they resolve. This is perhaps nowhere more true than when a child needs psychotherapeutic supports in order to manage his or her parents' conflicts.
  • Dr. Garber will routinely provide you with a receipt for services provided including CPT service type, data identifying the client and data identifying his practice. Unless otherwise agreed in advance, the receipt will NOT include a diagnosis code.
  • You are be free to submit receipts for psychological services rendered for third party reimbursement as you choose. Dr. Garber is glad to provide you with additional documentation in support of this choice at your request, but will not communicate directly with your third party payor.
  • If you choose to submit claims for reimbursement, be a strong self-advocate: keep a thorough record of who you speak with, when, and what is said. Sadly, you must be very organized, assertive, persistent and expressive (and speak English) in order to succeed.

 













top of page Who is the "client" or "patient"?
The clinical client is the person or the people who are directly engaged in psychotherapy. The legal client is the person, persons or agency that holds decision-making authority over the process, e.g., whether to discontinue the therapy, to release the records, or to allow Dr. Garber to obtain information from others.

  • Read more here read more here

In most instances, when someone over 18 years of age engages in psychotherapy, he or she is both the clinical client (there in the room receiving services) and the legal client (able to make relevant decisions). The exceptions include adults who are court-ordered to psychotherapy and/or those who have a legal guardian.

In many instances, when someone under the age of 18 is in therapy, that person is the clinical client but his or her parents are jointly the legal clients. This distinction is most easily made when the child is quite young. Children ages 14 and older have certain protections which can trump even their parents' decisions.

When a child is the clinical client and his or her parents were never married, are conflicted, separated, divorcing or divorced, it becomes much more difficult to identify the legal client and who can make relevant decisions. In Dr. Garber's practice:

  • Every effort will be made to assure that both parents are aware of, supportive of, and engaged in their child's psychotherapy.
  • Although legally one parent's request to enroll a child in psychotherapy may be sufficient, Dr. Garber will make every effort to assure that both parents support the process from the start.
  • Legally, if the parents share decision making authority in the eyes of the court, either parent's request to interrupt or terminate psychotherapy may be sufficient. In this instance, Dr. Garber will request an emergency parents' meeting and/or a final termination meeting with the child so as to minimize the child's experience of loss.
  • Dr. Garber recognizes the practical, social and emotional role that parents' partners, extended family, and children's mentors (e.g., teachers, coaches, faith leaders) can play in a child's life and will often request that these caregivers contribute to the child's therapy.

 











top of page  How does psychotherapy work?
A psychotherapist is a professional skilled in helping people to better understand their thoughts, feelings and relationships. Across types of therapy (e.g., cognitive, behavioral, dynamic, analytic), regardless of the professional's education (Ph.D. or Psy.D. or Ed.D., M.S.W or M.D.), psychotherapy is a process of facilitated change toward greater health, happiness and adaptation.

Psychotherapy works in two ways: When the psychotherapist's non-judgmental, open and accepting attitude and the security of the setting invite trust, many people become able to express thoughts and feelings that they otherwise find threatening, unacceptable or crazy. Anger or fear or guilt or grief. Jealousy or ambition or self-loathing. The professional's willingness to accept these expressions and to put them in a larger perspective can help to defuse or normalize them. The experience can be like setting down a burden that's been carried for decades.

The psychotherapist can also offer strategies and referrals to other resources that can help change troubling thoughts, feelings and behaviors. Familiar among these are journaling, role play, and imagery. Less familiar are techniques that include successive approximation, the use of transitional objects, and progressive muscle relaxation. Practiced in session and mastered as "homework," the psychotherapist can help you to build new skills with which to better cope with your world.












top of page Psychotherapy for children of divorce
Parents are supposed to anchor their children: To provide the safety and security necessary to refill their tiny gas tanks so that they can go off and meet the world, one step at a time. Dr. Garber has written about this back-and-forth dance of development poignantly in his book, "Holding Tight/Letting Go."

When parents conflict, the foundation of a child's security can be shaken or destroyed. The result can be seen in any number of ways -depression or rage, anxiety or regression, school failure, run-away, sexual or substance experimentation- but each of these can be reactions to the family turmoil.

Psychotherapy can provide a child whose emotional world has become a war zone a "port in the storm." The therapist and his or her office and that simple, single hour each week may be a child's most reliable, secure safe place while mom and dad fight it out. The therapist will help the child to express and understand his or her experience and emotions, will reassure that the parents' battles are not the child's fault, and that loving one parent is not a betrayal of the other. Most important to this therapy is its constancy as a "port in the storm."
  • Psychotherapy with children whose parents are conflicted, separating, divorcing or divorced may be unique among the many kinds of psychotherapy. The child is the clinical client and may qualify for any number of mental health diagnoses, but he or she is a victim of an ongoing trauma.
  • Legally, either parent may be able to enroll a child in psychotherapy. Dr. Garber takes the firm position that both parents must at least be aware of the child's proposed therapy from the start and -better yet- both parents should be involved in and supportive of that therapy. Read about "therapist alienation" at right.

How to get started? Dr. Garber will ask that you request psychotherapy for your son or daughter by email with a copy to the child's other parent. In this way, everyone can be on board simultaneously and the chance that Dr. Garber will be seen as biased or "on mom's side" can be minimized.

In fact, Dr, Garber is on the child's side.

Will the child's psychotherapy be drawn into the adults' legal battle? Dr. Garber will make every effort to assure that the child's therapy remains a "port in the storm," separate and insulated from the litigation.

In New Hampshire, case law may protect the child's psychotherapy from being drawn into divorce litigation. Read more here read more here



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record Can I see my record?
Dr. Garber keeps written or electronic records of all services provided consistent with relevant laws and ethics. Those files are maintained for seven years after the conclusion of the service and then destroyed.

Relatively current files (that is, closed within the past year approximately) are maintained in a more accessible manner. Older files are archived.

In general, the legal client may be able to access the record of service or be provided with a written summary of that record, subject to a number of considerations:
  • Any request to release the record of any service must be received in writing, signed and dated by the requesting party.
  • If your purpose requesting a record of service is to inform another, more current provider of the course of past treatment, it is usually far more efficient to sign an informed consent allowing Dr. Garber to communicate directly to the new provider.
  • Dr. Garber will not release a record in any instance in which he believes that doing so may cause harm.
  • Release of records of court-related (forensic) services may be subject to court order
  • Release of the records of a child's services may require the written consent of both parents.
  • A fee may be required in advance of record release for retrieval, photocopying and delivery of the record. Additional charges may be associated with interpretation of handwriting, test data and other content.






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"The Healthy Parent's ABCs"
"Keeping Kids Out Of The MIddle"
"Holding Tight/Letting Go"
"Developmental Psychology For Family
                        Law Professionals"




"Roadmap to the Parenting Plan Workbook"



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