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Clinical Services
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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
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03.22.2020: In response to
the COVID-19 health crisis and always erring on
the side of caution, Dr. Garber has temporarily
suspended face-to-face professional contacts.
Clinical services are now being provided via
electronic distance media (e.g., telephone,
VOIP, and video conferencinf platforms). With
apologies for interruptions of care and
inconveniences associated with devices and
communication infrastructure, this is the best
means of continuing to meet clinical needs.
Engaging in clinical services via electronic
distance media requires your consent and/or the
consent of others involved in your particular
situation. For details, please reach Dr. Garber at
any time at bdgarberphd@FamilyLawConsulting.org.
The appropriate consent form is provided here:
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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

- Its important to understand
the costs associated with psychotherapy, how Dr.
Garber accepts payment, and the limitations
associated with third party (health insurance)
reimbursement

- 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

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.
Read more here 
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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 and 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 
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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.
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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
recommended 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 
- 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.
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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 privilege, that is,
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

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.
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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., M.D., or LCMHC),
psychotherapy is a process of facilitated change
toward greater health, happiness and adaptation.
Psychotherapy works in three ways:
1. 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.
2. The psychotherapist can also serve as a coach or
mentor, to offer strategies and referrals to other
resources that can help change troubling thoughts,
feelings and behaviors. Familiar among these are
journalling, 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.
3. The psychotherapist is, at the very least, a
"port in the storm," that is, a safe place outside
of the real world pressures that can fuel
overwhelming emotions. This is often the case, for
example, when children shuttle back and forth
between parents engaged in divorce wars. The
children suffer the stresses of conflict,
instability, and triangulation into the process.
Child psychotherapy cannot resolve those pressures,
but is often necessary to help the child keep his or
her head above water until the adult conflict
subsides.
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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 the parent requesting services do so
via email to Dr. Garber 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 
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Can I see my record?
Dr. Garber keeps written
and/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 (or longer when the
clinical patient is ainor child) 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 a lgally entitled
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 and
less expensive 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 or scanning and delivery of the
record. Additional charges may be associated
with interpretation of handwriting, test data
and other content.
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