What is the first session of Cognitive Behavior Therapy for Insomnia (CBT-I) like?

The first session is not therapy, per se. It is for us to get to know each other, for me to get some detailed information about your sleep problems, any mood issues or conditions that affect your life, such as a brain injury, recent job change, divorce, etc. It’s also a time for you to ask questions about your sleep and about how I approach working with you. First, of course, we’ll spend a few minutes going over some of the paperwork you’ll have filled out – this is legally required in Colorado.

Then we’ll start talking about your sleep, lack of sleep, and mood. Sometimes the underlying issue with insomnia is a medical sleep problem. We can work in parallel with getting medical issues treated, but it’s very important to know from the beginning if there are signs you might have, for example, sleep apnea or restless legs, so that I can refer you appropriately. It is also important for me to know any medications you’re on, and any history of mood issues or neurological issues, such as brain injury.

After you fill out the paperwork and questionnaires, I’ll ask about your sleep history, plus aspects of daily life that can affect sleep, like medications, diet, caffeine, etc. I’ll ask about mood and any history of concussions or brain injury. We’ll also go over how to track your sleep so that both of us will have the information we’ll need to change the brain-body habits that are interfering with your sleep.

What about sessions after that?

From session 2 to the next-to-last session, we’ll always begin with looking at your sleep tracking. I’ll explain how sleep works, what sleep cycles are, and we’ll develop and work on a plan for how your chronic insomnia can be changed. We’ll drill down into the details of your sleep-wake patterns, and adjust them to change the pattern, checking in about what’s working and what’s not, so you can get back to better sleep. In the final session, we’ll develop an insomnia relapse prevention plan.

Forms

Please contact me to have me send you forms and questionnaires to fill out before your first appointment. You must review and sign the forms before your first appointment. If something in the forms is unclear, call me, and we can go over it on the phone. I may also need to verify insurance coverage before our first appointment.

What if I am seeing you for issues other than insomnia?

If you are experiencing trauma-related nightmares, there are specific, short-term approaches that can reduce or eliminate those nightmares and reduce trauma symptoms in 3 to 6 sessions: Imagery Rehearsal Therapy (IRT) and Exposure, Relaxation, and Rescripting Therapy (ERRT). In the initial session of each approach, we would go over your sleep issues and trauma symptoms. In the 2nd to 6th sessions, we would work with the content of your nightmares to modify and reduce them.

If you are seeing me for a diagnostic evaluation of whether or not you have bipolar disorder, we will meet probably 3 times. Some people have been told they have bipolar disorder when they do not, in fact, have it. Other people have been given some other diagnosis when bipolar is actually a better explanation of symptoms. The right diagnosis will lead to the most effective treatment. First, we will spend 1.5 to 2 hours going over your history with mood episodes in our first session. Then it may be helpful for me to talk to someone who knows you well, such as a friend or family member to get some additional background. Then you and I would meet for another session to clarify any final issues that might affect your diagnosis. I will then write up a brief summary letter for you with information and recommendations, and we will meet for a final feedback session to discuss your diagnosis and for me to recommend treatment resources that are available in Colorado.

Do you prescribe medication?

No, I am a psychologist (who has a doctorate degree, Ph.D.) and only psychiatrists, doctors, physician’s assistants, and nurse practitioners are allowed to prescribe medication. If, in our work together, I feel that medication may help, I can provide referrals. Our work together may also help you reduce or phase off of certain medications. If you are seeing anyone who is prescribing medication for you, best practice guidelines mean that I will need a release form to speak with them to coordinate your care.

How much does it cost?

My rate is $190 per 50-minute session (more if it goes over 50 minutes). However, unlike ongoing therapy, insomnia or nightmare treatment is usually brief – 4-12 sessions, meaning your total cost for therapy could be much less than a total cost of about $10,000 for a year of weekly therapy. Currently, I am a contracted provider with Aetna, Medicare, and Medicaid CO Access (Denver and Adams Counties). In the meantime, I can provide you with appropriate documents to send to your insurance company or to use for your Health Savings Account reimbursements. I accept checks, cash, or credit cards using an encrypted secure app called Ivy Pay.