Frequently Asked Questions About Therapy

People who have never been to therapy often have some straightforward questions they need answered. People who have been in therapy often have the same questions, only they know what to ask.

How do I choose a therapist ?

First, make sure the therapist is licensed in the state of Washington. As a rule of thumb, it is good for the therapist to have at least ten years of experience. Even though I have a PhD, I think that years of experience are more important than the degree or type of mental health license. Ask your friends or doctor or clergy for suggestions of names or use the internet to check out websites like Therapist Locater, the Anxiety and Depression Association of America, the International OCD Foundation.

Second, call and talk to the therapist for a few minutes. Ask them questions like:

How long have you been licensed?
My problem is _______. How much experience do you have working with that?
How would you approach working on a problem like ____?

Listen carefully to how well the therapist listens to you. Do they seem to “get it”?   The research is that having a good connection with your therapist is the single greatest factor in predicting a successful outcome in therapy. Your instincts on this mean a lot.

What are Dr. Yost’s qualifications?

I have been licensed in 3 states: WA, CO, and NJ. My license is currently active in Washington.  I have passed the national licensing exam, I have a PhD in Interpersonal Communication and a specialized Certificate in Marriage, Family, and Child Counseling from the University of Southern California. I am an AAMFT Approved Supervisor for training other therapists. I have more than 20 years of experience. I have taught for Rutgers University and other colleges. I frequently give presentations for the public and for professional audiences.
Aside from my professional qualifications, I like my work. Some people wonder if being a therapist isn’t kind of gloomy. I think doing therapy is uplifting –I work with people who want to make their lives better and are looking for how to do it. Every person and every story is interesting and hopeful. To quote an old saying, “When you look for the best in someone, expecting to find it; you surely will.”

Do you give free initial consultations?

No.  I am happy to talk with you on the phone for 15-20 minutes so that I can determine whether I am qualified to treat your problem and so you can decide whether you think I am the right therapist. I will also answer questions via email.  But for the first session, I want you to be as committed to the therapy as I am.

What happens in the first session?

When you arrive, I ask you to fill out a few forms (you can save time by doing this in advance by downloading the forms from this site).  My office has a welcoming waiting room and the consultation room is like a small living room with a couch and two chairs.  I sit in one of the chairs and you sit where ever you are comfortable.  We begin with me reviewing the forms and asking you what the issue is. I ask questions and try to get a sense of what the “presenting problem” is –the main reason you are coming.  While you are talking, I am sketching a “genogram” which is a chart that looks sort of like a genealogy diagram and allows me to see who the major people in your life are and what your relationship with them is like.  On one side I write down “issues” and on another side I write down strengths.  Towards the end of the session, I summarize what I have heard and suggest how I would approach treating the issues.  I answer any questions you many have. Then we decide if I am a good fit for you.

What is a typical session like?

At the start of every session, I ask how it is going.  This is your cue to tell me what you want to cover that day.  It is always best to discuss what is current: both the good and the bad.  If nothing major has happened, then I will refer to the treatment plan and we will agree on what to work on from there.  Often, based on what we have discussed in the session, I will assign “homework” so that you can continue working on the issue outside of the session.

What is homework in therapy?

Homework can be as simple as asking you to notice or change one small thing.  I might suggest a book or website.

Sometimes when doing cognitive behavioral therapy, you are asked to keep a journal of your thoughts or log something you are doing.  For couples, you might be assigned a “date night.”  The homework is always tied to what we are doing in a session and is usually written down to help you to remember to do it.  The good news is that homework is never graded!

How long is a session?

Generally, a session for an individual is 60 minutes long.  When I see a couple or a family, the session is 60 to 90 minutes.  When we meet longer, we often can meet less frequently.  Changing the length of a session is only an option for private pay clients; insurance companies generally only pay for a single session on a given day.

How often do we meet?

Most commonly, I meet with people weekly for the first 4 or 5 sessions until we know each other well.  After that, once every two weeks is frequently ideal.  I like to give homework and things for you to think about between sessions so that the therapy is more than just the hour you spend with me.  If someone is in crisis, I may suggest we meet twice a week until the situation stabilizes.

But what is therapy?

People are pretty resourceful.  When someone seeks therapy it is because they are stuck.  All the common sense solutions have been tried.  Therapy gives you a safe place to describe what is wrong and get a fresh perspective on it.  Sometimes that is enough.  Other  times, new skills are needed or emotional support helps you try something new.  Therapy is NOT just complaining or whining; it is talking with an eye towards helping you to think outside of the box and create change.  Therapy is not like hiring an impartial judge to decide who is really right or having Dr. Phil scold you and tell you what to do.

Who decides what will be worked on in therapy?

You decide what the treatment goals are.  After listening to you, I summarize what you have said and formulate treatment goals that I review with you.  Sometimes I suggest something that is evident to me and ask if we can include that. I work on the targets that you select.

What is a Licensed Marriage and Family Therapist?

Licensed Marriage and Family Therapists (LMFTs) all have at least a Master’s degree, years of training and supervised experience, as well as a license to practice. In fact, the average LMFT has 13 years of experience. All LMFTs share an orientation that recognizes that people live in a whole system of interlocking relationships that influence who we are and what we choose to do. Some other schools of psychotherapy emphasize diagnosing what is wrong with the individual. LMFTS are less concerned with labels and more interested in understanding how the problems have come to be and how to create change. Less blame, more change.

The title Marriage and Family Therapist can be misleading because LMFTs treat individuals as well as couples and families. LMFTs are qualified to treat the same behavioral health issues that other mental health providers address. But, because an LMFT is especially tuned into the context of relationships, most LMFTs have more training and comfort with working with couples and families than other disciplines.

What techniques do you use in therapy?

I prefer to use “Evidence Based” techniques in psychotherapy. This means that the techniques have been tested by researchers and shown to be effective.

Cognitive Behavioral Therapy (CBT) uses techniques that focus on what you think and what you do and how to change your patterns into something more useful. For example, people who are experiencing depression tend to be overly and inaccurately negative in their thoughts (“I am such a loser”).

Exposure and Response Prevention (ERP) is a form of CBT used primarily for treating Obsessive Compulsive Disorder and other anxiety disorders. People who have OCD are asked to fill out a questionnaire about their obsessions and compulsions and to rate how important they are. Then, picking the easiest ones first, we work on how to expose you to the things that you have been avoiding or dealing with by using rituals.

Family Systems work usually begins with a genogram to understand what your family may have taught you about life and what those relationships are currently reinforcing. Every family gives you strengths and challenges. Family Therapy may also include Structural/Strategic therapy to reorganize the family or Narrative Therapy to change the meaning of certain life events.

Family Systems work does not necessarily refer to how many people are in the room. I am very open to treating whole families but sometimes individual therapy also benefits from understanding the role the family has played in shaping a person or how the family currently affects the person. Often, it is easier to create change by inviting other members of the family in to work on the problems together. Sometimes this is not possible but we can still refer to your family and how these relationships affect you.

Interpersonal Therapy focuses on improving your understanding of your relationships and enhancing your skills for dealing with others.

Psychoeducational Therapy works by educating you about the issues and the neuroscience behind your symptoms to give you better understanding and tools for creating change.

What if my teenager won’t come to the therapy?

My preference when working with adolescents is use a double barreled approach: I do the family therapy by coaching the parents and seeing the whole family when needed. I refer the adolescent to a specialist and we coordinate our care. I like to tell a teenager that they get to choose WHO they will see for therapy, not WHETHER they are going. If the teenager refuses to participate at all, the parents should come to therapy anyway. I can coach parenting strategies for changing behavior at home and for eventually motivating the young person to come for help. Usually it does not take long for a teenager to become curious about who is making all these suggestions to their parents.

Can we do therapy over the phone, text, email or Skype?

None of these forms of communication are sufficiently secure to be HIPAA compliant.  Bearing this in mind, there are occasions when I will consult with you on the phone or via email. I will not text or Skype.  Insurance will not reimburse for anything other than face to face communication.


How much does therapy cost?

My usual and customary fee is $150 for a 45 minute session and $200 for a 60 minute session.  If we decide to meet for a shorter or longer session, the fee is pro-rated accordingly.

Will insurance pay for therapy?

Many insurance will pay for “behavioral health” benefits if it is deemed to be “medically necessary.”  Insurance companies do not want to pay for you to “find yourself”.  Most companies also exclude marriage counseling.

If you have medical insurance, they will often allow you to see someone out of network after paying a deductible.  Moreover, if your plan does not have a qualified provider for a particular specialty (such as OCD), then you can demand that they let you see someone out of network.

Each month, I will send you an itemized statement (a superbill) that you can submit to your insurance company.

How long does therapy take?

In general, therapy with me will take months, not years.  Part of how long the therapy takes is up to you: people who do their homework, who come in knowing what they want to talk about, who try to be flexible and see things from a different angle, who like to learn and read, and who like to ask questions generally get better faster.  In a way, a therapist is like a personal trainer.  If you only work out once a week, it takes a long time to get fit.  Another factor is the presenting problem; some issues are pretty simple and resolve in weeks, while others are complex and take longer.

What about prescribing medication?

I cannot prescribe medication.  Usually I try to see if we can succeed without meds because the research has shown that therapy tends to give more long lasting results than medication for both anxiety and depression.  However, if you are extremely uncomfortable or if the therapy is not getting any traction, I will refer you for medication to be taken in addition to the therapy.  Sometimes your primary care doctor can help, other times it is better to see a specialist.

How will I know I am getting better?

We will talk about your progress regularly.  One way you can tell is when you find you have nothing to talk about and wish you didn’t have to bother to come in. I will certainly tell you when I think you are ready to graduate, but usually we both can tell.  I want you to get better as quickly as possible.  I feel satisfaction when my clients improve.

What if I don’t agree with what is happening in therapy

Good point.  Bring it up.  I could be wrong.  There could be a misunderstanding.  It is certainly an opportunity to make things better.  And, unlike family members, I am trained to be fair and a good listener.   Always tell me if something doesn’t sit right with you.

How confidential is therapy?

Therapy is really confidential.  Although you can tell people that you are in therapy or what happened during the session, I cannot.  You own the session.  I am bound by both the code of ethics of my professional association, AAMFT, and the licensing statutes of the state of Washington.

There are. however, some exceptions.  For example:

  • You can sign a written waiver of confidentiality (release of information).
  • If you file a complaint against me then I will have to discuss your case with the licensing board.
  • The state licensing board or the court can subpoena your records.
  • Child abuse and elder abuse must be reported by law.
  • Intention to harm yourself or others must be reported by law.

For more information see the Revised Code of Washington RCW 18.225.105