What is a psychologist? A psychologist is a mental health professional trained to apply an understanding of human behavior, emotion, growth and relationships to create change. As a psychologist Dr. Garber is not a physician (i.e., a medical doctor), does not prescribe medication, and will not examine your body.  A psychiatrist, by contrast, is a physician who is prepared to recommend how certain medications and medical procedures might influence behavior, emotion and relationships. Mental health services may also be available from clergy, school counselors, Employee Assistance Providers (EAP) at work and master's level clinicians, including MSW and LICSW (social work) trained professionals. The quality of mental health care you receive can not be differentiated based on the provider's education or the letters after his or her name. Far more important will be the professional's experience and expertise and the quality of the "fit" in the therapeutic, evaluative or forensic service relationship. One quick tip... how soon a professional returns your initial call or e-mail inquiring about services may be related to overall resposiveness. What is the nature of the service? Dr. Garber is available to provide several distinct psychological services. It will be important to clarify which of these you are seeking from the time of your first call: Psychotherapy. Psychotherapy (also referred to as “therapy” or “counseling”) is a goal-driven relationship focused on growth and change. Dr. Garber is available to conduct psychotherapy with individual children, teenagers and adults, as well as with couples, families, sibling groups and in group psychotherapy meetings. Each of these interventions will require the time to collect an initial history and background regarding each participant (“client" or "patient”), negotiation of mutually acceptable and reasonable goals, and discussion of the best means and approximate time necessary to accomplish these goals. Dr. Garber will direct the course of the psychotherapy within the limits of his training, expertise and resources. Dr. Garber must reserve the right to advise you at any time that other resources may better suit your needs in addition to or instead of the services he offers. Dr. Garber's responsibility is to be available for all scheduled appointments barring illness, extreme weather and emergency. The patient's responsibility in psychotherapy is to attend all meetings as scheduled (barring illness, extreme weather and emergency), to be as open and honest as possible, and to reasonably follow through with any outside task or assignment which has been agreed upon. See also the related page on Psychotherapy Assessment.  Assessment seeks to apply psychological principles to understanding one or more specific question about an individual, couple's or (family) group’s behavior, thoughts or emotions. Assessment can include the administration, interpretation and summary of standardized instruments (e.g., IQ tests) and/or a less formal qualitative evaluation process including interview and observation. Unless otherwise determined, the assessment process is complete upon delivery of (written or oral) feedback and recommendations. When court-involved (“forensic”) assessment is conducted, specific conditions of payment, confidentiality and procedure are involved. Dr. Garber will alert you to these conditions at the earliest possible time.  See also the related page on forensic psychology services Consultation. In some circumstances, Dr. Garber works to provide an individual (e.g., a litigant, an attorney or teh court) with child-centered, psychological resources (e.g., research, statistics). For example, Dr. Garber frequently consults with school counselors, staff and teachers regarding behavior management issues regarding a specific child's learning challenges. Specific conditions of payment, confidentiality and procedure must be agreed upon from the start of these services. Learn more about Dr. Garber's expert consulting services in the context of child-centered litigation Mediation, negotiation and arbitration. Disputing parties can mutually elect or be court-ordered to engage with a third party for the purpose of resolving specific issues in the least contentious way possible. Although not certified as a mediator by the state of New Hampshire, Dr. Garber often serves in this capacity in child-centered matters (e.g., custody or visitation) under specific terms and conditions, particularly in the role of Parent Coordinator. Learn about Parent Coordination See also the related page on forensic psychology services Forensic (court-related) services are ordered through the court. Dr. Garber provides a variety of forensic psychology services. Learn more here   When and how can Dr. Garber be reached? Dr. Garber is not an emergency-response provider and is not reliably available after hours in case of emergency. If you have a life threatening emergency, call 9-1-1 immediately or go to the hospital emergency room. Dr. Garber may be available as a secondary resource on his after-hours phone line at 603.689.4192. Dr. Garber welcomes your routine contact via voice mail, fax and e-mail and can typically respond within one business day. When leaving a message, please indicate whether and how you would like a response to each message. Contact Dr. Garber  What is the typical duration of services? In most instances, Dr. Garber will recommend a specific time course or duration of services based on negotiated goals, resources and associated limitations. The recommended time course is most often set in terms of a number of meetings. Upon completion of the estimated number of meetings, Dr. Garber will recommend a review of status and progress in order to evaluate (a) the need for further services, (b) revision of goals and/or the methods of approaching these goals, (c) inclusion of new ancilliary resources to facilitate progress (e.g., referral for medication consultation, occupational therapy or a support group)  or (d) that services be discontinued in favor of discontinuing therapy altogether or transferring therapy to a different provider. Who is the client or patient? For clinical purposes, the client or patient is the individual seeking growth and change. Legally, however, the client or patient must be distinguished as that person who has the discretion to start or stop a service and/or has access to records of the service. Children. When a child is the patient, Dr. Garber's clinical responsibility is to the child and to the child's best interests. However, Dr. Garber's legal responsibility is to the child's legal guardian(s), usually the parent(s). There are important exceptions to this standard. These include teenagers' protections under federal law and New Hampshire's commitment to value children's confidentiality over and above the wishes of parents in some specvific instances. Learn more here Separated and Divorced Parents or Guardians. When a child is the clinical patient and his or her legal guardians are separated but share legal custody, Dr. Garber's legal responsibility is to both caregivers, although the clinical responsibility and primary focus remains on the child. What happens when co-parents dispute a child's psychotherapy? Teenagers. The law guarantees teenagers certain adult-like protections in matters of reproductive health, substance use, and physical illness (e.g., AIDS). Although safety always comes first, Dr. Garber will always work to respect a teenager's maturity, healthy choices, and independent functioning. Read more here Court Ordered Services. If you have been ordered to participate in psychological services by a court, the court itself is the legal “client.” This means that the court can determine the goals, frequency and duration of services, subject to Dr. Garber's agreement and recommendations. Learn more about psychological services in the context of divorce Confidentiality, privilege and privacy All three words generally refer to how much control you have over the information that you share with Dr. Garber. Confidentiality specifically refers to the legal protections that bear on information revealed in therapy, in your relationship with your other health care providers or with your attorney. Mental health providers are responsible under NH law to clarify the limits of confidentiality to clients/patients prior to commencing services and protecting these limits during and after the conclusion of service provision. Privilege defines the client's right to communicate openly with his or her attorney without fear that these communications will be revealed. See a discussion of confidentiality and privilege Privacy is not a legally definable or enforceable concept with regard to psychological services, but is an important part of any respectful relationship, as when a parent allows a teenager to speak "privately" to a therapist, acknowledging the limitations imposed on this guarantee under the law. Dr. Garber will do everything possible within the law to respect the confidentiality of the psychotherapy relationship and the privilege that may be relevant in forensic cases. There are, however, certain situations which legally mandate the release of what might otherwise be construed as confidential information. These include, but may not be limited to: Written Release. In most instances, the patient or the patient's legal guardian(s) can authorize release of confidential records to specific individuals and/or allow Dr. Garber to obtain information from specific individuals in writing. Threats to Health and Safety. The law requires that any health service provider  act to assure safety first and foremost. This means that any time that Dr. Garber suspects that an individual poses a threat to their own health and well-being or to others' safety, he is responsible to alert personnel including the police and/or child protective services.  If you are concerned about the safety of a child in the state of New Hampshire, contact the Division for Children, Youth and Families at 1-800-894-3533 immediately. Property Damage. New Hampshire may require notification of appropriate authorities should a threat of serious damage to property be present.  Court Order and Subpoena. Judges, juries and attorneys can demand release of otherwsie confidential or priviledged information through either of these two mechanisms. Although there are instances in which a subpoena can be resisted, it is generally the case that a court can compel the release any of such records. Other Legal Protections. For example, the law allows that teenagers can forbid health providers from revealing ceratin specific information relevant to HIV/AIDS status, reproductive health status and drug and alcohol consumption. Insurance Carriers. Your contract with your health, life and/or disability insurance providers may authorize these agencies to receive copies of any or all of your confidential records. Although Dr. Garber does not participate with any managed care or insurance companies and will not bill any third party insurance entity for services in your name, your effort to seek reimbursement may be sufficient to alert the company to request release of confidential psychological records which may impact your qualifications for future claims, policy renewals and/or payments. Please see Dr. Garber's position regarding health insurance claims Electronic payment of services implicitly requires that third parties become aware of your relationship with Dr. Garber's office and may therefore compromise your confidentilaity. Dr. Garber uses PayPal, an online credit and debit card vendor. Should you choose to make payment via PayPal, you are waiving all associated confidentiality restrictions, including those imposed under HIPAA. An important exception: New Hampshire's "Berg" Ruling. Finally, note that a NH Supreme Court 2005 ruling creates some situations in which a child's rights to privacy in psychotherapy may trump a parent's wishes for access to the records of that therapy. Read more here <>See the NH Board of Mental Health Practice on Berg <> <> Why should you consult with a physician? Your thinking, emotions and your physical health influence one another very closely, each affecting the other minute to minute. Assuring that your body is as healthy as possible and remains healthy is critically important to your success in psychotherapy and has direct bearing on the outcome of any evaluative process. New Hampshire law requires that Dr. Garber strongly encourage you to complete a thorough physical examination within at least six months of commencing psychological services and that you remain in consultation with a medical provider throughout the course of services What is supervision, consultation and coverage? In concert with legal and ethical guidelines, it is Dr. Garber's practice to engage in confidential peer consultation on a regular basis. Such consultation helps to assure the quality of services available. Consultation is conducted in a confidential setting with qualified, experienced and trusted colleagues in health and the law. Case discussion occurs anonymously unless specific release has been obtained from the legal patient. Dr. Garber often relies on these same colleagues for emergency “coverage” during any absence or vacation. Whenever possible, Dr. Garber will provide the name of any such emergency coverage in advance of a planned absence. By agreeing to participate in psychological services, you are accepting that Dr. Garber may engage certain colleagues for purposes of supervision, consultation and/or coverage. Does Dr. Garber keep records? It is Dr. Garber's practice consistent with ethical standards, state and federal laws to keep secure written and/or electronic records of  all services provided. Records of your services are accumulated in a paper and/or electronic file. Copies of these records are available for an administrative fee at the written request of the legal patient unless otherwise prohibited by the court or contrary to the well-being of any person in Dr. Garber's  exclusive discretion. Since 2003 the Health Insurance Portability and Accountability Act (HIPAA) of 1996 imposes very specific and strict protections on patient health care information. For more information, search HIPAA on the web or click here

"But I can't afford services!" Dr. Garber chooses not to participate in managed care and health insurance reimbursement panels. This means that payment is due at the time of service unless otherwise agreed in advance. Read more here Payment is accepted as cash, personal and bank check and via PayPal, a secure online credit and debit card vendor. Learn more about PayPal The out-of-pocket costs of psychological services can be daunting even if you are able to get reimbursed from your carrier at some point in the future. Acknowledging this, Dr. Garber may be able to reduce the costs of clinical services and, if necessary, would be glad to review your carrier's list of "preferred providers" (those mental health service providers who have agreed to accept direct reimbursement) so as to refer you to qualified and familiar colleagues who have agreed to accept the carrier's direct payments.