Congratulations on taking your first steps towards improving the quality of your life. Psychotherapy is a wonderful opportunity to work on the challenges experienced in life’s journey. There are many benefits and risks to psychotherapy, and we will meet together to help you work towards your desired goals. Before we get started it is important that you read through the policies and procedures in this document as they are the terms of our working relationship. Feel free to bring any questions to your first consultation. Our job is to help you sort through feelings to help you overcome or focus on what matters to you most. We do this by blending your own self expertise and our clinical knowledge together. We look forward to working with you.
What to Expect
Our goal is to provide therapy to individuals who seek support in improving the quality of their lives, families and relationships. Within a reasonable period of time after the initiation of treatment, each provider will discuss with you their understanding of the problem, treatment plan, therapeutic objectives and the view of the possible outcomes of treatment. If you have any unanswered questions about any of the procedures used in the course of your therapy, the possible risks, our expertise in employing them, or about the treatment plan, please ask and you will be answered fully. You also have the right to ask about other treatments for your condition and their risks and benefits. After the first couple of meetings, we will assess if our practice can be of benefit to you. In such a case, if appropriate, your clinician will give you referrals that you can contact. If at any point during the therapy, we assess we are being ineffective in helping you reach the therapeutic goals or perceive you as non-compliant or non-responsive, and if you are available and/or it is possible and appropriate to do, we will discuss with you the termination of treatment and conduct pre-termination counseling. In such a case, if appropriate and/or necessary, we may give a referral that may be of help to you.
Acknowledgment of Forms: Once you have read through my policies and practices you will sign an acknowledgment of forms. This form solidifies our working relationship and the terms of our therapeutic contract. This form is your consent to psychotherapeutic services as well as acknowledgment of receipt of said policies and HIPPA rights. Please feel free to bring any questions with you to therapy at any time.
Emails, Phone Calls and Emergencies
For small administrative matters such as checking appointment times or changing them, you are welcome to email me your clinician. Generally we receive and return these emails within 24-72 hours with the exception of weekends. If you need to contact your clinician via cellphone between sessions about a clinical matter, please leave a message on their assigned phone number. Your clinician checks messages each day unless they are out of town. If your clinician is planning on being out of town, you will be informed in advance. If you feel the need for many phone calls and cannot wait for your next appointment, we may need to schedule more sessions to address your needs. If an emergency situation arises, please indicate it clearly in your message to your clinician. If your situation is an acute emergency, you are thinking of harming yourself or someone else, and you need to talk to someone right away, go to the nearest hospital emergency room.
Cancellations and Lateness
Our office requires 24 hours notice of a cancellation. It is extremely difficult to fill your last minute cancelled session on a short notice. Therefore, we charge for appointments cancelled with less than 24 hours notice. Repetitive no-shows will result in a discharge from the practice. Three cancelled appointments with no notice will result in a discharge from the practice; unless no-shows were a result of an emergency.
If you are running late for your appointment, please phone or email your clinician as soon as you can to inform you will be late. If you are late for your session, we will still end at our regular time so that we have time to prepare for the next appointments and can be on time for them. There are no fee accommodations based on lateness.
Payment and Financial Accommodations:
Currently, we work with multiple insurance providers. The standard fee for out of network appointments is $150 for a 45 minute session. The fee, or insurance related copays, is to be paid at the start of each session unless other arrangements have been made. If you are late, we will end on time and not run over into the next person’s session at the same fee. In case of financial hardship, a payment plan can be arranged.
Out-of-network: Some or all your fees may be covered by your health insurance, if you have outpatient mental health coverage. However, insurance companies do not reimburse all conditions that may be the focus of psychotherapy, nor do they reimburse for every clinician. It is your responsibility to verify the specifics of your coverage. Please remember that our services are provided and charged to you, not your insurance company, so you are responsible for payment. Fees you pay for therapy services that are not reimbursed by insurance may be deductible as medical expenses if you itemize deductions on your tax return.
Other fees: If you become involved in legal proceedings that require our participation, you will be expected to pay for professional time and services even if a clinician have been called to testify by another party. Because of the difficulty of legal involvement and the interruption to our regular practice, we charge $450 per hour for preparation and attendance at any legal proceeding. We will provide bills/receipts at the end of each session expect to be paid upon receipt unless otherwise agreed upon.
Payments shall be charged same day of appointments. Clients have the option of paying in cash, check or credit card. Clients will be charged a $30 fee per check returned.
Credit Cards: A credit card must be kept on file. Charges will be submitted same day as session unless other arrangements are made.
Payment Plans: Clients with a payment plan must keep a credit card on file for monthly payments. Clients on a payment plan will continue to make monthly payments until debt is resolved. Remaining balance must be paid 120 days after termination, or the remaining balance will be billed to the card on file. In instances where a credit card charge is not possible, your identifying information may be sent to a collections agency for payment.
Our desire is to maintain your confidentiality. We do this by respecting your privacy in real-time and in the digital world. In person, there may be times in which we cross paths, whether at a supermarket or at an unforeseen event. In order to protect your privacy none of our clinicians will not greet you or establish communication. If you would like to greet your clinician, please feel free to do so; We will interpret this as a sign of welcomed interaction. However, we will not disclose the content of our relationship in group setting. See more below regarding social media policies. As a psychotherapy client, you have privileged communication. This means that your relationship with us as our client, all information disclosed in our sessions, and the written records of those sessions are confidential and may not be revealed to anyone without your written permission, except where law requires disclosure. Most of the provisions explaining when the law requires disclosure are described below.
When Disclosure Is Required by Law: Disclosure is required when there is a reasonable suspicion of child, dependent or elder abuse or neglect and when a client presents a danger to self, to others, to property, or is gravely disabled. When Disclosure May Be Required: Disclosure may be required in a legal proceeding. If you place your mental status at issue in litigation that you initiate, the defendant may have the right to obtain your psychotherapy records and/or my testimony. If you have not paid your bill for treatment for a long period of time, your name, payment record and last known address may be sent to a collection agency or small claims court. In couple or relationship therapy, or when different family members are seen individually, confidentiality and privilege do not apply between the couple or among family members. We will use clinical judgment when revealing such information.
If there is an emergency during our work together or after termination in which we become concerned about your personal safety, the possibility of you injuring someone else, or about you receiving psychiatric care, we will do whatever we can within the limits of the law to prevent you from injuring yourself or another, and to ensure that you receive appropriate medical care. For this purpose we may contact the person whose name you have provided on your New Client Intake Form or call 911/Mobile Crisis Unit.
Health Insurance and Confidentiality of Records: Your health insurance carrier may require disclosure of confidential information in order to process claims. Only the minimum necessary information will be communicated to your insurance carrier, including diagnosis, the date and length of our appointments, and what services were provided. Often the billing statement and your company's claim form are sufficient. While insurance companies claim to keep this information confidential, I have no control over the information once it leaves my office. Please be aware that submitting a mental health invoice for reimbursement carries some risk to confidentiality, privacy, or future eligibility to obtain health or life insurance.
Conﬁdentiality of E- mail, Voice mail and Fax Communication:
E-mail, voice mail, and fax communication can be easily accessed by unauthorized people, compromising the privacy and confidentiality of such communication. Please notify me at the beginning of treatment if you would like to avoid or limit in any way the use of any or all of these communication devices. Please do not contact us via email or faxes for emergencies.
Consultation: We consult regularly with other professionals regarding clients in order to provide you with the best possible service. Names or other identifying information are never mentioned; client identity remains completely anonymous and your confidentiality will be fully maintained. Many times consultation is best offered when reviewing audio/video recordings of counseling services. If, for some reason, We believe it is important to consult with another professional using audio/video recordings that identify you, we will have you sign a consent to audio/video record allowing us to share this information. Without such a release, we will not consult with another professional providing information that might lead another person to be able to identify you. Refusal to consent to audio/video recordings does not make you ineligible for services. All recordings are for education purposes and are destroyed after consultation.
Publication: De-identified information about our working relationship may be published, for education purposes, in academic journals. If we do publish any written work, where I reflect on any aspect of our working relationship, I will change all identifying information about you to keep your identity confidential. If I think there may be information unique to you that can be easily identifiable, I will share my written work before taking any steps towards publication.
Release of Information: Considering all of the above exclusions, upon your request and with your written consent, we may release limited information to any person/agency you specify, unless we conclude that releasing such information might be harmful to you. If we reach that conclusion, we will explain the reason for denying your request.
SMS/Social Media Policy
Please be aware of confidentiality and other issues that arise via electronic communication. In order to protect your privacy we have outlined some guidelines below:
Emails: Emails are sent over the Internet and are not encrypted, are not secure, and may be read by others therefore we, as the therapists, are not liable for any breach of confidentiality that may result from email usage. Email communications with will NOT be encrypted and, therefore, we, as the therapists, CANNOT guarantee the conﬁdentiality and security of any information sent to or from you, the client. At times we, the therapists, may send you information on resources that we may use in therapy. Your email will not be put on any subscription lists.
Emails SHOULD NOT be used to communicate urgent matters, such as symptoms, emergencies, suicidal thoughts, homicidal thoughts, medical emergencies, etc. Emails may be made part of your permanent medical record and would be accessible to anyone given access to those records. You also understand that you may withdraw permission from your therapist to communicate with you via e-mail or SMS by notifying my therapist in writing.
SMS/Mobile Text Messaging: SMS messages may not be secure and therefore we, as the therapists, am not liable for any breach of confidentiality that may result from SMS usage. For this reason we, as the therapists, advise not to send sensitive information via email or SMS message. This includes information about current or past symptoms, conditions, or treatment, as well as identifying information such as social security numbers or insurance identiﬁcation information. We, as the therapists will limit SMS messages to brief inquiries or responses regarding scheduling.
SMS messaging SHOULD NOT be used to communicate urgent matters, such as symptoms, emergencies, suicidal thoughts, homicidal thoughts, medical emergencies, etc. SMS messaging may be made part of your permanent medical record and would be accessible to anyone given access to those records. You also understand that you may withdraw permission from your therapist to communicate with you via e-mail or SMS by notifying your therapist in writing.
Social Media: There are no expectations that you, the client, will have to follow any existing blogs, podcasts, or social media pages, either on twitter, facebook, instagram, yelp, etc. There are also no recommendations that you review our practice on any social media outlets, especially as it may jeopardize your privacy. If you do decide to follow one of any of our professional social media pages we will briefly discuss the potential impact on our working relationship, should we find out. No messages sent via a social media platform will be responded to. These sites are not secure and messages may not be read in a timely fashion. Do not use wall postings, @replies, or other means of engagement in public online forum, if we have an already established client/therapist relationship. Engaging this way could compromise conﬁdentiality. It may also create the possibility that these exchanges become a part of your legal medical record and will need to be documented and archived in your chart.
Search Engines: Google, Facebook or other search engines may be used by your therapist in extremely rare exceptions like during times of crisis. If we, the therapists , have a reason to suspect that you, the client, are in danger and unreachable via email or phone, We, the therapists, may use a search engine as part of ensuring your welfare. These are unusual situations and such instances will be fully documented and discussed next meeting.
If you have a concern or complaint about your treatment, please talk about it with us. We will take your criticism seriously and respond with care and respect. If you believe that any clinician has been unwilling to listen and respond, or that they have behaved unethically, you can contact the Founders Rebecca Gillespie or Roxanne Ruiz-Adams, or the Division of Consumer Affairs which oversees licensing, and they will review the services we have provided.
Division of Consumer Affairs
You are also free to discuss your complaints and you do not have any responsibility to maintain confidentiality about what we do that you don’t like since you are the person who has the right to decide what you want kept confidential. I hope this answers some of your questions. Please let us know if you have concerns or questions about any of these policies and procedures or this agreement for working together in psychotherapy.