The following is a detailed explanation of the policies and procedures of my practice. Please review carefully and fully. I am happy to answer any questions you might have.
BOUNDARIES
Your relationship with me is a professional and therapeutic relationship. In order to preserve this relationship, it is important that we do not have any other relationship(s). Personal and/or business relationships undermine the effectiveness of the therapeutic relationship. I care about helping you but it would be inappropriate for me to be your friend or have a social relationship with you. It is considered inappropriate for us to exchange gifts. In order to protect your privacy if we should run into each other out and about in the world I will not acknowledge you unless you acknowledge me first. If you do wish to say hello, I will not make any introductions if either of us is with other people. Any conversation should be kept brief and should not be related to your treatment.
MEETINGS
Normally the first 2 to 4 therapy sessions are an evaluation period. During this time, we can both decide if I am the best person to provide the services you need in order to meet your treatment goals. Moving forward I will schedule a one-hour long session per week, at a regular time we agree on. Once an appointment time is scheduled, you will be expected to pay for that time unless you provide at least 24 hours advance notice of cancellation.
When doing EMDR therapy, once we get to reprocessing your traumatic memories longer, more intensive therapy sessions of 90 or 120 minutes are often significantly more efficient and effective. Each session necessarily involves catching up on daily stressors, thus longer sessions allow for substantially more time for focused work toward resolving the primary
symptoms of concern. My experience has shown me that much more can be accomplished in a shorter period of time through this approach.
Due to the nature of my work, there are times when unforeseen clinical crises or emergencies may arise with other clients, requiring that your appointment be canceled or delayed. When such situations are unavoidable, I will make every effort to inform you at the earliest possible time and reschedule the missed session time in order to minimize the inconvenience to you.
I understand that you may use drugs (including marijuana) and/or alcohol, however, therapy is most effective if you come to your appointments sober. If I have concerns that you are under the influence, I will have a discussion with you about whether or not it is appropriate to have our session that day. If you are visibly under the influence when you arrive and plan on driving away from our session, I may be required to contact the authorities as I will consider you a danger to yourself and others.
TELEPHONE CONTACT
I am not immediately available by phone. Though I am usually in my office between 9am and 7pm, I do not answer the phone when I am with a client. When I am unavailable, you can leave me a voicemail, and I will make every effort to return your call the same day, with the exception of Sundays and holidays. If you are difficult to reach, please give me some times when you will be available. If you are unable to reach me and feel that you cannot wait for me to return your call, please reach out to someone you know and trust, contact the San Diego Crisis Line at 1-888-724-7240, or go to the nearest emergency room.
ELECTRONIC COMMUNICATION
I use email communication only with your permission and only for administrative purposes unless we have another agreement. That means that email with my office should be limited to things like setting or changing appointments, and other administrative issues. Please do not email me with urgent or clinical matters because email is not a secure way to contact me and is not checked as frequently as voicemail. If you need to discuss a clinical matter with me, please feel free to call me or wait so we can discuss it during your next therapy session. You should know that any emails received from you and any responses sent will become part of your therapy record.
Because text messaging is an unsecure and impersonal mode of communication, I do not typically send or respond to text messages except for administrative purposes. Please, do not text message me unless we have made prior arrangements (typically restricted to scheduling). Any texts received from you and any responses sent by me will become part of your therapy record.
I do not communicate with, or contact, any of my past or present clients through my personal social media platforms such as Twitter, Facebook, Instagram, or Linked In. If I discover that I have accidentally established a personal online relationship with you, I will end that relationship and discuss it with you at our next session. This is because these types of casual social contacts can create significant security risks for you and inadvertently violate your privacy. If you choose to follow one of my professional social media pages, please be mindful of the lack of privacy and confidentiality of anything you post, and do not engage in a clinical conversation with me on these sites.
I have a website that you are free to access which I use to provide information to others about me and my practice. I understand that you might choose to gather information about me via the web. In this day and age there is an incredible amount of information available on the internet, much of which may actually be known to that person and some of which may be inaccurate. Some clients review their health care provider on various websites. Unfortunately, mental health professionals cannot respond to such comments or correct any errors because of confidentiality restrictions. If you encounter reviews of me and have concerns, please share it with me so we can discuss it.
CONFIDENTIALITY
In general, the privacy of communications between a client and their psychologist are protected by law, and I can only release information about our work to others with your written permission. But there are exceptions, and these are listed below.
There are some situations in which I am legally obligated to take action to protect
others from harm, even if I have to reveal some information about your
treatment. These situations include:
- If I have reasonable suspicion that a child or elderly/disabled person is being or has been abused, I may be required to make a report to the appropriate authorities.
- I am required to report if someone knowingly viewed, downloaded, streamed, or accessed child pornography (which includes films, photographs, videotapes, etc.).
- If I believe that you are threatening serious bodily harm to another, I am required to take protective actions. This may include notifying the potential victim, contacting the police, or seeking hospitalization for you.
- If you threaten to harm yourself, I may be obligated to take protective action. This may include hospitalization for you or contacting those designated by you who can help provide safety/ protection. If such a situation occurs in the course of our work together, I will attempt to fully discuss it with you before taking any action.
- If you file an insurance claim to be reimbursed for some portion of the cost of therapy, this gives the insurance carrier the right to inquire regarding your information. I may disclose medical information to a provider of health care, health care service plan, or contractor for the purposes of diagnosis or treatment.
- In most legal proceedings, you have the right to prevent me from providing any information about your treatment. If you bring up your mental health in a court preceding you have waived this right. In some legal proceedings, a judge may order my testimony if they determine that the issues demand it, and I must comply with that court order.
- I may occasionally find it helpful to consult with other professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my client. The consultant is also legally bound to keep the information confidential. Ordinarily, I will not tell you about these consultations unless I believe that it is important to our work together.
- On occasion I may need to disclose information to employees or agents of my practice for operational purposes.
- In the event of my death or incapacity, another therapist of similar competence, can take possession of your file and continue therapy if you wish, or you have the right to request a copy of your file to take to another therapist.
Although this written summary of exceptions to confidentiality is intended to inform you about potential issues that could arise, it is important that we discuss any questions or concerns that you may have. I will be happy to discuss these issues and provide clarification when possible. However, if you need specific clarification or advice I am unable to provide, formal legal advice may be needed, as the laws governing confidentiality are quite complex and I am not an attorney.
H.I.P.A.A.
The H.I.P.A.A. Notice of Privacy Practices provides information about how I may use and disclose your protected health information. A copy of the Notice of Privacy Practices is generally made available to you at the time of intake and can be provided to you at any time upon request. While the critical information is already contained in this Consent form, I encourage you to read the Notice of Privacy Practices in full. The Notice of Privacy Practices is subject to change. If I change the Notice of Privacy Practices, you may obtain a copy of the revised notice from me.
AUDIO AND VIDEO RECORDINGS
I am continuously seeking to improve my skills and seek certifications/ consultations to do so, therefore there may be times when I request to videotape a session. It is always your right to say no, and whatever answer you give will not impact your ability to obtain treatment. By signing below, you agree that neither you nor I will record any part of our sessions unless you and I mutually agree in writing beforehand that the session may be recorded.
ENDINGS
There are a number of circumstances under which therapeutic services can/should end. You may end therapy at any time, but a minimum of a final phone call or session is requested for us to wrap things up.
If and when services are ended I will maintain your records for the period of time required by law and will make them available to you or a subsequent therapist upon written request. If therapy is ended for any of the following reasons I will be happy to provide you with referrals to other appropriate treatment professionals.
If you and I both agree that you have reached your treatment goals, this is something to celebrate and be proud of. In this case we will discuss and review your progress and the treatment and then we will end therapy. You are always welcome to contact me if you would like return to therapy.
I am ethically obligated to end services if I believe you are not benefitting from therapy. Prior to such a decision we can discuss any possible adjustments to our work that might produce change and help you progress. If finding another therapist might be a better option for you this will be discussed as well.
If you are unhappy with your treatment or your progress, I hope to create an environment in which you will be comfortable telling me this, that way we can address your concerns and possibly improve the treatment and our relationship. If that does not work or you are not interested, then I will be happy to provide you with referrals to other appropriate treatment professionals.
Other reasons for possible termination of services include: amassing a substantial unpaid account balance, refusing to comply with treatment recommendations, repeated boundary violations, or if I fear for my physical safety. If I have any of these concerns, I will make every attempt to discuss them with you prior to making a decision to end services and as appropriate you will be given a reasonable opportunity to make the needed changes.
BILLING AND PAYMENTS
My hourly fee is $175. If we meet more than that time, I will pro-rate accordingly. If you arrive more than 15 minutes late for an appointment without notifying me, I will consider the appointment canceled and charge for the session. You will be expected to pay for each session at the time it is held, unless we agree otherwise in advance. In circumstances of unusual financial hardship, I may be willing to negotiate a temporary fee adjustment or payment installment plan. Invoices for payment(s) are available at your request. An additional $10.00 per week will be charged for session fees not paid on the date of service, which will begin to accrue on the day directly following the date of service. Fees may be paid via cash, check, or credit card. There is a $25.00 fee for returned checks.
I reserve the right to review my fees once a year on February 1st. If at that time I choose to increase my fees you will be given a 60 day notice of the increase.
In addition to weekly appointments, I charge this same hourly rate for other professional services you may need, though I will prorate (in 15 min increments) the hourly cost if I work for periods of less than one hour. Other professional services include but are not limited to report writing, telephone conversations lasting longer than 10 minutes, attendance at meetings with other professionals you have authorized, preparation of treatment summaries, or letters in support of transition. If you become involved in legal proceedings that require my participation, you will be expected to pay for any professional time I spend on your legal matter, even if the request comes from another party. I also charge a copying fee of $0.05 per page for records requests.
If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. If such legal action is necessary, its costs will be included in the claim. In collection situations, the only information I will release regarding a client’s treatment is their name, the dates/times/nature of services provided, and the amount due.
INSURANCE REIMBURSEMENT
In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. I am not currently on any insurance panels and will be considered an ‘out of network provider.’ I will not bill your insurance. If requested I will supply you with a superbill to submit to your insurance company for possible reimbursement for the therapy fees. You (not your insurance company) are responsible for full payment of my fees.
DISCLAIMER
I am not responsible for care received from professionals I refer you to. Our agreements do not involve other providers in the suite, who operate their own practices.
Your signature below indicates that you have read the information in this document and agree to abide by its terms during our professional relationship.
