Policies & Procedures
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.
Your relationship with me is a professional and therapeutic one, and therefore there are limitations placed on our interactions. In order to preserve this alliance, it is important that we do not have any other type of relationship(s) as 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 generally considered inappropriate for us to exchange gifts. In order to protect your privacy should we run into each other out and about in the world, I will not acknowledge you unless you acknowledge me first. Any conversation should be kept brief and should not be related to our work together or your treatment.
Normally the first few therapy sessions are an evaluation period. I do a thorough assessment of your needs and your history so that we can develop a strong treatment plan to guide our work together. In general, I will schedule one therapy session per week, at a regular day and 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 (insurance permitting). Multiple or recurrent no shows or late cancellations may result in termination of services, see the section titled Endings for more details.
Once we get to reprocessing your traumatic memories with EMDR, then 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 issues that brought you into therapy. Much more can be accomplished in a shorter period of time through this approach. This is my recommendation, although I recognize there may be limiting factors and we can discuss those and how to proceed as the need arises.
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. If/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 and/or alcohol (including marijuana or prescription drugs), however, therapy is most effective if you come to your appointments sober. Use of drugs and/or alcohol is likely to negatively impact the results of any EMDR reprocessing that we do, so we need to discuss this and develop a plan of approach. 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 or if I have concerns that you are under the influence, and have plans to drive away from session, I will consider you a danger to yourself and will act accordingly.
If we are meeting in person in the office and you are feeling unwell or under the weather, the expectation is that you will notify me as soon as possible and we will switch to meeting via telehealth, or cancel the appointment if you prefer. If you arrive to session under the weather, I reserve the right to whether or not we will meet.
When you need to contact me for any reason, these are the most effective ways to get in touch in a reasonable amount of time:
Please refrain from making contact with me using social media messaging systems such as Facebook Messenger or Instagram. It is important that we be able to communicate and also keep the confidential space that is vital to therapy. Please speak with me about any concerns you have regarding my preferred communication methods.
I subscribe to the following service(s) that can allow us to communicate more privately through the use of encryption and other privacy technologies. None of them will cost you money, but each requires some setup before they can be used. Please ask if you would like to use any of these services:
MY AVAILABILITY & RESPONSE TIME
I am not immediately available by phone or text message. During my work week, Monday through Thursday (9 am to 7 pm), you can typically expect a response the same day for voicemails and text messages. Friday through Sunday and during holidays I may not respond until the following week. I may occasionally reply more quickly than that, but please be aware that this will not always be possible. If you are difficult to reach, please give me some times when you will be available.
If you need to contact me about an emergency, the best method is by text/secure message (via iPlum, 858-276-8831), simply let me know it is urgent and I will return your message as soon as possible, it could take several hours. Please do not email me with urgent or emergency situations as I do not check email as frequently.
Please note that SMS (normal smart phone text messages) are not designed for emergency. SMS text messages occasionally get delayed and on rare occasions may be lost. So, please refrain from using SMS as your sole method of communicating with me in emergencies.
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.
I do not communicate with, or initiate contact with, any of my past or present clients through my personal social media platforms such as 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 attempt to engage in a clinical or administrative conversation with me on these sites. If you do so, I will not respond until we meet in person, and I will delete your post.
Please know that if we use electronic communications methods, such as email, texting, online video, and possibly others, there are various technicians and administrators who maintain these services and may have access to the content of those communications. Of special consideration are work email addresses. If you use your work email to communicate with me, your employer may access our email communications. There may be similar issues involved in school email or other email accounts associated with organizations that you are affiliated with.
Additionally, people with access to your computer, mobile phone, and/or other devices may also have access to your email and/or text messages. Please take a moment to contemplate the risks involved if any of these persons were to access any communications, we might exchange with each other. Proceed accordingly.
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 you or your treatment. These situations include:
- If I have reasonable suspicion that a child, disabled or elderly person has been or is being 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 someone, 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 some of your information such as diagnosis, dates of treatment and treatment plans. I may disclose medical information to a provider of health care, health care service plan, or contractor for the purposes of diagnosis, treatment, or payment.
In most legal proceedings, you have the right to prevent me from providing any information about your treatment. However, if you bring up your mental health in a court preceding you waive 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.
In the case of another health epidemic in which cases are being tracked by the government, I may legally required to notify local health authorities that you have been in the office. If I have to report this, I will only provide the minimum information necessary for their data collection and will not go into any details about the reason(s) for our visits.
I routinely meet with other professionals to obtain consultation and may discuss your treatment and our work together. During such consultation, I do not provide the name or identifying information about the person discussed. The consultants are also legally bound to keep the information presented 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 these cases, those individuals/agents will be bound through an agreement with this therapist to ensure your information remains protected and confidential.
In the event of my death or incapacity, I have an agreement with a group of colleagues to take possession of my files, and then it would be their responsibility to facilitate you finding another therapist, and giving you access to your records if needed.
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. If you need specific clarification or advice that 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.
AUDIO AND VIDEO RECORDINGS
I am continuously seeking to improve my skills and seek certifications/consultations to do so, and 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. No recording (video or audio) of any part of our sessions will occur unless you and I mutually agree, in writing, beforehand that the session may be recorded.
There are a number of circumstances under which therapy can or 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 should you desire it.
If you and I both agree that you have achieved your treatment goals, this is something to celebrate and be proud of. In this case we will discuss and review your progress and our work together and then we will end therapy. In this case, you are always welcome to contact me if you would like return to therapy.
I am ethically obligated to end therapy if I believe you are not benefitting from this service. Prior to such a decision we can discuss any possible adjustments to our work that might produce change and help you begin to progress. If finding another therapist might be a better option for you this will be discussed as well.
If you have repeated cancellations and/or no shows to your appointments, we may need to end therapy. My goal will be to try to problem solve ways for us to continue our work together, however, if this behavior continues then I may end therapy with you. If I do not hear from you for 30 days or longer, without prior arrangement, I will consider the therapy ended.
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, so that we can address your concerns and possibly improve the treatment and our relationship. If that does not work or you are not interested, then we will end the therapy.
Other reasons for possible termination of services include: amassing a substantial unpaid account balance, refusing to comply with treatment recommendations, if I feel that your issues are outside my scope of expertise, repeated boundary violations, or if I fear for my 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 therapy and, as appropriate, you will be given a reasonable opportunity to make the needed changes.
BILLING AND PAYMENTS
My hourly fee is $185. If we meet more than that time, I will pro-rate accordingly. If you will be 15 minutes or more late for your session, you must let me know and it will be up to my discretion if we will meet. If I have not heard from you and you are 15 minutes late, I will consider the appointment cancelled and charge for the missed session. You will be expected to pay for each session at the time it is held, unless we agree otherwise in advance. I will request you sign an authorization that I will keep on file allowing me to bill a credit card for such instances. 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 and potentially raise my fees once a year. If 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 ($185/hr.) 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, or preparation of treatment summaries. 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 charge a copying fee of $0.05 per page for records requests. This fee will be waived if you choose to have your records sent by encrypted email or fax.
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.
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 an insurance plan for which I am a covered provider (Medi-Cal), then I will submit claims for you. By signing this agreement, you are authorizing me to release any information necessary (including notes, treatment plans and diagnosis) to your insurance plan to process claims, determine medical necessity, or to request additional sessions. By signing this agreement, you are also authorizing your insurance plan to pay benefits directly to me.
If you have a health insurance plan for which I am not a paneled provider I will be considered an ‘out of network provider.’ Some insurance plans cover a portion of mental health treatment in these situations. If requested I will supply you with a superbill (which is like a receipt) to submit to your insurance company for possible reimbursement for the therapy fees. Regardless, payment is due at the time of service and you are responsible for that payment.
If you would like to seek reimbursement through your Health Savings Account (HAS) or a Health Reimbursement (HRA) this would be a similar process in which I can provide you with a superbill and it is your responsibility to seek reimbursement from these accounts for this service. In either case you (not your insurance company) are responsible for full payment of my fees. If you have a Flexible Spending Account (FSA) debit card, you can also choose to pay for my services that way and it will be processed just like any other credit card payment.