Therapy guidelines and confidentiality issues must be established, understood, and adhered to between therapist and client. Please read all the sections, sign, and bring this form to your first session, prior to beginning therapy.

PSYCHOLOGICAL SERVICES

Therapy is not easily described in general statements. It varies depending on the personalities of the therapist and patient, and the particular problems you bring forward. There are many different methods I may use to deal with the problems that you hope to address; central to all of them is non-judgmental positive regard by me for each individual person who chooses to seek my help.  

Psychotherapy calls for a very active effort on your part.  Our work cannot proceed well in only our one hour a week together. In order the therapy to be successful, you will have to work on things we talk about between our sessions.  The good news is that by working hard, you will come to a closer relationship with yourself and with those who are most important to you.

Effective therapy, in my view, moves forward only when you, the patient, do not feel judged, talked down to or told what to do.  It is only in this atmosphere of mutual respect and regard that you will surface and examine your issues in ways that give you insight to choices you’ve made in the past and discover options for better choices and coping skills in the future.  Therapy has benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. The good news is that through this work, therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress.

Our first session will address what you believe brings you to therapy exploring some of the background and history of different areas of your life. By the end of that session we will be identify some first impressions of the areas of focus for our work together. You should evaluate this information along with your own opinions of whether you feel comfortable working with me. Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion.

The unconditional positive regard I mentioned earlier should also be balanced with healthy boundaries for both of us. To optimize our therapeutic relationship, I have found the following guidelines work well with my patients.

APPOINTMENTS 

I ask your cooperation in making and keeping your appointments.

• All sessions are within a given amount of time, typically fifty (50) minutes, or for the occasional double session one hundred (100) minutes.
• When, after our initial visit, you decide to engage in continuous psychotherapy, we will negotiate an appointment time which will provide you a consistent time for your sessions. This time will be reserved exclusively for you.
• Responsibility to self and others can often be an important focus in therapy. Please note that if you are late, it will shorten our time together so I can be ready for my next scheduled appointment.
• Some clients avoid bringing up serious and complex problems until their sessions are almost over. You will do better for yourself if you bring up such problems at the beginning of the hour, so we have time to work things through, rather than at the end when we do not.
• Should you require additional sessions other than your normally scheduled ones, please ask me. I will do my best to schedule the extra appointment for you.

INSURANCE and FEES

Finances are important to everyone.  The therapeutic relationship can be an important place to learn how to deal with financial obligations responsibly and successfully.  I believe these guidelines can help facilitate that goal.  My regular fee for self-pay is $175 per session.  If I am “in-network” with your insurance, I will take care of billing and you will be responsible for your co-pay; please find out your co-pay prior to our first appointment. If I am “out of network”, your insurance may provide some reimbursement to you; nevertheless, you will be responsible for payment to me, according to our agreed upon rate.  You will be responsible for filling out your own insurance forms; I will supply you with the necessary data, after each six visits.  Some insurers such as Tricare, require prior authorization and a referral from an MD, please find out your requirements prior to your first visit.  Please note: when budgeting for therapy many insurance companies will not reimburse you until you have paid your annual deductible fee.  If insurance is not a viable option for our work together, we will discuss an appropriate fee that can work for both of us.

I expect you to pay for your session at the time of your session. I also expect you to pay your full fee. You may pay with either cash, check, credit card, or Zelle...  A service charge of $15.00 will be assessed for all returned checks.

You understand and authorize that if insurance is used that I, as your counselor, may release information to insurance companies or employers for verifying insurance coverage or for you to process insurance claims.

MISSED APPOINTMENTS

My practice is generally full with a waiting list for openings.  If you need to cancel, please do so at least forty-eight hours in advance.  This allows those who need to reschedule the opportunity to take your open slot; and, it avoids you being charged for the missed appointment.  With less than forty-eight hours notice, it is less likely that I can fill that slot with someone else in need.  Therefore, with less than forty-eight hours’ notice of cancellation, you will be responsible for the full fee.  Of course, there are exceptions for true emergencies.

CONTACTING ME

I am rarely immediately available by telephone. I will make every effort to return your call by the next business day.  After many years of practice, (I’m now in my late seventies J ) I am in the office only Tuesday through Thursday, so the next business day on Thursday may well be the following Tuesday. In today’s world many folks are captives of their electronic devices. Recent research in both psychology and neuroscience suggest strongly, in the interest of our emotional well-being, that we limit our use of email and texting; I try to model that by checking my in box only once or twice a day on work days, and rarely on non-work days  If you are unable to reach me and feel that you can’t wait for me to return your call, please contact your family physician or the nearest emergency room and ask for the psychologist or psychiatrist on call.  

CONFIDENTIALITY

I am a Fellow of the American Psychotherapy Association.  As such, I adhere to the APA Code of Ethics, as well as the laws of the State of Florida.  Whatever transpires between us is confidential.  Professional guidelines require all information given in individual and/or conjoint therapy sessions be held in confidence and not discussed or written about outside of sessions.  For several reasons, it is better to have the individual sessions fully confidential.  When a couple is being treated, confidentiality can become more complex. Any information given in the individual sessions will not be held in confidence from the partner; that is, information in individual sessions needs to be openly discussed in your couples sessions, unless otherwise specified and reasons made clear. This remains at my discretion and will be discussed with all participants.

If you are under eighteen years of age, please be aware that the law may provide your parents the right to examine your treatment records. It is my policy to request an agreement from parents that they agree to give up access to your records. If they agree, I will provide them only with general information about our work together. I will also summarize your treatment when it is complete. Before giving them any information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have with what I am prepared to discuss.

In all cases, strict confidentiality is maintained except in instances involving child abuse, elder abuse, dependent abuse, and attempts or thoughts of harming yourself or others. In such instances, and at my sole discretion, I am obligated by law and my own Code of Ethics to inform the appropriate agencies.  These situations rarely occur in my practice, so please feel free to discuss with me any concerns you have regarding the confidentiality of these highly sensitive issues.

I may occasionally find it helpful to consult other professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my patient. The consultant is also ethically and legally bound to keep the information confidential. If you don’t object, I will not tell you about these consultations unless I feel that it is important to our work together.

While this written summary of guidelines should prove helpful in informing you about potential gains from therapy as well as problems, it is important that we discuss any questions or concerns that you may have at our next meeting. I will be happy to discuss these issues with you.  In the event you feel the need for formal legal advice for any issue involving our therapy, please consult an attorney.