(650) 367-7797

Office Policies & Agreement for Psychotherapy Services

Your first visit to a new therapist is very important, and you may have many questions. This letter is to introduce myself and give you information to help you decide whether we can work together. Please take time to read it and let me know if you have any questions or need more information.

QUALIFICATIONS
I received my doctorate in 1986 from the California School of Professional Psychology—Berkeley Campus. I continued my training as a post-doctoral fellow at the Stanford University Department of Psychiatry and Behavioral Medicine, Alcohol and Drug Treatment Center. I work from an integrationist perspective and rely on a broad range of techniques, including psychodynamic, experiential, and cognitive-behavioral interventions. As a psychologist, I bring certain expertise to our collaboration while you bring self-knowledge, the ability to learn from your life experiences, and a vision of what your want your life to be. I enjoy working with a diverse range of individuals, couples and families. Clients with whom I have worked with successfully include those who are dealing with:

  • Mood Disorders (Depression, Bipolar, Dysthymia)
  • Anxiety Disorders (Panic, Generalized Anxiety and Obsessive Compulsive Disorders)
  • Self-Esteem and Perfectionism Issues
  • Forgiveness Practice
  • Relationship Problems
  • Histories of Abuse & Trauma
  • Addiction
  • Spiritual concerns

THE PROCESS OF THERAPY/EVALUATION
I will assess whether I can be of benefit to you in our first meetings. I do not accept clients who, in my opinion, I cannot help and I will refer you to others who work with your particular issues. Within a reasonable period of time after starting treatment, I will discuss with you my working understanding of your problem, propose a treatment plan, and explain therapeutic objectives and possible outcomes of the therapy. If you have questions about any of the procedures used in the course of your therapy, their possible risks, my expertise in employing them, or about the treatment plan in general, please ask me and I will answer you fully. You also have the right to ask about other possible treatments for your condition and their risks and benefits. If you could benefit from any treatments that I do not provide, I have an ethical obligation to assist you in obtaining those treatments.

TERMINATION AND FOLLOW-UP
Deciding when to stop our work together is meant to be a mutual process. Before we stop, we will discuss how you will know when to come back or if a regularly scheduled “checkup” will work best for you. If it is not possible for you to phase out of therapy, it is important for you to have closure on the therapy process with at least two termination sessions.

Noncompliance with treatment recommendations may necessitate early termination of services. As a professional, I look at the issues with you and try to exercise my educated judgment about what treatment will be in your best interest. Your responsibility is to make a good faith effort to fulfill the treatment recommendations to which you have agreed. If you have concerns or reservations about the treatment recommendations, I strongly encourage you to express them so that we can resolve any possible differences or misunderstandings.

If during our work together I assess that I am not effective in helping you reach your therapeutic goals, I am obliged to discuss this with you and, if appropriate, terminate treatment and give you referrals that may be of help to you. If you request it and authorize it in writing, I will talk to the psychotherapist of your choice in order to help with the transition. If at any time you want another professional’s opinion or wish to consult with another therapist, I will assist you in finding someone qualified. You have the right to terminate treatment at any time. If you choose to do so, I will offer to provide you with names of other qualified professionals whose services you might prefer.

Failure or refusal to pay for services after a reasonable time is another condition for termination of services. Please contact me to make arrangements any time your financial situation changes.

DUAL RELATIONSHIPS
Therapy never involves sexual, business, or any other dual relationships that would impair my objectivity, clinical judgment or therapeutic effectiveness or could be exploitative in nature.

BENEFITS & RISKS OF PSYCHOTHERAPY
Participation in therapy can result in a number of benefits to you, including improved interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits requires effort on your part. Psychotherapy requires your active involvement, honesty and openness in order to change your thoughts, feelings and/or behavior. I will ask for your feedback and views on your therapy and its progress. Sometimes more than one approach can be helpful.

During evaluation or therapy, remembering unpleasant events feelings or thoughts can result in experiencing considerable discomfort, strong feelings, or anxiety, depression, insomnia, etc. I may challenge some of your assumptions or perceptions or propose different ways of thinking about or handling situations that may cause you to feel very upset, angry or disappointed. Attempting to resolve issues that brought you into therapy may result in changes that were not originally intended. Psychotherapy may result in decisions to change behaviors, employment, substance use, schooling, housing, or relationships. Sometimes another family member views a decision that is positive for one family member as negative. Change will sometimes be easy and swift, but more often it will be gradual and even frustrating. There is no guarantee that psychotherapy will yield positive or intended results.

PHONE CALLS & EMERGENCIES
If you need to contact me between sessions, leave a message for me at 650.367.7797. I check my messages regularly each day unless I am out of town. If I am planning on being out of town, I will let you know in advance. I will also let you know who I have covering for me in my absence. Phone consultations of 5 minutes or less will not be charged. Longer phone consultations with you will be billed at your regular session rate, prorated for the length of time, and can be paid at your next appointment. 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 me. If your situation is an acute emergency and you need to talk to someone right away, contact the closest 24-hour emergency psychiatric service:

Santa Clara County, 408-885-6100
San Mateo County, 650-573-2671
Stanford Medical Center Emergency Room, 650-723-5111 (ask for psychiatrist on call)
Crisis Hotline 650-494-8420
The Police 911

CANCELLATIONS
Since scheduling of an appointment involves the reservation of time specifically for you, a minimum of 24 hours notice is required for re-scheduling or canceling your appointment. Your full fee will be charged for sessions missed without such notification. Most insurance companies do not reimburse for missed sessions. Please let me know as soon as you know that you will not be able to keep your scheduled appointment.

PAYMENT & FINANCIAL ARRANGEMENTS
Fees for service and schedule information are available upon request. I see some clients for reduced fees, and 1 will be happy to let you know if I have any openings for lower-fee appointments. I will provide you with a statement at the beginning of each month containing a record of therapy appointments from the previous month, fees we agreed upon, and the payments you made during the month. This monthly statement is your receipt for tax or insurance purposes. Please let me know if any problem arises during the course of therapy regarding your ability to make timely payments.

Some or all your fees for service may be covered by your health insurance if you have outpatient mental health coverage. However, insurance companies reimburse not all issues/conditions/problems that are the focus of psychotherapy. It is your responsibility to verify the specifics of your coverage. Please remember that my 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. As described below in the section Health Insurance and Confidentiality of records, please be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk.

CONFIDENTIALITY
As a psychotherapy client, you have privileged communication. This means that 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 in the enclosed Notice of Privacy Practices.

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, which 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 and family therapy, or when different family members are seen individually, confidentiality and privilege do not apply between the couple or among family members. I will use my clinical judgment when revealing such information. Since the therapy process works best for children when they are allowed privacy for their thoughts and feelings, I will not disclose the specific content of your child’s therapy unless your child has given permission for information to be shared or unless disclosure is necessary for your child’s safety.

Emergencies:
If there is an emergency during our work together or in the future after termination in which I become concerned about your personal safety, the possibility of you injuring someone else, or about you receiving psychiatric care, I will do whatever I 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 I may contact the person whose name you have provided on your General Information form.

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. Sometimes treatment summaries or progress toward goals are also required. Unless explicitly authorized by you, Psychotherapy Notes will not be disclosed to your insurance carrier. 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 relatively 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 me via e-mail or faxes for emergencies.

Consultation
I consult regularly with other professionals regarding my clients in order to provide you with the best possible service. Names or other identifying information is never mentioned; client identity remains completely anonymous, and confidentiality is fully maintained.

** Considering all of the above exclusions, upon your request I will release information to any person/agency you specify, unless I conclude that releasing such information might be harmful to you or your child in any way. If I reach that conclusion, I will explain the reason for denying your request.

COMPLAINTS
If you have a concern or complaint about your treatment, please talk with me about it.

If we cannot resolve your concern, you can contact the Board of Behavioral Science Examiners, that oversees licensing, and they will review the services I have provided.

Board of Behavioral Science Examiners
400 R Street, Room 3150, Sacramento, CA 95814
916-445-4933

I hope this answers some of your questions. Please let me know if you have concerns or questions about any of these policies and procedures or this agreement for working together in psychotherapy.