This agreement is designed to create clarity about our working relationship. Please feel free to ask any questions about how we will work together towards your goals.
What is psychotherapy?
Psychotherapy (or ‘counseling’) is a process where emotional distress and disorders are assessed and treated with talk therapy. As a Licensed Clinical Social Worker, I am trained to work with you to safely experience feelings that may arise while working through distress (such as sadness, guilt, anger, frustration, loneliness, or helplessness.) The benefits of psychotherapy can include significant reduction in emotional distress, improved relationships, better problem solving, healthy behaviors and coping skills, resolution of specific problems and greater life satisfaction.
Intake and course of treatment:
Your first session will be an initial evaluation. By the end of the first session, we will determine 1) what your presenting problems are and if I am the right person to help you with them, 2) if you are comfortable working with me as your therapist, and 3) what your initial treatment goals are. We will periodically review progress and determine if treatment feels complete, or if new treatment goals will be established.
Treatment time and frequency:
Sessions are 55 minutes, and scheduled weekly, bi-weekly or at longer intervals based on your treatment needs. We share responsibility for starting and ending sessions on time; please avoid presenting new topics near the end of a session. Extended sessions are possible by mutual agreement (please see fees & payments).
Fees & Payment:
Current fee schedule can be found on my website. Payment/co-payment is required at the time of service, and can be made by cash, check or credit card.
Cancelled or Missed Appointments:
Your appointment time is reserved for you. Please give 24 hours notice if you need to cancel your appointment so I can offer that time to someone else. If an appointment is missed or cancelled with less than 24 hours notice, you will be billed for the session at my current hourly rate. You will be responsible for payment, your insurance company will not pay for missed appointment fees.
Our sessions are private. Health care privacy law (HIPPA) protects the confidentiality of our communications in therapy. (A complete “Notice of Privacy Policies” is available on my website; a hardcopy is available upon request.) Please note that I am legally required to disclose information if there is concern that you may harm yourself, harm others, or if child/elder abuse is suspected. Any request for communication (for example, with your physician, a family member or probation) will require your written permission. While there may be special challenges to living together in a small community, please know that your confidentiality is maintained regardless of possible outside contacts.
Social Media and Telecommunication:
Due to the importance of your confidentiality and the importance of minimizing dual relationships, I cannot accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.
I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies. If you are having an emergency, please call me and/or follow the after hours emergency procedures.
If you need to contact me, please leave a detailed message on my voice mail (585-447-8349) and your call will be returned the within 24 hours, Monday-Friday. On weekends, my voice mail is checked less frequently. (Please see ‘phone care and crisis procedures’ for urgent matters). Please keep scheduling calls brief, to avoid getting into therapy material outside of session.
Phone Care and Crisis Procedures:
Therapy is best provided in person rather than by telephone. However, if an urgent situation arises, please describe the nature of the urgent matter in your message. I will work with you to determine whether the issue needs immediate attention requiring a sooner appointment or whether it can wait until our next scheduled visit. If you wish or need phone therapy services, we may do so at my in-office rate.
For our purposes, ‘crisis’ means that you are afraid that you may harm yourself, harm someone else or otherwise feel desperately out of control. If you are in crisis, please call 911 or go to the nearest emergency room where a physician can provide the type of care that you may need.
Please note that many after hours resources are listen in the "RESOURCES" tab on my website.
If you are a minor, your parents may be legally entitled to some information about your therapy. I will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.
Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with you and a termination process if I determine that the psychotherapy is not being effectively used or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.
Should you fail to schedule an appointment for two consecutive months, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.
THESE PRACTICE POLICIES ARE AVAILABLE IN THE PATIENT PORTAL FOR NEW CLIENTS TO READ AND ELECTRONICALLY SIGN THAT THEY HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.