Counseling sessions are 50 minutes in length. Although some sessions may very intimate psychologically, ours is a professional relationship rather than a social one. Our contact will be limited to counseling sessions you arrange with me. Please do not invite me to social gatherings, ask me to write references for you, or ask me to relate to you in any way other that the professional context of our counseling sessions. You will be best served if out sessions concentrate exclusively on your concerns. Upon occasion, if appropriate, I might request audio or video taping for educational purposes. Please inform me if you would be comfortable with this and your wishes will be respected.
Effects of Counseling:
While benefits of counseling are expected, specific results are not guaranteed. Counseling is a personal exploration and may lead to major changes in your life perspectives and decisions. These changes may affect significant relationships, your job, and/or your understanding of yourself. Some of these changes could be temporarily distressing. The exact nature of these changes cannot be predicted. Together we will work to achieve the best possible results for you.
Client rights and responsibilities:
Some clients need only a few counseling sessions to achieve their goals; others may require months or even years of counseling. As a client, you are in complete control and may end our counseling relationship at any time, though I do ask that you participate in a summary session. You also have the right to refuse or discuss modification of any of my counseling techniques or suggestions that you believe are harmful. You agree to come to counseling free from the influence of drugs including alcohol. I assure that my services will be rendered in a professional manner consistent with accepted legal ethical standards. If at any time for any reason you are dissatisfied with my services, please let me know so we can resolve it.
Should you and/or I believe that a referral elsewhere is needed, I will provide some alternatives including programs and/or people who may be available to assist you. You will be responsible for contacting and evaluating those referrals and/or alternatives.
In return for a fee of $100 per session, I agree to provide counseling services for you. The fee for each session will be due and must be paid at the conclusion of each session. Cash, checks, or credit cards are acceptable for payment. The fee for group sessions is $25 per person per session. If for any reason I am called testify in your behalf, you must agree to pay the cost whenever the request may occur. If you have insurance and your insurance company pays for mental health services, please present your insurance card so that I may verify benefits for outpatient counseling services. By your signature at the end of this document, you give me permission to provide any necessary information required of your insurance carrier in order for your claim to be filed by my office. I will discuss any questions you have concerning my fee.
Consent to Treatment:
You hereby authorize me to conduct assessments and treatments as may be deemed necessary for the best interest and care of yourself and/or for your child. You understand that treatment plans and goals will be jointly established as a part of the assessment and counseling process.
Records and Confidentiality:
All of our communication becomes part of the clinical record. Records are property of my confidential files. Client files are disposed of five years after the file is closed. Most of our communication is confidential, but the following limitations are exceptions that do exist:
(1) It is determined that you are in danger to yourself or someone else
(2) If you disclose abuse, neglect, or exploitation of a child, elderly, or disabled person
(3) If you disclose sexual contact with another mental health professional
(4) If I am ordered by a court to disclose information
(5) If you direct me to release your records
(6) If I am otherwise required by law to disclose information
If I see you in public, I will protect you confidentiality by acknowledging you only if you approach me first.
In the case of marriage or family counseling, I will keep confidential (within the limits cited above) anything you disclose to me without your family member’s knowledge. However, I encourage open communication between family members and I reserve the right to terminate our counseling relationship if I judge the secret to be detrimental to the therapeutic progress.
In the event that you will be unable to keep an appointment, please notify me at least 24 hours in advance. If you fail to give me this advance notice you will be billed accordingly. If you are absent for two weeks in a row without notice, your name will be dropped off the appointment roll.