Cell Phone and E-mail Communication
Cell phone and e-mail communication can be intercepted by third parties therefore confidentiality cannot be guaranteed. We are permitted to use this form of communication but must inform you that I cannot guarantee confidentiality. This is particularly important because I use a cell phone for my office. It provides ease of accessibility that a land line, pager, and answering service does not. Psychotherapists are required to make a record of each client contact. E-mail communications are printed in full and become part of a client’s file.
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Confidentiality from Third Parties (Other Than Parents)
Psychotherapy is confidential from parties other than parents with important exceptions:
1. Information may be released to designated parties by written authorization of clients, parents, or legal guardians.
2. When reimbursement for psychotherapy is sought from insurance companies or other third parties, information, including psychological diagnoses, must be provided to the third party. In some cases, explanations of symptoms and treatment plans, and, in rare cases, entire client records, must be provided to the third party. If health coverage is provided by the parent’s employer, the employer may have access to such information. Insurance companies usually claim to keep psychological diagnoses confidential, but may enter this information into national medical information databanks, where it may be accessed by employers, other insurance companies, etc. and may limit future access to disability insurance, life insurance, jobs, etc. I will provide you with copies of reports submitted to insurance companies at your request.
3. Psychotherapists are required to release information obtained from children or from collateral sources (other individuals involved in a client’s psychotherapy, such as parents, guardians, and spouses) to appropriate authorities to the extent to which such disclosure may help to avert danger to a psychotherapy client or to others, e.g., imminent risk of suicide, homicide, or destruction of property that could endanger others.
4. Psychotherapists are required to report suspected past or present abuse or neglect of children, adults, and elders, including children being exposed to domestic violence, to the authorities, including Child Protection and law enforcement, based on information provided by the client or collateral sources.
5. If children participate in psychotherapy in compliance with a court order, psychotherapists are required to release information to the relevant court, social service, or probation departments.
6. I must release information, which may include all notes on your child’s psychotherapy and contact with collateral sources, in response to a court order, and may also be required to do so in response to a legitimate subpoena.
7. Psychotherapists often consult with other professionals on cases, and teach or write about the psychotherapy process, but disguise identifying information when doing so. Please indicate to your therapist if you wish to place restrictions on consultation, teaching, or writing related to your case.
8. Psychotherapists reserve the right to release financial information to a collection agency, attorney, or small claims court if you are delinquent in paying your bill.
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Professional Records
Psychotherapy laws and ethics require that California licensed and pre-licensed psychotherapists keep treatment records. Professional records can be misinterpreted and/or upsetting to untrained readers. Your child and you are entitled to receive a copy of these records unless your therapist believes that seeing them would be emotionally damaging to you or your child, in which case your therapist will review them together with your child or with you or will send them to a mental health professional of your choice, to allow you or your child to discuss the contents. Clients will be charged copying costs plus $4.00 a minute for professional time spent responding to information requests.
Your child’s record includes a copy of the signed informed consent form, acknowledgement of receipt of privacy policy and practices, progress notes, any releases of protected health information, and copies of your insurance claims and records. Records are kept in a locked file cabinet in my office or in a cloud-based psychotherapist software program. Please note that my records stay on my person from the moment I leave the office until I arrive home and are immediately placed in this confidential, locked cabinet or entered into the cloud-based software program.
Alternative Treatments
Other treatment approaches are available as an alternative, or as an adjunct, to individual child psychotherapy. These include family therapy, group therapy, 12-step groups and support groups, medication, expressive therapies (e.g., art, writing, psychodrama), cognitive therapy, behavior modification, guided imagery, Eye Movement Desensitization and Reprocessing (EMDR), Accelerated Information Processing (AIP), Traumatic Incident Reduction (TIR), Electroencephalograph (EEG) Spectrum Therapy, Critical Incident Debriefing, careful use of hypnosis and guided imagery, and nutritional consultation.
I am not trained in all of these modalities. For those I have been trained in I will provide you with an explanation for the intervention and obtain your consent if indicated. For those therapies in which I am not trained, I may provide you with referrals if I believe your child would benefit from these services.
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Fee for Psychotherapy
Fees for out-of-pocket psychotherapy sessions and collateral contacts: our agreed upon fee at the onset of therapy per 45-50 minutes, including any time missed by being late. Payment is due at each session. Fees are also offered on a sliding scale. If a sliding scale fee was agreed upon in your case, the amount agreed upon is $ per /45-50 minutes.
Phone calls exceeding 10 minutes once a week: $1.00 per minute.
Participation in court related matters, including testimony: $250.00 per hour.
I understand that payment is due at the end of each session. I agree to cooperate with procedures required to collect third-party payments. If I receive a third-party payment, I agree to turn it over to my therapist as soon as possible.
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Litigation Limitation
Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters that may be of a confidential nature, it is agreed that should there be legal proceedings (such as, but not limited to, divorce and custody disputes, injuries, lawsuits, etc.), neither you (the patient) nor your attorney, nor anyone else acting on your behalf will call on me to testify in court or any any other proceeding, nor will a disclosure of the psychotherapy records be requested. If, however, you become involved in legal proceedings that require my participation, you will be expected to pay for all of my professional time, including preparation and transportation costs, even if I am called to testify by another party. Because of the difficulty of legal involvement, I charge $100.00 per hour for preparation, travel, and attendance at any legal proceeding.
Cancellations
I understand that my child’s psychotherapist reserves an appointment time for my child. I agree to call 24 hours in advance if I must cancel a session in order to allow my child’s therapist to reschedule her time. If I provide less than 24 hours notice of a cancellation, unless a sudden medical emergency has occurred, I will pay the regular session fee. I understand that my insurance company will not reimburse for this expense.
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Emergencies
I understand that I may telephone my child’s therapist in an emergency. My child’s therapist is not always immediately available by phone and may not be available in the late evening. If unavailable, my therapist will return my call as soon as possible. If I cannot reach my therapist, I can call the 24-hour Crisis Team at 800-479-3339, or I can call 911. When my therapist is out of town, and if I am not also seeing another mental health professional, such as a psychiatrist, my child’s therapist will provide me with phone numbers of alternate sources of help.
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Psychotherapy Contract for Parents or Guardians of Child Clients
I have read the above information, have asked questions as needed, and understand the issues related to risks and benefits of psychotherapy, medical concerns, assessment, the need for children and adolescents to have confidential psychotherapy, collateral contacts with parents and others, treatment children of separated or divorced families, professional records, confidentiality from third parties, alternative treatments, length of psychotherapy, fees for psychotherapy, emergencies, and cancellations.
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Length of Psychotherapy
Some psychological problems in children can be alleviated in a few sessions. Other problems requires years of treatment. It is often difficult to predict the length of therapy needed. Some disorders cannot be properly treated within the limitations of some health insurance policies. If this is the case, we will discuss how best to meet your child’s needs.
The decision to terminate therapy belongs to the parent or legal guardian, except in cases in which the decision is that of the child at a certain age, e.g. cases involving issues of child abuse, substance abuse, birth control, pregnancy, and severe need.
Terminating therapy with a child should be done over a number of sessions, particularly in
cases of a long-term therapeutic relationship. Should you or your child decide to terminate therapy prior to the child’s therapist’s recommendation, it is important that your child have a final meeting with his or her therapist.
If I believe you are terminating your child’s therapy before adequate treatment has been received for your child’s psychological problems, your child’s therapist will provide you with referrals for other therapists or you may choose to continue therapy with your current therapist.
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Based on my understanding of these issues, I agree to proceed with treatment for my child.