In describing each of the following items regarding psychotherapy, Dr. Wiger and Dr. Burns are speaking in general terms about the process and content of psychotherapy. This overview is our attempt to provide you with some general notions about some central questions that often arise as potential clients consider engaging psychological services.
We are aware that not every therapist agrees with our general statements. It is incumbent on you, the client, to engage in conversation with your potential therapist about the details described below.
Psychotherapy is not easily described in general statements. It varies depending on the personalities of the psychologist and client, and the particular problems you are experiencing.
There are many different methods the therapist may use to deal with the problems that you hope to address.
Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things you and the therapist talk about both during our sessions and at home.
Psychotherapy can have 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. On the other hand, psychotherapy has also been shown to have many benefits. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience.
The first few sessions will involve an evaluation of your needs. By the end of the evaluation, the therapist will be able to offer you some first impressions of what the work will include. The therapist may be able to offer you a tentative outline of the treatment if you decide to continue with therapy. You should evaluate this information along with your own opinions of whether you feel comfortable working with the therapist.
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 procedures, you and the therapist should discuss them whenever they arise. If your doubts persist, the therapist most often will be happy to help you set up a meeting with another mental health professional for a second opinion.
The first 2 to 4 sessions are most often viewed as a time of evaluation and assessment. During this time, you and the therapist can both decide if a working relationship is possible that will provide you with the services you need in order to meet your treatment goals. A usual schedule consists of one 50-minute session (one appointment hour of 50 minutes duration) per week at a time agreed on, although some sessions may be longer in duration or more frequent than once-a-week.
Once an appointment hour is scheduled, you will be expected to pay for it unless you provide 24 hours advance notice of cancellation unless you and the therapist both agree that you were unable to attend due to circumstances beyond your control. It is important to note that insurance companies do not provide reimbursement for cancelled sessions. Again, it is important to discuss with the therapist the policy by which he/she operates regarding missed appointments.
Our hourly fee is $130.00. Other therapists charge at a different rate. There often are variations of fees charged dependent upon agreements with insurance companies and/or managed care companies.
In addition to weekly appointments, most therapists charge an amount for other professional services you may need, though frequently these rates are pro-rated according to the hourly cost. Other services include report writing, telephone conversations lasting longer than ten minutes, consulting with other professionals with your permission, preparation of records or treatment summaries, and the time spent performing any other service you may request of the therapist.
If you become involved in legal proceedings that require the therapist’s participation, you will be expected to pay for all of professional time, including preparation and transportation costs, even if the therapist is called to testify by another party. Because of the difficulty of legal involvement, we charge $175 hour for preparation and attendance at any legal proceeding.
Due to work scheduling, therapists are often not immediately available by telephone. While our office-hours are usually between 9 AM and 6 PM, a therapist probably will not answer the phone when engaged with a client. When unavailable, the telephone is answered by voice mail (in our case) that is monitored frequently. Most therapists make effort to return your call on the same day you make it, with the exception of weekends and holidays.
If you are unable to reach your therapist and feel that you can’t wait for a return call, contact your family physician or the nearest emergency room and ask for the mental health worker on call. If the therapist is intending to be unavailable for an extended time, he/she usually will provide you with the name of a colleague to contact, if necessary.
LIMITS ON CONFIDENTIALITY
The law protects the privacy of all communications between a client and a psychologist. In most situations, the therapist can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by HIPAA. On your first appointment, the therapist will provide you with information as to what HIPAA is, and its implications for your involvement in therapy.
There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows:
The therapist may occasionally find it helpful to consult other health and mental health professionals about a case. During a consultation, the therapist makes every effort to avoid revealing the identity of a client. The other professionals are also legally bound to keep the information confidential. The therapist is required to note all consultations in your Clinical Record.
You should be aware that we share a waiting room and an office lease with other mental health professionals. All of the mental health professionals are bound by the same rules of confidentiality. Each mental health professional maintains a private practice wherein separate business accounts and files, separate phones, faxes, e-mail accounts, and have no formal business affiliations beyond a shared lease-arrangement.
Disclosures required by health insurers or to collect overdue fees are discussed below.
If a client threatens to harm himself/herself, therapists may be obligated to seek hospitalization for him/her, or to contact family members or others who can help provide protection
There are some situations where therapists are permitted or required to disclose information without either your consent or authorization:
• If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychologist-client privilege law. Therapists cannot provide any information without your (or your legal representative’s) written authorization, or a court order. If you are involved or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order a disclosure of information.
• If a government agency is requesting the information for health oversight activities, therapists are required to provide it for them (eg. coroner or medical examiner, Veterans Affairs, Workers Compensation claims, national security purposes).
• If a client files a complaint or lawsuit against a therapist, the therapist may disclose relevant information regarding that client in order to defend themselves.
There are some situations in which therapists are legally obligated to take actions, which are necessary to attempt to protect others from harm and may require the therapist to reveal some information about a client’s treatment. These situations are unusual in practice.
If the therapist has reasonable cause to suspect that a child has suffered harm as a result of child abuse or neglect, the law requires that the therapist file a report with the appropriate governmental agency, usually the Alaska Department of Health and Social Services. Once such a report is filed, the therapist may be required to provide additional information.
If a therapist has reasonable cause to believe that a vulnerable adult suffers from abandonment, exploitation, abuse, neglect, or self-neglect; or that a disabled person has been abused, the law requires that the therapist file a report with the Alaska Department of Administration. Once such a report is filed, the therapist may be required to provide additional information.
If a client communicates an immediate threat of serious physical harm to an identifiable victim, the therapist may be required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client.
If such a situation arises, the therapist will make every effort to fully discuss it with you before taking any action and will try to limit the disclosure to what is necessary.
While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that you discuss any questions or concerns that you may have now or in the future with your therapist. The laws governing confidentiality can be quite complex. In situations where specific advice is required, formal legal advice may be needed.
The laws and standards of the psychological profession require that the therapist keep Protected Health Information about you in your Clinical Record. With an appropriate written request, you [your legal representative] have the right to examine and/or receive a copy of your records. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers.
Your Clinical Record usually includes information about your reasons for seeking therapy, a description of the ways in which your problem impacts on your life, your diagnosis, the goals set for treatment, progress towards those goals, medical and social history, treatment history, any past treatment records received from other providers, reports of any professional consultations, your billing records, and any reports that have been sent to anyone, including reports to your insurance carrier.
In addition, the therapist usually keeps a record of the contents of sessions. These notes vary from session to session, and are utilized to jog the therapist’s memory and retain important information. They also contain particularly sensitive information that you may reveal to the therapist.
HIPAA provides you with several rights with regard to your clinical record and disclosures of protected health information. These rights include requesting that the therapist amend your records; requesting restrictions on what information from your clinical record is disclosed to others; requesting an accounting of most disclosures of protected health information that you have neither consented to nor authorized; determining the location to which protected information disclosures are sent; having any complaints you make about policies and procedures recorded in your records; and the right to a paper copy of this Agreement (HIPAA Rules and Regulations). A therapist will discuss any of these rights with you.
HIPAA provides you with several rights with regard to your Clinical Record and disclosures of protected health information. These rights include requesting that the therapist amend your record; requesting restrictions on what information from your Clinical Record is disclosed to others; requesting an accounting of most disclosures of protected health information that you have neither consented to nor authorized; determining the location to which protected information disclosures are sent; having any complaints you make about policies and procedures recorded in your records; and the right to a paper copy of this Agreement, the attached Notice form, am happy to discuss any of these rights with you.
MINORS AND PARENTS
Clients under 18 years of age who are not emancipated and their parents should be aware that the law may allow parents to examine their child’s treatment records unless the therapist decides that such access is likely to injure the child, or the parent and the therapist agree otherwise. Because privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, a therapist may sometimes request an agreement from parents that they consent to give up their access to their child’s records. If the parents agree to such an arrangement during treatment, the therapist will provide them only with general information about the progress of the child’s treatment, and his/her attendance at scheduled sessions, and with a summary of their child’s treatment when requested. Any other communication would require the child’s Authorization unless the therapist feels that the child is in danger or is a danger to someone else. In such instances, the therapist would notify the parents of such concern.
BILLING AND PAYMENTS
You will be expected to pay for each session at the time it is held, unless you and the therapist agree otherwise or unless you have insurance coverage that requires another arrangement. Payment schedules for other professional services will be agreed to when they are requested. In circumstances of unusual financial hardship, the therapist may be willing to negotiate a fee adjustment or payment installment plan.
If your account has not been paid for more than 90 days and arrangements for payment have not been agreed upon, some therapists utilize the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court which will requires the therapist to disclose otherwise confidential information. In most collection situations, the only information released regarding a client’s treatment is his/her name, the nature of services provided, and the amount due.
In order to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. The therapist often provides you with assistance in helping you receive the benefits to which you are entitled; however, you (not your insurance company) are responsible for full payment of fees. It is very important that you find out exactly what mental health services your insurance policy covers.
You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator.
Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. "Managed Health Care" plans such as HMOs and PPOs often require authorization before they provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions.
While much can be accomplished in short-term therapy, some clients feel that they need more services after insurance benefits end. Some managed-care plans will not allow the therapist to provide services to you once your benefits end.
You should also be aware that your contract with your health insurance company requires that the therapist provide it with information relevant to the services provided to you. Often this includes a clinical diagnosis. Sometimes the therapist is required to provide additional clinical information such as treatment plans or summaries, or copies of your entire Clinical Record. In such situations, you may request the therapist supply only the minimum information about you that is necessary for the purpose requested.
This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, the therapist has no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. You always have the right to pay for psychological services yourself to avoid the problems described above in relationship to insurance companies.