OFFICE POLICIES & GENERAL INFORMATION Agreement for Psychotherapy Services

(Updated August 2011)

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 have a doctorate in clinical psychology and am licensed by the state of California to practice as a marriage, family and child therapist. I have been providing child and adult psychotherapy services since 1981. I received my clinical training at Children's Health Council in Palo Alto, Lucille Salter Packard Children's Hospital at Stanford, Emergency Treatment Center in Santa Clara, and East Valley Mental Health Center in San Jose. To keep abreast of new developments, I regularly attend seminars and read professional literature in areas in which I specialize - young children, adoption and attachment, moving through transitions and healing from losses (death/divorce/ jobs), coping with illness or disability, identity issues that arise for adults in the process of parenting, and marital relationships. I am a member in good standing of the California Association of Marriage and Family Therapists and the American Psychological Association. I offer individual therapy for adults and children, therapy with parents and children together, and counseling for parenting issues. My theoretical orientation focuses on the importance of early life experiences, current interactions between family members and the development of individual emotional and spiritual resources. We face challenges to our development at many stages of life; early trauma or unmet needs and disconnection from our whole selves can impede creation of a satisfying life and relationships. Facing these difficulties in the context of family and therapy relationships can bring about healing and growth. In therapy your task will be to express, as openly as you can, what you think the problems are and what you have done to try to resolve them. My task is to listen carefully so I can understand your problems and describe them in ways that help you know yourself in a new way, gain a new perspective on your problems, and find resources and solutions that fit who you are. I use symbolic methods (play, stories, art) to understand what children are "saying" about their problems and then help you as their parent(s) understand what they are communicating and what they need.
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 will try to help you in obtain those treatments.

TERMINATION AND FOLLOW-UP

We may work together for one period of time, or we may work together several times during your life as your or your childs issues surface in different ways or circumstances. 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. Regular checkups provide valuable feedback for me about your progress and offer an open door if you or your child is again experiencing difficulties. 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 yours or your child's best interests. 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 professionals opinion or wish to consult with another therapist, I will assist you in finding someone qualified; if you give written consent, I will provide him/her with the essential information needed. 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 talk to me to make arrangements any time your financial situation changes.
DUAL RELATIONSHIPS

Therapy never involves sexual or any other dual relationship that impairs my objectivity, clinical judgment, or therapeutic effectiveness or that could be exploitive in nature. This is a small community and many of my clients know each other. You may see someone you know in the waiting room, or you may see me around town. I will never acknowledge working therapeutically with you without your written permission. Many clients choose me as their therapist, because they know me before they start therapy and are aware of my expertise. I will discuss with you the complexities and potential difficulties that may be involved in us working together if we know each other from another setting. Dual relationships can enhance therapeutic effectiveness or can detract from it, and it is often not possible to predetermine which effect you will have. It is my responsibility to watch out for your best interest, and it is your responsibility to let me know if any aspect of our relationship becomes uncomfortable for you. I will always listen carefully and respond accordingly to your feedback. If you are uncomfortable, it may mean that we cannot work together, and I will provide you with names of other qualified professionals.
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 very 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. 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 might 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 a decision that is positive for one family member is viewed as negative by another family member. 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.
APPOINTMENTS

My office hours are Tuesday through Thursday afternoons and Friday mornings. Sessions are by appointment only. Individual sessions last 45-60 minutes; longer sessions may be scheduled for deeper work with fees prorated accordingly. I will try to keep on schedule so you won't have to wait, but sometimes situations arise that cause me to be late starting your session. Your patience would be greatly appreciated. Please be assured that you will receive the same individual attention during your appointment. Emergencies - If I do not show up for my appointment with you and you cannot reach me within 24 hours, please contact my colleague Barbara Brandt, Ph.D. at 650/941-1535.
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. Unless we reach a different agreement, 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.
PHONE CALLS

If you need to contact me between sessions, leave a message for me at 650/323-3358, and I will return your call as soon as possible. Please call from 9:00 am to 6:00 pm for nonemergency calls. I check my messages a few times a day unless I am out of town and a colleague is covering my practice. If I am going to be out of town, I will let you know who you can contact. Call my emergency number between 6:00 pm and 9:00 am only if it is urgent and indicate it clearly in your message. Phone consultations of 5 minutes or less will not be charged. Longer phone consultations with you or with someone you have authorized me to speak to about you or your child 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.
EMERGENCIES

Some emergencies are immediately life threatening, and you should call 911 first. If an emergency situation arises, please indicate it clearly in your message to me. If you need to talk to someone right away, you can call the closest 24-hour emergency psychiatric service: Santa Clara County 408.885.6100; San Mateo County 650.573.2671 Stanford Medical Center Emergency Room (ask for psychiatrist on call) 650.723.5111 Packard Children's Hospital at Stanford (ask for child psychiatrist on call) 650.497.8000

PAYMENT & FINANCIAL ARRANGEMENTS

You will be expected to pay my standard fee of $150 for 45-50 minute sessions at each session or at the end of the month unless other arrangements have been made. I see some clients for reduced fees, and I will be happy to let you know if I have any openings for lower-fee appointments. You may pay by check or cash. I will provide you with a statement at the beginning of each month containing a record of therapy contacts the previous month, fees, 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. A simple conversation may avoid problems. Telephone conversations, longer sessions, site visits, travel time, consultation with other professionals, review of reports/records, will be charged at the same rate prorated for the length of time. Written reports are charged at the rate of $450 for 1-2 pages, and $750 for 3-5 pages.

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INSURANCE

Some or all your fees for service may be covered by your health insurance if you have outpatient mental health coverage for non-network providers. However, not all issues/ conditions/problems that are the focus of psychotherapy are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. You are also responsible for meeting your insurance requirements for coverage, if any (such as referral from your primary care physician). 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 to your confidentiality.
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 disclosure is required by law. 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. (Please see the Notice of Privacy Practices.) When Disclosure May Be Required: Disclosure may be required in a legal proceeding. If you place your mental/emotional 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 or may work with you to help you reveal any secrets. 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. If you would like me to talk to someone else, such as a grandparent or other extended family members, teacher, therapist, or anyone else about you or your child, you must sign an authorization for me to release information. I will not release records to any outside party unless I am authorized to do so by all adult family members and children older than 12 who were part of the treatment.

Because records of any previous assessments or therapy are an invaluable resource for our work together, I will ask you to sign an authorization for former counselors or therapists to release information to me. Information from others remains part of your record in my office and cannot be released by me to you or to others. At any time you may revoke in writing any authorization to release confidential information you have previously signed; this prevents further communication between the parties named and goes into effect on the date received. 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 proper psychiatric care, I will do whatever I can within the limits of the law to prevent you from injuring yourself or others 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: Disclosure of confidential information may be required by your health insurance carrier or HMO/PPO 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 companys 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 or future eligibility to obtain insurance. Some of the risk results from insurance companies use of computers and their accessibility. Medical data has been reported to have been sold, stolen, or accessed by law enforcement agencies. Confidentiality of E-mail, Cell Phone and Fax Communication: E-mail and cell phone communication can be relatively easily accessed by unauthorized people, compromising the privacy and confidentiality of such communication. E-mails are especially vulnerable to unauthorized access because they are essentially a digital version of a postcard, and there are many people who can intercept them as they make several hops across computers on internet servers and e-mail providers. I use a cell phone for out-of-office communication with clients, but I do not use e-mail for clinical communication. You use these methods to communicate with me at your own risk. Please do not use e-mail or faxes for emergencies. I may fax treatment data for payment of claims as necessary with an appropriate cover for confidentiality. Litigation Limitation: Due to the nature of the therapeutic process which involves making full disclosure of private and confidential matters, it is agreed that should there be legal proceedings (such as but not limited to divorce and custody disputes, injuries, lawsuits, etc), neither you nor your attorney nor anyone else acting on your behalf will call on me to testify in court or at any other proceeding, nor will a disclosure of psychotherapy records be requested. Consultation: I consult regularly with other professionals regarding my clients in order to provide you with the best possible service. Names and other identifying information are 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.
MEDIATION & ARBITRATION

All disputes arising out of or in relation to this agreement to provide psychotherapy services will be referred to mediation before, and as a pre-condition of, the initiation of arbitration. The mediator shall be a neutral third party chosen by agreement between us. The cost of such

mediation shall be split equally unless otherwise agreed. In the event that mediation is unsuccessful, any unresolved controversy related to this agreement will be settled by binding arbitration in San Mateo County, California, in accordance with the rules of the American Arbitration Association which are in effect at the time the demand for arbitration is filed. Notwithstanding the foregoing, in the event that your account is overdue (unpaid) and there is no payment plan agreement, I may use legal means (court, collection agency) to obtain payment. The prevailing party in arbitration or collection proceedings will be entitled to recover a reasonable sum for attorneys fees. In arbitration, the arbitrator will determine that sum.
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, which 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. Please print out, initial & sign the two-page Acknowledgment that you have received & read these Procedures (in the Forms section of this website) & bring it with you to our first appointment I look forward to meeting with you. Sincerely,

Linda Stewart