Welcome to my practice! I appreciate you giving me the
opportunity to help. This document outlines important information
we must agree to before we begin working together. Our work is
most helpful when we share a mutual understanding of the rules I
must comply with due to various laws and ethical codes. If you
are concerned to the point of not agreeing with anything here,
please stop and call me so we can discuss.
Introduction to My Practice
I am a counselor who specializes in working with adults on issues
of anxiety and work/career. I am trained as a general mental
health counselor but my postgraduate training has focused mostly
on anxiety disorders, organizational mental health, and career
issues. I primarily use a research-based approach called
Acceptance and Commitment Therapy. ACT is a behavioral therapy,
meaning that it requires behavior change from you to create
psychological and emotional change. We work together on new
behaviors to try out and then see if they're successful outside
of the therapy room (and yes, that means homework).
In our first meeting, I will go over some administrative things
(like confidentiality, etc.) and then ask you to talk about what
brought you to my office. I will do my best, by the end of that
first meeting, to explain my take on what you've told me and try
to give you a rough outline of what treatment would look like.
After the initial meeting, I meet with most clients once every
one to three weeks, with sessions tapering in frequency after 10
or so appointments. You may need more frequent meetings,
especially if your symptoms are intense or if they've been going
on a very long time. We will talk about what frequency I think is
most likely to help and what frequency you feel comfortable with.
Most clients benefit from 45 minute sessions, which are
considered "industry standard" by most insurance companies. Some
clients need longer meetings and we can talk about why, if I
recommend those for you.
The Benefits and Risks of Therapy
First, the risks. Therapy can be very uncomfortable and hard
work. You may experience sadness, guilt, anxiety, anger,
frustration, loneliness, helplessness, or other negative
feelings. It is possible that despite the increasingly common
nature of therapy, some people in your life have misconceptions
about therapy or about people who seek therapy and may think
differently of you for seeking help. Our work may uncover
relationships that aren't working for you or may cause you to
change your behavior in a way that your associates do not
appreciate, even if the change was welcomed by you. It is also
possible that your problems may temporarily worsen before they
improve. Most of these risks are to be expected when people are
making important changes in their lives. Finally, even with our
best efforts, there is a risk that therapy may not work for you.
Benefits of therapy have been shown by scientists in hundreds of
well-designed research studies. People who are depressed may find
their mood lifting. Others may no longer feel afraid, angry, or
anxious. In therapy, people have a chance to talk things out
fully and try new behaviors until their feelings are relieved or
the problems are solved. Your relationships and coping skills may
improve greatly. You may get more satisfaction out of social and
family relationships. Your personal goals and values may become
clearer. I do not take on clients I do not think I can help.
Therefore, I will enter our relationship with optimism about our
progress.
Relationship Between Counselor and Clients
Laws and ethical codes put limits on the relationship between a
therapist and a client, and I will abide by these. Let me explain
these limits, so you will not think they are personal responses
to you.
First, I am trained to practice counseling-not law, medicine,
finance, or any other profession. I am not able to give you good
advice from these other professional viewpoints. I will recommend
that you consult with these professionals when issues come up
that are better addressed by folks with specialized
training.
Second, state laws and the rules of the ACA require me to keep
what you tell me confidential (that is, just between us). You can
trust me not to tell anyone else what you tell me, except in
certain limited situations. I explain what those are in the"About
Confidentiality"section of this brochure and in my Professional
Disclosure Statement (PDS).
If we meet on the street or socially, I may not say hello or talk
to you very much. My behavior will not be a personal reaction to
you, but a way to maintain the confidentiality of our
relationship. If you choose to approach me outside of my office,
please consider how you will explain to anyone who accompanies
you or me, how we know each other, as I will be unable to
acknowledge you until you acknowledge me, first.
Third, in your best interests, and following the ACA's standards,
I can only be your therapist. I cannot have any other role in
your life. I cannot, now or ever, be a close friend to or
socialize with any of my clients. I cannot be a therapist to
someone who is already a friend. I can never have a sexual or
romantic relationship with any client during or after the course
of therapy. I cannot have a business relationship with any of my
clients, other than the therapy relationship. I also may not
accept gifts nor attend social events clients invite me to and
hope that my refusal will not offend you. These standards are in
place to protect you, my client, from potential harm. Likewise, I
cannot connect with my clients via social networking sites such
as Facebook. Standards around how clients and counselors connect
on professional sites, such as psychology blogs, are constantly
evolving and we should maintain an open and frank conversation
about whether such connections are permitted and/or
appropriate.
Confidentiality - Expectations and Limitations
I will treat with great care all the information you share with
me. It is your legal right that our sessions and my records about
you be kept private. That is why I ask you to sign a
"release-of-records" form before I can talk about you or send my
records about you to anyone else. In general, I will tell no one
what you tell me. I will not even reveal that you are receiving
treatment from me. In all but a few rare situations, your
confidentiality (that is, our privacy) is protected by
federal and state laws and by the rules of my profession. Here
are the most common cases in which confidentiality is not
protected:
1. If you were sent to me by a court or an employer for
evaluation or treatment, the court or employer expects a report
from me. If this is your situation, please talk with me before
you tell me anything you do not want the court or your employer
to know. You have a right to tell me only what you are
comfortable with telling.
2. Are you suing someone or being sued? Are you being charged
with a crime? If so, and you tell the court that you are seeing
me, I may then be ordered to show the court my records. Please
consult your lawyer about these issues.
3. If you make a serious threat to harm yourself or another
person, the law requires me to try to protect you or that other
person. This usually means telling others about the threat. I
cannot promise never to tell others about threats you make.
4. If I believe a child, disabled person, or animal has been or
will be abused or neglected, I am legally required to report this
to the authorities. Please note that in the State of Oregon, it
is considered child abuse when a child witnesses domestic
violence.
Please, don't bring me or your records into court!
If you ever become involved in a legal dispute, I want you to
understand and agree that I will not provide evaluations or
expert testimony in court. You should hire a different mental
health professional for any evaluations or testimony you require.
This position is based on three reasons: (1) My statements will
be seen as biased in your favor because we have a therapy
relationship; (2) the testimony might affect our therapy
relationship, and I must put this relationship first; and (3) I
am not a trained forensic professional (I am not trained to
participate in the legal system) and I could inadvertently do
something to damage your case due to lack of training in that
area. My records are written to document what care I gave you and
to prove to your insurance company that I provided appropriate
treatment. They are often in "clinicalease" and are not written
to support any particular court case.
Consultations
There are some situations where I need to consult with another
professional about your care, who is not a part of your care
team. I ask that you authorize me to do so in the following
situations:
1. When I am away from the office for a few days, I have a
trusted fellow therapist "cover" for me. This therapist will be
available to you in emergencies. Therefore, he or she needs to
know about you. Of course, this therapist is bound by the same
laws and rules as I am to protect your confidentiality. I also
have other licensed healthcare professionals assigned to manage
my practice should I become suddenly disabled or deceased.
2. I sometimes consult other therapists or other professionals
about my clients. This helps me provide high-quality treatment.
These people are also required to keep your information private.
Your name will never be given to them, some information will be
changed or omitted, and they will be told only as much as they
need to know to understand your situation.
3. It may be beneficial for me to confer with your primary care
physician with regard to your psychological treatment or to
discuss any medical problems for which you are receiving
treatment. While I require a written release to participate in
non-urgent consultations, I will consult with your medical
professionals without a release when you are experiencing a
medical or psychiatric emergency.
Except for situations like those I have described above, my
office staff and I will always maintain your privacy. I also ask
you not to disclose the name or identity of any other client
being seen in this office. If your records need to be seen by
another professional, or anyone else, I will discuss it with you.
If you agree to share these records, you will need to sign an
authorization form. This form states exactly what information is
to be shared, with whom, and why, and it also sets time limits.
You may read this form at any time.
Records
It is my office policy to destroy clients' records 15 years after
the end of our therapy. Until then, I will keep your case records
in a safe place. At this time, I use an Electronic Medical
Records (EMR) system that is considered compliant with current
laws on medical privacy, to store your record. I am happy to
discuss the advantages EMRs provide. My EMR system includes a
portal through which you can contact me in a confidential manner
and through which I can provide you billing statements and other
information.
Record Status
Active clients are those who are working with me on a
regular treatment plan and we meet together no less than once a
month. Any client listed as "active" in my EHR, I will follow up
with on a pretty regular basis to check on progress and welfare.
If we have not met for over a month, I will move your file to
INACTIVE status.
Inactive clients are those who I am not seeing
regularly (less than once a month) or with whom treatment is "on
hold" for some definable reason. Inactive clients may still
receive periodic emails from me about the practice, via this EHR
portal. I will not directly follow up on the progress or welfare
of inactive clients and instead have a policy of "you call me,"
when you need an appointment or any other support. Clients who
are on inactive status will have their files closed after
three months of no appointments. If I have not met with you in
over a month or if you do not respond to my emails (and I don't
have any concerns about your safety), I will move your file to
inactive status.
Closed clients are those who have been discharged
from my care completely and whose files are now archived and
scheduled for destruction in the number of years specified by
applicable law. If I have not met with you for three or
more months, I will close your file. OR if we met only once or
twice and you do not schedule a follow-up appointment and I
cannot get a hold of you, I will move your file to closed. After
that, you can call or write me anytime for referrals or to
discuss coming back to therapy. If I have ever had any concern
about your safety, I will do my best to offer you referrals
before closing your file.
My Background
Please see my Professional Disclosure Statement for training and
degree information.
About Our Appointments
The very first time I meet with you, we will need to give each
other much basic information. For this reason, I usually provide
a free 20-minute introductory phone consultation so that you can
learn about my basic office policies and decide whether you would
like to proceed with an intake session. Following this, we will
usually meet for 45 or 60 minute sessions every week or two,
depending on our mutual availability and your clinical needs. As
your symptoms get better, we will meet less frequently.
Sometimes, clients benefit from appointments that begin in the
office but include some out-of-office time. For example, some
clients process thoughts or emotions better when on a walk
outside while others may benefit from confronting their anxiety
in real-life situations (in-vivo exposure therapy). I am trained
to practice "in-vivo" (in real life) techniques but taking
therapy out of the office has implications we should discuss
before choosing to do so. If we choose to conduct therapy outside
of the office setting, we will discuss risks and benefits ahead
of time and if we choose to engage in that type of work, I will
document your verbal consent in a progress note.
Scheduling and Canceling Appointments
An appointment is a commitment to our work. We agree to meet here
and to be on time. If I am ever unable to start on time, I ask
for your understanding. I also assure you that you will receive
the full time agreed to or I will charge you a prorated fee for
the actual time of our meeting. If you are late, we will probably
be unable to meet for the full time, because it is likely that I
will have another appointment after yours. I greatly appreciate
it when you can give me one week of notice prior to missing a
regular appointment time. I reserve the right to charge you for
any appointment cancelled or missed with fewer than 48 hours
notice, given via phone, email, or text. Insurance
companies do not reimburse for missed appointment fees but EAPs
often do (like Lyra Health and Modern Health). I do
encourage you to discuss extenuating circumstances with me and
when I am financially able, I often forgive missed appointment
fees in those cases. Please note that forgiving a missed
appointment fee on one occasion is not a promise to do so in the
future.
I will always do my best to let you know of my planned absences
and schedule changes as far in advance as possible. As the parent
of young children, my practice does generally follow the Portland
Public Schools (PPS) holiday schedule from September through June
and my schedule my change slightly in the summer to account for
scarcity of childcare at that time. Additionally, my practice
follows PPS's inclement weather policy. I also disclose my
parenting status so that you know sometimes either I or one of my
children is sick and I have to cancel due to illness. I try to
minimize this by having backup childcare available but even the
best plans sometimes fail. I ask for your patience during those
times and I try to offer as much flexibility to my clients as I
ask of them for these circumstances.
Your care team - Comprehensive mental health care extends
beyond counseling
If you could benefit from a treatment I cannot provide, I will
help you to get it. You have a right to ask me about such other
treatments, their risks, and their benefits. Based on what I
learn about your problems, I may recommend a medical exam or use
of medication. If I do this, I will fully discuss my reasons with
you, so that you can decide what is best. If you are treated by
another professional, I will coordinate my services with them and
with your own medical doctor.
Sometimes we need skills on your care team that I don't have. I
might suggest you see another therapist or another professional
for an evaluation. As a responsible person and ethical therapist,
I cannot continue to treat you if my treatment is not working for
you. If you want another professional's opinion at any time, or
wish to talk with another therapist, I will help you find a
qualified person and will provide him or her with the information
needed.
Fees, Payments, and Billing
**As of September, 2019, Rates are broken out into a separate
practice policy in this EHR**
I ask that clients pay their "patient/client portion" of any
appointment at the end of their session. I accept cash, credit
cards, and check for patient portions of balances due. Fees will
be due for all appointments performed or missed with less than 48
hours of notice to the counselor by email, phone, or text.
Unpaid Balances Policy
I ask most clients to keep a credit card on file for
patient/client responsibility amounts.This policy does not apply
to most Lyra and Modern Health clients. My credit card processing
through this site is both secure AND HIPAA compliant (using
Counsol and Stripe platforms). I reserve the right to
bill your insurance (if applicable) and then, your credit card
for patient-responsibility balances that go unpaid 24 hours after
your appointment occurs UNLESS we have an explicit agreement to
delay billing until a later date. If you are using your
insurance, I will charge only for your copay, anticipated
co-insurance amount, or deductible amount. If you are a
cash-paying client, I will charge you the full session fee.
If you think you may have trouble paying your bills on time,
please discuss this with me. I will also raise the matter with
you so we can arrive at a solution. If there is any problem with
my charges, my billing, or any other money-related point, please
bring it to my attention. I will do the same with you. Such
problems can interfere with our work. They must be worked out
openly and quickly.
Insurance and Third-Party Payers
Please see my separate policy on using your insurance for more
information.
If You Need to Contact Me
I am a private practice counselor and do not have the bandwidth
to provide 24/7 services. I am usually in the office Monday
through Friday. Since I cannot answer the phone when I am meeting
with a client, I encourage clients to leave email messages (here
on the secure system for security). I make best efforts to return
messages within 24 business hours and usually am much faster than
that. Generally, I will return messages daily except on Saturdays
and holidays.
Direct email (to katie@playfairconsulting.com) or text messaging
(to 510-910-2033 or to 503-610-6162), and voicemails can be a
convenient way to communicate with me but they are NOT
HIPAA COMPLIANT and I can make no guarantee as to the
confidentiality of direct communication outside of this
portal. Unsecure email messages are stored on servers and
transmitted over internet connections over which I have no
control. Therefore, I suggest you email me directly only for
administrative and scheduling issues and not for communication
about the issues we may be addressing in therapy. All emails sent
to katie@playfairconsulting.com should be assumed to be
non-confidential due to issues mentioned previously. You may
email me through this online system called Counsol as it meets
HIPPA guidelines for protecting your health information.
If you have an emergency or crisis, I want to know and greatly
appreciate your voicemail or email notification. I also ask that
you dial 911, go to your nearest hospital emergency room, or dial
your local crisis line. The Multnomah County Crisis Line can be
reached at 503-988-4888. The Clackamas County Crisis line can be
reached at 503.655.8401.
If there is an emergency during our work together, or I become
concerned about your personal safety, I am required by law and by
the rules of my profession to contact someone close to
you-perhaps a relative, spouse, or close friend. I am also
required to contact this person, or the authorities, if I become
concerned about your harming someone else. Please provide this
contact information in the enrollment forms, provided within the
website.
Statement of Principles and Complaint Procedures
It is my intention to fully abide by all the rules of the
American Counseling Association (ACA) and by those of my state
licensing boards. Problems can arise in our relationship, just as
in any other relationship. If you are not satisfied with any area
of our work, please raise your concerns with me at once. Our work
together will be slower and harder if your concerns with me are
not worked out. I will make every effort to hear any complaints
you have and to seek solutions to them. If you feel that I (or
any other therapist) have treated you unfairly or have even
broken a professional rule, please tell me. You can also contact
the state or local counselor association and speak to the
chairperson of the ethics committee. He or she can help clarify
your concerns or tell you how to file a complaint.
You may also contact the state board, below:
Oregon Board of Licensed Professional Counselors and
Therapists at 3218 Pringle Rd SE #250, Salem, OR 97302-6312.
Telephone: (503) 378-5499 Email: lpct.board@state.or.us Website:
www.oregon.gov/OBLPCT
In my practice as a therapist, I do not discriminate against
clients because of any of these factors: age, sex, marital/family
status, race, color, religious beliefs, ethnic origin, place of
residence, veteran status, physical disability, health status,
sexual orientation, or criminal record unrelated to present
dangerousness. This is a personal commitment, as well as being
required by federal, state, and local laws and regulations. I
will always take steps to advance and support the values of equal
opportunity, human dignity, and racial/ethnic/ cultural
diversity. If you believe you have been discriminated against,
please bring this matter to my attention immediately.
Our Agreement
I, the client (or his or her parent or guardian), understand I
have the right not to sign this form. My signature below
indicates that I have read and discussed this agreement; it does
not indicate that I am waiving any of my rights. I understand
that any of the points mentioned above can be discussed and may
be open to change. If at any time during the treatment I have
questions about any of the subjects discussed in this brochure, I
can talk with you about them, and you will do your best to answer
them. I understand that after therapy begins I have the right to
withdraw my consent to therapy at any time, for any reason.
However, I will make every effort to discuss my concerns about my
progress with you before ending therapy with you.
I understand that no specific promises have been made to me by
this therapist about the results of treatment, the effectiveness
of the procedures used by this therapist, or the number of
sessions necessary for therapy to be effective.
I have read, or have had read to me, the issues and points in
this brochure. I have discussed those points I did not
understand, and have had my questions, if any, fully answered. I
agree to act according to the points covered in this brochure. I
hereby agree to enter into therapy with this therapist (or to
have the client enter therapy), and to cooperate fully and to the
best of my ability, as shown by my acceptance of the terms,
below.