Consent For Treatment
Therapy can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits, however, 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, its progress, and other aspects of the therapy and will expect you to respond openly and honestly. Sometimes more than one approach can be helpful in dealing with a certain situation. During therapy, remembering or talking about unpleasant events, feelings, or thoughts can result in you experiencing considerable discomfort or strong feelings of anger, sadness, worry, fear, etc., or experiencing anxiety, depression, insomnia, etc.

At times I may challenge some of your assumptions or perceptions or propose different ways of looking at, thinking about, or handling situations, which can cause you to feel very upset, angry, depressed, challenged, or disappointed. Attempting to resolve issues that brought you to therapy in the first place, such as personal or interpersonal relationships, may result in changes that were not originally intended. Psychotherapy may result in decisions about changing behaviors, employment, substance use, schooling, housing, or relationships. Sometimes a decision is positive for one family member that can be viewed negatively by another family member.
Change will sometimes be easy and swift, but can also be slow and even frustrating.

I am trained in marriage and family therapy and will likely draw on various psychological approaches according, in part, to the problem that is being treated and my assessment of what will best benefit you. These approaches include, but are not limited to, Gottman-Method couples therapy, Emotionally-Focused couples therapy, cognitive behavioral,
cognitive, psychodynamic, existential, system/family, developmental (adult, child,
family), humanistic and psycho-educational. I provide neither custody evaluation recommendation nor medication or prescription recommendation nor legal advice, as these activities do not fall within my scope of practice.

CONFIDENTIALITY


All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission except where disclosure is required by law.

WHEN DISCLOSURE IS REQUIRED OR MAY BE REQUIRED BY LAW


Some of the circumstances where disclosure is required or may be required by law are:
(1). There is a reasonable suspicion of child, dependent, or elder abuse or neglect;
(2). A client presents a danger to self, to others, to property, or is gravely disabled;
(3). A client's family members communicate to April that the client presents a danger to others.

In couple and family therapy, or when different family members are seen individually, even over a period of time, confidentiality and privilege do not apply between the couple or among family members -unless otherwise agreed upon. I will use my clinical judgment when revealing such information. I will not release records to any outside party unless s/he is authorized to do so by all adult parties who were part of the family therapy, couple therapy or other treatment that involved more than one adult client.

Disclosure may also be required pursuant to a legal proceeding by or against you. If you place your mental status at issue in litigation initiated by you, the defendant may have the right to obtain the psychotherapy records and/or testimony by me.

Eā€“MAILS, CELL PHONES, COMPUTERS, & FAXES


It is very important to be aware that computers and email communication can be relatively easily accessed by unauthorized people and hence can compromise the privacy and confidentiality of such communication. Faxes can easily be sent erroneously to the wrong address. Emails, in particular, are vulnerable to unauthorized access due to the fact that Internet servers have unlimited and direct access to all emails that go through them. It is important that you be aware that emails, faxes and important texts are part of your records. Please notify me if you decide to avoid or limit in any way the use of any or all communication devices, such as email, cell phone, or faxes. If you communicate confidential or private information via email or text message, I will assume that you have made an informed decision, will view it as your agreement to take the risk that such communication may be intercepted, and will honor your desire to communicate on such matters in that exchange. Please do not use email or texts for emergencies.

EMERGENCY


If there is an emergency during therapy, or in the future after termination, where 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 the proper medical care. For this purpose, I may also contact the person whose name you have provided on the intake form.

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 which 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 nor your attorney(s), 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 the psychotherapy records be requested unless otherwise agreed upon.

CONSULTATION


I consult regularly with other professionals regarding my clients; however, each client's identity remains completely anonymous and confidentiality is fully maintained.

RECORDS & YOUR RIGHT TO REVIEW THEM


Both the law and the standards of my profession require that I keep treatment records for at least 3 years. Unless otherwise agreed to be necessary, I will retain clinical records only as long as is mandated by Florida law. If you have concerns regarding your treatment records, please discuss them with me. As a client, you have the right to review or receive a summary of your records at any time,
except in limited legal or emergency circumstances or when I assess that releasing such information might be harmful in any way. In such a case, I will provide the records to an appropriate and legitimate mental health professional of your choice. Considering all of the above exclusions, if it is still appropriate, and upon your request, I will release information to any agency/person you specify
unless I assess that releasing such information might be harmful in any way. When more than one client is involved in treatment, such as in cases of couple and family therapy, I will release records only with signed authorizations from all the adults (or all those who legally can authorize such a release) involved in the treatment.

TELEPHONE & EMERGENCY PROCEDURES


If you need to contact me between sessions, please call or text 954.654.9609 and your message will be returned as soon as possible. I check messages continuously during the daytime only, and less frequently at night. If an emergency situation arises, indicate it clearly in your message and if you need to talk to someone right away call 24-hour crisis line for Broward County, Ft Lauderdale: 211 or 954.537.0211 or the Police: 911. Please do not use email or texts for emergencies.

PAYMENTS & INSURANCE REIMBURSEMENT


Clients are expected to pay the one-time initial fee of $285 for a 90 - minute session, following the standard fee of $190.00 per 50 - minute session at the end of each session unless other arrangements have been made. Please notify me if any problems arise during the course of therapy regarding your ability to make timely payments.

Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companies. I will provide you with a copy of your receipt at your request, which you can then submit to your insurance company for reimbursement, if you so choose. You must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage.

TERMINATION


As set forth above, after the first couple of meetings, I will assess if I can be of benefit to you. I do not accept clients who, in my opinion, I cannot help. In such a case, I will give you a number of referrals that you can contact. If at any point during psychotherapy, I assess that I am not effective in helping you reach the therapeutic goals or that you are non-compliant, I am obligated to discuss it with you and, if appropriate, to terminate treatment. In such a case, I would give you a number of 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 professional's opinion or wish to consult with another therapist, I will assist you with referrals, and, if I have your written consent, I will provide her or him with the essential information needed. You have the right to terminate therapy at any time. If you choose to do so, and if appropriate, I will offer to provide you with names of other qualified professionals.

CANCELLATION


Since the scheduling of an appointment involves the reservation of time specifically for you, a minimum of 24 hours (1 day) notice is required for re-scheduling or canceling an appointment. If an appointment is canceled within the 24-hour period leading up to your scheduled appointment time or you miss the appointment, you will be charged 100% of our agreed upon fee unless there is an opportunity to reschedule within that same week (7 days from the time of the missed appointment). However, this is at the discretion of the therapist.

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