Welcome to my practice! I am delighted to begin this journey with you. If you have any questions regarding this consent, I would be happy to review with you during your first session.
Please review this consent carefully – you will be provided with a copy of the signature page at the beginning of your first session. You can also download the form here.
What is Psychotherapy?
Psychotherapy means many things to many people. Some see it as a way to work through current problems; some see at is a way to overcome problems of the past. I see the psychotherapy as an individual experience that will help you to gain insight in order to have a more fulfilling life. There are many different methods of practice; regardless of the method, in order for psychotherapy to be successful, we will both need to agree to take an active role in the process. There are a multitude of benefits to psychotherapy–increased mood, improved relationships with others, greater life satisfaction, and a greater understanding of self. There are possible risks as well. Know that at the end of some of our sessions together, you may leave “feeling worse”; meaning, that you may have uncomfortable feelings of sadness, guilt, or even anger. Your friends or family may view you as “weak” for coming to therapy as there is stigma attached to most mental health/wellness treatments. And there is the risk that therapy may not work for you-however, as previously stated, your active participation and willingness to become vulnerable in a safe, non-judgmental, confidential environment will increase the benefits that you can achieve from the process.
What to Expect from Our Relationship
As a professionally trained, licensed counselors, I will use our best knowledge and our skills to assist you. As a doctoral candidate in counseling psychology, I practice under the standards of the American Psychological Association (APA). These standards are designed to protect both the practitioner as well as the client. I hold client confidentiality to the highest standard. I want for you to feel safe sharing your stories with us-We will not share this information in any way that could be damaging to your reputation and/or your well-being. With this being said, I can only be your counselor. We cannot form a relationship outside of our counseling relationship (such as friends, business partners); this would jeopardize our counseling relationship. If at any time, you feel as though the relationship is not meeting your expectations, I invite you to discuss this with me. I will be happy to review alternate treatment options including a referral to another practitioner who may better suit your needs.
What to Expect During our Sessions Together
During our first session, you can expect to discuss the presenting problem, which has brought you to therapy, your psychological and/or psychiatric history, family history, relational history, and any other biopsychosocial information that will be relevant to your treatment. Clearly, in an initial session, we will not be able to cover all of your history and many times, significant information will be presented when you least expect it. Know that the quantity of content is not more or less beneficial than the quality of content you bring to sessions. Please know that any questions that we may ask of you are not motivated by our personal curiosity per se, but more of a need to gather relevant clinical contexts. You may elect to decline to answer certain questions in which you are not comfortable answering. It is our hope that over time, as you begin to feel safer and more secure in sessions, that you will be able to talk freely and openly, as we are here to assist you, not judge you.
Confidentiality
All communications between you and your counselor are confidential and we are bound by our code of ethics as both professional counselors as well as by the APA. Without your written permission, we are unable to release information to others (including other treating professionals). If you chose to authorize another party to receive any information regarding information shared at sessions, you may also revoke this authorization in writing at any time after. As a self-pay client, there will be no need to disclose any protected health information with the expectation of collection for overdue accounts. Under state law, your records that we will keep documenting your sessions is privileged; meaning that we cannot release information in legal, judicial, or administrative proceedings without your written consent or a court order. When a third party mandates an evaluation, privilege does not apply. Know that in most legal proceedings, your information will remain confidential.
Limits to Confidentiality
If at any point and time during our relationship you threaten to harm yourself, I may be obligated to seek hospitalization for you and/or contact family members in order to provide support and protection. If an incident as such occurs, we will ensure that we have done our utmost to address with you prior to taking action. By law, if you were to threaten to harm or kill another person, I may be required to take action. Actions include, but are not limited to notifying the victim, contacting police, or seeking hospitalization for you. If I have reasonable cause to suspect abuse to children, I am mandated by law to report this suspicion to the Pennsylvania Department of Welfare. If I have reasonable cause to suspect that an older adult is in need of protective services, I may report to an appropriate agency. If you are an adult with a legally appointed guardian, information may be disclosed that would be necessary for health-care related decisions. If you are a client in group therapy, confidentiality outside of the group cannot be assured as other group members are not bound by law to keep your information confidential. We will review expectations regarding confidentiality with members of the group, however, we will not be held responsible for group members breeching confidentiality.
Clinical Consultation
Joy B. Krumenacker and Marci Sturgeon-Rusiewicz will frequently consult with one another regarding client cases in order to ensure the best possible services are being delivered to our clients. During this consultation, your identity will not be revealed. If the other clinician would ever make reference to your identity, she is also legally bound to keep the information confidential. We may also consult with and/or seek supervision with other professionals regarding your case; again, maintaining the highest level of confidentiality in order to protect your identity.
Payment Policies and Procedures
All payments are expected to be made in full on the day of services. I will only accept cash, credit cards, PayPal, and checks at this time. I have chosen to not accept insurance at this time for various reasons, however primarily it is to minimize the exposure of your protected health information. This prevents your insurance carrier from receiving information regarding your current and past issues or struggles, a psychiatric diagnosis, your course of treatment, and/or your prognosis. No records of therapy will ever exist in the Medical Information Bureau which could compromise your ability to obtain insurances such as life, health, disability, or long-term care. Self-pay requires no psychiatric diagnosis. I also feel that psychotherapy is a unique experience and each client will have different needs. With self-pay, we are not limited on the modalities of therapy that insurances companies dictate for use. You will not have limits placed upon your sessions. You remain in control of your treatment.
Self-Pay Rates/Fees
I operate on a sliding scale, meaning that your individual or group rate may be based upon your incomes. You sessions will cost you between $80-$150 per session and the price will remain consistent for six months. At the end of six months, your rate will be reevaluated; all rates are subject to change every six months.
Late-Cancellation/no show Policy
If you do not show up for our scheduled appointment, you will be charged a no show fee of $50. All appointments must be cancelled at least 4 hours in advance in order to avoid a late cancellation/no show fee. Please understand that this policy is not a penalty for you, it is protection for me. I have booked this time with you and in the event that you cancel, it is highly unlikely that I will be able to schedule another client in your time. I know how valuable your time is, and we ask that you have an equal respect for mine.
In the Event of a Crisis
I will not always be available by telephone and many times, you will receive my voice mailboxes. I will make every effort to return your call within 24 business hours, with the exception of weekends and holidays. If your therapist is unavailable for an extended time (such as a vacation, conference, etc), the number of the other therapist will be given to you to contact if necessary. If you are experiencing a clinical emergency such as having suicidal thoughts or harming yourself or another: Call 911or Go to the nearest emergency room or Call UPMC’s Resolve Crisis Network @ 1-888-7YOUCAN.