Limits of Confidentiality: All information that you disclose to me within our sessions is confidential and will not be revealed to anyone without your written permission (or your parents’ permission if you are under 18 years old). Disclosure may be authorized or required by law
- where there is reasonable suspicion of child abuse, elder abuse or otherwise vulnerable adult abuse (e.g. disabled);
- where there is reasonable suspicion that you may present a danger of violence towards others;
- where there is reasonable suspicion that you are likely to harm yourself unless protective measures are taken.
Disclosure may also be required pursuant a legal proceeding.
Records: Your clinical file will consist of (a) legal forms such as this document, (b) record of visits and payments, and (c) clinical progress notes.
Education, Training, and Experience: I have an MSW in Social Work and have a valid license to practice as a Clinical Social Worker in Arizona ( Lic. No. LCSW-17211) and Missouri (Lic. No. 2017038061). I am also a qualified clinical supervisor in Arizona. Previous to my MSW, I earned an M.Ed. in Counseling Psychology and a B.S. in Disability Studies and have a valid certification to practice and supervise as a Rehabilitation Counselor nationwide (Cert. No. 111984). After receiving my MSW, I completed a Post-Graduate Fellowship in Psychoanalytic Thought and an ADA Coordinator Certification (Cert. No. 66935970-4617). My clinical experience includes crisis intervention, treatment of past abuse, trauma, post-traumatic stress disorder (PTSD) and psychogenic non-epileptic seizures (PNES); evaluation and treatment of mood, anxiety, alcohol and substance use disorders and chronic pain; career counseling, case management, advocacy, accommodations of people who experience disabilities, blindness and visual impairments; and training clinicians and others. My experience also includes treating medical conditions from the medical model, researching and writing policies and law, providing training and supervision for clinicians, counselors and other professionals, as well as standard of care and forensic expert related services.
Length and Success of Services: The length and success of psychological treatment depends on the motivation and aptitude of the person being treated, and so I can make no guarantees of success. I allow you to decide when to terminate the treatment.
Risk of Services: You should be aware, although I anticipate otherwise, despite treatment you may not improve at all, you may not improve as quickly as you may like, or you may start to improve only after treatment has ended. You should also be aware that treatment is intended to induce change in your life, and that when this change occurs it may disrupt your accustomed manner of living and your relationships with others. Treatment can also provoke feelings of affection for me or anger at me, and these experiences should be considered normal aspects of treatment to be discussed openly with me.
Your Rights: You may review information that I have about you at any time. You may terminate services at any time.
In all cases, professional treatment never includes sexual contact with the treatment provider.
Payment for Services: My general consultation fee is $125 per hour during the daytime and $150 per hour in the evening (after 6:00pm in Arizona) and for on-site services regardless of the time of day. My fee for standard of care and/or forensic expert related services are based on $300 per hour and requires a retainer. Additional fees related to time and travel for on-site services may apply for services outside of Flagstaff, AZ. Fees for workshops, public speaking, or requests to write are determined on a case-by-case basis with factors such as the size of the audience, topic requested, and if travel is required. You will be expected to pay at the time of service unless other arrangements have been made. Payment can be in cash (which ensures confidentiality), by check, money order, bank draft, or with a credit card.
If, because of rising costs, I have to raise my fees, I will not do so for current clients; but any client who leaves treatment for more than a month and then decides to return to treatment will be charged the new fee.
Problem Payments: In the event that there is a misuse of “other payment arrangements”, I reserve the right to require advance payment, use collections for past due balances, and/or terminate services. For costs that I incur from my bank due to checks or other methods of payment unpaid by your bank for any reason, you will be expected to reimburse me.
Insurance Reimbursement: I do not accept Medicare or any managed care plans. If you carry other insurance, you will still be responsible for payment of each session, in full. Then, if you request, I will provide you with a monthly statement (for a $25 fee per statement) which you can submit to your insurance company for reimbursement. This statement will include your diagnosis, the procedure code, the number of sessions, and the amount you have paid me. It will be your responsibility to contact your insurance company to determine if it will reimburse you under these terms, and, if so, what percentage of the fee it will cover.
Note, however, that your use of insurance will breach the confidentiality of your treatment because any employee of the company can demand the details of your treatment. Furthermore, insurance companies require a psychiatric diagnosis (which becomes an indelible part of your world-wide medical record.)
Cancellation: The scheduling of an appointment involves the reservation of time specifically for you, and I will wait the entire time for you to arrive. If you are late, we will meet for whatever time remains. You will be required to pay for the full session. If you do not attend your scheduled appointment, and you have not notified me at least 24 hours in advance, you will be required to pay the full cost of the session.
If you do not attend your scheduled professional workshop or a concierge service, and you have not notified me at least 48 hours in advance, you will be required to pay the full cost of the workshop or service. If you have requested a concierge service that requires me to reserve travel and/or lodging, those costs are due upfront and are non-refundable.
Texting: Because of the danger of privacy breaches, I discourage the use of text messages unless they are short, information specific, and do not refer to any psychological details.
E-mail: I discourage the use of e-mail with established clients. If you choose to contact me through e-mail, please understand that e-mail is not a secure form of communication and that it can be intercepted by anyone at any time.