About Psychotherapy
By the end of our first or second session, I will tell you how I see your case at this point and how I think we should proceed. I view therapy as a partnership between us. You define the problem areas to be worked on; I use my specialized knowledge to help you make the changes you want to make. Psychotherapy requires your very active involvement and your best efforts to change thoughts, feelings, and behaviors. For example, I will expect you to tell me about important experiences, what they meant to you, and what strong feelings were involved.
I expect us to plan our work together. In our treatment plan, we will list the areas to work on, our goals, the methods we will use, the time and money commitments we will make, and some other things. I expect us to agree on a plan that we will both work hard to follow. From time to time, we will look together at our progress and goals. If we think we need to, we can then change our treatment plan, its goals, or its methods.
An important part of your therapy will be practicing new skills that you will learn in our sessions. I will ask you to practice outside our meetings, and we will work together to set up homework assignments for you. I might ask you to do exercises, keep records, and read to deepen your understanding. You will probably have to work on relationships in your life and make long-term efforts to get the best results. These are important parts of personal change. Change will sometimes be easy and quick, but more often it will be slow and difficult and will need repetitions, and so you will need to keep trying. There are no instant, painless cures and no “magic pills” for changing well-learned habits. However, you can learn new ways of looking at your problems that will be very helpful for changing your feelings and reactions.
How Long Therapy Might Take
Most of my clients see me once a week for 3–5 months. After that, we meet less often for several more months. Therapy then usually comes to an end. The process of ending therapy, called “termination,” can be a very valuable part of our work. Stopping therapy should not be done casually, although either of us may decide to end it if we believe it is in your best interest. If you wish to stop therapy at any time, I ask that you agree to meet for at least one more session, to review our work together. We will review our goals, the work we have done, any future work that needs to be done, and our options. If you would like to take a “time out” from therapy to try it on your own, we should discuss this. We can often design such a “time out” to be more helpful.
The Risks and Benefits of Therapy
As with any treatment, there are some risks as well as many benefits of therapy. You should think about both the benefits and risks when making any treatment decisions. For example, in therapy there is a risk that clients will, for a time, have uncomfortable levels of sadness, guilt, anxiety, anger, frustration, loneliness, helplessness, or other negative feelings. Clients may recall unpleasant memories. These feelings or memories may bother them for a while. Sometimes, too, a client’s problems may worsen after the beginning of treatment. Risks like these are temporary and should 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 out as you would like. All of these factors should be weighed against the costs of not changing and continuing as you are.
Therapy has many benefits that have been shown by scientists in hundreds of well-designed research studies. Most clients will find their symptoms greatly lessened, will feel more confident and relaxed, and will improve their daily functioning. People who are depressed may find their mood lifting. Other clients may no longer feel afraid, angry, or anxious. In therapy, people have a chance to talk things out fully until their feelings are relieved or the problems are resolved. Clients’ relationships and coping skills can improve greatly. They may get more satisfaction out of social and family relationships. Their personal goals and values may become clearer. They may grow in many directions—as persons, in their close relationships, in their work or schooling, and in the ability to enjoy their lives.
Psychological assessment (with or without administering tests) can increase our understanding of your personality, psychological dynamics, intellectual and emotional resources, or other areas, and so it may help us design or improve your therapy. If this seems beneficial, I will discuss it with you before proceeding.
Consultations
If you could benefit from a treatment I cannot provide, I will help you 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 him or her and with your own medical doctor if you want me to.
What to Expect from Our Relationship
Psychological services are best provided in an atmosphere of trust. You expect me to be honest with you about your problems and progress. I expect you to be honest with me about your expectations for services, your compliance with medication, and any other barriers to treatment.
As a professional, I will use my best knowledge and skills to help you. This includes following the standards of the American Psychological Association, or APA. In your best interests, the APA puts limits on the relationship between a therapist and a client, and I will abide by these. Let me explain these limits.
First, I am licensed and trained to practice psychology—not law, medicine, finance, or any other profession. I am not able to give you good advice from these other professional viewpoints.
Second, state laws and the rules of the APA 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 a few unusual situations. I explain what those are in the “About Confidentiality” section of this document, as well as the HIPAA Notice of Privacy Practices form you will also sign before we begin therapy.
- If we meet on the street or socially, I may not say hello or talk to you at all. I am not ignoring you; it is a way to maintain the confidentiality of our relationship.
- If you ever become involved in a divorce or custody dispute, or any other legal matters (such as a lawsuit over injuries), I want you to understand and agree that I will not provide my records, or evaluations, depositions, or testimony in court. There are several reasons for this:
- I may not possess the professional skills to make decisions about issues besides those we deal with in therapy
- Therapy often involves full disclosure of information that you might not want to have revealed in court
- If you are holding back information because of that fear, our work will not be as productive as it could be
- My statements will be seen as biased in your favor because we have a therapy relationship
- What I might say in testifying or being deposed might change our therapy relationship, and I must put that relationship first. If you want custody evaluations and recommendations, I will be happy to refer you to those with this expertise
- Even though you might invite me, I will not attend your family gatherings, such as parties or weddings.
- As your therapist, I will not celebrate holidays or give you gifts, and I may not receive any of your gifts eagerly.
About Confidentiality
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 Information/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 let anyone know that you are in treatment with me without your agreement.
In all but a few rare situations, your confidentiality (that is, the privacy of what you tell me) is protected by federal and state laws and by the rules of my profession. Here are the most likely situations where your confidentiality is not protected:
- 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 telling.
- Are you suing someone or being sued? Are you charged with a crime? If so, and if you tell the court that you are seeing me, I may then be ordered to show the lawyers my records. Please talk to your lawyer about what to say to me.
- 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. I simply cannot promise never to tell others about threats you make.
- If I believe that a child, older adult, or other dependent person has been or will be abused or neglected, I am legally required to report this to the authorities.
As a therapist, my legal and moral duty is to protect your confidentiality, but I also have a duty under the law to the wider community and to myself if there is harm, threat of harm, or threat of neglect.
I may talk about you with other therapists or other professionals because it helps me to provide high-quality treatment (e.g., case consultation). These professionals are also required to keep your information private. I maintain your privacy with them. I never tell them your name, I change or skip some facts about you, and I tell only what they need to know to understand your situation and help me.
If your records need to be seen by another professional, or anyone else, I will discuss this with you. If you agree to share these records, you will need to sign a release-of-information form. This form says exactly what information is to be shared, with whom, and why. You may read this form at any time. If you have questions, please ask me.
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.
It is my office policy to destroy clients’ records 10 years after our last meeting. Until then, I will keep your case records in a safe place and make them available when you authorize their release.
After I destroy your records, I will retain, for up to 25 years, a summary of the dates of treatment, number of sessions, why you came to see me, diagnoses, and any outcome information I have.
If I must discontinue our relationship because of illness, disability, or other presently unforeseen circumstances, I ask you to agree to let me transfer your records to another clinician who will make sure they are kept safe, confidential, and available when you want them, and then destroy them someday.
If we do family or couple therapy (where there is more than one adult present), and you want to have my records of this therapy sent to anyone, all of the adults present will have to sign a release of information.
Please understand that I have no control over how your records are handled once they leave my office. For more on these issues, please read my Notice of Privacy Practices.
You can review your own records in my files at any time. You may add to them to correct errors or provide more information, and you can have copies of them (but you will have to assume the risks of loss of confidentiality when you receive and store your copies). If I believe that it might be in some way harmful for you to view your records, I may suggest that we review them together or that I provide you with a summary of the records in place of the entire record. I ask you to understand and agree that you may not examine records created by anyone else that you have had sent to me.
In some very rare situations, I may temporarily remove parts of your records before you see them. This may happen if I believe that the information will be harmful to you, but I will discuss this with you.
You have the right to ask that your information not be shared with family members or others, and I can agree to that limitation. You can also tell me if you want me to send mail, or phone you at a more private location or number than, say, your home or workplace. If this is of concern to you, please tell me so that we can make arrangements.
About Our Appointments
The very first time I meet with you, we will need to give each other a lot of basic information. For this reason, I usually schedule 90 minutes for this first meeting. Following this, we will usually meet for a 50-minute session once or twice a week, then less often. We can schedule meetings at times convenient for both of us. I will try my best to tell you at least a month in advance of my vacations or any other times we cannot meet. Please ask about my schedule in making your own plans.
Cancellations and No-Shows
I consider our meetings very important and make them a priority over other activities. I ask you to do the same. An appointment is a commitment to our work. A cancelled appointment slows our progress, so please try not to miss sessions if you can possibly help it. Your session time is reserved for you. We agree to meet at my office or via secure live video-chat and to be on time. If I am ever unable to start on time, I ask your understanding and promise that you will receive the full time agreed to or be charged proportionately. 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 am rarely able to fill a cancelled session, so you will be charged the full fee for sessions cancelled with less than 24 hours’ notice, for other than the most serious reasons.
Fees, Payments, and Billing
Payment for services is an important part of any professional relationship. This is even truer in therapy; one treatment goal is to make relationships and the duties and obligations they involve clear. My current regular fees are as follows. I reevaluate my fees each January, based on changes in the cost of running my business, and implement the change in April. You will be notified several months in advance of any changes.
Regular therapy services: For an individual session of 50 minutes, the fee is $250. For a session of 90 minutes, my fee is $375. Payment is due at or before the time of service. I accept cash, checks, PayPal/Venmo, credit and debit cards in the office. For video-chat sessions, I accept credit card and PayPal/Venmo payments only.
Telephone consultations: I believe that telephone consultations may be suitable or even needed at times in our therapy. If so, I will charge you our regular fee, pro-rated over the time needed. If I need to have telephone conferences with other professionals as part of your treatment, you will be billed for these at the same rate as for regular therapy services. We will discuss this in advance, so we can set rules that are comfortable for both of us. Of course, there is no charge for brief calls about appointments or similar business.
Telemental Health Services (TMH; live video therapy): If you decide to receive therapy via TMH, I will be able to serve you through the Regroup or Spruce platform (secure and HIPAA compliant platforms) that you can access through your computer, tablet, or smart phone. TMH uses a video camera from these devices to send both voice and video between the both of us. You will be required to be in a private room by yourself, and I will also be in a private room to ensure your privacy. A separate consent form will be provided to you if you opt for TMH sessions.
Extended sessions: Occasionally it may be better to go on with a session, if possible, than to stop or postpone work on a particular issue. This extension time will be charged on a pro-rated basis.
Psychological testing: Services are $250 per hour. Psychological testing fees include the time spent with you, the time needed for scoring and studying the test results, any consultations necessary, and the time needed to write a report on the findings. The amount of time involved depends on the tests used and the questions the testing is intended to answer.
Other services: Charges for other services, such as hospital visits, consultations with other therapists, home visits, or any court-related services (such as consultations with lawyers), will be based on the time involved in providing the service at my regular fee schedule. Some services may require payment in advance.
I realize that my fees involve a substantial amount of money, although they are well in line with similar professionals’ charges. For you to get the best value for your money, we must work hard and well. I will assume that our agreed-upon financial arrangements will continue as long as I provide services to you. I will assume this until you tell me in person, by telephone, or email that you wish to end it. You have a responsibility to pay for any services you receive before we end the relationship. Because I expect full payment at the time of our appointments, I usually do not send bills. At the end of each month, I will send you a statement if you request it. The statement can be used for health insurance claims, as described in the next section. It will show all of our meetings, the charges for each meeting, how much has been paid, and how much (if any) is still owed. At the end of treatment, and when you have paid for all sessions, I will send you a final statement for your tax records. If there is any problem with my charges, my billing, or any other money-related point, please bring it to my attention immediately. I will do the same with you. Such problems can interfere greatly with our work. They must be worked out openly and quickly.
If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small-claims court. In most collection situations, the only facts I release regarding a client’s treatment are his or her name, the kind of services provided, and the amount due. If such legal action is necessary, its costs will be included in the claim.
If You Have Health Insurance
I have chosen not to join or participate in any health insurance plans or panels. If you choose to use your insurance, I will not file claims for you, but I will give you a receipt for my services with the information the insurers need to pay you back if allowed by your contract. This information will include standard diagnostic and procedure codes, the times we met, my charges, and your payments.
If You Need to Contact Me
I cannot promise that I will be available at all times. You can always leave a message on my voicemail, and I will return your call as soon as I can. Generally, I will return messages within 24 hours except on holidays and during my vacation days, of which I will inform you.
If you have an emergency or crisis and cannot reach me immediately by telephone, you or your family members should call 911 or go to the nearest hospital emergency room.
If I Need to Contact Someone about You
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—to protect you. I am also required to contact this person, or the authorities, if I become concerned about your harming someone else. I will ask you for the name and information of your chosen contact person.
Children and Property Issues
I request that you do not bring children with you if they are young and need babysitting or supervision, which I cannot provide. You will be charged for any damage to, or theft of, property in this office or outside by you or anyone for whom you are legally responsible. I cannot be responsible for any personal property or valuables you bring into this office.
Shared Office Space
Although I share this office space with other professionals and we use some office equipment together, we are not in business together as partners, employers, or employees. I do not routinely consult with them on cases, or make referrals to or receive referrals from them. We are all independent licensed professionals.
Collecting Information on Progress and Outcomes
As a clinical psychologist, I naturally want to know more about how therapy helps people. To understand therapy better, I must collect information about clients before, during, and after treatment. Therefore, I ask you to help me by filling out some questionnaires about different parts of your life—relationships, changes, concerns, attitudes, and other areas.
Records Issues
If, as part of our therapy, you create and provide to me records, notes, artworks, or any other documents or materials, I will return the originals to you at your written request but may retain copies.
Statement of Principles and Complaint Procedures
It is my intention to abide by all the rules of the American Psychological Association (APA) and by those of my California license. 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 as soon as possible. Our work together will be slower and harder if your concerns with me are not worked out. Some issues that arise between us may be clinically relevant to other relationships in your life. I will make every effort to hear any complaints you have and to seek resolution.
If you feel that I have treated you unfairly or have broken a professional rule, please tell me. You can also contact the California Board of Psychology on the Internet at http://www.psychology.ca.gov, by e-mailing bopmail@dca.ca.gov, calling 1-866-503-3221 or writing to the following address:
Board of Psychology
1625 North Market Blvd
Suite N-215
Sacramento, CA 95834
Staff members there can help clarify your concerns or tell you how to file a complaint.
Other Points
You may not make any kind of electronic recording of our sessions without my written consent. Many clients use email and text messaging, but these are not secure and could lead to a loss of confidentiality. If you would like to use email to communicate with me, please read my Social Media Policy.
I will charge you at my regular rate for letters, reports, and similar documents you ask me to create for you.
As part of the confidentiality that I offer you, I ask you not to disclose the name or identity of any other client being seen at Gramercy Psychological Services.
Dr. Katiah Llerena, PhD 