WELCOME! Please take a few minutes to review this important information.
Goals of this practice ……
I view emotional wellness as having many components and will encourage successful acquisition of the following components:
- Understanding and adapting to change in your life.
- Coping with the stresses in life.
- Internalizing a positive self-concept and self-image.
- Nurture the ability to love and care for others.
- Enable the independent acts of taking care of oneself,
while meeting your needs and goals.
I believe the first step toward emotional well-being is the journey of self-awareness within the context of the family and life systems. My theoretical approach to change includes client-centered therapy, combined with a solution-focused approach. This approach enables you to create positive beliefs and productive behavioral patterns that empower you to be the master of your life.
Information for Clients
Welcome to the private practice of Paula VanDyke, MA, LMFT, LPC.
I appreciate your giving me the opportunity to be of help to you.
We often believe that our behaviors and feelings are caused by what happens in the real world. However, this is not quite true. When we have any kind of experience, it does not affect us directly. Rather, we first give it a meaning through our beliefs about it and then we react with behaviors congruent to those beliefs.
I think of my approach to helping people with their problems as “enlightenment”. You can learn to recognize negative patterns in your thought processes and reshape your thoughts into positive ones. Through daily practice and “homework’ you can learn to change thought processes that lead to undesirable behavior. We can, with practice, change these beliefs and behaviors and become happier persons who function better in the world.
I usually take notes during our meetings. You may find it useful to take your own notes, and also to take notes outside the office.
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 some special knowledge to help you make the changes you want to make. Psychotherapy is not like visiting a medical doctor. It requires your very active involvement. It requires your best efforts to change thoughts, feelings, and behaviors. For example, I want you to tell me about important experiences, what they mean to you, and what strong feelings are involved. This is one of the ways you are an active partner in therapy.
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, and 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, to keep records, and perhaps to do other tasks to deepen your learning. 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 frustrating, and you will need to keep trying. There are no instant, painless cures and no “magic pills.” However, you can learn new ways of looking at your problems that will be very helpful for changing your feelings and reactions.
The Benefits and Risks of Therapy
As with any powerful treatment, there are some risks as well as many benefits with 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 a client at work or in school. In addition, some people in your community may mistakenly view anyone in therapy as weak, or perhaps as seriously disturbed or even dangerous. Also, clients in therapy may have problems with people important to them. Family secrets may be told. Therapy may disrupt a marital relationship and sometimes may even lead to a divorce. Sometimes, too, a client’s problems may temporarily worsen after the beginning of treatment. 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 out well for you.
While you consider these risks, you should know also that the 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 until their feelings are relieved or the problems are solved. Clients’ relationships and coping skills should 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.
I do not take on clients I do not think I can help. Therefore, I will enter our relationship with optimism about our progress.
Consultations
If you could benefit from a treatment I cannot provide, I will be honest and open with you while referring you to a specialist in that field. 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, with your consent.
If for some reason treatment is not going well, I might suggest you see another therapist or another professional in addition to me. As a responsible person and ethical therapist, I cannot continue to treat you if my treatment is not working for you. If you wish for 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.
What to Expect from Our Relationship
As a professional, I will use my best knowledge and skills to help you. This includes following the standards of the American Psychological Association, as well as the standards of the American Association of Marriage and Family Therapist. In your best interests, the APA & AAMFT puts 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 licensed and trained to practice psychotherapy—not law, medicine, finance, or any other profession. I am not able to give you good advice from these other professional viewpoints.
Second, state and federal laws and the rules of the AAMFT/APA require me to keep what you tell me confidential (that is, private). 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 packet. Here I want to explain that I try not to reveal who my clients are. This is part of my effort to maintain your privacy. If we meet on the street or socially, I will not acknowledge you first. I will wait for you to make the initial acknowledgement, if you choose to do so. If you do not acknowledge me, that is okay. My behavior will not be a personal reaction to you, but a way to maintain the confidentiality of our relationship.
Third, in your best interest, and following professional 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 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.
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; I prefer that you do not give me any gifts.
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 are 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, your privacy) is protected by state law 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, my ethical stance 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, an elderly, or a handicapped person has been or will be abused or neglected, I am legally required to report this to the authorities.
There are two situations in which I might talk about part of your case with another therapist. I ask now for your understanding and agreement to let me do so in these two situations.
First, when I am away from the office for a few days, I may 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.
Second, I may consult with the other professionals in a professional setting about my clients. This helps me continue giving high-quality treatment. These persons are also required to keep your information private. Your name will never be given to them, and they will be told only as much as they need to know to understand your situation.
For the purpose of these consultations, I may want to make audio or video recordings of our sessions. I will always ask your permission first and will honor your answer. I will review the recordings with other professionals in a professional setting to assist with your treatment. I promise to destroy each recording as soon as I no longer need it, or, at the latest, when I destroy your case records. You can refuse to allow this recording, or can insist that the recording be edited.
Except for the situations I have described above, 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.
In this practice, I make every effort to keep the names and records of clients private. The staff and I will try never to use your name on the telephone, if clients in the office can overhear it. All staff members who see your records have been trained in how to keep records confidential.
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 a release 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. If you have questions, please ask me.
It is my office policy to destroy clients’ records 7 years after the end of our therapy. Until then, I will keep your case records in a safe place.
If I must discontinue our relationship because of illness, disability, or other presently unforeseen circumstances, I ask you to agree to my transferring your records to another therapist who will assure their confidentiality, preservation, and appropriate access.
If we do family or couple therapy (where there is more than one client), and you want to have my records of this therapy sent to anyone, all of the adults present will have to sign a release.
As part of cost control efforts, an insurance company will sometimes ask for more information on symptoms, diagnoses, and my treatment methods. It will become part of your permanent medical record. I will let you know if this should occur and what the company has asked for. Please understand that I have no control over how these records are handled at the insurance company. My policy is to provide only as much information as the insurance company will need to pay your benefits.
You can review your own records in my files at any time. You may add to them or correct them, and you can have copies of them. I ask you to understand and agree that you may not examine records created by anyone else and sent to me.
My Background
I am a licensed marriage and family therapist and a licensed professional counselor. I graduated from one of the top programs offered in this country. My education has exposed me to all of the latest theories and therapeutic techniques to helping clients regain control of their lives. I firmly believe that you are the expert of your life and I am trained to assist you in realizing your goals and working through problematic areas. I am trained in one-on-one, couple and family therapy.
I have a master’s degree in family therapy from the University of Houston at Clear Lake. This program is approved by the American Association of Marriage and Family Therapy (AAMFT). I am licensed Professional Counselor and a licensed Marriage and Family therapist in the state of Texas. I am a member of the APA, as well as the AAMFT.
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 schedule 1 to 1.5 hours 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 for both your and my convenience. I will tell you at least a month in advance of my vacations or any other times we cannot meet.
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 your understanding. I also assure you that you will receive the full time agreed to. 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.
A cancelled appointment delays our work. I will consider our meetings very important and ask you to do the same. Please try not to miss sessions if you can possibly help it. When you must cancel, please give me at least a 24 hour notice. Your session time is reserved for you. I am rarely able to fill a cancelled session unless I know a week in advance. If you miss a session, without giving the proper 24 hour notice, I will have to charge you for the lost time. Your insurance will not cover this charge.
I will reserve a regular appointment time for you into the foreseeable future. This allows you and me to plan accordingly, thereby making it easier to keep your appointments. I also do this for my other patients. If you miss two consecutive appointments I or one of the staff will try to contact you. Please let us know the best number to call for this purpose by filling in this blank_________________. Is it okay to leave a non-identifying message at this number, yes___ or no____?
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. You are responsible for seeing that my services are paid for. Meeting this responsibility shows your commitment and maturity.
My current regular fees are as follows. You will be given advance notice if my fees should change.
Initial Session: The initial session will be 1.5 hours and the fees are as follows:
Individual - $125.00
Couples/Family - $150.00
Regular session fees/therapy services: For a session of 50 minutes, the fee is $100.00. Payment is due prior to each session and we will take care of this before I see you. For our clients’ convenience we accept cash, checks, and most major credit cards. In the event a check is returned for insufficient funds. I will need to add a $35.00 insufficient funds fee. I have found that this payment arrangement helps us stay focused on our goals, and so it works best. It also allows me to keep my fees as low as possible, because it cuts down on my bookkeeping costs. I suggest you make out your check before each session begins, so that our time will be used best. Other payment or fee arrangements must be worked out before the end of our first meeting.
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, prorated over the time needed. Of course, there is no charge for calls about appointments or similar business.
Extended sessions: Occasionally it may be better to go on with a session, rather than stop or postpone work on a particular issue. When this extension is more than 10 minutes, I will tell you, because sessions that are extended beyond 10 minutes will be charged on a prorated basis.
Reports: I will not charge you for my time spent making routine reports to your insurance company. I view this as my responsibility to you and part of my commitment to your treatment.
Other services: Charges for other services, such as hospital visits, consultations with other therapists, and home visits will be based on the time involved in providing the service at my regular fee schedule. Some services may require payment in advance. I do not want to be in a position where I have to go to court. If you are in legal proceedings, please advise your lawyer of this. Court-related services (such as consultations with lawyers, depositions, or attendance at courtroom proceedings) are billed at 5x ($500.00 per hour) my normal rate to discourage my participation. For you to get the best value for your money, we must work hard and well.
I will assume that our agreed-upon fee-paying relationship will continue as long as I provide services to you. I will assume this until you tell me in person, by telephone, or by certified mail that you wish to end it. You have a responsibility to pay for any services you receive before you end the relationship.
Upon payment of each session you will be provided with a statement. This itemized statement can be used for health insurance claims, as described in the next section, as well as for your tax records. It will show the date of our meetings, the charges for each and how much has been paid.
If there is any problem with my charges, my billing, your insurance, or any other money-related point, please bring it to my attention. I will do the same with you. Such problems can interfere greatly with our work. They must be worked out openly and quickly.
If You Have Traditional Health Insurance Coverage
Because I am a licensed professional, many health insurance plans will help you pay for therapy and other services I offer. Because health insurance is written by many different companies, I cannot tell you what your plan covers. Please read your plan’s booklet under coverage for “Outpatient Psychotherapy” or under “Treatment of Mental and Nervous Conditions.” Or call your employer’s benefits office to find out what you need to know.
Please keep two things in mind:
1. I had no role in deciding what your insurance covers. Your employer decided which, if any, services will be covered and how much you (and I) will be paid. You are responsible for checking your insurance coverage, deductibles, payment rates, co-payments, and so forth. Your insurance contract is between you and your company; it is not between me and the insurance company.
2. You—not your insurance company or any other person or companies—are responsible for paying the fees we agree upon. I will provide you with and itemized statement for your insurance claim.
Please verify with your insurance company how to file your claim. My statement should provide the information asked for on the claim form.
I will provide information about you to your insurance company only with your informed and written consent. I may send this information by mail or by fax. My office will try its best to maintain the privacy of your records, but I ask you not to hold me responsible for accidents or for anything that happens as a result of required information sent to your insurance company.
If You Need to Contact Me
I cannot promise that I will be available at all times. I do not take phone calls when I am with a client. You can always leave a message on voicemail and I will return your call as soon as I can. Generally, I will return messages daily except on weekends and holidays.
If you have an emergency or crisis, please make this clear in your message. If you have a behavioral or emotional crisis, you or your family members should immediately call 911.
Other Points
If you ever become involved in a divorce or custody 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 two reasons: (1) My statements will be seen as biased in your favor because we have a therapy relationship; and (2) the testimony might affect our therapy relationship and I must put this relationship first.
Doing follow-up and outcome research is always educational. As a professional therapist, 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 therapy. Therefore, I am asking you to help me by filling out some questionnaires about different parts of your life-relationships, changes, concerns, attitudes, and other areas. I ask your permission to take what you wrote on these questionnaires and what I have in my records and use it in research or teaching that I may do in the future. If I ever use the information from your questionnaire, it will always be included with information from many others. Also, your identity will be made completely anonymous. Your name will never be mentioned, and all personal information will be disguised and changed. After the research, teaching, or publishing project is completed all the data used will be destroyed.
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 will retain copies.
Statement of Principles and Complaint Procedures
It is my intention to fully abide by all the rules of the American Psychological Association (APA), the American Association of Marriage and Family Therapists (AAMFT) and by those of my state licenses, as well as state and federal laws.
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, has treated you unfairly or has even broken a professional rule, please tell me. You can also contact the state or local psychological 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.
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 I can choose to discuss my concerns with you, the therapist, before I start (or the client starts) formal therapy. I also 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 packet, 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 packet. 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 packet. 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 signature here.
______________________________________________
Signature of client (or person acting for client)
Date___________________________
______________________________________________
Printed name
Relationship to client:
__ Self __ Parent __ Legal guardian __ Health care custodial parent of a minor (less than 14 years of age)
__ Other person authorized to act on behalf of the client
I, the therapist, have met with this client (and/or his or her parent or guardian) for a suitable period of time, and have informed him or her of the issues and points raised in this packet. I have responded to all of his or her questions. I believe this person fully understands the issues, and I find no reason to believe this person is not fully competent to give informed consent to treatment. I agree to enter into therapy with the client, as shown by my signature here.
______________________________________________ Signature of therapist Date______________________
I truly appreciate the chance you have given me to be of professional service to you, and look forward to a successful relationship with you. If you are satisfied with my services as we proceed, I (like any professional) would appreciate your referring other people to me who might also be able to make use of my services.
___ Copy accepted by client ___Copy kept by therapist
Please feel free to call us at 281-940-8745 and we will be happy to assist you.
