Terms of Service
INTRODUCTION
Welcome to Irvine Family Counseling Professional Corporation, a trusted home for the mental wellness and spiritual flourishing of individuals, couples and families. We look forward to supporting your needs. To begin, read this document which contains important information regarding our therapeutic practices and business policies. You will need to know this information prior to consenting to our services. Please read it carefully and make note of any questions you have so we can discuss them together in our first therapy appointment. When you sign this document, it will represent an agreement between us. It will further signify your belief that our services are adequately suited to meet your needs.
CONSENTING TO THE THERAPEUTIC RELATIONSHIP
Unlike other professional relationships, the therapeutic relationship is a highly personal one in addition to a professional one with inbuilt expectations. Given this, it is important for us to reach a clear understanding about how our therapeutic relationship will work. The next few sections cover the ethical values we practice and the professional policies we plan to adhere to as a part of our professional relationship with you. By the end of this document, you will have the information you need to make an informed decision about pursuing a therapeutic relationship with us. At any time, you may choose not to sign this form.
Our Ethos
With respect to our personal relationship, we take great care to ensure our actions are ethical and legal at all times, such that the Ethic Committees (AAMFT/ CAMFT), the Board of Behavioral Sciences (BBS), and other therapists acting in our shoes would approve. When working with clients, our ethics are our top priority. They include:
· Do no harm (Non-maleficence)
· Work for your benefit and not our own (Beneficence)
· Foster your independence (Autonomy)
· Honor our promises/ fulfill our responsibilities (Fidelity)
· Treat all individuals fairly (Justice)
· Treat all individuals truthfully (Veracity)
These principles, and their corresponding values, are the cornerstone of our therapy practice and will not be compromised for any reason. Therefore, without fail, you can expect that your therapy will be conducted in a manner that fosters your growth and well-being. Any complaints and feedback will be taken with careful consideration. Complaints may be filed with the BBS at https://www.breeze.ca.gov/datamart/mainMenu.do. For additional information on our ethics in practice, please see the attached form titled “Our Ethical Promises to You.”
Our Pathos
In distinguishing the personal relationship from the professional one, our ethics are based primarily on our personal conviction and are our pre-requisite for providing you the service but are not, in our view, part of the paid service itself. Similarly, the personalized care and attention we give you is genuine and comes from a place of pathos (or heart) and is not, in our view, part of the paid service.
Generally, we do not believe we are compensated for the unique bond we form among our clients which are personal in nature and priceless. However, we do believe we are compensated for our educational experience and level of expertise which provides us the opportunity to apply our skills and services to your benefit. Our empathy is free and should be seen as such to facilitate the genuine exchange of heartfelt compassion and empathy we give. Our professional agenda, career aspirations or any personal desires will not come before the individual we serve. For additional information on our pathos in practice, please see the attached visual titled “Inside a Therapist’s Heart.”
Our Logos
To support the growth and well-being of our clients and their families, we work with you systematically over a period of time to achieve the changes and improvements you are looking for. A structured process is involved, which is called the therapeutic process, and it serves as the framework of the therapy service. The rest of this document will pertain to the logistics of our therapy practice and the legal responsibilities we have as state-licensed mental health clinicians.
THE THERAPEUTIC PROCESS
Seated in comfortable sofas on a private office floor, we meet regularly to identify and meet mutually agreed-upon goals for 50 minutes a session. After we meet for a first-time appointment, the next 2-3 sessions will be used to gather information regarding your background, presenting difficulties, and current mental health symptoms. One month, or 30 days, is necessary to formulate a sound clinical diagnosis and treatment plan out of which future sessions are designed. Subsequent sessions usually follow this treatment plan and involve regular check points to assess progress. Deviations in the treatment plan are expected and will require modifications for staying relevant.
Given the diversity of circumstances giving rise to individual needs and concerns, the duration of time required for meeting therapeutic goals are difficult to predict. If your curiosity persists, you may ask us directly for an estimation of your therapy duration at one of your appointments. Certainly, therapy beyond what is necessary for your mental health will not be entertained out of respect for your time, finances and independence.
During the course of therapy, we draw on various psychological approaches according to the need that is being treated and our assessment of what will best benefit you. These approaches include, but are not limited to, cognitive behavioral therapies, humanistic-existential therapies, postmodern therapies, systemic therapies, and psychodynamic therapies.
We do not conduct psychological assessments, provide custody evaluation reports, recommend medications or prescriptions, or offer legal advice as these activities do not fall within our scope of practice. Further, we do not testify in legal proceedings unless subpoenaed.
RISKS AND BENEFITS
The benefits of therapy are endless. They include, but are not limited to, better relationships, improved work performance, enhanced self-awareness, solutions to specific problems, reduced feelings of distress, stronger communication skills, resolved childhood trauma, personal liberation, self-regulation strategies, intellectual insight, increased happiness, an enhanced sense of purpose, etc.
The risks of therapy may involve periods of discomfort. Among other discomforts not listed here, they include confronting denial, acknowledging vulnerabilities, revisiting old wounds, detaching from familiar comforts, unlearning bad habits, developing foreign skills, changing behavioral patterns, etc.
Moreover, there is no guarantee that therapy will yield the positive or intended results hoped for. The surest way to reduce this risk is to engage in the process consistently, thoughtfully and dutifully. If progress is not occurring within a reasonable amount of time, we may have a conversation to discuss the potential causes and alternative options for your mental health improvement.
MINORS
If you are the parent or legal guardian bringing a minor to therapy, please see the additional form titled “Consent for Minors”. When you sign this form, unless conditions for breaching confidentiality have been met, you will agree to having access to general information regarding your minor’s therapy in place of full access. This will enable your minor to have a confidential relationship with us while we serve as their confidant and advocate.
For minors under the age of 12, you may sign the “Consent for Minors” form on their behalf. For minors between the ages of 12-18, they will receive a copy of this form to sign separately. If you share custody of the minor, please provide a copy of the custody agreement prior to beginning therapy so we can be aware of which parent, or whether both parents, need to consent to treatment.
FEES AND SERVICES
Unless we agree to a sliding scale fee, our fee is $165 - $2-00 for an appointment hour of 50 minutes in duration. We spend the other 10 minutes on your behalf writing accurate, clinical notes. Payment is due for each session prior to the time it is held unless we agree otherwise. We require an updated Visa, MasterCard, American Express, or Discover credit card for your file to reserve your first appointment and to use when you have: 1) attended a session without providing prior payment, 2) have not communicated regarding a delay in payment, and 3) we have made attempts to contact you regarding an unpaid balance to no avail. While we do accept credit cards as a regular payment method on exception, we utilize cash, check, Zelle or Venmo payments as a general practice.
We do not meet shorter than a 50 minute appointment. If we decide to meet longer than a 50-minute appointment, your prorated rate will be based on this fee. Emergency phone calls less than 10 minutes are complimentary. Any conversation over 10 minutes, especially for emergency circumstances, is charged a prorated fee. Other therapeutic services priced at my prorated rate include report writing, attendance at meetings with other professionals you have authorized, preparation of records or treatment summaries, and the time spent performing others service you request of us.
Phone calls are offered as a professional courtesy and this service does not constitute an emergency psychological service. We are not responsible for your behaviors or decisions occurring outside the therapy room at any given time, whether before or after a phone call or therapy session. If you are unable to reach us and feel that you can’t wait for us to return your call, contact 911, your personal physician or the nearest emergency room to ask for the psychologist (or psychiatrist) on call. If we are unavailable for an extended period of time, such as on a vacation or leave of absence, a qualified professional may be available for you to contact during my absence.
APPOINTMENTS AND CANCELLATIONS
Since scheduling an appointment involves the reservation of time specifically for you, in place of other appointments that could take place, a minimum of 48 hours notice is required for rescheduling or canceling an appointment. Unless we reach a different agreement in advance, the full fee will be charged for sessions missed without such notification. If you were unable to attend due to circumstances beyond your control, the fee will be waived and if possible, we will find another time to reschedule the appointment.
LATE PAYMENTS
You are responsible for ensuring that your account balance is paid in full. If your account has not been paid for more than 30 days and arrangements for payment have not been agreed upon, we have the option of using legal means to secure unpaid payments. This may involve hiring a collection agency or going through a small claims court. If such legal action is necessary, such costs will be included in the claim. In most collection situations, the only information we will release regarding a client's treatment is the client’s name, the nature of services provided, and the amount due.
INSURANCE
We are considered an “out of network” provider meaning we accept PPO insurance. After compensating us directly for our service, we can provide a super-bill or a receipt of two or more services which you can submit to your insurance company for reimbursement (often around some percentage such as 50-80% as influenced by whether you have met your deductible). You can call your insurance company in advance to determine your out-of-pocket payment. For a list of helpful questions to ask your insurance company, please email us.
For those who do not have PPO insurance and/or require financial accommodations, we may provide, based on financial need, a sliding scale fee which is not fixed and subject to increase. Periodically, we will have conversations to reassess your level of need and your fixed rate may be adjusted. For questions regarding a sliding-scale fee, please raise with your clinician prior to the first scheduled appointment.
CONTACTING US
The subject matter of all electronic communication (text or email) will be limited to logistical information. For the sake of your privacy, please do not text or email information which should be discussed in therapy. We may opt to not return any electronic communication that violates this policy in order to reduce the amount of opportunities for your private information to be hacked.
Email is the best way to contact us outside of therapy. If we do not respond in a timely manner, you may call and leave a voicemail in our inbox which we monitor periodically throughout the day. We will make every effort to return your call within one-two business days, with the exception of weekends and holidays.
Phone calls less than 10 minutes are considered a professional courtesy and do not constitute a psychological service. We are not responsible for your behaviors or decisions occurring outside the therapy room at any given time, whether before or after a phone call or therapy session.
TERMINATION
Your participation in psychotherapy and other psychological services is voluntary and you have the right to withdraw from treatment at any time. When termination is considered, whether on our end or yours, we recommend a plan for termination to minimize any possible negative effects. When termination is considered for any reason, our services may remain available for future consideration and referrals may be provided for your continuation of care.
DISPUTE RESOLUTION
Should a conflict arise between you and us (Irvine Family Counseling Professional Corporation) as it relates to the services performed under this engagement, we will agree to attempt to resolve the issues under dispute amicably. If a resolution cannot be reached, then the parties agree to utilize a neutral mediator that they jointly select. The costs of the mediator shall be split evenly between us and you. If the matter is not resolved by mediation, any controversy or claim arising out of or relating to this contract, or the breach thereof, shall be settled by arbitration administered by the American Arbitration Association under its Commercial Arbitration Rules, and judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. The costs of the arbitrator shall be split evenly between Irvine Family Counseling Professional Corporation and client.
CONCLUSION
In the information provided above we have described our ethical practices and empathic approach. We outlined our logistical policies and provided avenues for you to obtain additional information not included in this document. In summary, you should have a clear understanding of our ethos, pathos and logos. You now have enough information to make an informed decision about whether you want to pursue a therapeutic relationship with us.
If the above meets your expectations and you’re ready to proceed with therapy, please read the final statements below and check the box. If any doubt persists and our conversations do not allay them, I will be happy to refer you to another therapist for a second opinion.