As a licensed Marriage and Family Therapist, I adhere to the legal and ethical standards of my profession. Ethical practice includes letting you know what to expect regarding my office policies so you can make an informed choice about working together. Many of these policies will be unrelated to our work together, yet it is still important that you understand them. Please take a moment to read this document. If any of these policies are unclear to you we can discuss any questions you may have at our first session together. It is the office policy to begin treatment after all documents have been read, understood, and agreed upon.
I hold a Master’s of Science degree in counseling as a Marriage and Family Therapist and hold a valid license to practice as a psychotherapist in the state of California (license #43708). Additionally, I am fully trained to provide psychotherapy services to adults, couples, families, adolescents and children. As a client of this office, you are entitled to be treated in a professional and respectful manner. Although in psychotherapy there are no guarantees for success, you are entitled to prompt attention to your needs and competent services provided by a duly accredited mental health professional.It is not in my scope of practice to perform child custody evaluations or provide child custody recommendations to the court. My role when working with children of divorce is to support their emotional wellbeing.
Risks in Treatment
Although psychotherapy is designed to improve the overall quality of life, the process at times involves the discussion of emotional issues that may be distressing. The greatest risk involved in this kind of treatment is often that the treatment provided may not be as effective as you hoped. If this should occur, you are encouraged to discuss this with your therapist so that you can work together to come to a mutually agreeable solution. Therapy often involves discussing unpleasant aspects of your life; you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have many benefits. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. Success in attaining treatment goals will also depend upon the motivation of the client during the course of treatment. Understand that effective results are best achieved by regular and consistent attendance in therapy.
In mental health there are often several ways to approach the problems presented by the patients. You have the right to discuss with your therapist their diagnostic impressions, their recommended treatment course, goals, and the methods they recommend for obtaining these treatment goals. Psychotherapy is oriented to helping a person resolve problems that you hope to address. Psychotherapy calls for a very active effort on your part. In order for the therapy to be most successful, it is advised that you implement what is discussed in session, between sessions.
To meet the professional standard of care, psychotherapists are expected to take reasonable steps to prevent suicide and to attempt to ensure safety with the least possible violation of the client’s privacy and self-determination. If a client makes a serious threat of physical violence to an identifiable victim, the therapist is required by law to notify the police and the intended victim. If a therapist has reason to suspect that a child, elderly adult or dependent adult is being abused or neglected, the therapist is mandated by law to make a report to the appropriate agency.
Our sessions are strictly confidential except under certain legally defined situations involving the abuse of a dependent individual including children and the elderly, or if there are threats to harm either yourself or another individual. In the case of danger to others, I am required by law to notify the police and to inform any intended victim(s). In the case of self-harm, I am ethically bound to inform the nearest relative, significant other, or to otherwise enlist methods to prevent self-harm or suicide. Information shared with a psychotherapist is confidential and will not be shared with anyone else except for these instances below, which must, by law, be reported to the appropriate authority or significant person:
- You sign a release on behalf of your child or for yourself permitting disclosure of information.
- You (or the child client) present a serious, imminent danger to self or others.
- Acts out with drugs, sex, cutting behavior, eating concerns, missing curfew, or is disrespectful and difficult to parent.
- There is reason to suspect abuse or neglect of a child, an elderly person, or a disabled person.
- When the patients case is being reviewed/discussed with the licensed supervisor.
- Under some circumstances when the therapist is ordered by the court to disclose and release patient information.
- If legal action is brought against the therapist by a patient, couple and/or family.
- Your insurance company requests information that will be utilized to review the necessity and appropriateness of the care you receive.
- When your account becomes delinquent and the therapist authorizes your name to be released to a third party to collect fees owed.
Please note, if you put your mental status at issue in litigation, the opposing party may have a right to psychotherapy records and/or testimony by your therapist.
Confidentiality of Couples and Families
During couples counseling, there may be occasions that I speak with or see one or both of you individually. These sessions should be seen as part of the overall couple’s therapy process. Therefore, when working with couples, I maintain a “no secrets” policy. Please do not share anything with me privately that you would not want discussed with your partner or family members engaged in therapy with you. I would be happy to refer you to an individual therapist if you have personal issues that you would like to work on outside of the context of couple or family therapy.
Confidentiality of Minors
The parent of a minor has a legal right to access information about their child’s treatment, unless otherwise stated by law. However, in order to facilitate effective treatment, this right must be balanced with the minor’s right to a confidential therapeutic relationship. The confidences of minors will be respected as deemed clinically appropriate, though safety concerns will take precedence over confidentiality when the two conflict. The special case of treating minor children, I request that both parents, married or unmarried, sign the consent for treatment form. There may be an ethical and legal obligation for me to provide information concerning treatment of the minor child to both parents. In order to understand my role as a treatment provider, we may require a copy of the custody agreement allocation of parent time. Both parents should understand that they are not the client, only the child is, and therefore neither parent has the right to privilege or confidentiality with respect to information they provide in sessions, and that the other parent typically is entitled to any information they do provide. Parents are not entitled to attend therapy appointments with the child unless appointments occur on their visitation day, or the parent consents t making an appointment on a non-visitation day. The parent bringing the child is responsible for any fees due for the appointment that day, unless both parents have made other arrangements for payment. If therapy recommendations include the involvement of both parents and parent involvement is declined by either party, then I may elect to terminate therapy and will refer you to another provider. Psychotherapy of your minor child is made solely for treatment purposes, and is NOT for legal or custody purposes. In the event that I am required to testify in court concerning treatment of your minor child, I decline to provide reports or discuss therapy with the attorneys of either party. We may file a motion with the court to quash any subpoenas that you or your attorney may file for testimony or records, and will charge you for our legal costs to do so. These steps may be taken to preserve my role as therapist with your child. If you initiate action to compel us to provide reports, discuss therapy with your attorney or in any other way involve me in legal actions, I will bill you for my time and any related legal expenses at the rate of $200 per hour, and expect payment in full at time of service. If you initiate action to compel me, or in fact compel me by court order to be involved in legal proceedings, we also may move to terminate our real as therapist. Minors and parents patients under 18 years of age who are not emancipated and their parents should be aware that the law allows parents to examine their child’s treatment records. You may refuse any aspect of your child’s treatment; however I may need to terminate treatment with your child if standard treatment recommendations are not adhered to.
Confidentiality of Families
There are occasions when various people in a family are seen for counseling, either individually or conjointly. It is simple to maintain your rights to confidentiality when one person in a family is seen for individual therapy. However, the nature of family sessions with multiple family members are seen individually or together, it becomes more difficult to maintain confidentiality, typically because the focus on counseling is to resolve a mutual issue of all parties involved, such as parent-child, marital or family problems. The following policies are maintained to help safeguard the confidentiality of your treatment when multiple family members are in counseling, or seeking counseling with me. If you are an existing patient seen in individually, couples, or family therapy every effort to keep your confidentiality will be taken. Your status as a patient will not be divulged to the party requesting services without your prior permission. If you are being seen conjointly in counseling with other family members, and a family member declines to continue in counseling, we can proceed with individual treatment, however the declining party may not be seen conjointly after that point and a referral will be made for conjoint therapy to a new therapist. Treatment notes of therapy with multiple family members will not be released without the consent of all parties.
Appointments and Cancellations
Our scheduled appointments will be set aside and held exclusively for you. If you need to cancel or reschedule an appointment, please notify me as soon as possible. If you arrive late for an appointment, I will see you for the remainder of your reserved time. Appointments not cancelled within 48 hours in advance of the appointment, will be charged at the full rate. Please note that insurance companies generally do not pay for missed sessions, and therefore you will be responsible for the missed session fees.
Sessions and Fees
It is customary to pay for sessions at the time of the session, unless otherwise arranged. A typical therapy session is 50 minutes in length. The fee for a typical 50-minute psychotherapy session is
. Couples and family sessions are most effective with an 80-minute session to ensure that there is adequate time to address all concerns. The fee for an 80-minute psychotherapy session is $225.00
. All fees paid for services shall be made payable to Bess Gattuso at time of service. If you choose to use your PPO health insurance, all copays, coinsurance and deductibles will be due at each session. Fees may be paid by cash or personal check. There will be a $20.00 service charge assessed for all returned checks. I will bill your insurance company for you as a courtesy, however all professional services are ultimately the responsibility of the patient or minor’s parents or guardians, regardless of insurance coverage. Billing is processed through a third party bookkeeper. Financial information is shared; however clinical information is kept confidential. I reserve the right to change my fees; however you will be informed prior to the new fee becoming applicable. You will have the choice whether or not to continue under the new fee schedule or obtain referral information from me. Insurance benefits have increasingly become more complex. It is sometimes difficulty to determine exactly how much mental health coverage is available, and in all instances, insurance companies tell us on the telephone that they do not guarantee that the information that they provide guarantees payment. You should be aware that your contract with your health insurance company requires that I release information relevant to the services that are provided to you. To bill your health insurance, I am required to include a clinical diagnosis and other clinical information such as treatment plans or summaries. I make every effort to release the minimal information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will be stored digitally. Insurance companies claim to keep your PHI secure and confidential. I have no control over what is done with your personal information once I release it to them. Examples of services typically not covered by insurance include couples counseling, written reports, life insurance or disability reports, legal or forensic evaluations or reports, custody evaluations, missed sessions, and most psychological testing.The first two psychotherapy sessions are an assessment period to determine whether there is an appropriate therapeutic fit. If the therapist or client determines that there is not an appropriate therapeutic fit, referrals will be provided to assist the client with finding appropriate services to meet their needs.
In addition to session fees, the following services shall be billed based upon the hourly fee:
- Telephone calls with client or others involved with client, lasting longer than 10 minutes.
- Written reports, letters, insurance treatment plans etc.
- Preparation of records or treatment summaries.
- Review of medical records, school reports, testing results and other professional materials.
- School visits and/or meetings at schools, including travel time.
- Time spent for performing any other services you may request.
- If you become involved in legal proceedings that require my participation you will be expected to pay for my professional time (even if I am called to testify by the other party.)
- Legal proceedings that require my participation (even if I am called to testify by the other party).
I reserve the right to use a collection agency if you do not pay your balance. Failure to make payments will result in your account being sent to a collection agency.
Client is responsible for payment of all charges at the time of service. At your request, I can provide a monthly statement of services to help you seek reimbursement from your insurance carrier. Please note that when you use your medical insurance to pay for psychotherapy you waive some of you rights to confidentiality. Insurance companies require a psychiatric diagnosis, and often request access to clinical information to determine claim eligibility. Once information is provided to an insurance company there is no way to ensure that confidential information will be treated as private. Additionally, a psychiatric diagnosis may affect your ability to obtain future health or life insurance at a reasonable cost. It is the client’s responsibility to pay for psychotherapeutic services, regardless of whether reimbursement is made by our insurance company.
Telephone and Email Contact
I check telephone and email messages twice daily and respond as promptly as possible, with the exception of weekends and holidays. However, it may take several hours before I can return your call. In the event of an emergency and you cannot wait for a return call, please contact your nearest emergency room. In general, telephone calls and email communications are not meant to take the place of an office visit. If you require extended time on the phone or email (over 10 minutes) you will be billed for the time. Communication by text message is limited to scheduling only. There will be a delay in my response in text messaging during weekends, holidays, and during my vacation times. I am not able to check text messages remotely or institute an automatic vacation response to text messages. If you text me and do not receive a response within 24 hours, please call or email to reach me.Please note that email, text, and fax are not secure forms of communication and are not recommended as a means of contact for confidential concerns. I cannot guarantee the confidentially of any communication sent to me via email, text, or fax. If you need to discuss clinical issues, please contact me by telephone.
In case of an emergency, leave a message for me and them immediately contact your local crisis services (call 911 or go to your local emergency room). When I am out of town or otherwise unavailable, a qualified professional will be available to support you.
In accordance with the laws and standards of California, treatment records are kept. You are entitled to receive a copy or summary. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. I recommend that the records be reviewed in my presence so that we can discuss the contents. Clients will be charged an appropriate fee for any time spent in preparing information requested. Copies will be made at the cost of $0.25 a page.
Length of Treatment
Although some clients may elect to pursue long term open ended treatment, many issues can be resolved in approximately 25 to 30 sessions. Some highly focused issues may be resolved in 10. Insurance requirements and limitation will need to be considered as it is often time limited. The success of any treatment depends on the motivation and aptitude of the person being treated and the severity of the presenting problem. It should be noted that there are no guarantees as to the treatment length or success.
It is the therapist’s responsibility to avoid intentional or reckless harm to the client and to maintain appropriate boundaries. Sexual contact with a client is both a civil and criminal offense and should be reported to the California State Board of Behavioral Sciences.
Termination of Services
Participation in psychotherapy is voluntary and you have the right to end treatment at any time. The client’s professional relationship with the therapist continues as long as the therapist is proving professional services, and until either the client informs the therapist that he or she wishes to terminate therapy or the therapist notifies the client that therapy is being terminated. Assistance in making appropriate arrangements for continuation of services will be provided when necessary. Please note that the termination of therapy is a very important part of the therapeutic process. It is highly recommended to allow multiple sessions before the termination of therapy, especially with children.