Office Policies & General Information

My Office Policies & Informed Consent for Psychotherapy

Cliff Heegel, Ph.D.

My office is a very safe and relaxed place for you to discuss the deepest and most disturbing issues in your life. I myself am very relaxed and open- that’s one of the reasons I am effective as a therapist. However, we live in a society that is can be chaotic, dangerous, and unpredictable. Stuff happens that no one would ever predict. People and circumstances can change suddenly. That means it is a good idea to clarify a few things before we start working together.

This office policy and informed consent brochure is a bit long and tedious, in my opinion, but the lawyers tell me it is a necessary protection for both of us. The odds are high that not much of it will apply to you or matter to you during your therapy with me. Please read over it and let me know if you have any questions, or concerns. Let me know if you would like me to modify any of the policies for you.

THE PROCESS OF THERAPY/EVALUATION AND SCOPE OF PRACTICE: Participation in therapy can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits, however, requires effort on your part. Psychotherapy requires your very active involvement, honesty, and openness in order to change your thoughts, feelings, and/or behavior. I will ask for your feedback and views on your therapy, its progress, and other aspects of the therapy and will expect you to respond openly and honestly. Sometimes more than one approach can be helpful in dealing with a certain situation.

During evaluation or therapy, remembering or talking about unpleasant events, feelings, or thoughts can result in you experiencing considerable discomfort or strong feelings of anger, sadness, worry, fear, etc., or experiencing anxiety, depression, insomnia, etc. I may challenge some of your assumptions or perceptions or propose different ways of looking at, thinking about, or handling situations, which could cause you to feel very upset, angry, depressed, challenged, or disappointed.

Attempting to resolve issues that brought you to therapy in the first place, such as personal or interpersonal relationships, may result in changes that were not originally intended.

Psychotherapy may result in decisions about changing behaviors, employment, lifestyles, substance use, schooling, housing, or relationships. Sometimes a decision that is positive for one family member is viewed quite negatively by another family member. Change will sometimes be easy and swift, but more often it will be slow or even frustrating.

There is no guarantee that psychotherapy will yield positive or intended results. During the course of therapy, I will likely to draw on various psychological approaches according, in part, to the problem that is being treated and my assessment of what will best benefit you. These approaches include, but are not limited to, behavioral, cognitive-behavioral, psychodynamic, existential, couples, analytical, or psycho-educational.

I do not provide custody evaluation recommendations, expert witness testimony, or medication or prescription recommendations, or legal advice, as these activities do not fall within my scope of practice.

TELEPHONE & EMERGENCY PROCEDURES: If you have an emergency and you need to contact me between sessions, please use email, text, or leave a voice message. Text or call me at the office phone number (901) 763-0999. Clearly state that the situation is an emergency. Your message will be processed as soon as possible. Because I work solo and I am often booked solid, I often cannot check messages or return calls in a timely manner.

I check my voicemail and email a few times a day depending on available time. I rarely make phone calls after hours. I turn my office phone off at bedtime. If an emergency situation arises after hours and I do not respond, call the Crisis Line at 901-247-7477 or call 911.

Do not use faxes or Facebook messaging for emergencies. Voicemail, text, or email are better.

DIGITAL COMMUNCATION SECURITY: EMAIL, CELL PHONES, FACEBOOK, FAXES, ETC.:

I routinely communicate by phone, text, email, fax, and Facebook messaging. Sometimes I will use Skype or Google Talk/Hangouts. I have an online scheduling system and I use email appointment reminders. I am relatively confident that my communication with you will be private at my end. Your private info on my office computer and my office phone is secured by me.

However, you are responsible for securing your digital communications at your end. Please be aware that your digital communications with me might not be totally private while being transmitted over the internet. Determined hackers can intercept your info. And, other parties could maliciously hack into your digital devices (computer, iPad, smart phone) and discover sensitive info that you have sent me or that I have sent you. Or, you might simply forget to log out and a family member or coworker could then access your confidential email or text exchanges with me. It happens.

SOCIAL NETWORKING: I am on Facebook and Twitter as are many other people. It is ok to message me via Facebook. However, you need to be aware that if you post something to my Facebook wall, retweet my tweets, or mention me on Twitter, other people like family, friends, and employers might see it. Your confidentiality could be compromised. It is best to limit important communication with me to less visible methods such as private Facebook messages, emails, or texts.

If you communicate confidential or private information via digital means including social networking I will assume that you have made an informed decision and are taking care of your personal digital security.

TREATMENT PLANS: Within a reasonable period of time after the initiation of treatment, I will discuss with you my working understanding of the problem, treatment plan, therapeutic objectives, and my view of the possible outcomes of treatment. If you have any unanswered questions about any of the procedures used in the course of your therapy, their possible risks, my expertise in employing them, or about the treatment plan, please ask and you will be answered fully. You also have the right to ask about other treatments for your condition and their risks and benefits.

TERMINATION: As set forth above, after the first couple of meetings, I will assess if I can be of benefit to you. I do not work with clients who, in my opinion, I cannot help. In such a case, if appropriate, I will give you referrals that you can contact. If at any point during psychotherapy I either assess that I am not effective in helping you reach the therapeutic goals or perceived you as non-compliant or non-responsive, and if you are available and/or it is possible and appropriate to do, I will discuss with you the termination of treatment and conduct pre-termination counseling. In such a case, if appropriate and/or necessary, I would give you a couple of referrals that may be of help to you.

If you request it and authorize it in writing, I will talk to the psychotherapist of your choice in order to help with the transition. If at any time you want another professional’s opinion or wish to consult with another therapist, I will give you a couple of referrals that you may want to contact, and if I have your written consent, I will provide her or him with the essential information needed. You have the right to terminate therapy and communication at any time. If you choose to do so, upon your request and if appropriate and possible, I will provide you with names of other qualified professionals whose services you might prefer.

CANCELLATION: Since the scheduling of an appointment involves the reservation of time specifically for you, a minimum of 24 hours (1 day) notice is required for re-scheduling or canceling an appointment. Unless we reach a different agreement, the full fee will be charged for sessions missed without such notification. Most insurance companies do not reimburse for missed sessions.

If I need to cancel with you, I or my representative will attempt to contact you. I maintain a Facebook page for my practice. If I am ill or my office is unexpectedly closed I will also post this info on my office Facebook page if possible.

CONFIDENTIALITY: All information disclosed within our sessions and the written records pertaining to those sessions are confidential and may not be revealed by me to anyone without your written permission except where disclosure is required by law.

WHEN DISCLOSURE IS REQUIRED OR MAY BE REQUIRED BY LAW: Some of the circumstances where disclosure is required or may be required by law are: where there is a reasonable suspicion of child, dependent, or elder abuse or neglect; where a client presents a danger to self, to others, to property, or is gravely disabled; or when a client’s family members communicate to (therapist’s name) that the client presents a danger to others. Disclosure may also be required pursuant to a legal proceeding by or against you.

If you place your mental status at issue in a law suit initiated by you, the defendant may have the right to obtain the psychotherapy records and/or testimony by me. If someone sues you and knows you are in psychotherapy, their attorney might request that you allow me to release your psychotherapy records.

In couples therapy, or when different family members are seen individually, even over a period of time, confidentiality and privilege do not apply between the couple, unless otherwise agreed upon. I will use my clinical judgment when revealing such information. I will not release records to any outside party unless I am authorized to do so by all adult parties who were part of the couples therapy or other treatment that involved more than one adult client.

EMERGENCY: If there is an emergency during therapy, or in the future after termination, where I become concerned about your personal survival, the possibility of you killing or seriously injuring someone else, I will do whatever I can within the limits of the law, to prevent you from injuring yourself or others and to ensure that you receive the proper medical care. For this purpose, I may also contact the person whose name you have provided on your personal data form.

HEALTH INSURANCE & CONFIDENTIALITY OF RECORDS: Disclosure of confidential information may be required by your health insurance carrier or HMO/PPO/MCO/EAP in order to process the claims. If you so instruct me only the minimum necessary information will be communicated to the carrier. I have no control over, or knowledge of, what insurance companies happen to do with the information I submit or who has access to this information.

You should be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk to confidentiality, privacy or to future capacity to obtain health or life insurance or even a job. The risk stems from the fact that mental health information is likely to be entered into insurance companies’ data base and is likely to be reported to the National Medical Data Bank. Accessibility to companies’ computers or to the National Medical Data Bank database is always in question as computers are inherently vulnerable to hacking and unauthorized access. Medical data has also been reported to have been legally accessed by law enforcement and other agencies, which also could put you in a vulnerable position.

LITIGATION LIMITATION: Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters which may be of a confidential nature, it is agreed that, should there be legal proceedings (such as, but not limited to divorce and custody disputes, injuries, lawsuits, etc.), neither you nor your attorney(s), nor anyone else acting on your behalf will call on me to testify in court or at any other proceeding, nor will a disclosure of the psychotherapy records be requested unless otherwise agreed upon.

CONSULTATION: I occasionally consult with other professionals regarding my clients; however, your identity remains completely anonymous and confidentiality is fully maintained.

RECORDS AND YOUR RIGHT TO REVIEW THEM: Both the law and the standards of my profession require that I keep treatment records for at least 6 years. Unless otherwise agreed to be necessary, I retain clinical records only as long as is mandated by Tennessee law. If you have concerns regarding the treatment records, please discuss them with me. As a client, you have the right to review or receive a summary of your records at any time, except in limited legal or emergency circumstances or when I assess that releasing such information might be harmful in any way. In such a case I will provide the records to an appropriate and legitimate mental health professional of your choice.

Considering all of the above exclusions, if it is still appropriate, and upon your request, I will release information to any agency/person you specify unless I assess that releasing such information might be harmful in any way. When more than one client is involved in treatment, such as in cases of couples and family therapy, I will release records only with signed authorizations from all the adults (or all those who legally can authorize such a release) involved in the treatment.

PAYMENTS & INSURANCE REIMBURSEMENT: We will discuss your particular situation at our first meeting. I accept insurance. I also accept cash, personal checks, and all major credit cards. I am a provider for several different insurance companies. Sometimes my contract with an insurance company determines my fee. Sometimes it does not. You are expected to pay the agreed upon fee at each session or at the end of the month unless other arrangements have been made. Lengthy telephone conversations, writing and reading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc. will be charged at the same rate, unless indicated and agreed upon otherwise.

Please notify me if any problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companies.

As was indicated in the section, Health Insurance & Confidentiality of Records, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written or verbal agreement on a payment plan, I can use legal or other means (courts, collection agencies, etc.) to obtain payment. (I have to do this about once every 5 years.)

MEDIATION & ARBITRATION: (I have not yet had to ever do this in all my years of private practice, but it is in here, just in case.) All disputes arising out of, or in relation to, this agreement to provide psychotherapy services shall first be referred to mediation, before, and as a pre-condition of, the initiation of arbitration. The mediator shall be a neutral third party chosen by our mutual agreement. The cost of such mediation, if any, shall be split equally, unless otherwise agreed upon. In the event that mediation is unsuccessful, any unresolved controversy related to this agreement should be submitted to and settled by binding arbitration in Tennessee in accordance with the rules of the American Arbitration Association which are in effect at the time the demand for arbitration is filed. Notwithstanding the foregoing, in the event that your account is overdue (unpaid) and there is no agreement on a payment plan, I can use legal means (court, collection agency, etc.) to obtain payment. The prevailing party in arbitration or collection proceedings shall be entitled to recover a reasonable sum as and for attorney’s fees. In the case of arbitration, the arbitrator will determine that sum.