IFS Therapy 
Real Results 

Patti Bee, LPC, IFS Therapy

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Informed Consent for Psychotherapy  & Mental Health Services- General Information

The therapeutic relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with me. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.

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Side Effects and Other Potential Unpleasantness

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The Therapeutic Process You have taken a very positive step by deciding to seek therapy. The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc.

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You should know that psychotherapy or counseling is not always easy. You will find yourself having to discuss very personal and sensitive information. You could find those conversations difficult and embarrassing, and you might be very anxious during and after such conversations. As you learn more about yourself, you might encounter increased conflict with friends, coworkers, and/or family members. It is possible that you might become somewhat depressed or sad. Psychotherapy is intended to alleviate problems, and sometimes, especially at first, and as you get to the root of something, you may feel them even more acutely than in the past. I may also ask you to do some things that might, at first, make you feel awkward or uncomfortable. Sometimes psychotherapy/counseling requires trying new ways of doing things. However, you will always be free to move at your own pace. I will challenge you and your old ways of thinking and doing things, but I cannot offer any promise about results you will experience. Your outcome will depend upon many things. I invite you to discuss these feelings or changes of feelings so that I can help to put things in perspective and perhaps alleviate some uncomfortable responses.

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If I believe that your problems require knowledge or skills that I do not have, I may refer you for a consultation with someone with specific training or experience. I will discuss any such referral with you before I act. At the very beginning of treatment, we will create a treatment plan with you. That is, I will document what you want to change, your goals, and how we will proceed to work together to assist your growth and change.  Every now and again, we review that plan to see if it needs to be updated.

It should be noted that any estimate of a timeline for how long therapy will take can not be guaranteed or promised. Many times, new inner material arises through our work together and this can produce more material to repair and resolve, which will take more time.

I cannot promise that your behavior or circumstance will change. Any outcome of results expressed or implied, either verbally or in my website text, or in any other form, can not be promised nor guaranteed. I can promise to support you and do my very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.
 

Confidentiality

The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:

1. If a client threatens or attempts to commit suicide or otherwise conducts themselves in a manner in which there is a substantial risk of incurring serious bodily harm.

2. If a client threatens grave bodily harm or death to another person.

3. If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.

4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.

5. Suspected neglect of the parties named in items #3 and # 4.

6. If a court of law issues a legitimate subpoena for information stated on the subpoena.

7. If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.
    

Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name.
 

The financial part of our relationship also imposes some confidentiality limits. If you are using insurance or another third-party payer, our office must share certain information with them, including but not limited to, your diagnosis and dates of your visits. If there is a managed care company, they may require us to provide additional information, such as a treatment plan, your symptoms and your progress. You should also understand that managed care information is often stored in national computer databases. Finally, if we find ourselves in a dispute with you over billing, our office may only provide the information necessary to clarify and to collect any outstanding balance.

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It is not considered ethical for a Licensed  Mental Health Provider to have a relationship outside of the therapy relationship with clients. Therefore, I do  not socialize with clients and I make all attempts to not have the same social supports in my life that are the clients same supports. In regard to any events, I also do not avoid living my usual pattern of life, so it may occur that we end up at the same event, or, we may see each other accidentally outside of the therapy office, I will not acknowledge you first. to protect your right to privacy and confidentiality.  This is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.

 

Phone & Email Contact Outside of Sessions:

 

You are always welcome to text or email me to indicate a communication about the logistics of your sessions, such as relaying an upcoming vacation, or that you need to reschedule your session.  However, I do not accept texts, emails, communications outside of the therapy session that are not of a logistical nature.  Additionally, texting and emailing is not a form of additional therapeutic support that I provide, and will not be allowed.  Therapeutic support is offered in  your regularly scheduled sessions, and/or any emergency sessions you  might need.   

 

Outpatient Service:  I provide outpatient services that entail weekly, or regularly scheduled sessions. I do not provide intensive outpatient services that would entail text, email, or phone support as needed.

 

Emergency Sessions:  If you are having a mental health emergency, you may text me to ask for an emergency session. Additional fees apply for emergency session. This option should not be exercised unless it is the last resort before you would check yourself into a hospital for a mental health emergency. 

Scheduling Sessions, Cancelling Sessions, or Rescheduling of Sessions
 

Scheduling a session with Patti Bee is a contractual agreement. You are contractually responsible to pay for your session regardless of whether you are satisfied with the outcome of any session. You are also obligated to pay for the full fee for the full length of the session that you booked. For example: if you book a 60 minute session and you need to be somewhere and leave the session early, you are not allowed to just pay for only a 45 minute session. The fee is dependent on the length of the session in minutes and you are obligated to pay the full fee for the full length of session you originally booked.
 

Sessions canceled later than 48 hours before the scheduled time or you session, are considered a “late cancel” and you will be charged the full amount of the session fee. If you contact Patti Bee past later that the 48 hour window to reschedule your session and there are no session times available the rest of that week; in that case scenario; it will be considered a “late cancel” and you will be charged the full fee for the session. Not showing up for a session and not calling is considered a “no show, no call” and you will be charged the full session fee for missing that session.
 

Your therapist travels sometimes whereby sessions are available while she is traveling. Other times she will take a normal vacation, whereby sessions will not be available. Your therapist will discuss this with you before any time that she will be away. If your therapist has offered that session are available while she is traveling, your session time may need to change due to conditions that are beyond her control, such as securing a place to hold the session and that place may only be available during specific hours. Your therapist will do her best to inform you ahead of time, and sudden changes in the schedule of session times may occur and be beyond her control.

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Payment:

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Scheduling a session is a contract. If a session is cancelled later than a 48 hour window  the full session fee is charged. If a client comes to a session late, the session is charged at the rate for the number of minutes the session was scheduled for. When you book a session with me, you are paying for my time. Payment is not based on being satisfied with results. Regardless of for how many minutes  you attend a session, it is invoiced for the full session rate. Payment is due at the end of the session. The easiest way to handle payment is with a card on file. If you wish to refrain from keeping a card on file with in your client portal then a $30 fee per session is assessed. 

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