Professional Disclosure Statement


Psychotherapy can be a very special opportunity to understand more deeply the struggles you are experiencing, and to make the changes which are important to you. Therapy can be a fascinating and stimulating process. It can also be difficult and at times painful. While there are no guarantees, your active participation will contribute greatly to this process.


Professional Qualifications

I hold a Master of Science in Social Work from the University of Wisconsin Madison. My BS is also in Social Work, also from the University of Wisconsin Madison. My clinical experience prior to private practice includes working with children and families as a behavioral health provider at a community clinic for the uninsured. Prior to that, I provided individual and group therapy to adult men and women in the San Francisco county jails. I am a licensed clinical social worker in the state of California since 2007.


My approach to therapy

I combine Western psychotherapy with mindfulness-based practices. Mindfulness is a skill that involves slowing down in order to notice--moment by moment, with curiosity and kindness--what you are doing, thinking, and feeling, so that if you like, you can make desired changes. Since our bodies are connected to our beliefs and feelings, by slowing down and bringing awareness to our bodies, the path towards healing can be revealed. Traditional psychotherapy primarily pays attention to thoughts, emotions and behaviors. In body-oriented psychotherapy, attention is also given to sensations and felt experiences in the body. It may be as simple as bringing attention and awareness to a felt sensation, or it might entail “taking over” a particular tension or holding, in order to explore what lies beneath. The goal of therapy is to encourage communication among parts and to bring attention to those parts that are lost, hidden or isolated. Body-oriented psychotherapy can provide an added dimension to the therapeutic process by presenting information that is often overlooked. With the partnership of the conscious mind, it can provide a deeper and more efficient path to work directly with the unconscious mind, facilitating self-discovery and transformation. I am trained and certified in EMDR and the Hakomi method and find both to be powerful ways to bring transformation and healing. I am in the process of training and certification for Emotion Focused Therapy with couples. I participate in regular professional training practice groups and consultation throughout the year. 


During our initial one to two sessions, we will both be getting to know each other and can both decide if I am the best person to provide the services you seek.  If I feel that I can be of assistance, I will offer you some first impressions of what our work might include.  In deciding whether you would like to continue, you should evaluate this information along with your own sense of whether you feel comfortable with me.  If in my opinion I cannot be of help to you, I will let you know this and will do my best to give you referrals that you can contact.  


If at any time during the course of therapy you have questions about my procedures, their risks, my expertise, or about the treatment plan, please don’t hesitate to ask when they arise so that we can discuss them. I will also be happy to provide you with names of other qualified professionals whose services you might prefer.  If at any point I assess that I am not effective in helping you, I will discuss it with you, and if appropriate, I will terminate treatment and give you referrals which may be of help to you.


Touch in Therapy

I am trained in some therapeutic modalities that can incorporate touch as part of psychotherapy. This sort of touch is always non-sexual in nature. It is always optional and never required for treatment services. If I consider that using a therapeutic intervention that incorporates touch could potentially be beneficial for your treatment, I will explain the prospective intervention to you and ask your permission before touching you. You always have the right to decline or refuse to be touched without any fear or concern about reprisal.


Availability between Sessions

I am often not immediately available by telephone.  When I am unavailable, my telephone is answered by electronic voice mail.  I will make every effort to return your call as soon as possible, although I may not return calls on weekends or holidays, and I may not receive your call until the next day if you call after 5 p.m.  If you can’t wait for me to return your call, contact your family physician or the nearest hospital emergency room. If you need to speak to someone after hours or on the weekend you may call the Alameda County 24-hr crisis line at 1-800-309-2131, or you may leave a message and I will return your call upon returning to the office. I request that you only email me to send necessary documents or forms, as my email is not encrypted and I do not always check it regularly.


Cancellations

If you are late for an appointment, you will have the remainder of the scheduled session available to you; we will not run over the scheduled time. It is important for the continuity of therapy that you come to all sessions. Since your appointment time is reserved exclusively for you, I have a 24-hour cancellation policy. In other words, if you cancel in less than 24 hours of the appointment time, you will be charged the full fee of the session.


Vacation Policy

I will take some vacation time during the year, usually no more than two weeks in length.  I will provide you with advance notice of any upcoming vacations as well as back-up coverage available.


Fees

The fee for a 50-minute session is discounted if paid by cash or check; $150 for an individual session, and $160 for a 50 minute couples session, or $200 for a 75 minute session. If you pay with credit or through an internet service the fee is an additional $5. Fees are due at the beginning of each session. Fees are reviewed yearly and may be raised $5 to $10 per year.  I do not charge for telephone conversations of ten minutes or less, so long as they are not more frequent than twice a month.  Phone consultations that exceed such frequency and/or length are billed at the prorated hourly rate.  Site visits, report writing and reading, 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. I reserve the right to assess a finance charge on past due bills, or in extremely delinquent cases to turn them over for collections. Should you elect to use your insurance mental health benefits, you should know that a diagnosis is required. Diagnosis and history will become part of your permanent medical records. These records are often accessible to other insurance companies and on occasion can be used by employers and private investigators for credit reports. Fees will be reviewed every six months.  Please notify me if any problem arises during the course of your therapy regarding your ability to make timely payments. 


Confidentiality

In therapy, everything we speak about will be held strictly confidential with the following exceptions: 


    1. you authorize the release of information in writing
    2. I’m concerned that you may pose a serious danger to yourself or others
    3. I need to release information to your insurance company for billing and/or authorization purposes 
    4. abuse of a child, elder, or dependent adult is suspected
    5. I am court ordered to release information
    6. I seek individual or group consultation.  In this case, your full name will never be disclosed.


Consent

I have read the above information and clarified any questions I have. I agree to the stated terms. If I use insurance coverage, my signature authorizes release of information required to process claims and authorizes payment to my therapist.



Name:______________________________________________________


Signature: ___________________________________________________         


Date: _______________________________________________________ 

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