New Patient Paperwork

This document will inform you about the general practice of psychotherapy and the policies and procedures specific to Dallas Whole Life Counseling. Please read each of the following items carefully, as they are intended to help you maximize the personal benefits of this and subsequent appointments.

After reading the following information carefully, please clarify any remaining uncertainties regarding the therapy process with your therapist. The treatment process is, by definition, a sensitive and highly personal one. It is best to voice any concerns you may have about the nature of this work from the outset, so that the therapist may better address your individual needs, wants, and resources in the work that is to follow.

The Therapy Process

Counseling treatment involves, most typically, regularly scheduled weekly meeting sessions in which the client and therapist discuss a variety of issues pertaining to the client’s inner and outer life. These issues might include but are not limited to, areas concerning: interpersonal relationships, family, career, emotional issues, sexual issues, stress management, and the general actualization of individual goals. Although treatment will primarily focus on the client’s present, day-to-day life, past experiences may at times be examined with the goal of better understanding and resolving present concerns. In some cases, simple homework, reading excerpts, and other practical exercises may be assigned to the client for completion between sessions. In other instances, clients may be referred to trusted medication care providers for the medical management of issues such as depression and anxiety.

Client Responsibility

The single factor that best predicts the benefits the client will experience through therapy is his or her willingness and ability to take responsibility for personal growth. It should be understood that the therapist will not “fix” you. He or she is a skilled facilitator of your own process of self-exploration and actualization. You will work together with the therapist to set personal goals, but you are responsible for generating issues for exploration, as well as completing any exercises or homework that may be assigned.

Cancellation and Punctuality

Professional courtesy is expected of both the client and the therapist. Out of respect for both parties, the following policies are in effect:

• If the client does not, for any reason, provide 24 hours notice for the cancellation or rescheduling of a session, he or she will be charged in full for that session. You are required to provide a credit card number and authorization to secure your appointment time.
• The client is expected to arrive on time for his or her session. If the therapist is running late for a session, he or she will either make up that time at the end of the session or offer to make up that time in a subsequent session.
• If you are using Insurance benefits, you are still required to provide 24-hour notice for the cancellation or rescheduling of a session. If you fail to do so, you will be charged the FULL amount for that session, rather than your co-pay. Depending on your specific insurance plan, this amount will range from $92.00 – $200.00.

Virtual Telephone and Video Counseling and Coaching

Dallas Whole Life Counseling offers phone and video sessions. Virtual sessions are scheduled and billed just like in-person sessions.

Confidentiality

In general, any material you discuss within your therapy session will remain confidential. There are, however, limits to client confidentiality. The most common exceptions to confidentiality are as follows:

• If there is suspected child abuse, elder abuse, or dependent adult abuse.
• When the threat to injure or kill oneself (by means of an aforethought, concrete plan of action) is communicated to the therapist.
• If you are required to sign a release of confidential information by your medical insurance.
• If you are required to sign a release for psychotherapy records when involved in litigation or other matters with private or public agencies.
• Clients under 18 do not have total privacy from their parents, although parents are encouraged to give teenagers complete confidentiality, except in the case of dangerous practices (i.e. self-mutilation, etc.).

Note: In the case of couples counseling, confidentiality still applies to any individual sessions. If you tell your therapist that you have been unfaithful to your spouse, for example, the therapist will not share this information with your spouse, even though you are pursuing treatment as a couple.

Treatment Approaches

Dallas Whole Life Counseling customizes its treatment to the individual needs, wants, and resources of each individual. As such, with any given client, a variety of therapeutic approaches and strategies may be employed. Two common methods are described below:

Dynamic/Family Systems Psychotherapy

Dynamic psychotherapy is based on the insight that many aspects of our personalities result from passing through and solving relationship issues at particular developmental stages. At any stage, the way we have reacted to events in our lives may have caused us to get stuck at a certain level of insight or problem-solving. We can have a mature exterior and be functioning more or less successfully, while internally we may feel vulnerable, confused, depressed, angry, afraid, and childlike. We may not feel able to bounce back from rejection, get past blocks, allow our real feelings to surface, or stay in touch with our feelings and desires. Our physical health may be compromised in many ways by emotional and relationship issues. Dynamic/family systems therapy is designed to help clients understand how their unconscious feelings and thoughts affect the ways they act, react, think, feel, and relate. This therapeutic focus encourages individuals to experience life more deeply, enjoy more satisfying relationships, resolve painful conflicts, and better integrate all the parts of their personalities.

Cognitive-Behavioral Therapy (CBT):
Cognitive-behavioral therapy is based on the assumption that a person’s behavior is the result of the way he or she habitually thinks and feels. The cognitive-behavioral model assumes that the areas of behavior, thoughts, and feelings all affect one another and that changes made in one area necessarily affect both other areas. Therefore, cognitive-behavioral therapy involves evaluating the way the client thinks and identifying “faulty” thinking patterns that were learned earlier in life. For example, if a client believes that she must do everything perfectly in life, she may feel very poorly about herself when she makes normal human mistakes. Cognitive-behavioral therapy includes many tasks and strategies designed to help the client to reevaluate his or her beliefs and may involve various “homework” assignments to be completed between sessions. Cognitive-behavioral therapy includes a variety of components aimed at altering behavioral responses. It may include training in relaxation and visualization exercises and may incorporate meditative techniques. The CBT approach may also involve practical problem-solving, changes in time management, and techniques for stress reduction.

HIPAA

A comprehensive information packet detailing HIPAA practices and procedures is available on request. Check with our office manager, or simply find this packet on the counter of our admin window.

Agreement for Psychotherapy, Counseling, or Coaching

I have read this informed consent completely and have raised any questions I might have about it with my therapist or medication provider. I have received full and satisfactory responses and agree to the provisions freely. I understand that my therapist is responsible for maintaining all professional standards set forth in the ethical principles of his or her professional association, as well as the state laws governing the practice of psychotherapy. This agreement constitutes the entirety of our professional contract. Both parties must sign any changes.

• Payment in full is due at the beginning of each session.
• I authorize Dallas Whole Life Counseling to charge my credit/debit account for any agreed-upon services and/or products.
• I understand that I may pay by check or cash if I prefer, but a valid credit or debit card is required to reserve an appointment space. Payments that are more than 30 days overdue will be automatically billed to the credit/debit account, along with any returned check fees.
• I understand that if I cancel or reschedule my session without 24-hour advance notice, my credit/debit account will be charged the full amount of that session, regardless of the reason for cancellation.
• I understand that, if I am using Health Insurance I am still required to provide 24-hour advance notice to cancel or reschedule my session. If I fail to do so, I will be charged the FULL amount for that session, rather than my co-pay. Depending on my specific insurance plan, this amount will range from $92.00 – $200.00.
• Credit/debit account information is kept in a secure client portal as well as a locked confidential file that is shredded at the termination of treatment.