REALLY IMPORTANT INFORMATION ABOUT MY PRACTICE AND HOW I WILL PROTECT YOUR PRIVACY
OFFICE POLICIES, PRIVACY PRACTICES AND GOOD FAITH ESTIMATES
I am providing you with the following information so you understand how my practice operates. The clearer our agreements are with each other the better focused we can be on your work. These policies and practices may evolve over time. I ask clients to review these policies once a year. Please let me know if you have any questions or concerns before signing.
WHAT IS A LCSW?
I am a Licensed Clinical Social Worker (LCSW) with mental health counseling privileges through the New York State Office of Professions. You may read more about my training and professional background on my website: www.CarolineRussellSmith.com.
GETTING WHAT YOU WANT OUT OF THERAPY AND THEN SOME!
Most people come into therapy with a sense of what they want to work on. Usually there are behaviors they want to change, relationships they wish to improve and/or emotions they hope to better understand and respond to differently. While it is not possible to guarantee any specific treatment results and I cannot predict how you will respond to my approach, I will collaborate with you to improve and/or resolve the specific concerns that led you to seek help. Mutual honesty, openness and effort are essential to the success of this endeavor. Also, therapy can be an adventure! If you are willing to show up and be as honest as possible about yourself, if you are willing to be curious about why you do what you do and feel the way you do, you will discover all kinds of unexpected riches that may or may not relate directly to your specific concern.
BENEFITS AND RISKS
As with any intervention, there are risks associated with mental health counseling. Risks during my initial evaluation, as well as over the course of treatment, include remembering and/or talking about unpleasant experiences. If I challenge some of your assumptions or perceptions, or if I propose different ways of looking at/handling situations, you might feel angry, depressed, agitated or disappointed. It is common for people to feel distressed during or after a session. I will be closely monitoring you and I ask that you keep me informed about how you are doing. This way we can titrate our work to keep you moving forward safely. Therapy should be challenging but not routinely overwhelming.
Attempting to resolve issues that brought you into therapy in the first place, such as personal problems or interpersonal relationships, may result in changes that were not originally intended. Some changes may lead to what seem to be worsening circumstances or even losses (for example, counseling cannot guarantee that a relationship will remain intact). Mental health counseling may also result in you making tough decisions about employment, substance use, schooling or housing. Sometimes a decision that is positive for one family member is viewed negatively by another.
Change will sometimes be easy and swift but, more often, it will be slow and can sometimes be intensely frustrating. I don’t intend for this to sound pessimistic. I just want you to be informed and understand that therapy is serious business, it is often emotionally intense, and progress is rarely linear.
Within the first 2-4 sessions I will offer you my initial understanding of your concerns and offer a plan for treatment including the approaches I will use, goals, a rough timeline and an invitation to let me know 4 or 5 sessions in if you feel we are on track. I welcome your feedback throughout the process. You may ask me about other treatments and their associated risks and benefits. You always have a right to refuse anything I suggest. Things I might suggest include getting involved with a therapy or support group, readings, podcasts, guided meditations, and/or adjunct therapies. These suggestions are never mandatory unless there are medical or substance abuse issues that are compromising your ability to benefit from the therapy I am providing. In those cases, I may suspend treatment in order for you to complete an adjunct therapy (rehab for example) or require concurrent participation in another treatment modality (e.g. psychiatry or an adjunct therapeutic modality). I do require that if another healthcare person is working with you, I have a signed release from you so I can communicate freely with that person about your care.
Please know that none of my approaches are intended to be a substitute for medical diagnosis or treatment and they do not replace the services of a licensed physician. You agree and understand it is your responsibility to consult with your physician for any specific medical problems. Further, you understand that I may suggest you contact a physician or psychiatrist if I believe it is advisable. In addition, you understand that any information shared during your treatment with me is not to be considered a recommendation that you stop seeing your physician or discontinue a prescribed medication. Please consult with your other providers about your care every step of the way.
OUR RELATIONSHIP
Our relationship will be a professional and therapeutic one. My professional code of ethics prohibits me from having personal and/or business relationships with my clients to prevent undermining the effectiveness of our therapeutic relationship. I share this right up front because our work may be emotionally intense and for folks who have never been to therapy it can seem quite odd and challenging at first to work so closely with someone you don’t have a relationship with outside the office.
Saratoga Springs is a small town. If you live here too our paths may cross at some point. If we meet in a social, public or professional setting, I will greet you with a smile and allow you to determine the nature of our interaction. You might just carry on or you may wish to stop and say hello. It is your decision, and I will respect your privacy. I do not discuss clinical material outside of session, but I am always delighted to say hello!
GOOD FAITH ESTIMATE
Under the law, health care providers need to give clients who do not have insurance or who are not seeking insurance reimbursement an estimate of expected charges for medical services including psychotherapy. You can ask me for a Good Faith Estimate before we begin working together or at any time during your treatment. If you receive a bill that is $400 more than your Good Faith Estimate you can dispute the bill. Make sure you save a copy of your estimate. For more information you can visit www.cms.gov/nosurprises.
PHONE, EMAIL & TEXTING
I do my best work in session and therefore use phone calls, text, and email VERY sparingly. I prefer that we discuss all clinical material in session and use phone/text/email only for administrative matters unless we have made another arrangement. All electronic communications are vulnerable to confidentiality breeches despite my best efforts for privacy protection. I will assume that you have made an informed decision about what you choose to send electronically.
HOWEVER, and this is a big exception, in the case of a mental health emergency please call me immediately. We will use this contact to establish a safety plan until our next session. Call me at (518) 857-9361. I check my messages daily. Leave me a message on my voicemail and I will call you back as soon as possible. If your safety or someone else’s is in danger and you cannot wait for a return call, please call 911 immediately or go to your nearest emergency room.
If you frequently reach out to me between sessions via phone, email, or text we will talk in session about what is going on. In most cases this increased contact is situational and temporary. I charge for conversations longer than 10 minutes at my pro-rated session rate. This is not to punish you. It is to protect my private time and privilege the therapy which happens in session where we will be able to do our best, focused work together.
If your challenges are chronic and you seek regular contact between sessions, we will need to make a shift. We might opt to meet more frequently for a period of time (if our schedules allow); we will identify ways for you to better care for yourself outside of session; and/or we might consider a higher level of care (intensive outpatient therapy or inpatient therapy). Though it is completely reasonable and healthy to reach out to a supportive person, the model of therapy I offer does not include regular contact via phone/email/text.
** FOR COUPLES: All communications with me outside of session need to include both parties meaning if you text me, please have both members of your couple on the text thread. Same with emails. If you text or email me without your partner, I will not respond until everyone is included. Please do not call me unless your partner is present. Your couple is my client, so I want always to be dealing with you both!
SESSION LENTH
I offer single (50 minutes), double (100 minutes) or triple sessions (150 minutes) depending upon the kind of therapy we are doing and my availability. Sometimes I offer day-long or weekend-long retreats. I try to end our therapeutic conversation with a few minutes to spare so we can schedule the next appointment and deal with any billing issues. Ending on time matters a great deal because during the short intervals between sessions I return client phone calls and attend to billing. If those things don’t get done, my clients – of which you are now one – are not happy!
Please arrive on time for your appointment. Lateness will result in reduced session time. I will end on time even if you are late. If I am running late, on the other hand, I will do my best to ensure that you have your full session even if it means running over our scheduled time a bit with your permission. I try really hard to be on time.
COUPLE THERAPY
I am a PACT Level 2 Practitioner. PACT stands for Psychobiological Approach to Couples Therapy which was developed by Dr. Stan Tatkin. Couples therapy differs from individual therapy in that I will often have you facing your partner during our time together instead of facing me. You are in each other’s care, so my work is to improve the functioning of your relationship rather than improve your relationships with me! I remain a very active participant in the session, and I will challenge you conversationally as well as with exercises that get you out of your chairs and interacting in various ways. Sessions are always 100 or 150 minutes as single sessions with couples are only useful for brief check-ins when a couple is solid in their recovery.
I will ask your permission to videotape couple sessions because a picture really is “worth a thousand words.” The video recordings will be occasionally used in session to show you how your couple is progressing. Most of the time I use the recordings when I am seeking consultation with my professional peers and mentors. These clinicians are bound by the same ethical standards I am. The videos will be stored on a password protected computer and are destroyed as soon as I have used them for the above purposes. I will provide you with a separate release form with more information about this process.
If you reach out to me between sessions during couple therapy, I will ask that it be by email or text so all parties can be included in the exchange. I do not keep secrets between partners or family members and have found that transparency serves your relationship and the therapy best.
SEX THERAPY
Exploring sexuality can be an important part of therapy for many people. Whether you are working with me individually or with a partner(s) we will always work with clothes on. I will never ask you to engage in sexual acts during session nor will I engage physically with you in any way. Sex therapy includes exploring your sexual and relationship history, your definitions of sex and intimacy, your fantasy life, the kind of sex you are having or wish to have, and any concerns you have about your erotic life. Sex therapy is usually about so much more than sex!
GIFTS
If you want to thank me in some way, please do it in writing. I treasure the notes and cards I have received over the years. This may sound presumptuous but once you get here you will see that my office is full to the brim with incredible objects.
INSURANCE
I do not participate with any insurance plans directly though I am happy to provide you with a bill you can submit for reimbursement. Ask me which companies I am already set up with to submit online. You will pay me in full for your treatment and you will be reimbursed according to the terms of your plan’s policy. Not all plans reimburse so please check this out before beginning treatment with me.
FEES AND PAYMENT
Please pay all session fees at the time of service. I accept cash, personal checks, and credit cards.
I raise my fees according to advancement in my training and experience. I will alert you to any fee changes 2 months in advance. I generally raise my rates by at least $10 every year.
If my bank returns your check, I will charge you my bank’s fee in addition to the original amount of your check. I ask that you settle-up prior to or at our next session.
CANCELLATION AND “FREEBIE” POLICY
If you need to reschedule your appointment, please give me at least 24-hour notice by calling or texting (518) 857-9361. You can also cancel and/or reschedule using my scheduling software. Simply find the confirmation email for you appointment and client the cancel/reschedule link.
I ask couples to give me 48 hours notice as filling double and triple session blocks is more challenging at the last minute. Please do not email cancellations as I may not see them in time.
I take this cancellation policy very literally. If you cancel within the 24-hour or 48-hour window I will charge you for this appointment. If I am able to pull someone off my cancellation list to fill your spot you are in luck! I will not charge you. This just isn’t always possible.
I do understand that “life happens” so I offer every client a one-time “freebie.” If you are ill, if you have car trouble, if the weather is rotten, if you forget about our appointment or your schedule changes beyond your control you can use this freebie. I will not charge you for your missed appointment. If you have a double session booked that you must cancel at the last minute, I will only charge for one of the hours you have missed.
After you use your “freebie,” cancellations within the 24-hour window (48 hours for couples) will result in a charge. I recognize that illness, car trouble, work obligations, childcare difficulties and other major life hassles are not under your control. As a private practitioner I do not get paid if clients cancel and this is my livelihood. Last-minute cancellations add up over the course of a year. Fortunately, my “freebie” policy works quite well. My clients understand that scheduling a session is like buying a ticket to an event. If you miss the event, it doesn’t matter why you missed it. You can’t turn in your ticket for a refund.
If transportation, weather or illness is an issue on a particular day I am happy to do a phone session or use FaceTime/Skype/Zoom or other telehealth platform so that you don’t need to cancel or use your “freebie.” IF YOU HAVE A FEVER, RUNNY NOSE, SORE THROAT, COUGH OR DIARRHEA PLEASE CONSIDER THIS OPTION FOR MY SAKE AND MY FAMILY’S. I WILL OFFER YOU THE SAME COURTESY. The pandemic has taught me that high quality therapy can happen virtually.
RECORD KEEPING
I keep very brief records noting only that you have been here, what interventions I used in session and what topics we discussed. As your psychotherapist, I must keep these records for 7 years in a secure location. Although there are exceptions, your records are generally confidential, unless you approve their release. If you want a copy of your records, please provide me with a written request. You may be charged a reasonable fee to offset the cost of providing copies.
CONFIDENTIALITY
The nature of our work will be confidential with a few exceptions:
· If there is an allegation of child or elder abuse or neglect, I am required to share pertinent information with the proper authorities.
· If there is an expressed intention to harm yourself or someone else, I will share pertinent information with the proper authorities to prevent such harm. I will also notify relatives or other health care providers if I am concerned about safety.
· Whenever permission has been granted in writing by you or your parent, as applicable, information may be shared with the identified entity.
· Information may be released to third party payers such as insurance companies for the purposes of receiving payment for services. This information will be limited to the information relevant to receive payment.
In all of the situations described above I will always attempt to notify you before releasing any confidential information about you and I will always share the least amount of information necessary
I consult with other mental health professionals in order to provide my clients with the best treatment. I participate in regular individual and group supervision, peer supervision (a group of local colleagues) and I attend professional conferences throughout the year. If I ever discuss some aspect f your care in any professional setting, I will be ethical and respectful and will never divulge any personally identifying information about you that would otherwise require a signed Release of Information.
WHEN I AM AWAY
I travel a fair amount during the year. I will do my best to let you know at least 2 weeks in advance of any scheduled travel. When I am away from the office for just a few days I will check my own voicemail and return calls. If I plan to be away for an extended period of time, or I know phone service will be inconsistent, I will have another clinician cover for me. You can call them in the event of an emergency, and they will assist you with seeking supportive care until I return.
TERMINATION (ENDING THERAPY)
In most cases we will both have a sense that it is the proper time to conclude our work.
I find that it’s best to plan for termination, so we have a chance to review your progress, identify any next steps and say goodbye with goodwill.
If you decide that you need to terminate immediately you are always entitled to make this call. You have the right to discontinue counseling at any time. Please simply provide me with written or phone notification prior to your last session and make sure all of your payments are up to date. If I am concerned that your termination places you or others at risk, I will mail you a plan including potential referrals to prevent, to the best of my ability, any harm to yourself or others.
There are four scenarios which might warrant me recommending an immediate end of treatment.
(1) If I believe I am not the best clinician to assist you because the nature of your concern is beyond the scope of my skill and/or training I will let you know immediately and refer you to a therapist who can better meet your needs.
(2) If you are violent, threatening (verbally or physically), or you harass me, the office staff or my family I reserve the right to terminate treatment immediately. I will offer other referrals, but I cannot guarantee you will be accepted for treatment.
(3) If treatment does not seem to be moving forward we will discuss next steps and identify a period of time during which we will agree upon various interventions. If at the end of that period of time there is no movement I will recommend that you consider a different therapist or different modality for treatment. Therapy is medicine and if the medicine isn’t working it is my ethical obligation to get you the proper medicine.
COMPLAINTS
Please let me know if you are unhappy with anything associated with our work together. I take criticism very seriously and will respond with care and respect. If you believe I have been unwilling to listen and respond to your concerns or that I have behaved unethically you can contact the New York State Office of Professions, Education Building, 2nd Floor, Albany, NY 12234. You are free to discuss anything about our work as your confidentiality is under your control.
TELEMEDICINE
Telemedicine in this context means the provision of psychotherapy over the phone, Zoom or some other method of interactive audio-visual communication. You have the right to refuse this form of treatment at any time. There are risks and benefits associated with telemedicine and, of course, technical failures can occur which are super frustrating. I have always offered phone sessions when patients are unable to travel to session due to illness, weather, or other life events but during the pandemic telemedicine became standard practice. It is so much better to see your face while we talk! If I am concerned that I am contagious and could pose a medical risk to you I might request that we do a telehealth session. I feel confident in my ability to offer you excellent care using telemedicine if you opt for this.
ADMINISTRATIVE AND LEGAL REQUESTS AND DISABILITY PAPERWORK
My role as a clinical social worker is primarily to provide treatment in session. If you ask me to provide administrative services (treatment documentation for a medical procedure for example), I will charge for my time at my hourly rate. Please discuss with me in advance of your need for record requests, treatment summaries and any specialized letters.
My role is a clinical one. Due to the nature of the therapeutic process and the fact that it often involves sharing deeply confidential material it is my intention not to serve in any legal capacity to protect your privacy.
In signing this document neither you nor your attorney(s), nor anyone else acting on your behalf, will call on me to testify in court or in any other proceeding nor will a disclosure of psychotherapy records be requested unless otherwise agreed upon. If my participation is unavoidable, I will provide you with an additional contract so we are both clear about my role, responsibilities and compensation.
I have been advised by my attorney that if you are seeking Disability based on a mental health condition your psychiatrist is the best and most compelling professional to complete your paperwork.
THANK YOU.
Thank you for reading all this. Please ask me any questions and discuss any concerns. I will have you sign a consent to treatment form saying that you have read these policies and procedures and agree to the terms of our working relationship.