Practice Policies
Updated February 15, 2022
I appreciate your giving me the opportunity to be of help to you. This document (my ‘Practice Policies’) is written to answer common questions clients often ask about therapy. Our work together will be most helpful to you when you have a clear idea of what we are trying to do.
This document discusses the following topics. Please feel free to make notes of any unclear points and we can discuss in person.
3. About Your Records and Confidentiality
4. About Appointments and Fees
1. About Psychotherapy
1.1 Different practitioners have different views of therapy. I'd like to describe how I see it.
Individuals present for therapy with a range of problems, from depression, irritability or insomnia to problems at work or in a primary relationship. These problems are not unique to therapy clients, and most people find some way to tolerate the distress. The person seeking therapy often finds themselves struggling to cope as well as before, or to have become more sensitive to the costs of tolerating the problem.
A number of factors will contribute to one’s ability to manage these problems. As I understand it, therapy presents an opportunity for an exploration of those important factors – including but not limited to — one’s natural disposition, learned responses, beliefs and thinking style, environmental factors and current social supports. Benefit can be expected to arrive as you are able to make better sense of what is getting in the way of you having the life that you want. My expertise consists in understanding how these factors bear influence, interact with one another, and how an individual acquires meaningful understanding of them.
How this work actually occurs differs with each client according to their presenting questions, interests, abilities, etc. Some clients favor exploration with the aim of gaining insight into how they have come upon the problems they have. Others are more interested in developing practical skills, e.g. in communication or emotional fortitude, for solving the problem as quickly as possible. Effective therapy matches the approach to the preferences of the client. In cases where you are unsure about how to best work, my aim would be to guide us in discovering your preferred problem-solving approach.
I am comfortable working in various styles. However we work together, know that I am committed to ensuring you find value in our meetings and that you ultimately find answers to the questions that brought you to therapy.
Therapy works best when you are actively engaged. This implies that you have worked on your own to get clear about how you want to improve. You work to develop a mindset and prepare your thoughts for each session. You're open to trying out new ways of thinking and behaving and noticing the results. And you're providing me feedback about how the support you're receiving is helping or not.
Finally, the wise patient also understands that lasting change takes time, can have an irregular pace, and will necessarily involve some pain. We should not expect to transform effortlessly overnight what has taken years to construct.
I've created an FAQ page with other reflections on therapy, accessible at: drtimpeterson.com/therapy-faq.
1.2 About the Course of Treatment
A course of therapy may flow from an initial consultation when it would seem that we could work well together in therapy. I have found it useful to separate the initial consultation from beginning a course of therapy in order to protect the option that something besides either therapy or therapy with me could serve you better. If we continue on into therapy, I am hopeful that our work together would bring some meaningful and sustainable relief.
A course of treatment varies based on a number of factors, including: the nature of your problem (is it more situational or developmental), your measure of successful treatment, and your availability in time, energy and money. I appreciate that it can be hard to have a sense of the extent of your problem or to determine your level of investment in advance. For that reason, I usually recommend a trial of 4 sessions of therapy following the initial consultation in order to conduct an appropriate assessment and to ferret out together some realistic goals.
By the end of this trial, I should be able to offer a preliminary conceptualization of your presenting problem and recommend a direction for your therapy. At this juncture we ought to be able to talk more confidently about what we might be able to accomplish in a short, medium and long term.
Most of my clients see me once a week for 6–12 months. After that, we might meet less often for several more months. Therapy then usually comes to an end. The process of ending therapy can be a very valuable part of our work and well worth spending our time on. Stopping therapy should not be done casually, although either of us may decide to end it if we believe it is in your best interest. If you wish to stop therapy at any time, I ask that you agree now to meet then for at least one more session, to review our work together. We will review our goals, the work we have done, any future work that needs to be done, and our options. If you would like to take a “time out” from therapy to try it on your own, we should discuss this. We can often design such a “time out” to be more helpful.
1.3 The Risks and Benefits of Therapy
During the initial evaluation or the course of therapy, you may remember unpleasant events, and experience considerable discomfort, such as strong feelings, anxiety, depression, and insomnia. I may challenge some of your assumptions or propose different ways of thinking about or handling situations. This may cause you to feel upset, angry, or disappointed. Attempting to resolve issues that brought you into therapy may result in changes that you did not originally intend. Psychotherapy may result in decisions to change behaviors, employment, substance use, schooling, housing, or relationships. Change can sometimes be quick and easy, but more often it can be gradual and even frustrating. There is no guarantee that psychotherapy will yield positive or intended results.
While you consider these risks, you should know also that many benefits of therapy have been shown by scientists in hundreds of well-designed research studies. Most clients will find their symptoms greatly lessened, will feel more confident and relaxed, and will improve their daily functioning. People who are depressed may find their mood lifting. Other clients may no longer feel afraid, angry, or anxious. In therapy, people have a chance to talk things out fully until their feelings are relieved or the problems are resolved. Clients’ relationships and coping skills can improve greatly. They may get more satisfaction out of social and family relationships. Their personal goals and values may become clearer. They may grow in many directions—as persons, in their close relationships, in their work or schooling, and in the ability to enjoy their lives.
1.4 If you could benefit from a resource that I do not provide, I will help you to get it. You have a right to ask me about such other services, their risks, and their benefits. Based on what I learn about your problems, I may recommend a medical exam or use of medication. If I do this, I will fully discuss my reasons with you, so that you can decide what is best. If you are treated by another professional, I will coordinate my services with him or her and with your own medical doctor if you want me to.
Psychological assessment may also help increase our understanding of your personality, psychological dynamics, intellectual and emotional resources, or other areas, and so it may help us design or improve your therapy. If this seems beneficial, I will discuss it with you and get your consent before proceeding.
2. About Our Relationship
2.1 I have worked as a helping professional, in the capacity of tutor, mentor, coach, trainer, therapist and consultant, since 2008. I have a doctoral degree (PsyD; 2014) in clinical psychology from Widener University (Philadelphia), whose program is approved by the American Psychological Association (APA). I have a master’s degree (Med; 2008) in education/human development from the Graduate School of Education of Harvard University. I am licensed as a psychologist in Texas (#37292). I am a member of the American Psychological Association, the Texas Psychological Association, the Bexar County Psychological Association, and the San Antonio Psychoanalytic Society.
2.2 Psychotherapy is known to work best when you have a strong alliance with your provider. In essence, this consists of liking your provider, having confidence in their abilities/expertise, feeling understood by them, and feeling like they share your goals and are optimistic about your ability to improve. If you don’t experience this with me, or if you don’t experience this with another provider, I strongly encourage you to seek another provider with whom you can develop this kind of alliance.
You can expect me to be honest with you about your problems and progress. In turn, I will expect you to be honest with me about your expectations for services, your behaviors outside of sessions, or about any other barriers to treatment.
I will from time to time invite you to share about your experience of our work together. What you share and how much you share is your choice. Your thoughts and feelings are private, and I aim to fully respect your privacy. The tradition of exploring your experience of therapy, however, suggests that presenting problems may manifest in the consulting room, and that studying them in real time can be helpful toward arriving at a deeper understanding and, ultimately, gaining the relief you are seeking.
2.3 As a professional, I will use my best knowledge and skills to help you. This includes following the standards of the American Psychological Association, or APA. In your best interests, the APA puts limits on the relationship between a therapist and a client, and I will abide by these. Let me explain these limits, so you will understand that they don’t apply just to you and me.
First, I am licensed and trained to practice psychology—not law, medicine, finance, or any other profession. I am not able to give you good advice from these other professional viewpoints.
Second, state laws and the rules of the APA require me to keep what you tell me confidential (that is, just between us). You can trust me not to tell anyone else what you tell me, except in a few unusual situations. I explain what those are in the “About Confidentiality” section of this brochure. For example, I try not to reveal who are my clients. This is part of my effort to maintain your privacy. If we meet on the street or socially, I may not say hello or talk to you at all. I am not ignoring you; it is a way to maintain the confidentiality of our relationship.
2.4 If You Need to Contact Me
I cannot promise that I will be available at all times. I do not take phone calls when I am with a client. You can always leave a confidential message on my voicemail and I will return your call as soon as I can. If I don’t return your message within 24 hours, please assume that a mechanical problem has occurred and call back. Generally, I will return messages daily except on Sundays and holidays. During times I am scheduled to be away for a few days, another professional will be available for urgent issues.
If you have an emergency or crisis, mention this when you are leaving a message. If you have a behavioral or emotional crisis and cannot reach me immediately by telephone, you or your family members should call one of the following community emergency agencies: the Crisis Care Center (The Center for Behavioral and Health Services) at (210) 225-5481 or the Crisis Line at (210) 223-7233; your PCP; or the nearest hospital emergency room.
If you are interested in contacting me via text or email, I assume that you are aware of and comfortable with the security risks of electronic communications. I have written about my policy on electronic communications in more depth on my website at drtimpeterson.com/policies
2.5 If I Need to Contact Someone about You
If there is an emergency during our work together, or I become concerned about your personal safety, I am required by law and by the rules of my profession to contact someone close to you—perhaps a relative, spouse, or close friend—to protect you. I am also required to contact this person, or the authorities, if I become concerned about your harming someone else. I will collect this emergency contact from you in your intake information form.
3. About Your Records and Confidentiality
3.1 I will treat with great care all the information you share with me. It is your legal right that our sessions and my records about you be kept private. That is why I ask you to sign a “release-of-records” form before I can talk about you or send my records about you to anyone else. In general, I will tell no one what you tell me. I will not even let anyone know that you are in treatment with me without your agreement.
In all but a few rare situations, your confidentiality (that is, the privacy of what you tell me) is protected by federal and state laws and by the rules of my profession. Here are the most likely situations where your confidentiality is not protected:
If you were sent to me by a court or an employer for evaluation or treatment, the court or employer expects a report from me. If this is your situation, please talk with me before you tell me anything you do not want the court or your employer to know. You have a right to tell me only what you are comfortable telling.
Are you suing someone or being sued? Are you charged with a crime? If so, and if you tell the court that you are seeing me, I may then be ordered to show the lawyers my records. Please talk to your lawyer about what to say to me.
If you make a serious threat to harm yourself or another person, the law requires me to try to protect you or that other person. I simply cannot promise never to tell others about threats you make.
If I believe that a child, older adult, or other dependent person has been or will be abused or neglected, I am legally required to report this to the authorities.
As a therapist, my legal and moral duty is to protect your confidentiality, but I also have a duty under the law to the wider community and to myself if there is harm, threat of harm, or threat of neglect.
3.2 Parents and/or guardians with legal custody can be told about their child’s diagnoses, the counseling methods used and recommended, significant safety concerns, and the progress of treatment, either as needed or when requested.
If you ever become involved in a divorce or custody dispute, or any other legal matters (such as a lawsuit over injuries), I want you to understand and agree that I will not provide my records, or evaluations, depositions, or testimony in court. There are several reasons for this: (1) I may not possess the professional skills to make decisions about issues besides those we deal with in therapy; (2) therapy often involves full disclosure of information that you might not want to have revealed in court; (3) if you are holding back information because of that fear, our work will not be as productive as it could be; (4) my statements will be seen as biased in your favor because we have a therapy relationship; and (5) what I might say in testifying or being deposed might change our therapy relationship, and I must put that relationship first. If you want custody evaluations and recommendations, I will be happy to refer you to those with this expertise.
If we do family or couple therapy (where there is more than one adult present), and you want to have my records of this therapy sent to anyone, all of the adults present will have to sign a release of information.
3.3 There are a few times when I might talk about you with a colleague. I ask you now to understand and agree to let me do this in these two times.
First, when I am away from the office for a few days, a trusted fellow therapist will be available to you in emergencies. He or she will need to know some things about your situation. Of course, this therapist has the same laws and rules as I do to protect your confidentiality.
Second, I sometimes talk with other therapists or other professionals about my clients, because it helps me to provide high-quality treatment. These professionals are also required to keep your information private. I maintain your privacy with them. I never tell them your name, I change or skip some facts about you, and I tell only what they need to know to understand your situation and help me. For the purpose of these consultations, I may want to make audio or video recordings of our sessions. I will review the recordings with my consultant to assist with your treatment. I will ask your permission to make any recording. I promise to destroy each recording as soon as I no longer need it, or, at the latest, when I destroy your case records. You can refuse to allow this recording, or can insist that the recording be edited.
Third, It may be beneficial for me to confer with your primary care physician (sic) with regard to your psychological treatment or to discuss any medical problems for which you are receiving treatment. In addition, Medicare requires that I notify your physician, by telephone or in writing, concerning services that are being provided by me unless you request that notification not be made.
3.4 If your records need to be seen by another professional, or anyone else, I will discuss this with you. If you agree to share these records, you will need to sign a release-of-information form. This form says exactly what information is to be shared, with whom, and why. You may read this form at any time. If you have questions, please ask me. You have the right to ask that your information not be shared with family members or others, and I can agree to that limitation.
You can also tell me if you want me to send mail, or phone you at a more private location or number than, say, your home or workplace. If this is of concern to you, please tell me so that we can make arrangements.
It is my office policy to destroy clients’ records 10 years after our last meeting. Until then, I will keep your case records in a safe place and make them available when you authorize their release.
After I destroy your records, I will retain, for up to 25 years, a one-page summary of the dates of treatment, number of sessions, why you came to see me, diagnoses, and any outcome information I have.
If I must discontinue our relationship because of illness, disability, or other presently unforeseen circumstances, I ask you to agree to let me transfer your records to another clinician who will make sure they are kept safe, confidential, and available when you want them, and then destroy them someday.
As part of cost control efforts, health insurance companies will ask for information on your symptoms, diagnoses, progress, and outcomes. My policy is to provide only as much information as the insurance company will need to pay your benefits. This information will become part of your permanent medical record. I will let you know whether a company has asked for this and what it has asked for. If the company does not get the information it asks for, it may refuse to pay your benefits for our treatment. Please understand that I have no control over how these records are handled once they leave my office. For more on these issues, please read my Notice of Privacy Practices.
You can review your own records in my files at any time. You may add to them to correct errors or provide more information, and you can have copies of them (but you will have to assume the risks of loss of confidentiality when you receive and store your copies). If I believe that it might be in some way harmful for you to view your records, I may suggest that we review them together or that I provide you with a summary of the records in place of the entire record. I ask you to understand and agree that you may not examine records created by anyone else that you have had sent to me.
4. About Appointments and Fees
4.1 Both my consultations and therapy sessions are scheduled for 50 minutes. The initial meeting is scheduled in our introductory conversation. Following sessions, where indicated, can be scheduled at the end of each appointment. Ideally we can find a regular time to meet each week. I find consistency as valuable for creating a safe, predictable environment. I understand if your schedule requires a week-to-week confirmation though I cannot guarantee that the same time slot will be regularly available.
I will tell you at least a month in advance of my vacations or any other times we cannot meet. Please ask about my schedule in making your own plans.
4.2 Cancellations and No-Shows
I have written about my cancellation and no-show policy in more depth on my website: drtimpeterson.com/policies
I consider our meetings very important and make them a priority over other activities and ask you to do the same. An appointment is a commitment to our work. A cancelled appointment slows our progress, so please try not to miss sessions if you can possibly help it. Your session time is reserved for you.
We agree to meet at my office and to be on time. If I am ever unable to start on time, I ask your understanding and promise that you will receive the full time agreed to or be charged proportionately. If you are late, we will probably be unable to meet for the full time, because it is likely that I will have another appointment after yours.
I am rarely able to fill a cancelled session, so you will be charged $80 for sessions cancelled after 10 am on the day before your appointment. Your insurance will not cover this charge. I am understanding of some mitigating circumstances. Please share about these with me promptly to avoid the charge.
4.3 Fees, Payments, and Billing
I have written about my payment policy in more depth on my website: drtimpeterson.com/policies
Payment for services is an important part of any professional relationship. This is even more true in therapy, where a common treatment goal is to make relationships and the duties and obligations they involve clear. You are responsible for seeing that my services are paid for. Meeting this responsibility shows your commitment and maturity.
I can collect payment by check or credit card but not by cash. If paying by check, I will collect that at the end of our sessions. If paying by credit card, it is my policy to keep your card information securely on file with my payment processor (Simple Practice) and to run charges at the end of each day.
My current fees are as follows:
An initial intake is $200.
Individual therapy: $180 per 50-minute session.
Couples therapy: $240 per 75-minute session.
Psychological assessment: varies by individual case.
Less common billable services include:
Telephone consultations: I believe that telephone consultations may be suitable or even needed at times in our therapy. Some insurers will pay for these services, but many will not. If so, I will charge you our regular fee, pro-rated in 10m increments, over the time needed. Of course, there is no charge for brief calls about appointments or similar business.
If I need to have telephone conferences with other professionals as part of your treatment, I am glad to confer without charge for up to 10 minutes. If a telephone conversation takes longer, you will be billed for these at the same rate as for regular therapy services. We will discuss this in advance, so we can set rules that are comfortable for both of us.
Extended sessions: Occasionally it may be better to go on with a session, if possible, than to stop or postpone work on a particular issue. This extension time will be charged on a pro-rated basis. It is also likely that your insurance will not pay for extra time, and so I will bill you.
Reports: I will not charge you for my time spent making routine and simple reports to your insurance company. However, I will have to bill you for any extra-long or complex reports the company might require. The company will not cover this fee.
Other services: Charges for other services, such as hospital visits, consultations with other therapists, home visits, or any court-related services (such as consultations with lawyers), will be based on the time involved in providing the service at my regular fee schedule. Some services may require payment in advance.
At the end of each year, I consider adjusting my fees in light of a re-evaluation of the costs of doing business. If I decide to increase my fees, I will give you notice of at least 60 days.
4.4 If You Have Health Insurance
Because I am a licensed psychologist, many health insurance plans will help you pay for therapy and other services I offer. Because health insurance is written by many different companies, I cannot tell you what your plan covers. Please read your plan’s booklet under coverage for “Outpatient Psychotherapy” or “Behavioral Health,” or under “Treatment of Mental and Nervous Conditions.” Or call your employer’s benefits office to find out what you need to know.
I have chosen to participate in a limited number of health insurance panels, currently just Aetna PPO and BCBS PPO (though I am an ‘authorized provider’ with Tricare). If you choose to use your insurance, I will file claims on your behalf if I am able. If I am unable, I will give you a receipt for my services with the information the insurers need to pay you back if allowed by your contract. This information will include standard diagnostic and procedure codes, the times we met, my charges, and your payments.
If you are not a subscriber to any of the above plans, your insurance may still pay a part of my fees as an out-of-network provider. I will be glad to assist in your pursuit of reimbursement by speaking with your insurance company should they contact me.
At the end of each month, my practice management system, Simple Practice, will send you a statement via a link to your client portal. The statement can be used for health insurance claims, as described in the next section. It will show all of our meetings, the charges for each meeting, how much has been paid, and how much (if any) is still owed. At the end of treatment, and when you have paid for all sessions, I will send you a final statement for your tax records.
I have written further about insurance use in more depth on my website at drtimpeterson.com/policies
4.5 If there is any problem with my charges, my billing, your insurance, or any other money-related point, please bring it to my attention immediately. I will do the same with you. Such problems can interfere greatly with our work. They must be worked out openly and quickly.
If you think you may have trouble paying your bills at times, please discuss this with me. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small-claims court. In most collection situations, the only facts I release regarding a client’s treatment are his or her name, the kind of services provided, and the amount due. If such legal action is necessary, its costs will be included in the claim.
I realize that my fees involve a substantial amount of money, although they are well in line with similar professionals’ charges. For you to get the best value for your money, we must work hard and well.
I will assume that our agreed-upon financial arrangements will continue as long as I provide services to you. I will assume this until you tell me in person, by telephone, or by certified mail that you wish to end it. You have a responsibility to pay for any services you receive before we end the relationship.
5. Other Points
5.1 You may not make any kind of electronic recording of our sessions without my written consent.
5.2 If you would like to use email or text to communicate, please read my Electronic Communication Policy.
5.3 As part of the confidentiality that I offer you, I ask you not to disclose the name or identity of any other client being seen in this office.
5.4 Shared Office Space: Although I share this office space with other professionals and we use some office equipment together, we are not in business together as partners, employers, or employees. I do not routinely consult with them on cases, or make referrals to or receive referrals from them. We are all independent licensed professionals.
5.5 Records Issues: If, as part of our therapy, you create and provide to me records, notes, artworks, or any other materials, I will return the originals to you at your written request but may retain copies.
5.6 If I am unable to provide continuing care to you due to my illness or disability, I have made arrangements with other fully qualified and confidential clinicians for your immediate care and for maintenance of your records. These arrangements are in effect as long as I am in practice.
5.7 Statement of Principles and Complaint Procedures
It is my intention to abide by all the rules of the American Psychological Association (APA) and by those of my state license.
Problems can arise in our relationship, just as in any other relationship. If you are not satisfied with any area of our work, please raise your concerns with me as soon as possible. Our work together will be slower and harder if your concerns with me are not worked out. Some issues that arise between us may be clinically relevant to other relationships in your life. I will make every effort to hear any complaints you have and to seek resolution. If you feel that I (or any therapist) have treated you unfairly or have broken a professional rule, please tell me. You can also contact the state licensing board for the discipline under which any therapist practices (psychologist, psychiatrist, licensed professional counselor, or social worker). Staff members there can help clarify your concerns or tell you how to file a complaint.
In my practice as a therapist, I do not discriminate against clients because of any of these factors: age, sex/gender, sexual orientation, marital or family status, race, color, religious beliefs, ethnic origin, place of residence, veteran status, physical disability, health status, or criminal record unrelated to present dangerousness. This is a personal commitment, as well as being required by some federal, state, and local laws and regulations. I will always take steps to advance and support the values of equal opportunity, human dignity, and racial, ethnic, and cultural diversity. If you believe you have been discriminated against, please bring this matter to my attention immediately.
5. 8 Our Agreement
Your consent on this document will represent our agreement to work together. I hope you feel free to raise questions about any aspect of it during the course of our meeting together. For ongoing reference, you can find it in the client portal or at my website: drtimpeterson.com/policies