Solano Psychotherapy Associates

Michael Gray, Ph.D.

Solano Psychotherapy Associates

Psychology Mail: 1496 Solano Ave. Meeting Room: 902 Curtis St. (510)525-6620

Lic.# Psy 10328 Albany, Ca. 94706

PSYCHOTHERAPY OFFICE POLICIES

Welcome to my practice, this document contains important information about my professional services and business policies. Please read the following carefully and feel free to discuss any questions you have. Individual changes can be made if they are agreed upon in advance.

DURATION OF TREATMENT: There is no standard length of treatment. Duration is based on your individual needs as mutually assessed on an ongoing basis.  I do both short term, crisis oriented work (six to eight weeks) and long term personality work which may last several years.  We will assess together what help you want and what that might take.

FREQUENCY OF SESSIONS: Sessions are generally once or twice weekly, depending upon your needs. Additional sessions can usually be scheduled when the need arises.

LENGTH OF SESSIONS: Each session is 50 minutes long. I will be prepared to begin and end our sessions on times.

FEE: I have a fixed fee. It will remain consistent throughout your psychotherapy, except for a $5 increase every two years. Payment is due each session, unless otherwise arranged. Please have your check prepared ahead of time.
INSURANCE: Since I do not bill insurance companies directly, I will provide you with a monthly statement for you to submit to your insurance carrier for reimbursement if applicable. Please note: Insurance companies generally do not reimburse for missed sessions. It is your responsibility to be informed on your coverage.

CANCELLATIONS: Missed or canceled sessions will be charged unless there is a full 24 hour advance notice. If you need to cancel in less than 24 hours and we are able to reschedule before your next regular appointment there is no charge for the missed appointment.

VACATIONS: Please let me know of vacations or other planned absences in as much advance as possible and I will do the same. I will also gladly provide you with a referral to a colleague in my absence if you want it.

PHONE CALLS: Please feel free to phone. I will return your call as soon as possible. There is no charge for brief phone calls; however, I do not conduct psychotherapy by phone so if you need more time we can schedule an additional session. If your call is urgent, please do not hesitate to mention that in your message and I will return your call at the first available moment. I have an answering service that will attempt to reach me in off hours.  That phone number will be on my answering machine message.

ADJUNCT THERAPIES: You may wish to pursue other modes of treatment in addition to or as an alternative to individual psychotherapy. For example: couples or family therapy, group therapy, medication for anxiety or depression, or hypnosis for phobias. I will be glad to discuss such options with you at any time.

RISKS AND BENEFITS: While it has been repeatedly demonstrated that psychotherapy is of benefit to most people, there is no guaranteed outcome. Risks include unexpected reactions that may be quite uncomfortable. You should keep me informed of your general emotional state and any reactions you have to the therapy, however slight. Expected benefits can include resolution of the specific concerns that brought you to psychotherapy, improved interpersonal relationships, lifting of depression, lessening of anxiety, and increased understanding of your thoughts, feelings, and behaviors.

YOUR RESPONSIBILITY in our work together, in addition to attending scheduled sessions and paying the agreed fee, is to be as open and honest with the things that are troubling you as you can. I will ask questions and make comments that will focus us on the things I need to understand to be of help to you. Working with me in this manner can bring up difficult and surprising feelings that may contain information vital to our work together. Therefore, I need you to keep me informed on your emotional reactions, even when you don’t think they are relevant.

CONFIDENTIALITY: All information about you and your therapy is confidential, and may not be revealed to anyone without your written permission, except as required by law in one of the following circumstances: (1) Where there is reasonable suspicion that a client is likely to hurt him/herself or another person if protective measures are not taken. (2) Where there is reasonable suspicion of child or dependent elder abuse. (3) Where information is ordered by the court pursuant to a legal proceeding. In this case I will do everything in my power to minimize the amount of information provided.

Also, I may occasionally find it helpful to consult other professionals regarding my work. During consultation, I make every effort to avoid revealing the identity of my patients. The consultant is also legally bound to confidentiality. If you do not object, I will not tell you about these consultations unless I feel that it is important to our work together.

Please sign below, make a copy of this document for yourself, and return the original to me.
Michael Gray, Licensed Psychologist

I have read and understand the above guidelines and I consent to the conditions of treatment as outlined above.

Name:______________________________ Date:_____________________

Please Print

Signature:_______________________________________