Welcome and congratulations on taking a big step in reaching your goals. It takes a lot of work and drive to reach out and find good help so you must really want this! I applaud you for your effort and look forward to working together. This disclosure form answers many client questions about my services. Please feel free to ask questions if you need clarification or more information. Open and honest communication is how we will get the best results! Barbara
Services and Benefits: Our work together is a mutual, collaborative process. We will develop goals based on what you want to focus on. I will help facilitate your achievement of your objectives. Participation in therapy or coaching can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek assistance. In the end, I hope it serves your needs to connect better to yourself and others, and to embrace your own capacity to change your experience – whether it’s your mood, or how you react to situations and people. Sometimes it is about coming to see reality as it is, and finding ways to be more at peace with it all.
Risks: I encourage you to be open and honest with yourself. Allow for times when things might not be so comfortable. You might face aspects of reality more directly and possible choices that you have been avoiding and this might be upsetting or hard to be with. Perhaps you already know this on some level.
Remembering or talking about unpleasant events, feelings or thoughts can result in your experiencing considerable discomfort, anger, sadness, worry, etc. or experiencing anxiety, depression, insomnia, etc. Working to resolve personal growth issues may result in changes that were not originally intended.
Sometimes a decision that is positive for one person might be viewed negatively by others in their life. Some clients report their increased awareness can make it feel more intense or worse temporarily before it gets better. There is also no guarantee that therapy will yield positive or intended results. I will use my professional skills to the best of my abilities to help manage possible risks.
Duration: Change will sometimes happen quickly, but more often it will take time and patience. There are a lot of different models on how people do their work. Some people prefer a weekly session and some biweekly or once a month. After we have established a base relationship and have worked on the current issue, some clients suspend meetings until events in their life cause them to reach out to me again. Others come for just a few sessions and we focus on a few defined objectives and then end.
Others prefer a longer relationship where we address not only the existing issue but the new ones that might arise as they go about their daily living. As the client you decide; naturally I will share my views on duration and possible goals but this remains your growth work and I embrace your empowerment.
Process: It is important to honor the commitment you have made to meet and to take an active role. It is helpful if you: (1) spend time between scheduled sessions thinking about what we discussed and you have learned; (2) follow through on any actions you agreed to take; (3) Experiment and practice with new behaviors; (4) take the initiative to bring up issues or topics to talk about at the next session. I will utilize various approaches according to the issue that is being treated and my assessment of what will best benefit you. As I get to know you I am able to customize the strategy for your particular objectives and personality. I am open to how personal growth can take different possible forms including walking outside, drawing pictures, and/or using props/objects. I prefer for it to be interactive so I invite you to give feedback about the process and progress. My approaches include but are not limited to hypnosis cognitive-behavioral, psycho-educational, active coaching, AIT and others.
Cancellations: The time scheduled for your appointment is reserved for you. If you need to cancel or reschedule a session, I ask that you provide me with 24 hours’ notice. If you miss a session or cancel with less than 24 hour notice, it will be your responsibility to pay for the session. It is important to note that insurance companies do not provide reimbursement for cancelled sessions. If you forget to appear for a scheduled session (and also forget to call in advance to let me know) 2 two times, I may, at my discretion, provide you with a referral for other counseling opportunities that might be able to accommodate your situation.
Late For Session: If you are running late, as long as you call to let me know, I’ll wait and hold the time slot for you. If I have not heard from you, I will attempt to contact you. If I don’t receive a call from you I will wait for 15 minutes after our appointed time, after which I will consider it a missed session and I may leave the office to attend to other things. Please be aware if you are late, your appointment will still need to end on time.
Session Duration: The standard appointment is ordinarily 50 minutes in duration and I leave a cushion of a few minutes to schedule the next session. I will let you know when there is 5 minutes left in the session so we can begin our conclusion. Clients sometimes choose to schedule longer sessions. This is best arranged in advance however if you decide you would like to extend a session while you are in it, tell me and if time permits on the schedule we can continue our work. The amount of time is billed in fractions of the same initial hourly rate.
Confidentiality: With very few exceptions, the information discussed during your session and all documentation (written or in any other medium) is kept private and confidential. Some important exceptions to this rule are listed in the notice of privacy document that is provided separately.
Technology and Confidentiality: Some clients may choose to use technology in their sessions. This includes but is not limited to video conferencing, telephone, email, text or chat. Due to the nature of online communication, there is always the possibility that unauthorized persons may attempt to discover your personal information. I will take every precaution to safeguard your information but cannot guarantee that unauthorized access to electronic communications could occur. Please be advised to take precautions with regard to authorized and unauthorized access to any of your technology used in your sessions. Be aware of any friends, family members, significant others or co-workers who may have access to your computer, phone or other technology used in your sessions.
Our Relationship: The relationship itself can be an important part of the process in coaching/therapy. It can illuminate habits and ways of interacting. We can use it to practice new ways of relating. Please keep in mind this is however a professional relationship therefore I am not able to engage in social activities. If we happen to see each other outside of the professional setting, in an effort to protect your privacy I will NOT acknowledge knowing you unless you initiate the exchange.
My Qualifications and Experience: I began my helping career as a scientist with the Navy environmental protection department as a civilian. I then decided to return to school to complete a PHD in Clinical and Health Psychology as well as further in-depth training in coaching, hypnosis and peak performance in order to help clients overcome challenges and live their best life.
Fees and Payment: Fees are up to date on the website. Payment is to be made before or at the time of service and may be by cash, check, or credit card. A 30 day notice will be given of any changes to fees. For initial sessions, payment is made via electronic invoice prior to session.
Insurance: I am "out of network" for insurance rather than on a "preferred provider list" of any particular insurance company. Please know that when any agency (such as a health insurance company) is involved, your confidentiality may be affected. Many insurance plans require submission of information about your therapy for review and authorization of services and justification for reimbursement. Insurance companies also require a diagnosis. Using an out of network provider usually gives you more freedom and privacy because insurance companies don’t tend to require as much detail. In-network providers are required to give more detail because the insurance company pays more of the cost. This being said, if you want to use insurance you will need to be given a diagnosis regardless if you use an in-network or out of network provider. If you have a security clearance, knowing this information can be very helpful. The military has become more accepting of mental health services though. If you do not wish to involve your insurance, than a diagnosis is not necessarily needed and often not given.
Contact: Please use my email as the primary means of contact, info@drcoxconsulting.com. My usual business hours are weekdays Monday – Thursdays 10am - 6:00pm. Often I am unable to answer phone calls as I do not answer the phone when I am in session with clients. If I am unable to answer the phone, please leave me a message. I check my messages during business hours and I will return your call as soon as I can, usually within 24 hours. You are welcome to leave a voice mail at any time, but I may not be able to retrieve your message until business hours. If using text or email, you acknowledge the understanding that these are not necessarily secure and confidential mediums of communication. If you communicate confidential or private information via unencrypted digital communication, text, email, or phone messages, I will assume that you have made an informed decision. Before sending you any initial email or text, I will ask for your verbal permission to do so. Except for matters of scheduling, please save other questions and interpersonal sharing for our scheduled sessions.
After hour Emergency: For after-hours emergencies, if you need immediate assistance, or are feeling suicidal go to the nearest hospital emergency room and/or call 911. You can also contact your medical group, primary care physician, or visit the emergency department of your local hospital.
Drug use: Please come to sessions not under the influence of mind/mood-altering drugs (except for prescriptions), whatever that may mean for you. I see our work as about learning to be with reality as it is.
Notes: Sometimes I may take notes while we talk. It helps my work with you.
Touch: Our sessions may include directing one’s awareness towards the body as emotion is often felt somatically. While different cultures may include gestures of touch such as handshakes and hugs, I wish to respect and defer to your preferences. We can discuss the issue of contact and how we shall handle scenarios such as greetings and goodbyes.
Peer Consultation and/or Supervision: As is common practice and encouraged in this field, I sometimes consult and seek supervision with another professional about my assessment, treatment, and/or questions about your case. Identifying information is not shared so as to protect your confidentiality. All of the consultants are ethically and legally bound to maintain confidentiality.
Parents & Children: Children need to understand that their parents have a right to know what goes on in session, but rather than reporting back what is said, I may discuss how things are going. I want both the child and the parent to know that it’s important for the child to feel like what he or she is saying will be kept private.
Endings: Your participation in this process is voluntary and you have the right to end whenever you want. However, if you do decide to exercise this option, I encourage you to talk with me about the reason. I ask that you allow a final session for us to review the work we’ve done, offer feedback, and have an ending with each other. Likewise, at my discretion, I reserve the right to end our work together and provide you with appropriate referrals, for reasons including but not limited to, failure to participate, untimely payment of fees, or my belief that I may not be the best person for your needs. If you request and authorize in writing, I will talk to the provider of your choice in order to help with the transition.
RIGHT TO REVOKE THIS CONSENT You have the right to revoke this consent in writing and terminate services. I have read and understand the information on these sheets. My signature indicates my adherence to all the policies contained within this Informed Consent for Services with Barbara Cox, PhD
