Psychotherapy is a very personal and life changing experience. Your own motivation for growth in therapy will largely determine how much you will benefit from it. In order to best enhance your chances of successful change and growth it is important that you understand your rights and obligations regarding the serious commitment of psychotherapy.

Psychotherapy can be a very healing experience yet it must proceed according to a set structure for the benefit of all parties - for you and your therapist. Because policies differ from setting to setting and from psychotherapist to psychotherapist I've outlined my policies to give you an idea of how I handle these matters. These policies describe basic operating procedures of the business side of my psychotherapy practice. I've found that when these guidelines are adhered to it permits the focus of therapy to be on the important healing work. Of course if you have concerns or reservations about any aspect of these policies we can discuss them in further detail so as to meet your specific needs when possible. If meeting these guidelines presents a hardship, you may be better served by finding a clinic or therapist with different policies that meet your requirements. I am convinced that it is very beneficial for the patient and potential therapist to spend time in the beginning stage of therapy making sure there is a good fit for the therapeutic work to have its best chance of succeeding. Please take time to review the office policies described below in order to acquaint yourself with my operating procedures and what is expected of you to allow the therapy to most effective.

FEE:
Currently my standard fee for individual, couple, or family 50-minute sessions is $125. I do offer flexibility or a sliding scale upon demonstration of need. Payment is due at the time of treatment, payable by cash or check to Robert Piehl, Ph.D. There will be a $15 charge for checks returned for insufficient funds. If your ability to pay is seriously compromised at this time you may be served by low-fee clinics in the area. These clinics are structured to serve persons of varied financial means. You can receive competent treatment at low-fee clinics especially if the clinic is a training center for newer therapists. My experience and training permit me to work at an advanced level and my fee structure reflects this capacity.

INSURANCE RE-IMBURSEMENT:
Insured clients are expected to pay full fee each session and do their own insurance billing. Some insurance companies provide partial payment for psychotherapy. Such coverage is considered part of the patient's ability to pay and the responsibility of the patient to collect. You are responsible for any portion of your bill not covered by your insurance (e.g. annual deductible, co-payments etc.). Verification of benefits is not a guarantee of payment. Please check carefully with your insurance company about your specific coverage.

There are very many kinds of mental health insurance available in the market today. These plans vary widely and have unique and specific aspects such that it is impossible for me to catalogue the myriad policies offered by numerous insurance companies. Therefore, it is your responsibility to know the type of coverage you carry and the limits of that coverage. Often companies offer a higher percentage of fee coverage for those therapists enrolled on their panel. They pay a lesser amount or percentage to therapists not enrolled on their panel.

I have intentionally chosen not to become a part of insurance panels because I do not want these companies to dictate the kind of therapy I provide or to set limits on the amount of time I can work with a given patient. The healing work of therapy should not be beholden to insurance companies whose main concern is economic bottom lines. Insurance companies insist on viewing counseling or psychotherapy through a "medical model" lens. This means that a diagnosis of mental illness is required for payment re-imbursement and this label becomes a permanent part of your medical history. The therapeutic focus is on symptom remission only and doesn't allow for continued emotional and psychological growth.

The state of mental health insurance coverage in these times is far from adequate and the solutions are complex. In the meanwhile, I invite you to consider your priorities. While economic considerations are an important part of choosing how to enter therapy they should not be the guiding principle. For example, many of my patients have been dissatisfied with "brief" therapy models required by insurance companies that only address surface issues - some patients want to go deeper to get at the more complex, core issues they may be dealing with. Others are unable to find Christian therapists within their insurance companies' panel and have elected to seek treatment outside the system for their own benefit. Please realize that insurance coverage is a bonus when seeking treatment and does not reflect limits to your access to needed services. Additionally, it can feel incredibly empowering to take charge of your own healing process and hold entire responsibility for your own growth.

CANCELLATION POLICY:
In order to be effective, therapy needs to take place on a regular basis. The best results occur when appointments are consistently scheduled and regularly attended. Put differently, missed appointments inevitably slow the healing work and jeopardize treatment continuity (time is lost in the next session by having to catch up with all that has gone on between sessions). The process of psychotherapy is a serious commitment to growth and needs to be prioritized to maximize its effectiveness. Rescheduling appointments is much preferred over cancellation due to the need to maintain treatment continuity. These considerations and my need to maintain a consistent schedule are the reasons for my cancellation policy: Appointments cancelled with less than 24 hours notice will be charged a cancellation fee at the price of the therapy hour. This is standard policy within the counseling profession.

TERMINATION:
The patient's therapeutic relationship with the therapist continues as long as the therapist is providing professional services and until the patient informs the therapist, in person or in writing that he or she wishes to terminate therapy, or the therapist notifies the patient that therapy is being terminated. It is customary that the patient gives the therapist at least one week's notice before stopping therapy.

CONFIDENTIALITY:
All information disclosed within the patient's therapy sessions, including case notes and records, will be treated as confidential and, under some circumstances, as privileged. No information will be revealed to anyone not present in therapy without the permission of the client or a legally authorized representative unless an applicable legal or ethical exception exists. However, the therapist is required by law to report any suspected child, spousal, elder or dependent adult abuse and any situation where the patient threatens violence to an identifiable victim. All actual or suspected acts of such abuse will need to be reported to the appropriate agency. The law also permits the therapist to break confidentiality when the patient presents a danger of violence to others or is likely to harm him or herself unless protective measures are taken. In addition, disclosures may be required in certain legal proceedings and actions.

Some courts have held that if an individual intends to take harmful, dangerous, or criminal action against another human being, or against him or herself, it is the therapist's duty to warn appropriate individuals of such intentions. Those warned may include a variety of persons such as: the person or family of the person who is likely to suffer the results of harmful behavior, the family of the patient who intends to harm him or herself or someone else, associates or friends of those threatened or making threats, and Law enforcement officials. Before informing anyone who should be warned, the therapist will take all possible steps to share that intention with the patient. Every effort will be made to resolve the issue with the client so as to prevent such breach of confidentiality.

CONTACTING THE THERAPIST:
Between therapy appointments, or in case of emergency, the patient can leave a message by calling (503) 750-1701. Days and hours of availability for sessions are Monday through Friday 8:00 am to 7:00 pm. Calls will be returned as soon as possible.

TREATMENT OF MINORS AS INDIVIDUAL PATIENTS:
When a patient who is a minor is in individual therapy, the parent or guardian has the right to ask for information about the minor's therapy, and the therapist, acting in the best interest of the minor patient, has the right to limit the amount of information disclosed.

If the minor patient is a participant in any legal proceedings raising the protection of all client/therapist communications as "privilege," then no disclosure will be made of any of the content of the therapy except by written waive of privilege, given in writing by the parent, guardian or other lawful representative acting on behalf of the minor patient.