Office Policies and Informed Consent for Treatment
Jessica Farber, Psy.D.
CA Licensed Psychologist, PSY 22360
3880 S. Bascom Ave., Suite 202, San Jose, CA 95124
Phone: (408) 981-8676, Fax: (408) 371-9193
This form provides you with information about my practice. Please read all of it and when you come in for your first appointment, I will provide you with a page to sign to indicate that you have read and understood it, and that you consent to treatment.
Confidentiality: The meetings between a patient and his or her psychotherapist are confidential and legally privileged. Information discussed in session will not be released to anyone without your written permission, except where disclosure is required by law. There are important situations when I am legally and ethically required to release certain information. These include the following situations:
Release of Information and Records: California Law requires that I keep appropriate treatment records during treatment and for at least seven years after the termination of treatment. Treatment records include, but are not limited to, your contact information and brief notes on each session including date, time, session length, fee, mental status, diagnosis, assessment, intervention and goals. The following situations relate to release of records that do not involve emergency situations or legal requirements.
Emergency Procedures: If you have a life-threatening emergency situation between sessions, please leave me a message on my mobile phone at (408) 981-8676, and then hang up and dial 911 or Emergency Psychiatric Services at (855) 278-4204. In order to maintain safety, psychiatric hospitalization is sometimes necessary. If I am out of town, I will designate a back-up therapist who will see you while I am gone if you have an emergency. I will leave contact information about this person on my outgoing voicemail message. Please do not contact me via voicemail at (408) 327-9367, fax or email for emergency situations, as I do not check these on a daily basis.
Length and Frequency of Sessions
Cancellation Policy: Once we agree to meet and an hour is reserved for you, you are responsible for payment for that session. If you cannot keep a scheduled appointment, you must provide me with 24 hours advance notice to cancel or reschedule your appointment, to avoid being charged for a missed session. If you cancel less than 24 hours in advance of a session, you will be charged for that session. I do make some exceptions to this rule upon my discretion, if the session can be rescheduled within the next two business days after the canceled appointment.
Email and Text Messaging Consent: If you desire, you can communicate with me via email or text messaging. By using these methods of communication, you are confirming that you are aware of the risks to your confidentiality that these communications hold. All email and text messages are routed through computer servers that may allow other people access any private health information included in these messages. Please be aware of these risks to your confidentiality and make decisions about these forms of communication in an informed way.
Consent for Minor Clients: California law stipulates that only one parent is required to consent to the treatment of a minor client. However, my policy is to receive consent from both parents, whether they are married, separated or divorced. Having agreement among parents about treatment is helpful to facilitate reaching therapeutic goals. In addition, even noncustodial parents have the legal right to access their children’s therapy records. Therefore, I will ask both parents to attend the initial session, or if this is not possible, to have a phone conversation and obtain consent in writing from the parent who cannot attend.
Benefits and Risks of Therapy, and Scope of Practice: By participating actively in therapy, you can receive benefits including improved relationships and the reduction of mental health symptoms such as depression or anxiety. By changing your thoughts and behaviors, you may enjoy benefits beyond the scope of the problem for which you originally sought therapy. During therapy, thinking about or talking about unpleasant situations or memories can be painful and lead you to feel sad, angry, worried or afraid. Change may be fast, but more often occurs as a slow process. There is no guarantee that therapy will yield positive or intended results. During therapy, I will choose therapeutic interventions that apply to your unique situation, which may include behavioral, cognitive-behavioral (CBT), psychodynamic, family systems, humanistic, Eye Movement Desensitization and Reprocessing (EMDR) and psycho-educational interventions. I do not provide medication consultation or prescription, child custody evaluation, legal advice or legal services, as these fall outside my scope of practice.
Dual Relationships: A dual relationship happens when a client and therapist have contact in another context besides therapy, for example, attending the same church. Dual relationships are clearly unethical if they impair the therapist’s objectivity or clinical judgment or they are exploitive to the client. Sexual contact between client and therapist is always illegal and unethical. A non-exploitive, legal, dual relationship may be of benefit to a client in therapy. If I find that I am in a dual relationship with you, I will discuss possible benefits and difficulties that may be involved. It is your responsibility to communicate to me if the dual relationship becomes uncomfortable in any way.
Termination of Treatment: Ideally, termination (or ending treatment) occurs when you feel that you have reached the goals for which you came to therapy. During our first meeting, I will assess whether or not I can be of benefit to you. If I feel that I cannot help you, I will refer you to a more appropriate treatment. If, during the course of therapy, I feel that I am not helping you reach your therapy goals, or you are not compliant with treatment (including attending therapy sessions regularly), I will provide you with referrals to other professionals that may be able to serve you better. You have the right to stop therapy at any time. If you request it and sign an authorization, I would be happy to speak to your new therapist on your behalf to make the transition smoother.