Policies and Consent for Treatment
Welcome to Pieces of Me, LLC! We look forward to working together with you to achieve your goals. There are a few ground rules we need to establish before we get started. Here are some of the policies we follow that may affect you:
Cancellations: Cancellations/rescheduling must be arranged at least 24 hours before the session. If a session is missed or cancelled/rescheduled within 24 hours of the session, you will be charged a $40 cancellation fee. If you are 15 minutes late or more to a session, it will be cancelled/rescheduled. An EAP or insurance company will not pay for the late cancel or missed appointment. In case of inclement weather, a challenge with transportation, or any reason you are unable to reach our office for an in-person session, you can opt to attend the session via video telehealth appointments. Otherwise, the session will be cancelled. If you come to your session under the influence of drugs or alcohol, the therapist may end the session early, and you will be liable for the full payment of the session.
Session Length: Counseling sessions range in length from 30 to 55 minutes, depending on the type of session, cost, and coverage.
Payments: Payments are due at the time of service for in-person sessions. Payment for video sessions must be received prior to the session via credit card, cash or check. We reserve the right to release your information to a collection agency to collect unpaid fees or cancel scheduled sessions due to an outstanding balance, if necessary. You are permitted to have a maximum of one outstanding session fee at a time in order to schedule another session. You may be refused service for non-payment of fees. Outstanding fees denied or not otherwise covered by an insurance company or EAP will be the responsibility of the client, regardless of prior quote of coverage. It should be noted it is the client’s responsibility to ensure their insurance coverage is active and up to date.
Pieces of Me, LLC will store debit or credit card information online in a secure and HIPAA compliant database to more conveniently bill for session fees, copays, deductibles, and cancellation fees. If you would prefer not to have your payment information stored, please coordinate with your therapist to arrange payment that is in compliance with payment policies.
Record Keeping: We will keep brief records of our sessions. Under the provision of the Health Care Information Act of 1992, you have the right to a copy of your file at any time. You have the right to request that we correct any errors in your file. You have the right to request that we make a copy of your file available to other health care provider(s) at your written request. We typically maintain records for 7 years following termination of therapy, and destroy records in a manner that preserves your confidentiality.
Limitations of Services: We do not offer 24-hour-care. If you need after-hours care, we will assist you in finding the proper resources. Our office correspondence is not monitored at night or on weekends or holidays. It is not intended for emergency correspondence. If this is an emergency, please call your doctor, dial 9-1-1, or go to the nearest emergency department. For psychiatric emergencies, you may contact the Boystown National Hotline by calling 800-448-3000 or Text VOICE to 20121. CommonSpirit (formerly known as CHI) by calling (402) 717-HOPE (4673), National Suicide Prevention Lifeline, 1 (800) 273-TALK, or texting 988 24 hours a day for assistance.
Purposes & Goals: Psychotherapy can have many purposes, such as to improve mental health and wellbeing, improve communication skills, build healthier relationships, heal from trauma, create healthier habits, and more. Your therapist will work with you to outline your unique goals in a treatment plan, and will discuss with you our working understanding of the problems/diagnosis, results and implications of any assessment tools or tests used, therapeutic objectives, and possible outcomes of treatment. We aim to help you create measurable and achievable goals, and will review progress with you periodically during the course of treatment. You can refuse services or recommendations at any time, and we will discuss alternatives for you. If you have questions or concerns about your treatment plan, please discuss them with your therapist.
Potential Risks & Benefits: Psychotherapy is a process in which we will discuss a myriad of issues, events, experiences, and memories for the purpose of creating positive change. It provides an opportunity to more deeply understand oneself, as well as any problems or difficulties you may be experiencing. Psychotherapy is a joint effort between client and therapist. Progress and success may vary depending on many factors. Participating in therapy may result in a number of benefits including, but not limited to reduced stress/anxiety, decreased negative thoughts, decreased self-sabotaging behaviors, improved interpersonal relationships, increased comfort in social, work and family settings, increased capacity for intimacy, and increased self-confidence. Such benefits may also require substantial effort on your part, including active participation in the therapeutic process, honesty with your therapist and yourself, and willingness to change feelings, thoughts and behaviors. There is no guarantee that therapy will yield all or any of the benefits listed above. Benefits are more likely to occur if clients make a good faith effort in therapy.
Participating in therapy may also involve some discomfort, including remembering and discussing unpleasant and traumatic events, feelings and experiences. The process may evoke strong feelings of sadness, anger, fear, anxiety, etc. There may be times in which we will challenge your perceptions and assumptions and offer different perspectives. The issues presented by you may result in unintended outcomes, including changes in personal relationships. Sometimes, a decision that is positive for one family member, is viewed quite differently by another. You should be aware that any decision on the status of your personal relationships or regarding your personal life is solely your responsibility. During the therapy process, many people find that they feel worse before they feel better. This is generally a normal course of events.
Personal growth and change may be easy and swift at times, but may also be slow and frustrating. You should discuss your concerns about progress with your therapist. Due to the varying nature and severity of problems and individuality of each client, we are unable to predict the length of therapy or guarantee a specific outcome.
How Family Members Can Help: If a friend or family member is able to offer healthy support, it can help you in the therapeutic process. They could potentially attend a session with you, listen to you, help with tasks, or hold you accountable for changes you are making. Feel free to discuss this with your therapist for more information. Each individual that attends a session for support will need to have a signed release of information form in order to participate.
If you participate in couples or family therapy, we adhere to a “no secrets” policy. This means that we do not keep information gathered in individual conversations (including phone or email) secret if the revealed information violates the integrity of the therapy.
Child Treatment Policy: We believe that privacy is important in developing trust and the overall success of therapy. It is our policy to share general information about treatment status with parents/guardians of minors under the age of 18 years old. We will not share what your child has disclosed to us without your child’s consent. At age 18 or older, minors are allowed to consent to treatment without a parent’s consent in the State of Nebraska. Minors 18 years and older can sign a release of information form for their therapist to provide certain information to the parent. If we ever believe that your child is at serious risk of harming him/herself or anyone else, we will inform you. We will not testify in court or give opinions about custody or parenting plans.
Ending Treatment: You normally will be the one who decides counseling will end, with a few exceptions:
If we are not, in our judgement, able to help you because of the kind of problem you have or because our training and skills are not appropriate, will inform you of this fact and refer you to another therapist who may meet your needs.
If you are violent or threatening toward your therapist, our office, or our family members, we reserve the right to terminate you unilaterally and immediately from treatment.
If you miss 2 or more sessions without at least 24 hours notice, we reserve the right to terminate therapy with you.
In the unlikely event of your therapist’s incapacitation or death, you will receive notice from other therapists or owners of the practice for coordination of care and resources.
If we end counseling with you, we will offer you referrals to other sources of care, but cannot guarantee that they will accept you for therapy.
You may discontinue therapy at any time. We recommend developing a plan for discontinuation with your therapist prior to termination of care.
Technology: Distance counseling includes phone sessions, email counseling and online video sessions. Emails involve requests for advice, guidance, to be listened to, or any other therapeutic reasons are considered email counseling. If you are interested, we will discuss with you if distance counseling is an appropriate treatment option. It is not recommended in all cases. Distance counseling is a different experience compared to in-person sessions. There can be a lack of face-to-face interactions; lack of non-verbal communication including visual and audio cues that are often relied on in personal communication; and issues regarding technology failure.
If distance counseling is deemed appropriate and necessary, comprehensive benefits, limitations, and boundaries surrounding distance counseling will be discussed. Fees for phone or online video sessions are the same as in-person sessions. Email counseling fees are standard at $20 per page of communication, and evaluated individually.
Emails can be used for asking simple questions, asking about rescheduling a time, a quick update, etc. Email may also be used for appointment reminders and self-help information. A HIPAA-compliant program called Simple Practice will be used to schedule sessions and communicate reminders. If you would prefer not to use email/app communication, please let us know.
Complaints: We encourage you to discuss any concerns or complaints directly with your therapist. You also have the option to contact your therapist’s licensing board for complaints; we can provide those specific phone numbers upon request.
Professional Consultation: Professional consultation is an important component of a healthy psychotherapy practice. As such, we regularly participate in clinical, ethical and legal consultation with appropriate professionals. If such consultations are with other Pieces of Me, LLC employees, we may use your name and other personally identifying information. Pieces of Me, LLC staff has limited access to your records. If such consultations are with individuals outside of the agency, we will not reveal any personally identifying information regarding you or your situation, unless you have signed a release of information for that individual.
Children: Children under 12 must be supervised outside of the session room by an adult during sessions.
Cell Phones: Please refrain from using cell phones during sessions. Please note that audio or video recording of sessions is not permitted.