Office Policies and Therapy Agreement

KRISTINA YARBROUGH, LMFT

Psychologies of the South, LLC

 

This form provides you, the client, with information that is additional to that detailed in the Notice of Privacy Practices and it is subject to HIPAA preemptive analysis.

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CONFIDENTIALITY: All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission except where disclosure is required by law.

WHEN DISCLOSURE IS REQUIRED OR MAY BE REQUIRED BY LAW: Some of the circumstances where disclosure is required or may be required by law are: where there is a reasonable suspicion of child, dependent, or elder abuse or neglect; where a client presents a danger to self, to others, to property, or is gravely disabled; or when a client's family members communicate to Kristina Yarbrough, LMFT that the client presents a danger to others.

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Disclosure may also be required pursuant to a legal proceeding by or against you. If you place your mental status at issue in litigation initiated by you, the defendant may have the right to obtain the psychotherapy records and/or testimony by Kristina Yarbrough, LMFT.

In couple and family therapy, or when different family members are seen individually, even over a period, confidentiality and privilege do not apply between the couple or among family members, unless otherwise agreed upon. Kristina Yarbrough, LMFT will use her clinical judgment when revealing such information and will only share information if necessary for therapeutic gains (as stated in client’s therapy goals).

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Kristina Yarbrough, LMFT will not release records to any outside party unless she is authorized to do so by all adult parties were part of the family therapy, couple therapy or other treatment that involved more than one adult client.

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EMERGENCY DURING THERAPY: If there is an emergency during therapy, where Kristina Yarbrough, LMFT becomes concerned about your personal safety, the possibility of you injuring someone else, or about you receiving proper psychiatric care, she will do whatever she can within the limits of the law, to prevent you from injuring yourself or others and to ensure that you receive the proper medical care. For this purpose, she may also contact the person whose name you have provided on the biographical sheet.

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LITIGATION LIMITATION: Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters which may be of a confidential nature, it is agreed that, should there be legal proceedings (such as, but not limited to divorce and custody disputes, injuries, lawsuits, etc.), neither you nor your attorney(s), nor anyone else acting on your behalf will call on Kristina Yarbrough, LMFT to testify in court or at any other proceeding, nor will a disclosure of the psychotherapy records be requested unless otherwise agreed upon.

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DIVORCED FAMILIES: In the event of divorce, it is Kristina Yarbrough, LMFT’s policy that you provide her with a copy of the part of your divorce decree which pertains to custody of the minor child, and right to consent for medical/psychological services before she can provide services.

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CONSULTATION: Kristina Yarbrough, LMFT consults regularly with other professionals regarding her clients; however, each client's identity remains completely anonymous, and confidentiality is fully maintained.

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E–MAILS, CELL PHONES, COMPUTERS, AND FAXES: It is very important to be aware that computers, texts and e-mail communication can be relatively easily accessed by unauthorized people and hence can compromise the privacy and confidentiality of such communication. Faxes can easily be sent erroneously to the wrong address. E-mails are vulnerable to unauthorized access since Internet servers have unlimited and direct access to all e-mails that go through them.

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It is important that you be aware that e-mails, faxes, and important texts are part of the medical records. Additionally, Kristina Yarbrough, LMFT’s e-mails are not encrypted. Kristina Yarbrough, LMFT’s computers are equipped with a firewall, a virus protection, and a password.

It is strongly suggested that messaging within the HIPAA-compliant Therapy Appointment portal be utilized due to the platform having higher security than email and text.

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If you communicate confidential or private information via e-mail and/or text Kristina Yarbrough, LMFT will assume that you have made an informed decision, will view it as your agreement to take the risk that such communication may be intercepted, and will honor your desire to communicate on such matters via e-mail. Please do not use e-mail, messaging, text or faxes for emergencies. (Emergency Procedures are stated below)

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RECORDS AND YOUR RIGHT TO REVIEW THEM: Both the law and the standards of Kristina Yarbrough, LMFT’s profession require that she keep treatment records for at least 7 years. Unless otherwise agreed to be necessary, Kristina Yarbrough, LMFT retains clinical records only as long as is mandated by Texas law. If you have concerns regarding the treatment records, please discuss them with Kristina Yarbrough, LMFT.

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As a client, you have the right to review or receive a summary of your records at any time, except in limited legal or emergency circumstances or when Kristina Yarbrough, LMFT assesses that releasing such information might be harmful in any way. In such a case, Kristina Yarbrough, LMFT will provide the records to an appropriate and legitimate mental health professional of your choice. Considering all the above exclusions, if it is still appropriate, and upon your request, Kristina Yarbrough, LMFT will release information to any agency/person you specify unless Kristina Yarbrough, LMFT assesses that releasing such information might be harmful in any way.

When more than one client is involved in treatment, such as in cases of couple and family therapy, Kristina Yarbrough, LMFT will release records only with signed authorizations from all the adults (or all those who legally can authorize such a release) involved in the treatment.

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TELEPHONE & EMERGENCY PROCEDURES: If you need to contact Kristina Yarbrough, LMFT between sessions for non-urgent matters, please email (if personal information will not be shared) or message in the portal (if personal information will be shared); and for urgent matters and emergencies, you may call Kristina Yarbrough, LMFT, and your call will be returned as soon as possible. Kristina Yarbrough, LMFT checks her messages (phone, portal messages and emails) a few times during the daytime only.

If Kristina Yarbrough, LMFT takes leave for vacation or other reasons, you will be notified of any changes in Kristina’s availability to respond to urgent matters and/or emergencies.

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If an emergency arises, and if you need to talk to someone right away, please call 911.

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Please do not use e-mail or text for emergencies.

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VIRTAL SESSION FORMAT

Kristina Yarbrough, LMFT uses Therapy Appointment for all virtual sessions. Kristina Yarbrough, LMFT ensures that she is in a location for the sessions where others cannot hear nor see any content of the session.

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It is required by law that clients must also be alone, and in a space without others able to hear or see the therapy session. If interruptions of privacy occur, simply let Kristina Yarbrough, LMFT know to “pause” until privacy is restored.

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FEES AND CANCELLATION POLICY:

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50 minutes, individual therapy: $175.00

**Additional minutes will be charged at $3.00 per minute, and additional time may only be allowed when client and Kristina Yarbrough, LMFT have made an agreement upon an additional amount of time (15-minutes, 20-minutes or 30-minutes). Additional minutes are offered for individual sessions only.

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75 minutes, family or couple’s sessions: $225

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**50-minute sessions are not available for family and couples. 

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Sliding-Scale rates may be offered and range from $70-$100. Kristina Yarbrough, LMFT makes the sliding scale rate determination based upon need. There are limited sliding scale spaces.

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Payment is expected BEFORE the session begins. If you have not made the session payment when the session begins, we will use session time for sending payment.

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If you need to cancel an appointment, you are responsible for canceling the appointment in Therapy Appointment. If you have any issues with the portal, please contact Kristina Yarbrough, LMFT via email and she will assist you with the cancelation.

 

Appointments not cancelled in less than 24-hours before the scheduled session will be charged the full session rate. This fee is due the day of the missed session.

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Sessions cancelled due to emergency reasons (i.e., car accident) will not be charged a missed session fee. Please contact Kristina Yarbrough, LMFT when possible, to inform her of the emergency.

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PAYMENT: Kristina Yarbrough, LMFT accepts payment via the HIPAA-compliant Venmo application only. The application is set to “private”, which makes all transitions with Kristina Yarbrough, LMFT unable to be seen by anyone other than Kristina Yarbrough, LMFT. The ID for payments is @Kristina-Yarbrough-2

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MEDIATION & ARBITRATION: All disputes arising out of, or in relation to, this agreement to provide psychotherapy services shall first be referred to mediation, before, and as a pre- condition of, the initiation of arbitration. The mediator shall be a neutral third party chosen by agreement of Kristina Yarbrough, LMFT and the client(s). The cost of such mediation, if any, shall be split equally, unless otherwise agreed upon.

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If mediation is unsuccessful, any unresolved controversy related to this agreement should be submitted to and settled by binding arbitration in Texas in accordance with the rules of the American Arbitration Association which are in effect at the time the demand for arbitration is filed.

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Notwithstanding the foregoing, if your account is overdue (unpaid) and there is no agreement on a payment plan, Kristina Yarbrough, LMFT can use legal means (court, collection agency, etc.) to obtain payment. The prevailing party in arbitration or collection proceedings shall be entitled to recover a reasonable sum as and for attorney's fees. In the case of arbitration, the arbitrator will determine that sum.

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THE PROCESS OF THERAPY: Participation in therapy can result in a number of benefits to you, your family and/or your child, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits, however, requires effort and time. There is no guarantee that psychotherapy will yield positive or intended results. During therapy, Kristina Yarbrough, LMFT is likely to draw on various psychological approaches according, in part, to the problem that is being treated and her assessment of what will best benefit you. These approaches include, but are not limited to depth psychologies, Dialectical Behavioral Therapy, somatic and mindfulness modalities, Family Systems, trauma healing modalities, psychoanalysis, and psycho-education. Kristina Yarbrough, LMFT has obtained high levels of training in higher education institutions and within the counseling/mental health community, and has many years of experience offering these and other healing modalities to clients and community, and she continues to read relevant research for the benefit of her clients and for the efficacy of the healing modalities utilized in therapy. 

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Kristina Yarbrough, LMFT provides neither custody evaluation recommendation nor medication or prescription recommendation nor legal advice, as these activities do not fall within her scope of practice.

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RISKS: There are risks associated with entering the therapy process. The goal of therapy is to change the negative symptoms you or your child is experiencing. Sometimes, when an individual begins the therapeutic process, symptoms initially become worse as the individual develops insight and introspection. It is not uncommon for a child’s behaviors to initially seem worse. You have the right to end therapy at any time. However, it is common for individuals to want to quit therapy just as the difficult (and important) work is beginning. Kristina Yarbrough, LMFT encourages you to discuss your concerns about treatment with her at any time.

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TREATMENT PLANS: Throughout treatment, Kristina Yarbrough, LMFT will discuss with you her working understanding of the problem, treatment plan, therapeutic objectives, and her view of the possible outcomes of treatment. If you have any unanswered questions about any of the procedures used during your therapy, their possible risks, Kristina Yarbrough, LMFT’s expertise in employing them, or about the treatment plan, please ask and you will be answered fully. You also have the right to ask about other treatments for your condition and their risks and benefits.

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DUAL RELATIONSHIPS: Despite a popular perception, not all dual or multiple relationships are unethical or avoidable. Therapy never involves sexual or any other dual relationship that impairs Kristina Yarbrough, LMFT’s objectivity and clinical judgment or that can be exploitative to clients. It is important to realize that in some communities, particularly small towns, military bases, university campus, etc., multiple relationships are either unavoidable or expected.

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Kristina Yarbrough, LMFT will never acknowledge working with anyone without his/her/their written permission. Many clients have chosen Kristina Yarbrough, LMFT as their therapist because they knew her before they entered therapy with her, and/or are personally aware of her professional work and achievements. Nevertheless, Kristina Yarbrough, LMFT will discuss with you the often-existing complexities, potential benefits and difficulties that may be involved in dual or multiple relationships if you have questions regarding this matter.

 

Kristina Yarbrough, LMFT will not be connected to clients on social media or other platforms with personal accounts and pages.

Dual or multiple relationships can enhance trust and therapeutic effectiveness but can also detract from it and often it is impossible to know which ahead of time. It is your responsibility to advise Kristina Yarbrough, LMFT if the dual or multiple relationship becomes uncomfortable for you in any way. Kristina Yarbrough, LMFT will always listen carefully and respond to your feedback and will discontinue the dual relationship if she finds it interfering with the effectiveness of the therapy or your welfare and, of course, you can do the same at any time.

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TERMINATION: As set forth above, after the first couple of meetings, Kristina Yarbrough, LMFT will assess if she can be of benefit to you. Kristina Yarbrough, LMFT does not accept clients who, in her opinion, she cannot help or who are not a good fit. In such a case, she will give you a number of referrals whom you can contact. If at any point during psychotherapy, Kristina Yarbrough, LMFT assesses that she is not effective in helping you reach the therapeutic goals or that you are non-compliant, she is obligated to discuss it with you and, if appropriate, to terminate treatment. In such a case, she would give you several referrals that may be of help to you.

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If you request it and authorize it in writing, Kristina Yarbrough, LMFT will talk to the psychotherapist of your choice to help with the transition. If, at any time, you want another professional's opinion or wish to consult with another therapist, Kristina Yarbrough, LMFT will assist you with referrals, and, if she has your written consent, she will provide her or him with the essential information needed. You have the right to terminate therapy at any time. If you choose to do so, and if appropriate, Kristina Yarbrough, LMFT will offer to provide you with names of other qualified professionals.