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(561) 573-6868 310 SE First St., Suite 2 Delray Beach, Fl 33483 State License #MH 0004775
Therapy vs. Friendship: I believe that there is a partnership between me and you, the client. YOU define the problem areas to be worked on. I use my knowledge of the most effective techniques for your particular issues to help YOU make the changes you want to make. It is not like visiting a medical doctor. It requires your very active involvement. You may find it useful to take notes, and also to take notes outside the office. It requires your best efforts to change thoughts, feelings and behaviors. I expect us to plan our work together. We will list the areas to work on, our goals, the methods we will use, the time and money commitments we will make, and some other things. I expect us to agree on a plan that we will both work hard to follow. From time to time, we will look together at our progress and goals. If we think we need to, we can then change our plan, its goals, and its methods. It is important to be aware that, depending on your goals, different amounts of time both in frequency of sessions and duration may be required. An important part of our work will be your commitment to practicing the new skills that you will learn in our sessions. I will ask you to practice outside our meetings, and we will work together to set up homework assignments for you. I might ask you to do exercises, to keep records, to read books or articles, and perhaps to do other tasks to deepen your learning. You will probably have to work on relationships in your life and make long-term efforts to get the best results. These are important parts of personal change. Change will sometimes be easy and quick, but more often it will be slow and frustrating, and you will need to keep trying. There are no instant, painless cures and no "magic pills." However, you can discover solutions and answers that you are not used to seeing because of old tapes, messages, and scripts get in the way. The process of ending our work together is called "termination”. It can be a very valuable part of our work. Stopping should not be done casually, although either of us may decide to end our work together if we believe it is in your best interest. If you wish to stop at any time, I ask that you agree now to meet then for at least one session to review our work together. We will review our goals, the work we have done, any future work that needs to be done, and our choices. You may like to take a "vacation" and try it on your own, if so, we should discuss this. We can often make such a "vacation" be more helpful. As a professional, I will use my best knowledge and skills to help you. I am a Licensed Mental Health Counselor. I am trained and licensed to practice mental health counseling—not law, medicine, or any other profession. I am not able to give you good advice from these other professional viewpoints. State laws require me to keep what you tell me confidential (that is, private). You can trust me not to tell anyone else what you tell me, except in certain limited situations. I explain what those are in the "About Confidentiality" section of this brochure. I want to explain that I try not to reveal who my clients are. I will never acknowledge working with you without your written permission. This is part of my efforts to maintain your privacy. If we meet on the street or socially, I may not say hello or talk to you very much. My behavior will not be a personal reaction to you, but a way to maintain the confidentiality of our relationship. Even if you invite me, I will not attend your family gatherings, such as parties or weddings. I will not give you gifts; I may not notice or recall your birthday; and I may not receive any of your gifts eagerly. In your best interest and following the standards of my profession, I cannot have any other role in your life. I cannot, now or ever, be a close friend or socialize with any of my clients. I cannot be a therapist to someone who is already a friend. I can never have sexual or romantic relationships with any client during, or after, the course of therapy. I cannot have a business relationship with any of my clients, other than the therapy relationship. When our therapy is completed, I will not be able to be a friend to you like your other friends. As a coach I follow these same guide lines. I am not a physician, so when medications are appropriate I will work closely with your physician. As with any powerful treatment, there are some risks as well as many benefits with therapy. You should think about both the benefits and risks when making any treatment decisions. For example, in therapy, there is a risk clients will have for a time uncomfortable levels of sadness, guilt, anxiety, anger, frustration, loneliness, helplessness, or other negative feelings. Clients may recall unpleasant memories. These feelings or memories may bother a client at work or in school. Some people in your community may mistakenly view anyone in therapy as weak, or perhaps as seriously disturbed or even dangerous. Also, clients in therapy may have problems with people important to them. Family secrets may be told. Therapy may disrupt a marital relationship and sometimes may even lead to a divorce. Sometimes, too, a client's problems may temporarily worsen after the beginning of treatment. Most of these risks are to be expected when people are making any important changes in their lives. Finally, even with our best efforts, there is a risk that therapy may not work out well for you. You should also know that scientists have shown the benefits of therapy in hundreds of well-designed research studies. People who are depressed may find their mood lifting. Others may no longer feel afraid, angry, or anxious. In therapy, people have a chance to talk things out fully until their feelings are relieved or the problems are solved. Clients' relationships and coping skills may improve greatly. They may get more satisfaction out of social and family relationships. Their personal goals and values may become clearer. They may grow in many directions—as persons, in their close relationships, in their work or schooling, and in the ability to enjoy their lives. I do not take on clients I do not think I can help. Therefore, I will enter our relationship with optimism about our progress. I will treat with great care all the information you share with me. It is your legal right that our sessions and my records about you be kept private. That is why I ask you to sign a "release-of-records" form before I can talk about you or send my records about you to anyone else. In general, I will tell no one what you tell me. I will not even reveal that you are receiving treatment from me. In all but a few rare situations, your confidentiality (that is, your privacy) is protected by state law and by the rules of my profession. Here are the most common cases in which confidentiality is NOT protected:
If your records need to be seen by another professional, or anyone else, I will discuss it with you. If you agree to share these records, you will need to sign a release form. I do not divulge the fact that you are a client or anything about you or your sessions to anyone, unless you make a request in writing to do so. If we do family or couple therapy (where there is more than one client), and you want to have my records of this therapy sent to anyone, all of the adults who were part of the treatment will have to sign a release. You can review your own records in my files at any time. The review will take place at my office in my presence. The review must be carried out in a manner that protects the confidentiality of other family members or other individuals whose treatment may be referred to in the record. In some very rare situations, I may temporarily remove parts of your records before you see them. This would happen if I believe that the information will be harmful to you, but I will discuss this with you. If there is an emergency during our work together, or in the future after termination, where I become concerned about your personal safety, the possibility of your injuring someone else, or about you receiving proper psychiatric care I will do whatever I can within the limits of the law to prevent you from injuring yourself or others and to insure that you receive the proper medical care. For this purpose I may also contact the person whose name you have provided on the biographical sheet. It is important for you to be aware that e-mail and cell phone communication can be relatively easily accessed by unauthorized people, and therefore the privacy and confidentiality of such communication can be compromised. Emails, in particular, are vulnerable to unauthorized access due to the fact that servers have unlimited and direct access to all emails that go through them. Faxes can easily be sent erroneously to the wrong address. Please notify me at the beginning of treatment if you decide to avoid or limit in any way the use of any or all of these communication devices. Because I have strong beliefs about confidentiality and maintaining your privacy I do not belong to any health insurance or managed care provider panels. I have no control over how records are handled at these companies and their staffs do not have the same training in maintaining confidentiality as do mental health professionals. Furthermore, the confidential information that may be required by your health insurance carrier in order to process claims is entered into the insurance company’s computers and accessibility is always in question. However, you may wish to submit your bills to your insurance company on your own. I will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company, if you so choose. Not all issues/conditions/problems, which are the focus of psychotherapy, are reimbursed by insurance companies. Your insurance contract is between you and your company; it is not between the insurance company and me. If you instruct me to provide information to your insurance company I will provide only the minimum necessary. I will not disclose psychotherapy notes unless authorized by you explicitly .You—not your insurance company or any other person or company—are responsible for paying the fees we agree upon. If you ask me to bill a separated spouse, a relative, or an insurance company, and I do not receive payment on time, I will then expect this payment from you. Sessions for singles: The very first time I meet with you, we will need to give each other much basic information. For this reason, I usually schedule 1 hour for this first meeting. Following this, we will usually meet for a 50-minute session once or twice a week and then less often. For Eye Movement Desensitization and Regulation (EMDR) I usually schedule 90 minute sessions. We can schedule meetings for both your and my convenience. I will tell you in advance of my vacations or any other times we cannot meet. Please ask about my schedule in making your own plans. Sessions for Couples: The most important investment you can make for yourself, your children, and your relationship is to take the time to connect with your partner and to develop a conscious committed foundation. Therefore I ask that you commit to an initial 2 hour session and then follow up sessions of 90 minutes. We will decide together how long this work will take. It can be once a week or every other week for anywhere from 3 months to a year or more. Sometimes you may want to do an intensive 2 day session rather than stretching it out. We will work together to determine your needs and what works best for you and your relationship. An appointment is a commitment to our work. We agree to meet here and to be on time. If I am ever unable to start on time, I ask your understanding. I also assure you that you will receive the full time agreed to. If you are late, we will probably be unable to meet for the full time. It is likely that I will have another appointment after yours. A cancelled appointment delays our work. I will consider our meetings very important and ask you to do the same. Please try not to miss sessions if you can possibly help it. When you must cancel, please give me at least 24 hours notice. Your session time is reserved for you. You will be charged the full fee for sessions cancelled with less than 24 hours notice, for other than the most serious reasons. Cancellations for a Monday appointment should be made no later than noon on Friday. I request that you do not bring children with you if they are young and need babysitting or supervision, which I cannot provide. Payment for services is important in any professional relationship. This is even more true in therapy. One treatment goal is to make relationships and the duties they involve clear. You are responsible for seeing that my services are paid for. Meeting this responsibility shows your commitment and maturity. You will be given advance notice if my fees should change. Regular therapy services: Please pay for each session at its end. I have found that this arrangement helps us to stay focused on our goals, and so it works best. It also allows me to keep my fees as low as possible, because it cuts down on my bookkeeping costs. I suggest you make out your check before each session begins, so that our time will be used best. Other payment or fee arrangements must be worked out before the end of our first meeting. Extended sessions: Sometimes it may be better to go on with a session, rather than stop or postpone work on a particular issue. When this extension is more than 10 minutes, I will discuss it with you, because sessions that are extended beyond 10 minutes will be charged on a prorated basis. Some form of therapies, such as Imago Relationship Therapy and Eye Movement Desensitization and Regulation (EMDR) require extended sessions and will be charged accordingly. Telephone conversations, site visits, report writing and reading, consultation with other professionals, release of information, reading records, etc.: You will be charged the same rate unless indicated or agreed otherwise. If the time required is less than 10 minutes you will not be charged. You will not be charged for calls making appointments or changing them. Because I expect all payment at the time of our meetings, I usually do not send bills. If there is any problem with my charges, my billing, or any other money-related point, please bring it to my attention. I will do the same with you. Such problems can interfere greatly with our work. They must be worked out openly and quickly. As your therapist I may request, during the course of sessions, permission to tape, whether by audio or video, all or part of the sessions. The recording will not take place unless you have agreed, by written consent, to have the session recorded. If you wish for another professional's opinion at any time, or wish to talk with another therapist, I will help you find a qualified person and will provide him or her with the information needed. If you could benefit from a treatment I cannot provide, I will help you to get it. You have a right to ask me about such other treatments, their risks, and their benefits. Based on what I learn about your problems, I may recommend a medical exam or use of medication. If I do this, I will fully discuss my reasons with you, so that you can decide what is best. If another professional treats you, I will coordinate my services with them and with your own medical doctor. If for some reason treatment is not going well, I might suggest you see another therapist or another professional in addition to me. As a responsible person and ethical therapist, I cannot continue to treat you if my treatment is not working for you. I regularly consult with other professionals regarding clients: however, the client’s name or other identifying information is never mentioned. The client’s identity remains completely anonymous, and confidentiality is fully maintained. I cannot promise that I will be available at all times. I usually do not take phone calls when I am with a client. You can always leave a message on my answering machine, and I will return your call as soon as I can. Generally, I will return messages daily except on Sundays and holidays. My telephone number is 561-573-6868 and my email address is: barbara@barbjacob.com . If you have an emergency or a behavioral or emotional crisis and cannot reach me immediately by telephone, you and your family members should call one of the following community emergency agencies: I fully abide by all the rules of the American Mental Health Counselors Association (AMHCA) and by those of my state license. Problems can arise in our relationship, just as in any other relationship. If you are not satisfied with any area of our work, please raise your concerns with me at once. Our work together will be slower and harder if your concerns with me are not worked out. I will make every effort to hear any complaints you have and to seek solutions to them. In my practice as a therapist, I do not discriminate against clients because of any of these factors: age, sex, marital/family status, race, color, religious beliefs, ethnic origin, place of residence, veteran status, physical disability, health status, sexual orientation, or criminal record unrelated to present dangerousness. This is a personal commitment, as well as being required by federal, state, and local laws and regulations. I will always take steps to advance and support the values of equal opportunity, human dignity, and racial/ethnic/cultural diversity. If you believe you have been discriminated against, please bring this matter to my attention immediately. 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 Barbara Jacob, MS, LMHC and client(s). The cost of such mediation, if any, shall be split equally, unless otherwise agreed. In the event that mediation is unsuccessful, any unresolved controversy related to this agreement should be submitted to and settled by binding arbitration in Palm Beach County, Florida in accordance with the rules of the American Arbitration Association which are in effect at the time the demand for arbitration is filed. Notwithstanding the above, in the event that your account is overdue (unpaid) and there is not agreement on a payment plan, Barbara Jacob, MS, LMHC can use legal means to obtain payment. The prevailing party in arbitration or collection proceedings shall be entitled to recover a reasonable sum for attorneys’ fees. In the case of arbitration, the arbitrator will determine the sum. Privacy of Information Shared In Counseling/Therapy: Your Rights and My Policies What to expect: The purpose of meeting with a counselor or therapist is to get help with problems in your life that are bothering you or that are keeping you from being successful in important areas of your life. You may be here because you want to talk to a counselor or therapist about these problems. Or, you may be here because your parent, guardian, doctor or teacher has concerns about you. When we meet, we will discuss these problems. I will ask questions, listen to you and suggest a plan for improving these problems. It is important that you feel comfortable talking to me about the issues that are bothering you. Sometimes these issues will include things you don’t want your parents or guardians to know about. For most people, knowing that what they say will be kept private helps them feel more comfortable and have more trust in their counselor or therapist. Privacy, also called confidentiality, is an important and necessary part of good counseling. As a general rule, I will keep the information you share with me in our sessions confidential, unless I have your written consent to disclose certain information. There are, however, important exceptions to this rule that are important for you to understand before you share personal information with me in a therapy session. In some situations, I am required by law or by the guidelines of my profession to disclose information whether or not I have your permission. I have listed some of these situations below. Confidentiality cannot be maintained when: You tell me you plan to cause serious harm or death to yourself, and I believe you have the intent and ability to carry out this threat in the very near future. I must take steps to inform a parent or guardian of what you have told me and how serious I believe this threat to be. I must make sure that you are protected from harming yourself. You tell me that you plan to cause serious harm or death to someone else who can be identified, and I believe you have the intent and ability to carry out this threat in the very near future. In this situation, I must inform your parent or guardian, and I must inform the person who you intend to harm. You are doing things that could cause serious harm to you or someone else, even if you do not intend to harm yourself or another person. In these situations, I will need to use my professional judgment to decide whether a parent or guardian should be informed. You tell me you are being abused-physically, sexually, or emotionally- or that you have been abused in the past. In this situation, I am required by law to report the abuse to the Florida Department of Soical Services. You are involved in a court case and a request is made for information about your counseling or therapy. If this happens, I will Not disclose information without your written agreement unless the court requires me to do so. I will do all I can within the law to protect your confidentiality, and if I am required to disclose information to the court, I will inform you that this is happening. Communicating with your parent (s) or guardian (s) : Except for situations such as those mentioned above, I will not tell your parent or guardian specific things you share with me in our private therapy sessions. This includes activities and behavior that your parent/guardian would not approve of – or would be upset by= but that do not put you at risk of serious and immediate harm. However, if your risk-taking behavior becomes more serious, then I will need to use my professional judgment to decide whether you are in serious and immediate danger of being harmed. If I feel that you are in such danger, I will communicate this information to your parent or guardian. Example: If you tell me that you have tried alcohol at a few parties, I would keep this information confidential. If you tell me that you are drinking and driving or that you are a passenger in a car with a driver who is drunk, I would not keep this information confidential from your parent/guardian. If you tell me, or if I believe based on things you’ve told me, that you are addicted to alcohol, I would not keep this information confidential. Example: If you tell me that you are having protected sex with a boyfriend or girlfriend, I would keep this information confidential. If you tell me that, on several occasions, you have engaged in unprotected sex with people you do not know or in unsafe situations, I will not keep this information confidential. You can always ask me questions about the types of information I would disclose. You can ask in the form of “hypothetical situations,” in other words: “ If someone told you that they were doing ----, would you tell their parents?” Even if I have agreed to keep information confidential- to not tell your parent or guardian- I may believe that it is important for them to know what is going on in your life. In these situations, I will encourage you to tell your parent/guardian and will help you find the best way to tell them. Also, when meeting with your parents, I may sometimes describe problems in general terms, without using specifics, in order to help them know how to be more helpful to you. (You should also know that, by law in Florida, your parent/guardian has the right to see any written records I keep about our sessions. It is extremely rare that a parent/guardian would ever request to look at these records.) 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