Brief therapy is goal directed, problem-focused treatment. This means that a treatment goal or several goals are established after a thorough assessment. A treatment is then planned with the goal(s) in mind and progress is made toward accomplishment of that goal in a timely manner. You will take an active part in setting and accomplishing your treatment goals. Your commitment to a treatment plan is necessary for you to experience the most successful outcome. If you ever have any questions about the nature of the treatment or your care, please do not hesitate to ask.

Limits of confidentiality statement: All information between practitioner and client is held strictly confidential. There are legal exceptions to this:

1.The client authorizes a release of information with a signature. 

2. The client’s mental condition becomes an issue in a lawsuit and the judge orders the therapist to comply with disclosure.

3.The client presents as a danger to self or others.

4.Child or Elder abuse/neglect is suspected. (Or harming someone who is disabled) All written and spoken material from any and all sessions is confidential unless written permission is given to release all or part of the information to a specified person, persons or agency.

Release of Information: If I am an insured client, I authorize the releases of information for claims, certifications, case management, quality improvement, benefit administration and other purposes related to my health plan.

Emergency Access: Peg is usually available after hours to cover emergencies. You may call her regular number. In the precounseling interview, it was explained that at times Peg may not be able to be reached for an extended period. We will discuss alternate resources.  If it is a life-threatening emergency, please call 911 and ask for a CIT officer to respond to you.

Financial Terms and Coverage for Insured Clients: Please refer to Financial and Missed Appointment Policy. If you are an insured client, you are responsible for obtaining authorization for treatment from your insurance company. Peg will bill your insurance company, however, you are responsible for co-payment amounts and deductibles and terms set by your insurance plan. Missed appointments are not covered by your insurance plan and the charge for the session is your responsibility. If at any time during treatment you become ineligible for insurance coverage, you will notify Peg and you will be responsible for 100% of the bill. Estimated cost for services will be discussed, disclosed and agreed upon prior to the first session.

Consent for Treatment: I authorize and request Margaret Seykora, LMHC to carry out psychological assessment, treatment and/or diagnostic procedures which now, or during the course of my treatment become advisable. I understand the purpose of these procedures will be explained to me upon my request and that they are subject to my agreement. I also understand that while the course of treatment is designed to be helpful, your clinician can make no guarantees about the outcome of treatment. Further, the psychotherapeutic process can bring up uncomfortable feelings and reactions such as anxiety, sadness and anger. I understand this is a normal response to working through unresolved life experiences and that these reactions will be worked on between me and the clinician. For couples: Often work done during therapy sessions can cause tension between partners as issues that have not been resolved may be brought to the surface in order to process and be resolved.