Office Policy/Service Contract

Revised June 1, 2023

OFFICE POLICY/SERVICE CONTRACT

Revised June 1, 2023

Welcome to Port Angeles, Arlington, and Port Orchard Psychological Services!

For many people, consulting a psychologist can be a new, possibly anxiety-provoking, experience, and this document can both inform you about relevant factors in psychological care AND inadvertently raise your anxiety! Our intention is to be informative and “perfectly clear” about the way psychological care works. Some of what we talk about herein is likely things you never thought about, so we want to make you aware of all the nuances of treatment at our office. Our goal is to develop a fair and clear understanding between us, Port Angeles Psychological Services, Arlington Psychological Services and/or Port Orchard Psychological Services (Paul C. Daley, Ph.D. [also known as Dr. Daley]) and you, our new client. Please feel free to jot down any notes and ask about any of these issues at any time.

“What are Dr. Daley’s qualifications?”

Paul C. Daley, Ph.D. (“Dr. Daley” [often, more informally, “Dr. Paul”), is a Licensed Psychologist (#913). He received his undergraduate training in Psychology from the University of Washington (Seattle, WA), and received his graduate training in Counseling Psychology from Colorado State University (Ft. Collins, CO), where his Ph.D. was granted in August of 1981. He interned at the Veterans Administration Medical Center in Woods (Milwaukee), Wisconsin. Before coming to Port Angeles (and later expanding to Arlington), he served as the Staff Psychologist and then the Program Director for the county mental health center in Grant County Oregon. He has been trained in diagnosis and assessment, individual therapy, marital therapy, family therapy, group therapy, and conflict mediation.

The licensure process in Washington is designed as a protection for the public. The process screens out people who lack minimal competencies. It is unlawful for anyone to present him/herself as a psychologist, or as someone who provides psychological services, without a license. The Examining Board of Psychology can be reached at:

Washington State Department of Health

Office of Investigative & Legal Services

Complaint Intake Unit

PO Box 47853

Olympia WA 98504-7853

or

Department of Health
Examining Board of Psychology
1300 Quince Street SE
P.O. Box 47869
Olympia, WA 98504-7869

“What is your approach to treatment?”

Dr. Daley’s orientation to treatment varies with each client and presenting problem. However, in general, his approach might be described as “pragmatic.” That is, the type of approach he uses is “finding what works for you,” but the success of your treatment will depend on your motivation, the complexity and clarity of your problems, your psychological, personal, and financial resources, and your wishes/preferences. For some types of problems, you will need someone to help you work your way through very painful, complex, and confusing feelings and ideas, and a long-term, insight-oriented therapy would be appropriate. On the other hand, if you have a specific goal you want to accomplish (e.g., getting yourself over an irrational fear), these types of problems can often be treated quite briefly. If you have any questions, feel free to ask Dr. Daley.

Our first few sessions will involve an exploration of your needs. For most clients, the process of then “digging in” to therapy happens rather naturally. Still, you can take a moment to ask Dr. Daley about his impressions and thoughts about you, your treatment, or anything else at any time.

You, too, will be making an evaluation of Dr. Daley, whether consciously or unconsciously. That is good. Therapists vary by personality and “style,” and you want to make sure you will be comfortable working with Dr. Daley. After all, therapy involves a large commitment of time, money, emotional intimacy, and energy, so you should do all you can to make sure this relationship works for you.

Dr. Daley often works by telling therapeutic “stories,” the idea being “a picture tells 1000 words.” A story can clarify complex concepts that are hard to put into words. Some people think the stories are just stories, but they are – almost always – metaphorical, a message, a lesson.

“Is there ‘homework’ connected with therapy?”

Sometimes. Between-session work can speed the process of psychotherapy. However, you are not required to complete homework assignments. You would be wise, however, to be thinking about/working on your issues between sessions. You would, in fact, be wise to create your own homework assignments between sessions/appointments (e.g., to think about an important aspect of your last session).

“What is a client-psychologist relationship like?”

A psychotherapy relationship is different than any other relationship. It is not like going to see your Primary Care Physician. Instead, it requires very active efforts on your part. The relationship must develop into a very safe and trusting one where you can feel free to talk about even the most unacceptable thoughts, feelings, and actions. This is much easier said than done. Learning to develop a level of trust that deep may not occur in brief therapy unless you make a conscious choice to take the risk of trusting Dr. Daley. Even in long-term therapy, it is not unusual for trust issues to hamper progress. It is hard to trust anyone that deeply.

“What is the role of a client in this type of relationship?”

Your role in this process is to be as clear as you can (we know it is not easy sometimes) about the problems you want solved, as open and honest about your behavior and your private thoughts and feelings as you can be (again, we know this can be difficult), and as active as possible in talking about, thinking about, and acting-differently-about your issues as you can be (again … we know it is not easy). Your role is also to keep your “eye on the ball,” so to speak. That is, if therapy is not working for you, tell Dr. Daley so adjustments can be made.

Sometimes people come to a therapist expecting to tell the therapist about themselves, and expecting the therapist to say something profound that makes the problem go away. This never happens. Effective therapy involves hard work on the part of both the client and the therapist.

Miscommunication is common in all relationships, and a normal part of a therapy relationship, so tell Dr. Daley if you do not understand what he meant, or if you come to feel angry or hurt, and actively work to clear up communication errors. It is very likely that relationship problems that develop with Dr. Daley parallel relationship problems you have in other relationships, and psychotherapy is the perfect place to learn how to cope better with interpersonal conflicts. In fact, relationship problems with Dr. Daley are a fantastic opportunity to learn better conflict resolution skills. Take a deep breath and talk to him about your feelings.

It is your responsibility to keep the pressure on yourself and Dr. Daley to make sure your therapy works for you.

Think of Dr. Daley as your employee, one with special expertise, but still working under your authority and direction.

“Are there risks to undertaking psychotherapy?”

Psychotherapy has both benefits and risks, although, in truth, the risks are minimal. The risks may include experiencing uncomfortable feelings (such as sadness, guilt, anxiety, anger and frustration, loneliness, helplessness, etc.), becoming aware of undesirable aspects of your character, spouse/marriage, family, or life, and/or being faced with very difficult and undesirable memories/conflicts/dilemmas. Rarely – very rarely – psychotherapy clients “break down” and require psychiatric hospitalization. (In 40+ years of practice, this has only happened once, and there were complex circumstances beyond just therapy that contributed to the breakdown; the risk of a “breakdown” is probably more theoretical than real.)

On the other hand, psychotherapy has been shown to have benefits for people, and can often lead to such improvements in your life as better relationships, greater inner peace, improved self-confidence and self-esteem, greater appreciation of others, solutions to problems, a stronger sense of self-direction, deeper intimacy, warmer friendships, deeper love, forgiveness of those who have betrayed you, clearer thinking about choices and options, improved conflict-resolution skills, better communication, significant reductions in feelings of distress, and a generally better life.

However, there are no guarantees of what you will experience in your psychotherapy.

“How long does therapy usually take?”

The length of your therapy depends on two major points:

1) the nature of your problems.

If your problems are simple and specific (for example, getting your children to do their chores), the total number of sessions will be smaller (perhaps 1 to 10 sessions). If, on the other hand, you are seeking help in overcoming a depression that has troubled you most of your life, your treatment could take 20 to 200 or more sessions.

2) your effort and hard work. . .

Studies indicate that the more strongly motivated and firmly committed you are to change, the more rapidly therapy can progress. Your motivation for change – not just your desire, but your hard work at it – is more critical to the success of therapy than Dr. Daley’s skills3) supportive Psychotherapy.

Some people need life-long – or at least VERY long-term – “supportive” psychotherapy. “Supportive psychotherapy” refers the benefits of psychotherapy even when life is going well. Talking about your life experiences and feelings and events that surface is helpful, and, sometimes, when one stops psychotherapy, a person’s life can slowly deteriorate. “Supportive psychotherapy” helps stave off that insidious deterioration that can sometimes happen.

Please feel free to discuss – at any time – the likely length of your treatment with Dr. Daley.

“When are psychological tests administered?”

Occasionally, Dr. Daley may ask you to take one or more psychological tests. Some of these tests are simple forms that you fill out on your own. Others are tests administered by Dr. Daley. Some tests are computer scored. Typically, Dr. Daley will go over the results of the tests with you at your next session. You may also ask to be tested. There are additional fees for most psychological tests (see “What are your fees?” below).

“Do you consult with other mental health professionals about your clients?”

Sometimes, yes. Good therapy practices suggest that it is wise for psychologists to sometimes review their clinical work with a respected and knowledgeable colleague. Dr. Daley sometimes meets with other therapists to discuss cases. In addition, depending on the special needs of each client, he may seek the consultation of physicians, other psychologists, or psychiatrists. All conferences/consultations with individuals outside of this office will be made either with your permission, or without disclosing identifying information. You have a right to ask us, IN WRITING, to not consult with specific other professionals.

“Who decides when to stop therapy?”

You do! You are the boss, and Dr. Daley is your educated employee. However, it is better for you if the decision to stop therapy is made mutually, between you and Dr. Daley.

Discussions of the termination of therapy should take a minimum of one full session. “By the way, I’m not coming anymore” or just “disappearing” from therapy robs you of the opportunity to confront and express tender and embarrassing feelings, disappointed or angry feelings, and all of the complex reactions associated with the loss of an important relationship. Clinical lore suggests that the memories of your therapy and therapist may remain with you for 10 or 15 years (or more) after therapy ends. Having a discussion of your thoughts and feelings (positive and negative) associated with ending therapy can significantly aid your transition out of a therapy relationship.

Sometimes the stopping of therapy is not smooth. The process of talking over painful subjects can become very uncomfortable, and you may find yourself wanting to suddenly quit therapy. You may disagree with the direction of the therapy or feel impatient for faster or greater change. If these feelings happen to you, please talk with Dr. Daley before making any decisions. Please remember, though, that you have the right to stop treatment any time you want to, and to refuse some or all of the services provided at this office. If you wish to discontinue your therapy here, you may ask us for a referral to another therapist.

Clients who have not had a session in over 30 days (or within a mutually agreed upon time) will be considered inactive. However, please be fully assured that anyone wishing to return to active therapy can do so at any time by contacting the office to make arrangements to resume the therapeutic relationship.

“What are your ethical and professional standards?”

Dr. Daley is bound by the Code of Ethics of the American Psychological Association and by state laws regulating the practice of psychology and psychotherapy. See (https://www.doh.wa.gov/LicensesPermitsandCertificates/

ProfessionsNewRenewor%20Update/%20Psychologist/Laws).

If you have questions about Dr. Daley’s professional behavior, you may want to follow a two- or three-step procedure. First, you should get a copy of the American Psychological Association’s “Ethical Standards” from our office, the Washington State Psychological Association, the American Psychological Association, or online. Then, after reading through these standards, you should either sit down with Dr. Daley and discuss your concerns, or file a formal complaint with the Department of Licensing, depending on the nature and “size” of your complaint. These options may put you on the “horns of a dilemma.” You might not want to directly confront Dr. Daley, and you may not be clear on the seriousness of the problem. To help clarify the issues, you might consider consulting a different psychologist, an impartial Licensed Psychologist for advice. Most psychologists will provide this service for free.

“Does your support staff have access to clinical/private/privileged/“secret” information about me?”

Yes, support staff DO have access to clinical information about you. When Dr. Daley writes a letter, the support staff usually “process”/type it, and they often edit letters and reports for clarity, spelling, punctuation, etc. Support/clerical staff also have access to your diagnoses and other billing information. If your managed care company requires us to fill out various forms, support staff often have access to the information in those forms because they sometimes have to fill out portions of the forms. The support staff at this office are not only trained in the strictest understanding of the meaning of confidentiality, but, with the new HIPAA regulations, they are now required to sign a confidentiality agreement in order to maintain their employment in offices like this (in which confidentiality is so crucial). You may ask that confidential/clinical/ private/“secret” information NOT be shared with support staff (although we ask that, except under special circumstances, you make this an all-or-nothing request [that is, it would be very difficult for us to keep track of requests to keep only certain bits of information away from the support staff, and much easier for us to keep everything or nothing away from support staff; be aware that we cannot agree to keep the information needed to bill for services secret from the support staff who do our billing, unless you wish to pay for your services “out of pocket”]). Please also be aware that the time demands on Dr. Daley will increase radically if he has to do all for you that support staff would normally do, and he charges his usual fees (Individual Therapy) for that extra time.

“What if all I want is ONE session?”

If you desire “single session” treatment, we will want to schedule a two-hour session. Charges will not be prorated if you do not need the entire two hours, but, in all likelihood, we will use all of the time. There are no reduced fees for single session therapies.

“Do you provide Telehealth Services?”

Telehealth/virtual/online therapy services are available so long as they remain professionally “approved”/ accepted. At the bottom-line, this means that these services are, realistically, available so long as either your insurance or you are willing to pay for them.

Before COVID19, telehealth services were considered professionally unacceptable except within very limited circumstances (e.g., a client who is away on vacation having an urgent need for a session). Since COVID19, telehealth has become a “normal” method of delivering mental health services, and probably will remain so.

There are advantages and disadvantages to telehealth. It is very convenient for client and therapist. You, the client, might especially appreciate the absence of “travel time” for therapy: you just find a quiet, private room, and you are there, travel time reduced to less than five minutes.

The disadvantages are more numerous, but not necessarily large. Much of yours and your therapist’s non-verbal behavior is lost. Neither client nor therapist can, for example, see if the other’s foot is bouncing anxiously. Very significant amounts of non-verbal communication are lost with telehealth. Secondly, confidentiality can be compromised. For example, many clients go to a private room, but they lack confidence about whether or not their spouse (or others) in the household are actually fully blocked from hearing what is being said. Indeed, some spouses are thought to be listening at the door. Headphones can reduce the chance of others in the household hearing what your therapist says, but you will have to figure out how to keep others from hearing you. And keeping others from hearing you is important even if you think you do not care if they hear you because, very often, the things you will want to talk about involve others in your household, and if you don’t mind, you don’t care, you don’t mind, you don’t care, and then suddenly you get secretive about some particular subject, unnecessary issues and problems may surface in your relationship with that person. Privacy failures can also affect your therapist, because he will not know when it is and is not OK with you to talk about so-and-so in your household. It will be important for you to create private spot at your location where others cannot hear you or your therapist.

Technical problems are also common with telehealth. Video feed freezes, audio feed freezes or stutters or delays. Audio volume can be problematic. Audio and video feeds can mismatch. Or one feed or the other cannot be established, video or audio. The connection is sometimes suddenly lost. Some online service providers have more and less assurances of confidentiality. Some require you to install new apps. Some have time limits. Some will not allow more than one person. Many/most have trouble handling two or more people talking at once. Screen sharing is not supported by some apps. Signal strength can vary on your end or our end, and one or both of us can talk at length without realizing that the other one cannot see or hear us any more. Some problems are minor but they can be slightly disorienting (e.g., color distortions). Sometimes you do not check your background and there is something embarrassing in the picture behind you.

Sometimes it is embarrassing – or “too much information” – when the only private room you can find is your bedroom, and inviting your therapist therein can be “weird” at best. Please feel free to talk about those feelings. We can work them through, I assure you. There can also be embarrassment/discomfort stemming from which video feed you or Dr. Daley are watching and where it is on your screen. For example, if the video of you or Dr. Daley is in the lower right hand corner, it can seem like we are not looking at each other, and not engaged in the session. Normally, I have my progress note over the top of my own image, so I do not see what I am doing/looking like. If you do that, as many people do, and then you find, at the end of the session, or after the session, that your appearance was askew (e.g., buttons misaligned, hair askew, etc.), that can be embarrassing.

Telehealth also allows you and the therapist to “double track” on other tasks (e.g., texting and emailing). If I observe you possibly doing that, I will ask you about it; if you think I am being distracted, please ask me about it. It is my expectation and request that you NOT do that, that your focus be strictly on your therapy for that appointment time, just as it would be during an in-person appointment.

Overall, on balance, telehealth tends to be a good option for many people, and it works for Dr. Daley, so we can do our session online even if you live right next door to our office, if that is what you want.

If you prefer to meet in person, the crisis proportions of COVID19 has passed, and Dr. Daley sees approximately half of our clients in person. To aid in your decision making about in-person v. online, be aware that the Port Angeles office is a remodeled three story house. Dr. Daley is the only one on the main floor (support staff is downstairs behind solid-core, sound-dampened doors). Dr. Daley keeps the consultation office door open (as long as there is no one else in the building), the furnace fan is constantly on, and there are two fans going in the office, all of which contributes to very large ACH (Air Changes per Hour [i.e., good ventilation]). And we sit about 7.5 feet apart, face-to-face. As such, in-person session are thought to be safe.

So, both options, in-person or online/telehealth are available to you.

“How long is a therapy ‘hour’?”

A regular therapy appointment is 45-50 minutes in length. Please understand that if you arrive late, your appointment hour will not be extended (usually another client is scheduled after you). However, you will still be charged for the full “hour,” since that is the amount of time reserved for your appointment.

“What if I simply do not show up for my appointment?”

Your therapy “hour” is “reserved” for you, but things happen in life, and, because of that, the first time you cancel an appointment with less than 24 hours notice (or no show your appointment), you will not be charged. The next time you “no-show” or cancel with less than 24 hours advanced notice, you will be charged $50, and you must pay that at your next appointment. The next time you no-show or cancel without 24 hours notice, the charge will be $100, then $150 the next time, and then the full fee for each late cancellation or no-show after that. Remember, your health insurance will not cover missed appointments fees; you must pay them out-of-pocket.

We are not allowed to implement this policy with veterans, so we ask veterans to please respect that no-show or cancellations with short notice deprive us of income and other clients of using that hour. With rare exceptions, if a veteran client misses three sessions without 24-hour-notice, we will take them out of the regular schedule, and shift them to a “call for appointment” scheduling.

“What if I need to cancel an appointment?”

As long as you provide 24 hours notice, there will be no charge. If you cancel with less than 24 hours notice, you will be charged as described above (under “What if I simply do not show up for my appointment?”). (We are reasonable people, and we are not going to charge for late-canceled appointments for events beyond your control. For example, if you are in an automobile accident on your way to the session, we are not going to charge you for missing that appointment, whereas if you were in an automobile accident two days before the appointment and forgot to call and cancel, you will be charged for missing that appointment.)

“What are your fees?”

Initial Consultation $300.⁰⁰ per hour
Individual, Marital, or Family therapy* $200.⁰⁰ per hour
Court or Attorney referred evaluations $300.⁰⁰ per hour
Courtroom testimony, preparation, depositions, and/or standby $300.⁰⁰ per hour
Report preparation $300.⁰⁰ per hour
Emergency services $300.⁰⁰ per hour
Phone consultations $200.⁰⁰ per hour

“Who has final responsibility for the bill? Me or the insurance company?”

READ THIS SECTION CAREFULLY:

Remember that you are, ultimately, responsible for your entire fee/bill.

If you have health insurance coverage, we will bill your insurance company for you, as is standard practice in most health care offices, if that is what you want us to do (which most people DO want), but any problem(s) with the insurance coverage become your responsibility to resolve. (We will gladly help you in any way possible, and, realistically, it will be our office that resolves problems, but the ultimate responsibility for the cost of services here is yours.) If you do not pay us, we will send your bill to collections.

Insurance billing requirements.

You should be aware that most insurance companies require us/Dr. Daley to provide them with your diagnosis and dates of service. Sometimes they ask for additional clinical information such as treatment plans or summaries (e.g., L&I and the Veterans Administration), or copies of the entire record (in rare cases [e.g., L&I and the Veterans Administration]). This information will become part of their records and will probably be stored in a computer or a “cloud” storage (and it is likely that EVERYONE in that organization will have access to your records). Though all “insurance”/“third party payors” claim to keep such information confidential, we have no control over what they do with private information once it is in their hands. In some cases, they may share the information with a national medical information databank. We will provide you with a copy of any reports we submit, if you request it.

If you have been referred by a managed care company or an EAP, it is your responsibility to make yourself aware of the rules, limitations, benefits, etc. of that company, and to provide us with clear (preferably written) documentation of your wishes if you do not want us to comply with any of those requirements (typically, you will have signed a document with those companies indicating your agreement to their program specifications, and we have no way of knowing that you do not wish us to comply with some aspect of their plan unless you tell us).

“When is payment for services due?”

Payment of your portion of the fee is due right before or after each session. You may ask us to provide you with a statement indicating how many sessions were billed to your account, how much you paid, and how much the insurance company paid, etc. If you prefer, you may pay on a monthly basis, upon receipt of your monthly statement. Checks should be made out to Dr. Paul C. Daley.

“What happens when I fall behind on my payments?”

This is a rare event because you will be asked to pay for your portion of your services at the time they are rendered/delivered. However, should you fall behind on your payments, we will not assess any finance charges as long as some payment is made each month. If a payment is not received for more than one month, a 1.5% per month finance charge (18% per year) will be assessed (computed on the outstanding balance each month).

Delinquent accounts may be turned over to a collection agency, or we may initiate action against you in small claims court IF we cannot work out a payment schedule with you. You will also be responsible for the cost of our efforts to collect our fee from you. If we have to pursue payment from you through a collections agency or small claims court, we will release your name, your address, your social security number, your date of birth, your employer, your work phone number, the amount due, the fact that Dr. Daley provided a professional service to you, the dates of service, any other data/information demanded by the process, and whether or not mail we have sent to you has been returned. We will NOT release any protected or confidential information about you (that is, we will NOT release your progress notes or information therein).

“What if there is a disagreement with the monthly statement/bill or a problem with payment?”

If you have any problem with your bill or making your payment, please let us know right away. Most billing errors/“issues” are the result of a simple oversight, and conflicts can usually be settled through discussion and negotiation, easily. Payment problems are almost always easily negotiated.

“How can I reach Dr. Daley after-hours?”

Dr. Daley is USUALLY available by cell phone (360-809-3765) after hours, but if he does not answer, and you have an emergency, you can call 1-800-584-3578 or a national crisis line at 1-800-273-8255. Dr. Daley DOES NOT PROVIDE EMERGENCY SERVICES. If you have a mental health emergency, call one of the above numbers, or 911, or go to the emergency room at the local hospital. You can also try the emergency services at the local mental health center.

“Do I have the right to see my records?”

Yes. Our offices keep a record of the health care services Dr. Daley provides to you (for example, summaries of your sessions, test results, and reports). You may ask to see and have a copy of those records, or Dr. Daley can provide you with a written or verbal summary of your records, as you prefer. You will be charged for the retrieval and copying of your records AND for a professional review (by Dr. Daley) to insure that your records do not contain information that could harm you. These charges will be in accordance with the current acceptable fees for such practices. If the record contains references to others (e.g., your spouse), it will require special review and preparation (in order to protect their privacy), at an additional fee.

To see your record, please schedule an appointment with Dr. Daley. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. Dr. Daley will offer to review your record with you so that he can explain any technical language, any of the assessment terminology used, answer any other questions you might have, and so that he might try to soothe any pain that disclosure creates for you. He is also available to clarify the records for other parties/people/entities, at your request. However, you have a right to force him to release your records without such review.

“What if there are errors in my records?”

You have the right to ask to have your record corrected. It is preferable that you make a request in writing, including specification of the changes you are requesting, but, if you cannot or will not do that, we will help you. The goal is to make the records accurate. Dr. Daley and these offices have the right to refuse to make corrections that are deemed inaccurate. However, if Dr. Daley refuses to make a correction that you believe is important, you can write an addendum to that record, which will become a permanent part of that record.

“How confidential are the services I receive from Port Angeles Psychological Services, Arlington Psychological Services, and/or Port Orchard Psychological Services?”

The confidentiality of psychological information is extremely strict. This office will not tell anyone that you are coming here – let alone what is discussed – except under the following circumstances:

1) You may ask Dr. Daley to disclose confidential information to someone (for example, to your physician or another therapist). HIPPA rules do not require you to provide written permission for your different treating providers to consult with each other, but the laws allow you to ask us NOT to share Protected Health Information with other providers (in writing). Still, in general, we will ask you to sign a release form that specifically states what information can be released and to whom you want it released.

2) Dr. Daley may ask you for permission to disclose confidential information to another professional (for example, to consult with another therapist, psychologist, medical provider, or psychiatrist). You do not have to agree to this request. If you do agree, we will ask you to sign a release form that specifically states what information can be released. If you do not want information disclosed, except as specified below, we will honor your wishes.

3) In cases of medical emergency, if Dr. Daley knows something that could save your life, he will disclose this information without your permission. Obviously, this rarely occurs.

4) Dr. Daley is also a “mandated reporter.” This means that he is required by law to inform the proper authorities – even if you do not give your permission – if he believes you are:

a) of immediate danger to yourself (e.g., suicidal);

b) of immediate danger to others (e.g., homicidal [Dr. Daley is required to not only inform the police, but to inform potential victims, and, under certain circumstances, he may be required to have you involuntarily hospitalized]);

c) of immediate danger to others’ property;

d) unable to meet your own basic needs (for example, for food and shelter);

e) physically, emotionally, or sexually abusing children or a disabled person(s); or

f) physically, emotionally, or sexually abusing an elderly person,

Please note that some clients may think about suicide – even seriously – and Dr. Daley is NOT under any obligation to report these thoughts to anyone. Dr. Daley is only required to disclose this type of confidential information without your permission if he honestly believes you will kill yourself (or others) in the immediate future.

If you are abusing children, the disabled, or the elderly, Dr. Daley will always encourage you to make the report to the authorities yourself (things tend to go better that way). However, whether or not you make this report yourself, Dr. Daley is required by law to make such a report to authorities himself. Please keep in mind that he is here to help, he is not an officer of the law, and that every effort will be made to handle the report of such issues in a dignified and therapeutic manner.

5. A court of law may subpoena your records.

Generally, the confidentiality of your relationship with your therapist/Dr. Daley is protected by law and you will usually have the right to stop Dr. Daley from providing any information about your treatment (if it is subpoenaed), but Dr. Daley might be required to testify under certain circumstances, examples of which are:

a) if the court rules that other legal issues outweigh your right to the protection of your privacy (e.g., you become a mass murderer);

b) if a case involves custody of your children (because your mental health – and that of the other parent – may become central issues in such cases);

c) if a case involves questions of your emotional conditions (e.g., if you apply for benefits of some sort based on your assertion of having suffered emotional problems);

d) if the court rules that you have already broken confidentiality by discussing your therapy with someone else (e.g., if you talk over your therapy with your boy/girlfriend, the court might rule that you violated your own confidentiality); or

e) if the court sent you to us for psychological evaluation, and you agreed to participate.

6. Under Washington State Law, health care providers (including mental health providers) must or can disclose information about you under certain circumstances. Although Dr. Daley does not anticipate being asked to disclose any information about you under this law, you should know about the law and what it would require or allow us to do:

a) technically, we are allowed to disclose information – without your permission – to your physician or any other health care provider who works with you if we feel this is in your best interest;

b) technically, we are allowed to disclose information – without your permission – to immediate family members or to an individual known to have a close personal relationship with you if this is done according to the rules of good professional practice, and justified by the need to provide you with appropriate health care;

c) we are allowed to disclose some information – without your permission – if we are involved in a research project that has been approved by a human subjects review panel;

d) we are allowed to disclose certain information – without your permission – if we are subject to a financial audit;

e) we are allowed to disclose information about you – without your permission – to an official of a penal institution if you are imprisoned;

f) we are allowed to disclose information – without your permission – to federal, state, or local law enforcement authorities to the extent which the health care law requires it; and,

g) we can disclose certain portions of your records to appropriate authorities engaged in collecting data for legal, administrative, financial, billing, or actuarial services provided to this office.

Normally, even when the law says we do not need your permission, we will ask you for it anyway.

“What if I am not yet 18 years old?”

In the treatment of teenagers, there is a delicate “confidentiality balance” that cannot be fully resolved. On the one hand, establishing a trusting relationship with a teenager can be a very delicate and difficult task, and if the teen feels that his/her confidences will be betrayed, s/he is unlikely to confide in the first place. On the other hand, teenagers can do a remarkable job of pointing themselves in frightening directions in life, and parents might rightfully feel betrayed to suddenly learn that their teen’s psychotherapist knew of their impending dysfunction, and never said a word.

Teens in therapy and their parents need to decide “which way to go” with this issue. As a parent, do you want to grant confidentiality and risk being shocked at what the teen does, or ask for regularly scheduled feedback and risk that, in the process, the teenager does not reveal relevant or significant information?

If you are under 18 years of age, please be aware that the law may provide you with the right to confidentiality, but it also makes you financially responsible for your treatment. Parents are only responsible for payment for services if they agree to be responsible.

No matter what agreement is reached between a teenager, the parents, and Dr. Daley, if Dr. Daley thinks that the teenager is at immediate risk of suicide or homicide, he/we will notify the parents (and police) of this concern.

“Could there ever be a situation in which I want Dr. Daley to provide information to someone and he might refuse to do so?”

The surprising answer to this question is “Yes.” … and No. That is, sometimes clients want to use therapy records in an inappropriate fashion. Dr. Daley’s code of ethics requires him to do all that he can do to prevent the misuse of psychological information, by you or against you. If you request your records, and Dr. Daley learns of your intention to use the information therein inappropriately, he will make every effort to insure that you fail in the effort. For example, if you only came to therapy to try to prove that your ex-spouse is a poor parent to your children, Dr. Daley will make note of that fact in the information he releases.

“If Dr. Daley is compelled to testify in court in my case, are there fees?”

Yes. If Dr. Daley is compelled by a court of law to testify, you will be required to pay his fee – in advance – for travel to and from, attendance at, and preparation for any legal proceeding even if his testimony harms your case, and even if he is never actually “called” to testify.

Your best “stance” in therapy is to use Dr. Daley as your therapist – and only your therapist (unless you are only here for a psychological evaluation) – and leave everything else out of the process. The process is meant to be private, confidential, softly inviting of insight, not part of some legal action.

“What if all I need is a Psychological Evaluation?”

If you have consulted us in order to obtain a psychological evaluation – or been referred ONLY for a psychological evaluation – and you are not seeking further services, we will continue to make every effort to maintain an open and clear-communicating relationship with you. However, this process can be complicated by circumstances surrounding your referral. For example, if you have been forced to seek an evaluation by a court of law, or if you are embroiled in some type of legal battle, you may not feel like you want to be completely open with Dr. Daley. You may be angry about having to submit to a psychological evaluation. These issues should be discussed with Dr. Daley.

If someone else is paying for the evaluation, then that other person/entity, that “third party” (third to you and Dr. Daley) becomes the “client” of this office. That is, the person/agency paying for services “owns” the rights to decide what to do with the “product” of the assessment, the written report.

If you have been forced by a court of law to undergo an evaluation, you have the right to question us in detail about the evaluation procedure, as well as the right to refuse to participate in the evaluation. Three factors often surface when an agency pays your fee. First, many examinees are confused by the referral, and request an evaluation “because they told me I should come here.” Please recognize that psychological evaluations can have major impacts on your life and your benefits with these agencies, and you should be fully informed as to the nature of – and reason for – the evaluation. Secondly, when an agency is paying the fee for your evaluation, that agency earns the right to receive the written report of your evaluation, even if you are displeased with some or all of the report. If an agency (e.g., Division of Vocational Rehabilitation, Labor and Industries, Division of Disability Determination Services, Division of Child and Family Services [or other agencies]) is paying for your evaluation, you may refuse to begin the evaluation, but you cannot retrospectively revoke your permission to disclose confidential information to the referring agency unless you pay all of the fees involved. Finally, by your signature below, you are agreeing not to use an evaluation conducted at one agency’s request for subsequent legal or court issues, or for use by other agencies asking different evaluative questions.

If you desire feedback about your evaluation, you may schedule an additional session to review the evaluation (the referring agency may or may not pay your fee for this “extra” session, and payment must be arranged in advance). Written reports will not be released until the fee for the evaluation has either been paid or guaranteed. Written reports will not be released to legal representatives or courts until Dr. Daley has gone over the final report with you so that you understand the exact nature of what is being disclosed. Again, if you have any questions, ask.

Summary

There is a fine line between providing people with information versus overwhelming them with information. This policy statement is intended to help you make informed choices about your psychological services. Indeed, it is very rare that serious problems ever arise. Please feel free to ask Dr. Daley any questions, or offer him feedback about any aspect of this practice.

Paul C. Daley, Ph.D.

Port Angeles, Arlington, and Port Orchard Psychological Services