Benefits, Risks & Alternatives to Therapy
Many people benefit from psychotherapy. Success can vary depending on particular problems and the uniqueness of each person. Self-exploration, gaining understanding, finding ways of working with the inner life, understanding dreams, dealing with challenges, as well as learning new skills, are helpful and can contribute to change. Finding a trained professional to support the journey can enhance and facilitate the process.

Most people experience uncomfortable feelings in the course of therapy, such as unhappiness, anxiety, anger, guilt and frustration. These are natural experiences which can lead to change and growth when therapy is used to process them.

Alternatives to psychotherapy abound. Some people find relief from intense anxiety, depression and other overwhelming experiences via exercise, mindfulness practices, self-help books, journal keeping, spiritual practices, medication and other forms of activity that support deeper self-exploration or even just a break from overwhelming distress. 

There are no guarantees. However, commitment to regular sessions deepens the process and assists more rapid achievement of goals.

In most cases (see “Exceptions to Confidentiality” and “No Secrets Policy” below) communications between client and therapist will be held in strict confidence - unless you provide your therapist written permission to release information about your treatment. If you participate in conjoint, marital or family therapy, the therapist will not disclose confidential information about treatment to a third party (other than to a third-party payer) unless all treatment participants provide written authorization to release such information.   

Exceptions to Confidentiality  
Therapists are legally-mandated to report all known or suspected instances of child abuse, dependent adult abuse and elder abuse. Therapists are also required to break client confidentiality when it has been determined that a client presents a serious danger of physical violence to another person. A therapist may break confidentiality when she believes a client is likely to be dangerous to him or herself. Third party payers, such as insurance, managed care companies and employee assistance programs, require that therapists release information (including diagnosis, prognosis, progress, & treatment plan) and may access medical records at any time.

In addition, section 215 of The Patriot Act of 2001 requires therapists (and others) in certain circumstances, to provide FBI agents with books, records, papers and documents and other items and prohibits the therapist from disclosing to the client that the FBI sought or obtained the items under the Act.  

“No Secrets” Policy  
The “no-secrets” policy means that if a client participates in family, conjoint, marital or couples therapy, and shares information with the therapist of which the others in therapy are unaware, the therapist may work to help this client bring such information into session if in her professional judgment maintaining the “secret” is likely to impede or counter the goal mutually agreed upon by the therapist and those who are in therapy.  
Alternately, if a client remains unwilling to share this information and the therapist believes the “secret” impedes or negatively affects your therapeutic goals, she may choose to terminate or suspend services until such time as the client becomes ready to share the information with others in treatment.  Please feel free to ask your therapist about this policy.  

Minors and Confidentiality  
Communications between therapists and clients who are minors (under the age of 18) are confidential. However, parents and other guardians who provide authorization for their child’s treatment are often necessarily involved in their treatment. Consequently, the therapist, in the exercise of her professional judgment, may discuss the treatment progress of a minor client with the parent or caretaker. Clients who are minors and their parents are urged to discuss any questions or concerns that they have on this topic with their therapist.  

Appointment Scheduling and Cancellation
The session is a sacred time for each client.  The therapist holds the time and expects it to be a priority in each client's schedule. Sessions are by appointment and typically scheduled to occur once weekly at the same time and day if possible.  

The therapist may suggest a different amount of therapy depending on the nature and severity of treatment concerns. Consistent attendance greatly contributes to a successful outcome.    
In order to cancel or reschedule an appointment, clients are expected to notify the therapist at least 48 hours in advance of the scheduled appointment, and there will not be a charge. Clients who do not provide at least 48 hours’ notice of cancellation in advance of a scheduled session are generally responsible for payment for the missed session. 

I inform clients well in advance of my vacation schedule. Clients are asked to provide at least 1 week notice of vacations or other events likely to result in missed sessions.  

All therapists are required to disclose information about their fees prior to entering into an agreement to provide services. 

$625 per  Substance Abuse SAP evaluation with treatment recommendations or follow-up recommendations; 

$200 per 50 minute psychotherapy, SAP, case management/treatment compliance follow-up hour 

Phone calls that last over 10 minutes are usually charged on the basis of the hourly fee.
Fees are payable at the time services are rendered, and it is best to pay at the beginning of each session to maximize the use of session time.  

Fees may be raised on a yearly basis.  

Although I no longer contract with insurance companies, I provide monthly, quarterly or annual statements as needed.

You should be aware that insurance plans generally limit coverage to certain diagnosable mental conditions.  You should also be aware that you are responsible for verifying and understanding the limits of your insurance coverage. While under care for medically-necessitated services, the focus of therapy will be symptom reduction and skill development for independent self-regulation.  

Therapist Availability Between Sessions 
Telephone consultations between office visits are sometimes necessary, however, it is best to limit such contacts and address important issues within regularly scheduled sessions.  You may leave a message for your therapist at any time on her confidential voicemail. If you wish her to return your call, please be sure to leave your name and phone number(s), along with a brief message concerning the nature of your call. Non-urgent phone calls are generally returned within 24-48 hours (between 9 am to 6 pm Monday through Thursday, and 9 am to 5 pm on Fridays).  

If you have an urgent need to speak with your therapist, please indicate that in your message and follow any instructions that are provided by her voicemail. She will return your call at her earliest opportunity. If for some reason she does not respond to your call quickly, please do not hesitate to call 9-1-1 or one of the crisis phone numbers below.

During extended absences, your therapist will work with you to develop arrangements for continued services with another professional in her absence. In the event of a medical emergency or an emergency involving a threat to your safety or the safety of others, please call 911 to request emergency assistance.

The following resources are available to assist individuals who are in crisis: 

Suicide Prevention: (415) 781-0500 

National 24-Hour Youth Shelter: (800) 843-5200 

Rape and Assault: 
    National (800) 656-HOPE or (800) 656-4673
    San Francisco (415) 647-7273 
    SF Domestic Violence Helpline: (877) 384-3578  
    National Domestic Violence Helpline: 
    (800) 799-SAFE, or, (800) 799-7233 
    (24 hr)English and Spanish  

National AIDS/HIV/HCV Nightline number: 
    (800) 273-AIDS

Problem Gambling: 
(800) GAMBLER or (800) 426-2537

Web-site for Grief Support and Education: see the FAQs & Resources page of this website for more resources

Additional Communication
The therapist may need to communicate with a client by telephone, mail, or other means outside of session. Clients need to indicate all contact time and modality preferences.  

About the Therapy Process  
It is the therapist’s intention to provide services that will assist you in reaching your goals. Based upon the information that you provide to your therapist and the specifics of your situation, your therapist will provide recommendations to you regarding your treatment. 

Therapists and clients are partners in the therapeutic process. You have the right to agree or disagree with your therapist’s recommendations.  Your therapist will also periodically provide feedback to you regarding your progress and will invite your participation in the discussion.  

Due to the varying nature and severity of problems and the individuality of each client, your therapist is unable to predict the length of your therapy or to guarantee a specific outcome or result.  

Termination of Therapy  
The length of treatment and the timing of the eventual termination of treatment depend on the specifics of the treatment plan and the progress achieved.  

If you or the therapist determines that there is a lack of benefit from treatment, either may elect to initiate a discussion of treatment alternatives.  Reasons for termination include, but are not limited to, conflicts of interest, lack of compliance with treatment recommendations, lack of participation in therapy, lack of adequate progress in therapy, client needs outside scope and / or experience of therapist, and untimely payment of fees.  
Clients have the right to terminate therapy at their discretion, however, it is a good idea to plan for termination, in collaboration with the therapist, in the completion of treatment goals. It is generally recommended that clients participate in several sessions, depending on the length of therapy, to provide positive closure and reflect on progress.
Treatment alternatives may include, among other possibilities, referral, changing a treatment plan, or terminating therapy.

(415) 342-5196
Carolyn B. Cooper, MS, LMFT, SEP, SAP
            Licensed Marriage & Family Therapist, 
                Somatic Experiencing Practitioner,                                                                                     Certified EMDR Practitioner,
                      Substance Abuse Professional (49 CFR Part 40),
          (Former) Authorized Problem Gambling Treatment Service Provider
CA License#MFC 44480