Robert A. Berley, Ph.D., C.G.P.
Licensed Psychologist

1314 NE 43rd St.,214 span>(206) 935-4573
Seattle, Washington 98105

INFORMATION FOR CLIENTS

State law requires all patients be given information about psychological treatment and office policies. Because each person is unique, psychotherapy is not easily described in any general way. So while the intent is to help you be a more aware consumer, this can only be an overview of what we develop as appropriate and useful to you when you enter treatment. Please read the following information and then sign the back; a second copy will be yours to keep. Note that the Health Insurance Portability and Accountability Act (HIPPA) requires additional knowledge regarding your personal health information. That is covered in a separate document you will be asked to read and sign, though aspects are summarized here.

Unlike medical treatment, psychotherapy requires active effort on your part, most often involving talking about difficult or unpleasant aspects of your life. You may find yourself experiencing uncomfortable feelings such as sadness, loneliness, guilt or anxiety. With time, psychotherapy often leads to a significant reduction in feelings of distress, better relationships and the resolution of specific problems. There is no guarantee, however, and you have the right to choose whether or not to participate in treatment; at any time you may ask for a review of your progress, stop therapy, or request a referral to another therapist.

As you may know, I use a message service when I'm not available to answer the phone. This is the most direct and reliable way of contacting me. In an emergency, you can leave a message and I will be notified. I will then return your call as soon as I am able. Email and texting are acceptable methods of communication if the content is brief, but may not be totally private and so should not be used for anything other than confirming appointments or other limited messages.

My regular fee is $200.00 for a session that is typically 50 minutes long, and at the same rate for other activities such as extended sessions, testing, report writing, and so on. You will receive a statement at the end of each month and payment is expected by the following session. Your time is reserved for you, so if you arrive late you will lose the time you have missed. You will be charged for any session you do not attend unless you let me know prior to the session and either I am able to fill it or we can conveniently reschedule for another time in the next six days. Decisions regarding extended illnesses or vacations will be discussed as the situation arises.

It is advisable to let your family doctor or any specialist treating you know that you are going to be working with me. It's also a good idea to have a general physical exam to note any health problems which might contribute to your current symptoms.

Your involvement in treatment and all of our conversations are legally protected (privileged) and strictly confidential. No identifying information about you will be given to anyone unless you provide me with written permission beforehand. Treatment involving couples will require consent by both partners. Washington law may permit or even insist on the submission of information to relevant individuals in the case of child abuse, suicidal behavior, direct threats to harm another person, and certain information regarding HIV. In addition, if you speak about inappropriate behavior on the part of another health care provider, I may be required to report that information to the relevant state licensing board. Current law also permits the mutual exchange of relevant information among treating health professionals without requiring the patient's specific consent.

The law also requires providers to offer a "good faith estimate" of the cost of treatment. Because psychotherapy is unique to each individual, any estimate will necessarily be inexact. You can reasonably expect to meet on a schedule we agree to with a fee noted above for direct and indirect services. Other fees may be part of treatment and be decided upon as we work together.

I will keep treatment records of our work, and you are entitled to receive a copy on request. Any potential release of information will be discussed with you whenever possible, with the primary goal of maintaining the usefulness of your treatment. Per WAC 246-924-354(g), Washington law permits the maintenance of limited treatment records. These minimal records protect patient privacy since they become part of your personal health information potentially available to others (see the HIPAA Privacy document for details). Your signature below conveys your request that I retain only the date of service, the fee, and the service offered or treatment code. A copy of this information is available to view or download at robertberleyphd.com.

To give you some idea of my background, I have been a psychotherapist since 1980. In 1971, I received my B.A. in physics and chemistry and an M.S. in Education from the University of Pennsylvania. I earned my doctorate from the University of Washington in 1983 and became licensed as a psychologist in 1985. For three years I was on the staff of an inpatient drug and alcohol treatment facility, and then for two years served at a hospital-based eating disorders treatment program. I have been admitted as a member of the American Academy of Psychotherapists and certified as a group psychotherapist by the American Group Psychotherapy Association. I am also a member of the American Psychological Association and subscribe to their Code of Professional Ethics.

The State Examining Board of Psychology asks that you be informed that licensure was established to ensure that a psychologist has a doctoral degree from an accredited university, adequate initial training and supervision, and has passed a national written examination and a state oral examination given by the Washington State Examining Board of Psychology. They are responsible for maintaining professional standards and offering disciplinary recourse for patients. They may be reached at The Department of Health, Examining Board of Psychology, P.O. Box 47868, Olympia, WA 98504-7868.

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