“Hope” is the thing with feathers -
That perches in the soul -
And sings the tune without the words -
And never stops - at all -

Emily Dickinson

 
Contact K'Ailsa Rowan with questions or to make an appointment:
408-390-3680 or 

krowan@counselingforaction.com.


Office Hours by appointment only. My usual hours are Monday-Thursday 1 PM - 6 PM.

Book now!


Important: Email may not be confidential. If you want to be sure your contact is confidential, please either phone or use secure text in the Client Portal.


Kaye-Ailsa Rowan, M.A., LMFT

AAMFT Approved Supervisor

California License LMFT 47779


The Fine Print: Policies, Privacy Practices, Business Information, and so on


Office Policies and Informed Consent for Therapy

Office Policies and Informed Consent for Psychotherapy


Welcome to Counseling for Action. Counseling for Action is an independent, private psychotherapy practice owned by Kaye-Ailsa Rowan, LMFT (CA License 47779) and opened in 2009. Although Counseling for Action shares office space, equipment, and some support staff with other businesses in our office and office suite, I am not partnered with or otherwise affiliated in the same practice with these other businesses. Each business is responsible for our own clients and maintains confidentiality about our clients.

Your first visit to a new therapist is very important, and you may have many questions. The therapeutic relationship is unique in that it is a highly personal and at the same time, a contractual agreement. This frame helps to create the safety to take risks and the support to become empowered to change. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a framework for our work together. Please read it and feel free to ask questions about it at your first session or any time after that.

Confidentiality and Privacy

Therapy is confidential with certain specific exceptions. In most cases, I must have the written permission of all consenting persons participating in the therapy to discuss your case outside of the office, except as required or permitted by law. “Consenting persons” includes everyone 12 or older who participates in the therapy.

Exceptions to confidentiality, include, but are not limited to: reporting child, elder and dependent adult abuse; when a client makes a serious threat of violence towards a reasonably identifiable victim; when a client is dangerous to him/herself or the person or property of another; for payment processing by an insurance company; consultation with other medical professionals; when required by a court of law; or in an emergency. The “Notice of Privacy Practices” contains additional details about the exceptions under the law.

In some cases, parents or legal guardians of minors or dependent adult clients have the right to request a copy of the clients’ records if it will not cause harm to the client or interfere with their ability to benefit from therapy. If I believe the request will interfere with the client’s ability to benefit from therapy, I have the right to provide a summary of treatment instead.

I will always act to protect your privacy even if you do give permission to share information about you. You may direct me to share information with whomever you choose, and you may change your mind and revoke that permission at any time. You may request anyone you wish to attend a therapy session with you.

To protect your confidentiality and the boundaries of the therapy relationship, I limit contact with clients outside the office. I do not purposely link with or interact with you on social media, and if we see each other accidentally outside of the therapy office, I will not acknowledge you first. If you acknowledge me first, I will be happy to speak briefly with you, but I feel it appropriate to avoid lengthy discussions in public or outside of the therapy office.

Electronic Records and Communications

You are protected under the provisions of the Federal Health Insurance Portability and Accountability Act (HIPAA). This law ensures the confidentiality of all electronic transmission of information about you. Whenever Counseling for Action transmits information about you electronically (for example, in our Client Portal), it is done with specific safeguards to insure confidentiality.

If you elect to communicate with me by email or text, please be aware that they are not completely confidential. All emails and text messages are retained in the logs of your or Counseling for Action’s internet service provider. While under normal circumstances no one looks at these logs, they are, in theory, available to be read by the system administrator(s) of the internet service provider or to be provided to others under state or federal law. Any email or text messages I receive from you, and any responses that I send to you, can be kept in your treatment record.

Record-Keeping

I keep records as required by California and Federal law. These include information such as your presenting problem and history, session times and general topics discussed, and plans for future treatment. Counseling for Action maintains your records electronically using a secure HIPAA-compliant program. You have the right to a copy of your file or a summary of it on request. You have the right to request that I correct any errors in your file. You have the right to request in writing for me to make a copy of your file or a summary available to any other health care provider.

Privilege

By law, your therapy records are protected from many court actions. This is called “privilege”. Thus, if I receive a legal request for your records or to appear in court, I will assert your privilege to protect your private health information. Then, I will contact you for instructions.

Scheduling, Fees, & Cancellations

Your scheduled time is set aside specifically for you. Having and keeping this regular appointment contributes to the continuity and effectiveness of your therapy. You are responsible for coming to your session on time and at the time we have scheduled. Sessions last for 45 minutes. Appointments are either in person or by video (also called “teletherapy”). In-person appointments are held at my office. For video appointments, I will provide you with a link prior to the appointment. If you are late, we will end on time and not run over into the next person’s session.

Payment

You are responsible for paying for your session weekly unless you and I have made other arrangements in advance. Fees are paid electronically. As of July 1, 2020, the fee for a session is $150.00. If you and I decide to meet for a shorter or longer session, Counseling for Action will bill you prorated on the hourly fee. If you have a reduced fee arrangement, the prorated fee is based on the amount you personally pay per session. Also, I increase my fees annually by $10, usually on July 1 of each year, and I will remind you in advance when I do so.

Counseling for Action does not bill insurance directly. At your request, Counseling for Action will provide a monthly statement (“superbill”) that you can submit to your insurer.

I am not willing to have clients run a bill with me. If you are more than two sessions behind in payment, I reserve the right to decline to schedule further sessions until your account is cleared. If you eventually refuse to pay your debt, I reserve the right to give your name, contact details, and the amount due to a collection agency.

Missed Sessions

If you miss a session without canceling, or cancel with less than 24 hours' notice, you will still be charged your full session fee as usual. If you are unable to attend a session in person, but still want therapy, you have the option to contact me and convert it to a telehealth session instead of canceling. The only exceptions to this rule about cancellations are for illness or an emergency.

In the unlikely event that I forget your scheduled appointment, your next appointment is free.

If you miss your scheduled appointment without notifying me (a “no show”), I will not hold your regular time for the following week unless you confirm it. This prevents you from developing a large balance for “No Show” appointments. Also, if you do not schedule an appointment for three consecutive weeks (unless other arrangements have been made in advance, such as for travel), or miss multiple scheduled appointments in a row without contacting me, I will consider that you have ended therapy. When you return to therapy, I will work with you to set up a new appointment time.

What Is and Is Not Included in Your Fee

Your weekly session fee includes brief (less than 15 minutes/week) phone calls with you or with medical providers, such as your doctor or psychiatrist. However, if I spend more than 15 minutes in a week on the phone with you or while coordinating care as requested by you; if you leave more than 15 minutes’ worth of phone messages in a week; or if I spend more than 15 minutes reading and responding to emails or text messages from you during a given week, I will bill you on a prorated basis for that time.

If you need frequent contact between sessions, I will discuss with you whether we should schedule more frequent sessions.

Letters and Reports: Occasionally you may need me to prepare a written letter or report, such as a letter supporting surgery or a written report to another medical provider, your school, or an insurer. For such letters I charge your session fee for up to one hour of work, or a prorated fee if the letter takes longer than one hour to prepare. I will discuss the fees with you when we decide that I will prepare such a report or letter.

Phone Calls, Emergencies, and Vacations

Both my confidential voicemail and the messaging service in the Client Portal are available for messages at any time. My office hours are Monday through Thursday afternoons. Non-urgent messages left after 5 PM, on Fridays and weekends, or on holidays will be returned on the following business day.

Urgent consultations of 15 minutes or less are included in my service. If you have an urgent situation and require a consultation, please say so at the beginning of your message, and leave phone numbers where I can reach you. Such messages will be returned as soon as possible.

If your situation is an acute emergency and you need to talk to someone right away, contact a 24-hour emergency psychotherapeutic service in one of the following ways:

·       Call the Santa Clara County Suicide and Crisis Line (free, 24 hour): 1-855-278-4204

·       Text “TALK” to the free Crisis Text Line at 741741

·       Follow the emergency procedure specified by your health plan

·       Go to your nearest Emergency Room

·       Dial 911


If you need to leave a message that is not urgent, please leave a detailed message and convenient times and phone numbers when I can reach you.

Vacation Policy: I will give you advance notice about scheduled vacations. During these vacation times and for some holidays, I will provide you with the name and phone number of a colleague who will be available to assist you in urgent situations. I am not available and do not check voicemail, text messages, or email during these scheduled breaks. If you leave a message, I will return it on the first business day following the vacation.

Therapist Emergency: If an emergency makes me unable to keep appointments, I will notify you. In the unlikely event that I am unable to notify you, you will receive a phone call from another licensed therapist who will be authorized to notify clients, maintain medical records, and help you find alternate services pending my return to work.

Other Rights and Responsibilities

You have the right to ask questions about anything that happens in therapy. If you are unhappy with what is happening in therapy, I hope you will talk about it with me so that I can respond to your concerns. I will take such criticism seriously, and with care and respect. I am always willing to discuss how and why I have decided to do something and to look at alternatives that might work better. You can feel free to ask to try something that you think will be helpful. You can ask about my training for working with your concerns, and you can request a referral to someone else if you decide I am not the right therapist for you.

Ending therapy is usually a mutual decision; however, either of us has the right to end your therapy with me at any time, even if you have not met your goals. If you decide to end therapy and in my professional judgment it is not in your best interests to stop, I will tell you. Also, if I believe ending therapy, seeing another therapist, or trying a different type of treatment would work better for you, I will tell you, and then we can discuss what is best to do next.

I reserve the right to end therapy unilaterally in several cases. If we have contracted for a specific short-term piece of work, we will finish therapy at the end of that contract. If I am not in my judgment able to help you, because of the kind of issues you are dealing with or because I judge that my training and skills are not appropriate, I will inform you of this and make appropriate recommendations. If you do violence to, threaten (verbally or physically), or harass me, my office, any of my staff, officemates, or family, I reserve the right to end treatment with you immediately. I also reserve the right to end therapy if you default on payment or miss multiple sessions in a row, as described in “Fees and Cancellations”. If I end our work together, I will offer you referrals to other sources of care, but I cannot guarantee that they will accept you for therapy.

If you believe that I have behaved unethically, you can complain about my behavior to the California Board of Behavioral Sciences.

You are free to discuss our work with anyone you wish and do not have any responsibility to maintain confidentiality. You are the person who has the right to decide what you want kept confidential.

About the Therapy Process

Psychotherapy is both a science and an art. It is a process that is intended to create change that leads to healing. My goal is to provide you with professional services that help you maintain healthy relationships with yourself and others. Everyone, and every family, has areas where they are strong or skilled. One of my goals as a therapist is to help you use your strengths to heal other parts of yourself or your family. While I cannot promise that your behavior or circumstances will change, I can promise to support you and do my very best to understand you and any repeating patterns in your life or your family, as well as to help you clarify what it is that you want for yourself.

Therapy has potential emotional risks. Approaching feelings or thoughts that you may not think about regularly may be painful. Making changes in your beliefs or behaviors can be scary, and sometimes disruptive to the relationships you already have. You may find your relationship with your therapist to be a source of strong feelings, sometimes rewarding and sometimes painful. It is important that you consider carefully whether these risks are worth the benefits to you of changing. Most people who take these risks find that therapy is helpful.

Even so, therapy is a process with a beginning, in which we decide whether to work together and set goals; a middle, where we work together on those goals; and an ending, where we consolidate your changes and make a plan to help you maintain them. Some clients end therapy completely once their goals met; others make an aftercare plan that includes referrals to other professionals or periodic “check-ins” with me.

Client Consent to Psychotherapy

I am age 12 or older. I have read this statement, had enough time to be sure that I considered it carefully, asked any questions that I needed to, and understand it. I understand the limits to confidentiality required by law. I agree to pay the fee of $150.00 per session, or my agreed upon sliding scale fee. I understand my rights and responsibilities as a client, and my therapist’s responsibilities to me. I agree to undertake therapy with Kaye-Ailsa Rowan, M.A., LMFT. I know that I can end therapy any time I wish.

When you sign our Consent to Treatment or click the Consent checkbox in the Client Portal, you agree to follow these policies.