Policies

Professional Disclosure Statement

I am a Licensed Mental Health Counselor, Licensed Alcohol and Drug Counselor and Certified Rehabilitation Counselor. I have a graduate degree in Rehabilitation Counseling and a certificate in advanced graduate studies from the University of Massachusetts at Boston. The licensing board that oversees the LMHC credential is The Massachusetts Division of Professional Licensure. The licensing board that oversees the LADC1 credential is the Massachusetts Department of Public Health. Newton Counseling Center is a solely owned and operated business belonging to me, David Poles.

The current scope of my services includes:

• Teaching clients how to get and stay sober
• Teaching clients how to grow from change of life events i.e. marriage, divorce, job loss, attending college
• Teaching clients how to manage, reduce and grow from anger with integrity
• Court ordered anger management evaluations and treatment
• Court ordered alcohol and other substance dependence evaluations and treatment
• Weekly College Student Support Group for clients ages 18-24
• Clinical supervision for graduate level clinicians working toward licensure of LADC1, LMHC and or CRC credentials
• Family education and support for those with chemically addicted loved ones

Fees

Fees are due at the beginning of each session; cash or check only.

Initial Evaluation	$120.00 for 60 minutes
Individual, couple, or family sessions	$100.00 for 50 minutes
Individual 30 minute face to face sessions	$75.00
Report writing & other services (not covered by insurance)	$120.00 for 60 minutes (pro-rated for less than 60 minutes)
Weekly 90 minute Group Session	$50.00 due prior to each session

There is no charge for the occasional brief telephone contact (5 minutes or so). The fee for longer calls is $2.00 per minute. Insurance will not pay for telephone calls.

Cancellations

The times set aside for you are not easily filled when cancelled with short notice (less than 24 hours). Late cancellations and missed appointments will be charged at the standard session fee ($100.00) or your insurance fee schedule (whichever is less; not just the co-pay). Please note that insurance will not pay for missed appointments. Prior to the first time we meet, you will be asked to provide your credit card information so that if you do not show up and have not given me 24 hour notice, I will be reimbursed for the session. Late cancellation and missed appointment fees may be waived on a case-by-case basis for circumstances beyond your control.

Insurance

If you choose to use your insurance (see "Confidentiality" below for reasons you may choose not to do so), it is your responsibility to understand your coverage, including deductibles, co-payments, and benefit limits, and to pay for non-covered services. I am on a limited number of insurance panels, including Blue Cross Blue Shield, United Behavioral Health, Harvard Pilgrim and Aetna. If I am not a provider, your insurance may allow you to see me out-of-network. You would pay me first and I would give you a detailed receipt with which you could seek (usually partial) reimbursement from your insurer. Please contact your insurer to find out if this is possible under your plan's coverage.

Telephone Accessibility

When you call 617-332-7588 (at any time), you may reach my voice mail. I will return your call as soon as possible, almost always the same day. As I am not always available, if an urgent situation develops and you need help immediately, indicate that in your message, then call 911 or go to the nearest emergency room.

Confidentiality Policy and Exceptions

Professional ethics and legal standards require that our conversations and my records (even the fact that you are a client) be kept strictly confidential, unless you sign a release. However, there are times when I am legally and ethically obligated to breach confidentiality, including:

• If you present a serious, imminent danger to yourself or others;
• In cases of apparent abuse or neglect of a child, an elderly person, or a disabled person;
• When a judge orders the release of information;
• If legal action is brought against me by a client and/or family;
• When necessary to collect fees owed.

In the rare event that confidentiality must be breached, I will make an effort to discuss it with you before taking any action and I will reveal only the minimum amount of information necessary

All insurance companies require information about you that includes, at minimum, a psychiatric diagnosis that becomes a permanent part of your medical record. Managed care companies often require considerably more information about your therapy. They may also require that we follow their prescribed form of treatment. If at any time in the future you apply for life insurance, disability insurance, or private health coverage, those companies will probably require you to sign a release to get a copy of your records. You could then be denied coverage, or have to pay more for it.

I cannot control the confidentiality of any information (especially including diagnosis) once it is disclosed to insurance companies or their agents. I will not be able to tell you whether employers have access to information about you or if such information is distributed to national data banks. The security of data on the web is compromised frequently, and even though health care companies usually protect data, there is no guarantee of confidentiality.

If you would prefer not to use your insurance, please ask me about your option to pay privately.

Please refer to the separate Notice of Privacy Practices for more information about confidentiality.

Records

As required by law and professional ethics, I maintain confidential records of our sessions and any other contacts. These records (written or verbal) are available to others only at your written request. You have the right to withdraw your permission in writing to prevent future disclosures. You are entitled to receive a copy of these records, unless there is reason to believe that releasing them might be harmful to you. In that case, I will provide them to an appropriate and legitimate licensed mental health professional of your choice.

Consultation

In order to serve you best, I will on occasion consult with other professionals when appropriate. Your name and identifying details will not be disclosed.

The Treatment Process

The goals of therapy are arrived at by mutual agreement. Depending on the nature of these goals, the length of therapy can range from one or two sessions to several years.

 Participation in therapy can result in a number of benefits, including reduction of the intensity of the distress or unease that brought you to therapy, improved interpersonal relationships, and insight. However, there are no guarantees that therapy will result in positive or intended results.

There are risks in undertaking therapy. Psychotherapy may sometimes involve recalling or reliving distressing aspects of your history. As a result, you may at times experience difficult emotions like sadness, guilt, anxiety, anger, loneliness, frustration, or helplessness. Occasionally, with your permission, I may challenge some of your long-held perceptions and propose different ways of looking at or handling situations, and these challenges may potentially feel uncomfortable.

If at any time you have any questions about the process of your therapy, I depend on you to bring them up for discussion. This may be difficult for you to do, but "stretching" yourself to try new ways of relating to me may be helpful in making positive changes in your relationships with others.

My orientation as a psychotherapist is eclectic, drawing from several theoretical perspectives including: holistic, mindfulness-based, contemplative, spiritual, body-oriented, cognitive-behavioral, psychodynamic, existential, psycho-educational, and solution-focused, along with use of coaching techniques when appropriate.

Ending Therapy

After the first couple of meetings we will assess if I can be of benefit to you. If we are not a good match, I will offer referrals to other clinicians or resources. If at any point during psychotherapy it becomes evident that our work together is not effective, I will discuss this with you, and if appropriate, terminate treatment and suggest alternatives.

I will do my best to support the concluding of our work together, no matter the reason. When you decide you are ready to leave, I would like to help you leave well. Please give at least one week's notice so that we can review our work together, and plan for the future.

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