Working with Dr. Nothmann

What can I expect if I decide to go forth with therapy with you after the evaluation?

If psychotherapy is begun, I will usually schedule one or two 45 to 50-minute sessions (one appointment hour of 45 to 50 minutes duration) per week at a time we agree upon. We will sign a patient contract, an example of which is provided here.

In therapy, the time is yours. We will use it to continually work on the issues brought forth by you and to reevaluate your treatment plan as well as working on any new topics that arise during the therapy. Treatment for Post-Traumatic Stress Disorder is a complicated process. This is not brief psychotherapy directed at one issue. We will be approaching many areas of your life and reaching into things far past the “surface.” It is important for you to know this to take into consideration if this type of therapy is correct for you at this time in your life. You may find that things become overwhelming at times, that your functioning decreases as opposed to increases, and while all of these things are horrible, they are sometimes necessary for growth. At ANY time, you have a right, and I have the responsibility to point out that we may need to examine our pacing of treatment. This would include going “too deep too fast.”

Further, you and I both will continue to have other rights and responsibilities in treatment. Honesty, attendance, timeliness, respect of my boundaries and other things are important for us to talk about and do in order to be able to work together to achieve your overall improvement. In turn, I will be honest, on time and respect your boundaries as well as continue to work with you to find the best approach for your particular concerns. If we work together, we will form a therapeutic bond, and this will be one of the most helpful factors in your improvement. There is much more to this, which we will discover together. Many things can threaten the bond, the biggest being lack of the trust that we will hopefully be able to build.

In the meantime, here is another list of rights and responsibilities in therapy from another source:

A Recovery Bill of Rights for Trauma Survivors by Thomas V. Maguire, Ph.D.

Will I be able to contact you outside of sessions?

I am often not immediately available by telephone. While I am usually in my office between 9 AM and 5 PM, I will not answer the phone when I am with a client. When I am unavailable, my telephone is answered by a machine that I monitor frequently. As much of my time is also taken up with paperwork or other responsibilities, it sometimes may take me a while to return non-emergency phone calls. Given certain limitations (e.g., not after 10 PM) I will make every effort to return your call as soon as possible in emergency cases, which I will clearly define with you. If you are unable to reach me and feel that you can’t wait for me to return your call, contact your family physician, the nearest emergency room or call 911 and ask for the mental health specialist on call. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact if necessary.

Do you keep records? Can anyone else look at them? May I see them?

What if I want to discontinue therapy?

You always have the right to terminate therapy. As long-term, psychodynamic psychotherapy tends to raise significant feelings about the therapeutic relationship, I do strongly suggest that we discuss the issue of termination before actually terminating our therapeutic relationship. Should you decide that you desire continued therapy, I will gladly provide you with contact information for professionals who may be helpful. Should you desire, I can also provide you with a variety of other information resources to help you locate another therapist. It is always your right to request this.

PROFESSIONAL RECORDS

The laws and standards of my profession require that I keep treatment records. You are entitled to receive a copy of the records unless I believe that seeing them would be emotionally damaging, in which case I will be happy to send them to a mental health professional of your choice. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. I recommend that you review them in my presence so that we can discuss the contents. Patients will be charged an appropriate fee for any time spent in preparing information requests.

CONFIDENTIALITY

In general, the privacy of all communications between a patient and a psychologist is protected by law, and I can only release information about our work to others with your written permission. But there are a few exceptions:

In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if he/she determines that the issues demand it.

There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a patient’s treatment. For example, if I believe that a child, elderly person, or disabled person is being abused, I am mandated by law to file a report with the appropriate state agency.

If I believe that a patient is threatening serious bodily harm to another, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the patient. If the patient threatens to harm himself/herself, I may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection.

These situations have rarely occurred in my practice. If a similar situation occurs, I will make every effort to fully discuss it with you before taking any action.

I may occasionally find it helpful to consult other professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my patient. The consultant is also legally bound to keep the information confidential. If you don’t object, I will not necessarily tell you about such consultations unless I feel that it is important to our work together.

While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have in person. I will be happy to discuss these issues with you if you need specific advice, but formal legal advice may be needed because the laws governing confidentiality are quite complex, and I am not an attorney. If you request, I will provide you with relevant portions or summaries of the state laws regarding these issues.

There are also HIPAA Regulations regarding confidentiality, record-keeping and disclosure. Please see the sample HIPAA Agreement here.