Brisbane Ci
AGREEMENT TO ENGAGE IN PSYCHOLOGICAL THERAPY
To ensure that you are fully aware of considerations relevant to engaging in psychological therapy, and that you get the
most out of your therapy encounter, please read the following information carefully prior to signing this agreement.
Con dentiality
All therapy notes and personal information provided throughout the course of a psychological therapy encounter will
remain con dential and secure, available only to the psychologist working directly with you, with contact information
available also to administrative staff. Exceptions to con dentiality occur under the following circumstances :
Information and/or psychological therapy notes are subpoenaed by a court of law
Failure to disclose the information would place yourself or another person at serious and imminent risk
You have been referred under the Mental Health Care Plan – in which case a brief written report to the referring
medical practitioner is required at various stages throughout the provision of psychological services (Please
clearly advise if there is any information you would prefer not to be disclosed in such reports.)
Your prior approval has been obtained to
- provide a written report to another professional or agency, eg GP, solicitor
- discuss the material with another person, eg a spouse, relative or employer
If disclosure is otherwise required or authorised by law
To ensure you are provided the best possible psychological care, careful and sensitive discussion of the therapy
encounter with quali ed professional colleagues is sometimes required for the purpose of professional supervision.
All registered Psychologists are bound by the above outlined con dentiality requirements, as determined by the
Professional Codes of Conduct issued by the Australian Psychological Society (APS) and relevant State Registration
Board. To maintain absolute con dentiality, excluding the above exceptions, no information pertaining to your therapy
encounter will be discussed with any friend, spouse, family member or any third party, without your signed consent.
Fees
Fees are as outlined on the Brisbane City Psychology website, and as agreed with yourself at the commencement of
psychological therapy. All fees have been determined in accordance with APS guidelines, with these typically being
signi cantly below APS recommended fees. Individuals referred via a GP Mental Health Care Plan, Psychiatrist or
Paediatrician are entitled to receive a Medicare rebate for psychological services for up to 10 sessions within any
twelve month period. All fees are to be paid in full at the time of service provision with Medicare claims
processed at the Clinic via the EFTPOS/Medicare facility. Rebates are deposited to your account within 24-72hrs.
Excluding standard review letters to your GP/Psychiatrist/Paediatrician, all additional reports and letters incur a fee
re ecting the time taken to prepare and write these – typically 1-3 hours (longer for detailed Neuropsychological
reports). Costs for reports are outlined on our website.
Cancelling or Changing an Appointment & Cancellation Fees
It is appreciated that at times unexpected and unavoidable circumstances may result in the need to cancel or reschedule
an appointment at short notice, and this will of course be considered with regard to cancellation fees. However, in
general a minimum of 24 hours notice is required to cancel or reschedule an appointment without incurring a fee. (As
much notice as possible would of course be greatly appreciated.) Please be considerate of this courtesy, as with
suf cient notice, these can be offered to others awaiting an appointment, avoiding unused/wasted appointments.
Please also be aware that non-attended appointments result in a loss of income for your therapist, and accommodation
fees for scheduled appointments are charged to your therapist irrespective of whether or not you attend.
A cancellation fee of $150 will be charged if less than 24 hours notice is provided.
79 Wickham Terrace Brisbane QLD 4000
Tel: 0435 591493 or (07) 3270 4555 Fax: (07) 3270 4559
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TeleHealth Consultations - Provision of a TeleHealth service
Where appropriate the psychology service may be provided by telephone or videoconferencing, for which Medicare
provides a rebate equivalent to in-person appointments. Brisbane City Psychology is responsible for the cost of the
call to you and the cost associated with the platform we use to conduct such services.
To access TeleHealth consultations you will need access to a quiet, private space where you will not be interrupted by
others - including children; an appropriate device, i.e. smartphone, laptop, iPad, computer - with a camera, and/or
microphone; and a reliable broadband internet connection. You are also asked to dress as you would for a face-to-face
appointment (e.g. not pyjamas). TeleHealth sessions should not be undertaken while you are travelling.
The privacy of any form of communication via the internet is potentially vulnerable and limited by the security of the
technology used. To support the security of your personal information this practice uses the secure encrypted platform
“Coviu” which is compliant with the Australian standards for online security and encryption, and recommended by the
Australian Psychological Society. FaceTime technology, which is able to be used with iPhones and other Apple
devices, and WhatsApp are alternative secure and double-end encrypted platforms which may also be used if you have
access to these.
Limitations of TeleHealth
A TeleHealth consultation may be subject to limitations such as an unstable network connection which may affect the
quality of the psychology session. In addition, there may be some services for which TeleHealth is not appropriate or
effective. Your psychologist will consider and discuss with you the appropriateness of ongoing TeleHealth sessions.
Attendance
To gain maximum bene t from psychological therapy it is most bene cial (for your own progression) to attend
regularly, and to arrive on time for your appointment. Non attendance and late arrival will limit the time available to
provide an effective service to you. In the event of late arrival, sessions will still need to end no later than fty minutes
from the originally scheduled time. When longer EMDR appointments have been scheduled, it may not be possible to
undertake this particular therapy intervention in the event of late arrival, as at least 100 minutes is required to
undertake EMDR to full completion. A different therapy intervention would however still be able to be employed, and
the full longer consultation fee would still apply. Please note that when an appointment has been cancelled or not
attended without adequate notice (other than in an emergency), no further appointments will be offered until payment
of the cancellation fee has been received.
Effectiveness of Psychological Therapy
Psychological therapy is very much a collaborative process, such that its effectiveness is dependent on the
collaboration between yourself and your therapist, and relies heavily upon individual factors such as readiness to
engage in the therapy process, including a willingness to consider re ections provided by your therapist (which can
sometimes be challenging and dif cult), preparedness to accept and undertake any tasks or challenges necessary to
effect change, a willingness to communicate openly about fears and vulnerabilities, and often acceptance of at least
some responsibility for the need to change. These conditions are necessary to enable signi cant improvement in
emotional wellbeing. If you have any concerns about your readiness to actively and willingly participate in the
psychological therapy process, or if for any reason (eg gender, age, race, personal style) you would prefer to meet with
a different therapist, please do discuss this openly with your therapist, who will endeavour to suggest an appropriate
alternative therapist, and/or refer you to the APS “Find A Psychologist” service.
It is a general psychological therapy requirement that an individual be engaged in just one therapy encounter at any
given time, for their own wellbeing and bene t. Meeting with more than one therapist at a time can be very
detrimental to the effectiveness of either therapy encounter, and is strongly advised against. If you are planning to
engage in any other individual or group therapy, you will be required to discontinue or pause your individual therapy at
Brisbane City Psychology, until the other therapy encounter has been fully completed.
Please Note: Alcohol or drug usage within 48hrs of your appointment can signi cantly impact the therapy encounter
and therefore cannot be allowed. You are therefore requested to refrain from doing so within this time frame.
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Risks Associated with Psychological Therapy
It is also important to be aware that whilst the eventual outcome of psychological therapy is for the majority of people
very positive, appreciated and valued, the process can also – particularly in the early stages, expose a wide range of
dif cult feelings, reactions and moods. These might include anger or depression feelings, nightmares and/or ashback
memories, anxiety, feelings of guilt, fear, frustration, disappointment or sorrow, and for some people mood swings and
irritability. For couples and families there might initially be an increase in tension due to dif cult feelings/experiences
being exposed or potentially exposed, concerns about the openness and honesty of your partner or a family member, or
feelings of fear and threat becoming heightened. There may also be physical signs or symptoms of increased emotional
distress, including headaches, gastro-intestinal distress, lack of energy, breathlessness, sleep disturbance, increased
heart-rate (associated with anxiety) or nausea. It is important to discuss any such concerns with your therapist.
For some people these dif culties can at times interfere with daily life, and personal and professional commitments
and responsibilities. It is therefore important to let your therapist know if there are any current or pending personal or
professional situations which might be negatively affected or jeopardised if such dif culties arose during the course of
engaging in psychological therapy (e.g. an impending job interview, exam, home care needs or an important home or
employment responsibility). In these instances therapy might be better postponed until your personal situation is more
amenable to engaging in therapy.
Similarly, although not typical, for some individuals, engaging in psychological therapy can expose dif cult feelings
that may result in a desire to self-harm or harm others. If this occurs, or has occurred previously when engaging in
therapy, it is very important to discuss this with your therapist and/or your GP/Psychiatrist/Paediatrician immediately,
so that your own and others’ personal safety can be maintained to the greatest degree possible.
In some instances, particularly if there has been signi cant trauma or neglect in an individual’s life, negative feelings
can sometimes be actively “projected” onto the therapist, which are a re ection of your feelings toward the original
abusive or neglectful other. Every effort will be made to identify and work with these psychodynamics, to help you
better understand these and direct and/or express these feelings to the appropriate source. Aggressive behaviour can
also sometimes occur as a defence against feeling or exposing vulnerable feelings. Please be aware however, that
beyond an initial working with these dynamics, any degree of continued aggressive or disrespectful behaviour toward
your therapist (or administrative staff) beyond the rst two to three sessions, will not be tolerated, and may result in
therapy needing to be discontinued. It may be that you are not yet ready to engage in therapy, or it may be that you
would be better suited to work with a different therapist, gender, or style of therapy. This will be discussed with
yourself, should this arise, during the course of therapy.
Getting the best out of Psychological Therapy
In summary, to get the best out of a psychological therapy encounter, the following are helpful considerations :
• Aim to attend every scheduled session, regularly and on time
• Be prepared to share your thoughts and feelings - particularly dif cult ones, openly with your therapist
• Complete any home tasks or challenges set by your therapist
• Openly discuss any doubts, concerns or uncertainties (including the therapy process) with your therapist
Agreement
I have read and understand the information contained in this document, and accept the terms and conditions upon
which psychological therapy will be provided by Brisbane City Psychology.
Name:_________________________________ Signature: _____________________________ Date:___________
OR where signature is not possible psychologist’s con rmation of verbal consent:
TeleHealth
I have discussed the information in this consent form with the client and received verbal consent to proceed with
TeleHealth services.
Psychologist signature ………………………………………………………………… Date ……./………/……..
Please See Over …>
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Dr Louise M. Blundell,
BSc(Hons) MA(ClinPsych) DPsych MAPS
Principal Clinical Psychologist
PSY0000991790 APS:022268 BPS:85193
79 Wickham Terrace Spring Hill QLD 4000
Tel/Text: 0435 591493 or Tel: (07) 3270 4589
Fax: (07) 3270 4559
Length of Appointments
Initial ‘Assessment’ Appointments are for the purpose of collaboratively exploring your dif culties to determine the
most appropriate therapy approach to meet your unique personal needs. This typically requires 90 - 120 minutes of
therapist time – comprising 50 minutes face-to-face consultation, with your therapist then later devoting at least 30
minutes to privately re ect on the meeting, write comprehensive notes, consider and ‘formulate’ regarding your
situation, and to plan the future therapy encounter to best meet your personal individual needs.
Subsequent Appointments are for the purpose of then engaging in the therapy process. These appointments typically
require 60 minutes of therapist time - comprising 50 minutes face-to-face consultation, with your therapist then
devoting (after you leave) 10 minutes to re ect on the meeting, write up notes and plan subsequent sessions. Reports
additional to standard ireview letters to your referring GP, Psychiatrist or Paediatrician, incur an additional charge
re ecting the time taken to prepare and complete this.
EMDR Appointments
Eye Movement Desensitisation & Reprocessing (EMDR) is a particular therapy approach sometimes used in the
treatment of Post Traumatic Stress Disorder. EMDR appointments require 120 minutes face-to-face consultation. This
allows 10-15 minutes preparation time, 90 minutes to engage in the EMDR process, and 10-15 minutes for discussing
your EMDR experience and debrie ng. Please note: Medicare rebates do not increase to accommodate the double
session required for EMDR. EMDR sessions do therefore cost signi cantly more than a regular session, and are
therefore only recommended when considered likely to be of particular bene t. EMDR does however, often
signi cantly reduce the overall number of sessions that might otherwise be required for PTSD.
Neuropsychology Assessments
The number of appointments required can vary considerably, but typically require six to eight meetings in total (with
each being 50-60 minutes long), to undertake an initial screening, subsequent Neuropsychological assessment, and at
least one feedback session. Neuropsychology reports incur an additional cost re ecting the time taken to complete this.
These are typically and necessarily complex, lengthy and detailed.
All fees re ect the length of time devoted to each session or report
General timing etiquette
To enable your therapist to be on time for all appointments (including your own) it would be very greatly appreciated if
you could be as respectful as possible of the above time frames. A non-intrusive alarm will sound two minutes before
the end of your session to let you know that you and your therapist need to wind up the session.
The therapy session is carefully managed to enable suf cient time to work through your concerns. However very
occasionally when a session has been particularly dif cult, it is sometimes necessary – out of respect to the client
(which could at times be yourself) to go over time by a few minutes, or (rarely) sometimes even a little longer.
Therefore, on the very infrequent occasions that this occurs your patience whilst awaiting commencement of your own
meeting is very much appreciated. You will still in this event receive your full 50 minute face-to-face consultation.
Contact Outside of Scheduled Appointments
Due to the large number of clients for which your therapist has responsibility, and as a general therapy etiquette, it is
not possible to accommodate requests to discuss concerns outside of therapy sessions, other than to communicate
regarding appointment times. While your therapist may at times provide therapy-related information to you, via text or
email – please respect that they will not be able to respond to further requests to discuss these outside of therapy
sessions. As your therapist is with clients throughout the day, they will typically respond to messages at the end of the
day, so we would ask that you please be patient and understanding of this. Please note that emails are not regularly
reviewed, such that text or telephone messages about appointments are the preferred communication method. Calls or
texts to our mobile telephone can be received from 9am to 5pm weekdays. Our landline has a 24hr answer service, so
messages can be left at any time on this number, but will not be received until the following working day.
In the event of an emergency situation please contact your GP/Psychiatrist or go to your nearest hospital.
Thank you for your understanding of these considerations - it is very much appreciated.
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