PRELIMINARY INFORMATION 

Below is a summary introduction to psychotherapy with David Yeats.  The forms below can be copied, filled out in advance, and brought to the first session—or they can be filled out at the time of the first session.


INTRODUCTION     

David Yeats has been a Licensed Clinical Social Worker since 1986.  He co-founded the Boulder Men’s Center, and maintained a Practice in Boulder until 1999, when he moved to Hawaii for three years.   He returned to Boulder in December 2002, and resumed his Practice.    While in Hawaii he directed two programs for the YWCA: the Decision Point Alternatives to Violence Treatment Program and the Ohana Visitation Center. He has presented locally and nationally at workshops and conferences for lay persons and clinicians on a variety of clinical subjects and has taught elementary and middle school and junior college and university level courses.   David is married with five adult children.  


RANGE OF PRACTICE      

David works with clients who are dealing with a wide variety of issues, including: anger, anxiety; depression; relationship issues; parenting issues, (including divorce and blended families); childhood and adult trauma (including physical, sexual, emotional abuse); family violence; anger management; gender issues; sexuality issues; life stage and developmental issues; spirituality issues; self esteem, sense of self, and identity issues; addiction issues; and parent-teen relationship issues; among others. David works in individual, couple, family and group formats.

David’s clinical approach is broad, drawing from a wide range of clinical theories and approaches.  He is guided by a high regard for clients’ thoughts, feelings, values, experiences, history, and intuitions, and is a good listener with a fairly interactive style.  He is highly optimistic that clients can create greater clarity, peace, and joy through involvement in the process of psychotherapy.

FEES  
The usual and customary fee for a 50 minute psychotherapy session is $125.  If you are interested in becoming involved in psychotherapy and cannot manage the fee, there are several available options: 1) Bi-weekly instead of weekly sessions, 2) payment plans, 3) establishing a specific Psychotherapy Contract, and 4) it may be possible to negotiate a lower fee, (if you can be available late mornings or early afternoons on Wednesday or Thursday), 

You can discuss implementing a Psychotherapy Contract, wherein you and David agree to work toward your specific goals over a predetermined number of sessions within a specific period of time. If this is an appropriate structure for you, it is possible to establish a reduced fee per session during this agreed on timeframe.

By signing below, you are acknowledging you are aware and agree that MISSED APPOINTMENTS THAT HAVE NOT BEEN CANCELLED ARE BILLED FOR THE AGREED ON AMOUNT OF THE SESSION.   If missing a scheduled appointment is necessary, 24 hours notice should be given.  Late cancellations may be charged one half of the agreed on psychotherapy fee, but not less than $25.  
 
CREDIT CARD PAYMENT     
It is possible to pay for psychotherapy services using credit cards.  Attention will be paid in therapy as to whether this form of payment is a supportive option for clients, since sometimes credit cards create more problems.

INSURANCE     
At this time, insurance will not be an option for most clients.  It may be possible to negotiate a fee that reduces the impact of this reality (See Fees above).  Clients who itemize on their taxes may claim psychotherapy as a medical expense.

CONFIDENTIALITY    
As a psychotherapy client you have a legal and moral right to privacy, with the only exceptions being those noted in the disclosure statement (see below), as mandated by law in the State of Colorado.

SUPERVISION     
Most clinical therapists utilize some form of supervision or consultation as a means of helping to assure high quality therapeutic services for their clients.  If supervision or consultation should occur regarding a client’s psychotherapy work, it is done anonymously so as not to reveal the client’s identity.

COMMUNICATION   
The best means of communication is via voice mail, at (303) 444-8064.  Messages are confidential, and are checked regularly.  Normally, calls are returned within 24 hours.  In case of emergency, please call the emergency cell number, (303 579-1148).  If there is no answer, please leave a message.  Calls to this number are checked often.  It is possible to occasionally use email, at DAYeatsMSW@Hotmail.com, but emails may not be read or responded to immediately.  Email communications may sometimes jeopardize confidentiality as well, which is a risk the client may choose to run.

TERMINATING THERAPY 
Normally, ending therapy is done best when there is mutual understanding and agreement between client and therapist that ending is the best choice.  Ultimately, this decision rests with the client.  If a client is choosing to end or take a break from psychotherapy, it is requested that this be addressed directly.  Clients should expect that they can continue to utilize the services of the therapist over time, although there may be very occasional circumstances where the therapist may terminate psychotherapy, for example, in the event of non-payment for services.  


THERAPEUTIC AGREEMENT     
Each client has a right to be informed about the process, form, time, cost, goals, methods, and education utilized by a therapist.  The information above addresses many of these issues.  At any time, a client is encouraged and should feel free to ask about anything they may need to know related to the process of psychotherapy.  Successful therapy work depends on an ongoing open exchange between client and therapist.

PRELIMINARY INFORMATION 
Below is a summary introduction to psychotherapy with David Yeats.  All forms (you can print them from the "Introductory Paperwork" section) can be filled out in advance, and brought to the first session—or they can be filled out at the time of the first session.


INTRODUCTION     
David Yeats has been a Licensed Clinical Social Worker since 1986. He co-founded the Boulder Men’s Center, and maintained a Practice in Boulder until 1999, when he moved to Hawaii for three years. He returned to Boulder in December 2002, and resumed his Practice. While in Hawaii he directed two programs for the YWCA: the Decision Point Alternatives to Violence Treatment Program and the Ohana Visitation Center (offering families supervised visitation). He has presented locally and nationally at workshops and conferences for lay persons and clinicians on a variety of clinical subjects and has taught elementary and middle school and junior college, university, and graduate level courses. David is married with five adult children.  


RANGE OF PRACTICE      
David works with clients who are dealing with a wide variety of issues, including: anger; anxiety; depression; relationship issues; parenting issues (including divorce and blended families); childhood and adult trauma (including physical, sexual, emotional abuse); family violence; anger management; gender issues; sexuality issues; life stage and developmental issues; spirituality issues; self esteem, sense of self, and identity issues; addiction issues; and parent-teen relationship issues; among others. David works in individual, couple, family and group formats.

David’s clinical approach is broad, drawing from a wide range of clinical theories and approaches. He is guided by a high regard for clients’ thoughts, feelings, values, experiences, history, and intuitions, and is a good listener with a fairly interactive style. He is highly optimistic that clients can create greater clarity, peace, and joy through involvement in the process of psychotherapy.

FEES  
The fee for a fifty-five minute psychotherapy session is $160; however, there is a discount of about 10% (to $145) if a client pays in cash at the time of the session. If you are interested in becoming involved in psychotherapy and cannot manage the fee, it may be possible to negotiate a lower fees, less frequent sessions, and payment plans. If you are interested in becoming involved in psychotherapy and cannot manage the fee, there are several available options: 1) Bi-weekly instead of weekly sessions, 2) payment plans, 3) establishing a specific Psychotherapy Contract, and 4) it may be possible to negotiate a lower fee, depending on availability. David can give you a statement you can submit to your insurance carrier for possible out-of-network reimbursement.

You can discuss implementing a Psychotherapy Contract, wherein you and David agree to work toward your specific goals over a predetermined number of sessions within a specific period of time. If this is an appropriate structure for you, it is possible to establish a reduced fee per session during this agreed on timeframe.

By signing below, you are acknowledging you are aware and agree that MISSED APPOINTMENTS THAT HAVE NOT BEEN CANCELLED ARE BILLED FOR THE AGREED ON AMOUNT OF THE SESSION. If missing a scheduled appointment is necessary, 24 hours notice should be given.  Late cancellations may be charged one half of the agreed on psychotherapy fee, but not less than $25.  

CREDIT CARD PAYMENT     
It is possible to pay for psychotherapy services using credit cards .  Attention will be paid in therapy as to whether this form of payment is a supportive option for clients, since sometimes credit cards create more problems.

INSURANCE     
David can give you a statement you can submit to your insurance carrier for possible out-of-network reimbursement.  David currently does not accept insurance.  However, if you wish to work with David, you may be able to work with David for a fee close to your session copay.  There areseveral options for payment in addition to or in lieu of insurance reimbursement. (See  the "Fees"  link). Clients who itemize on their taxes may claim psychotherapy as a medical expense.

CONFIDENTIALITY    
As a psychotherapy client you have a legal and moral right to privacy, with the only exceptions being those noted in the disclosure statement (see below), as mandated by law in the State of Colorado.

SUPERVISION     
Most clinical therapists utilize some form of supervision or consultation as a means of helping to assure high quality therapeutic services for their clients. If supervision or consultation should occur regarding a client’s psychotherapy work, it is done anonymously so as not to reveal the client’s identity.

COMMUNICATION   
The best means of communication is via voice mail, at (303) 335-9170. Messages are confidential and are checked regularly. Normally, calls are returned within 24 hours.  In case of emergency, please call the emergency cell number (303 579-1148).  If there is no answer, please leave a message. Calls to this number are checked often. It is possible to occasionally use email, at DAYeatsMSW@Hotmail.com, but emails may not be read or responded to immediately. Email communications may sometimes jeopardize confidentiality as well, which is a risk the client may choose to run.

TERMINATING THERAPY 
Normally, ending therapy is done best when there is mutual understanding and agreement between client and therapist that ending is the best choice. Ultimately, this decision rests with the client.  If a client is choosing to end or take a break from psychotherapy, it is requested that this be addressed directly.  Clients should expect that they can continue to utilize the services of the therapist over time, although there may be very occasional circumstances where the therapist may terminate psychotherapy, for example, in the event of non-payment for services.  

THERAPEUTIC AGREEMENT     
Each client has a right to be informed about the process, form, time, cost, goals, methods, and education utilized by a therapist. The information above addresses many of these issues. At any time, a client is encouraged and should feel free to ask about anything they may need to know related to the process of psychotherapy. Successful therapy work depends on an ongoing open exchange between client and therapist.




 CLIENT RIGHTS DISCLOSURE STATEMENT

The Statement below is information about your rights as a client that each therapist is mandated by law to provide to clients.  Your signature below indicates that you have read and understand your rights as a client as well as understand and the “Preliminary Information” about the process and structure of psychotherapy.

Acknowledgement:   Psychotherapy involves risks and responsibilities for client and therapist alike.  A client shows great courage to open herself or himself to self examination and growth in the presence of another human being.  It is the responsibility of the therapist to honor and respect each client and to render the best possible service as understood and agreed to by both client and therapist.  

 “The practice of licensed or registered persons in the field of psychotherapy is regulated by the Mental Health Licensing Section of the Division of Registrations. The Board of Social Work Examiners can be reached at 1560 Broadway, Suite 1350, Denver Colorado 80202, or by phone at (303) 894-7756.

As to the regulatory requirements applicable to mental health professionals: in their profession, a Licensed Clinical Social Worker (LCSW) must hold a masters degree in social work and have two years of post masters supervision.

You are entitled to receive information from your therapist about the methods of therapy, the techniques used, the duration of your therapy and the fee structure. You can seek a second opinion from another therapist or terminate therapy at any time.

In professional relationships, sexual intimacy is never appropriate and should be reported to the licensing board at the address above.

PRIVILEGED COMMUNICATIONS: Information provided by a client during therapy sessions is legally confidential and cannot be released without client consent in the case of social workers, except as provided by Section 12-43-18of the Colorado Revised Statutes, and other legal obligations as described below.. 

THERAPIST’S LEGAL OBLIGATION: There are some situations in which therapists are required to take actions they believe necessary to attempt to protect others from harm, in which case, some information about the client’s treatment may have to be released. These situations are unusual, and include the following:

If there is reasonable cause to know or suspect that a child has been subjected to abuse or neglect, or if the therapist has observed a child being subject to circumstances or conditions that would reasonably result in abuse or neglect, the law requires that a report be filed by the therapist with the appropriate governmental agency. Once such a report is filed, the therapist may be obligated to provide further information.

If there is reason to believe that any at-risk adult has been or is in imminent danger of being mistreated, self neglected, or financially exploited, the law requires the therapist to file a report with the appropriate governmental agency. Once such a report is filed, the therapist may be obligated to provide further information.

If a client communicates serious threat of immanent harm to her or himself and /or against a specific person or persons, the therapist must make every effort to notify such person, and/or appropriate law enforcement agency, and /or take other appropriate action, including seeking hospitalization of the client.”.

Further, on occasion, a therapist may be subpoenaed by the courts to testify, and on very rare occasions, information may be released to the Social Work Licensing Board in the event of a grievance filed by a client.  

In addition, a client’s identity may be revealed to appropriate persons regarding payments in default. Other than in those situations, a client can expect absolute confidentiality about the nature of the work being done, or even the fact of the client’s involvement in therapy.   

“12.43.214(2) CRS: If a client is a child consenting to mental health services pursuant to Section 27-10-103, CRS, disclosure will be made to the child. If a client is a child whose parent or legal guardian consenting to mental health services, disclosure will be made to that person.” 

Other than for the above exceptions, before any information can be shared with others, clients complete a written and signed specific release of information authorizing the sharing of information with specific persons or agencies. 



Client Signature_________________________________________________________ Date _____________

Client Signature_________________________________________________________ Date _____________

Witness Signature (if client is a minor)________________________________________ Date _____________








David A. Yeats LCSW - StillPoint Psychotherapy