CHRISTINE M. LARSON, Ph.D.
Licensed Psychologist
401 shady avenue, Suite 104A
Pittsburgh, Pennsylvania 15206
Phone: (412) 519-9549
Information for Clients
Welcome to my practice. I appreciate your giving me the opportunity to be of help to you. This brochure answers
questions that clients often ask about therapy. I believe our work will be most helpful to you when you have a
clear idea of what to expect. The brochure is yours to keep. Please read all of it. Mark any parts that are not clear
to you. Write down any questions you have. After you read this brochure, we can talk about how these issues
apply to you. When you have read and fully understood this brochure, I will ask you to sign an acknowledgement.
The Benefits and Risks of Therapy
As with any powerful treatment, there are some risks as well as many benefits with therapy. It is important to
consider both the benefits and risks when making treatment decisions. For example, in therapy, there is a risk
clients will have, for a time, uncomfortable levels of sadness, guilt, anxiety, anger, frustration, loneliness,
helplessness, or other negative feelings. Clients may recall unpleasant memories. These feelings or memories
may bother a client at work or in school. Also, clients in therapy may have problems with people important to
them. Family secrets may be told. Therapy may disrupt significant personal relationships and sometimes may
even lead to the end of those relationships. Sometimes a client's problems may temporarily worsen during
treatment. Risks are to be expected when people are making any important changes in their lives. Finally, even
with our best efforts, there is a risk that therapy may not work out well for you.
While you consider these risks, you should also know that the benefits of therapy have been documented by
scientists in hundreds of well-designed research studies. People who are depressed may find their mood lifting.
Others may no longer feel afraid, angry, or anxious. In therapy, people have a chance to talk things out fully until
their feelings are relieved or the problems are solved. Clients' relationships and coping skills may improve
greatly. They may get more satisfaction out of social and family relationships. Their personal goals and values
may become clearer. They may grow in many directions— as persons, in their close relationships, in their work
or schoolwork, and in the ability to enjoy their lives.
Consultations
If you wish for another professional's opinion at any time, or wish to talk with another therapist, I will help you
find a qualified person and will provide him or her with the information needed.
If you could benefit from a treatment I cannot provide, I will help you to find it. You have a right to ask me about
such other treatments, their risks, and their benefits. Based on what I learn about your problems, I may
recommend a medical exam or a consultation with a medical doctor about the possible benefit of medication. If I
do this, I will fully discuss my reasons with you, so that you can decide what is best. If you are treated by another
professional, I will coordinate my services with them and with your own medical doctor.
If for some reason treatment is not going well, I might suggest you see another therapist or another professional
in addition to me. As a responsible person and ethical therapist, I cannot continue to treat you if my treatment is
not working for you.
What to Expect from Our Relationship
As a professional, I will use my best knowledge and skills to help you. This includes following the rules and
standards of the American Psychological Association (APA). I agree with these rules and ethical guidelines
because I believe that therapy works best when I have no other relationship with you except a therapeutic one. It
is in your best interest that the APA puts limits on the relationship between a therapist and a client, and I will
abide by these. Let me explain these limits, so you will not think they are personal responses to you.
First, I am licensed and trained to practice psychology—not law, medicine, or any other profession. I am not able
to give you good advice from these other professional viewpoints.
Second, state laws and the rules of the APA require me to keep what you tell me confidential (that is, private).
You can trust me not to tell anyone else what you tell me, except in certain limited situations. I explain what
those are in the “about Confidentiality" section of this handout and in the Notice of Privacy Practices. To
maintain privacy, I try not to reveal who my clients are. So if we meet on the street or socially, I will not
acknowledge that I know you unless you say “hello” to me first. It is perfectly fine if you choose to ignore me or
act like you don’t know me. If you do acknowledge me, it is best that we not talk much with each other. My
behavior will not be a personal reaction to you, but a way to maintain the confidentiality of our relationship and
to keep the nature of our relationship confined to the therapy office.
Third, in your best interest and following the APA's standards, I can only be your therapist. I cannot have any
other role in your life. I cannot be a close friend or socialize with any of my clients. Even if you invite me, I will
not attend your parties, events, or social gatherings. I can never have sexual or romantic relationships with any
client during, or after, the course of therapy. I cannot have a business relationship with any of my clients, other
than the therapy relationship.
About Confidentiality
I will treat with great care all the information you share with me. It is your legal right that our sessions and my
records about you be private. That is why I ask you to sign a "release-of-records" form before I can talk about you
or send records about you to anyone else. In general, I will tell no one what you tell me. I will not even reveal that
you are in treatment.
In all but a few situations, your confidentiality (that is, your privacy) is protected by state law and by the rules of
my profession. Here are the most common cases in which confidentiality is not protected:
1. If you were sent to me by a court, employer, or government agency for evaluation or treatment, the court,
employer, or government agency expects a report from me. If this is your situation, please talk with me
before you tell me anything you do not want others to know. You have a right to tell me only what you are
comfortable with telling.
2. Are you being charged with a crime, involved in a legal dispute or lawsuit, or engaged in divorce or custody
proceedings? If so, and you tell the court that you are seeing me, I may then be ordered to show the court my
records. Please consult your lawyer about these issues.
3. If you make a serious threat to harm yourself or another person, the law requires me to try to protect you or
that other person. This usually means telling others about the threat. I cannot promise never to tell others
about threats you make.
4. Psychologists are mandated by Pennsylvania law to report child abuse. If, based on my professional
experience, I have reasonable cause to suspect that a child is being abused I may be required to report it. I
would make an effort to speak with you before making a report.
There are two situations in which I might talk about you and our therapeutic relationship with another therapist. I
ask now for your understanding and agreement to let me do so in these two situations.
First, when I am away from the office for vacations, sickness, emergencies or working out of town, I have a
trusted fellow therapist(s) "cover" for me. This therapist will be available to you in emergencies. I might need to
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tell this therapist about you. Generally, I will tell this therapist only what he or she would need to know for an
emergency. Of course, this therapist is bound by the same laws and rules as I am to protect your confidentiality.
Second, I sometimes consult other therapists or other professionals about my clients. This helps me to provide
high-quality treatment. These persons are also required to keep your information private. Your name will never
be given to them, and they will be told only as much as they need to know to understand your situation.
Except for the situations I have described above, I will always maintain your privacy. I also ask you not to
disclose the name or identity of any other client being seen in this office.
If you want your records seen by another professional, or anyone else, I will discuss it with you. If you want to
share these records, you will need to sign a release form. This form states exactly what information is to be
shared, with whom, and why, and it also sets time limits. You may read this form at any time.
If we do family or couple therapy (where there is more than one client), and you want to have my records of this
therapy sent to anyone, all of the adults present will have to sign a release.
Generally, your health insurance company will receive only my statement. This gives the dates of our
appointments, my charges, and a diagnosis. It will become part of your permanent medical record. As part of cost
control efforts, managed care companies often ask for more information on symptoms, diagnoses, treatment
plans, progress and treatment methods. I will let you know if this should occur and what the company has asked
for. Please understand that I have no control over how these records are handled at the insurance company or
managed care company. I may have a medical billing professional handle my billing. This person may at times
have to interact with your insurance company or managed care company to ensure correct payments for services.
This person is very familiar with the need for confidentiality.
You can review your own records in my files at any time. I ask you to understand and agree that you may not
examine records created by anyone else and sent to me. I will keep your case records in a safe place. In some very
rare situations, I may temporarily remove parts of your records before you see them. This would happen if I
believe that the information will be harmful to you, but I will discuss this with you.
My Background
I am licensed in the Commonwealth of Pennsylvania as a psychologist. I have eight years of experience providing
psychological services. I am trained and have experience in individual, couples, family, and group therapy, and I
provide services for children, adolescents, and adults. My qualifications are briefly described below. If you need
further explanation or would like a copy of my vita, please ask.
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I have an MA and PhD in Psychology (Clinical) from the University of Toledo.
I completed an APA accredited Predoctoral Internship at the University of Pittsburgh Counseling Center and
a Postdoctoral Residency at Duquesne University Counseling Center.
I am a member of the American Psychological Association and the Pennsylvania Psychological Association.
About Our Appointments
Psychotherapy sessions are 45 to 50 minutes in length and usually occur once or twice a week. Most of my
clients see me once every 1-2 weeks, for 3 to 4 months. After that, we meet less often for several more months,
before ending therapy. I try to keep a regular schedule every week, however, I cannot guarantee that your
appointment will be at the same time and day every week. I sometimes must work out of town or have other
professional obligations that require me to change my schedule. I try to keep this to a minimum. I will inform you
of my vacation times and other times when we cannot meet.
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An appointment is a commitment to our work. We agree to meet here and to be on time. If I am ever unable to
start on time, I ask your understanding, and I will offer you the full time agreed to. If you are late, we will
probably be unable to meet for the full time. It is likely that I will have another appointment after yours.
A canceled appointment delays our work. I will consider our meetings very important and ask you to do the same.
Please try not to miss sessions if you can possibly help it. When you must cancel, please try to give me at least a
week's notice. You will be charged the full fee for sessions canceled with less than 24 hours' notice, for
other than the most serious and unusual reasons. This session cannot be billed to your insurance company.
Please, note that the reason behind this policy is to protect the provider's time, not to penalize you financially. If
you are wondering why you should pay for the services you have not received, please, consider the fact that when
you make an appointment with the provider, you are booking the provider's time that is no longer available for
scheduling. Your session time is reserved for you. I am rarely able to fill a cancelled session unless I know in
advance. If you late-cancel a session or no-show, I will have to charge you for the lost time. I offer a financial
incentive (discount) for prompt credit card (online) payments of late-cancellations and no-shows. If paid online
within 24 hours: 50% discount; if paid within 48 hours: 20% discount; if paid within 72 hours: 10% discount.
Fees, Payments, and Billing
Payment for services is important in any professional relationship, and this is especially true in therapy. You are
responsible for seeing that my services are paid for. Please pay for each session at its end. I have found that this
arrangement helps us to stay focused on our goals. I suggest you make out your check (or provide online credit
card payment) before each session begins, so that our time can best be used to address the issues that brought you
into therapy. My current fee for a 45-50 minute individual therapy session is $120. Initial assessments are $150.
If my fees should change, you will be given advance notice. An administrative fee of $30 applies if your check
“bounces” due to insufficient funds. I reserve the right to discontinue services if your account is 30 days past due.
I realize that my fees involve a substantial amount of money, although they are well in line with similar
professionals’ charges. For you to get the best value for your money, we must work hard and well. If there is any
problem with my charges, my billing, your insurance, or any other money-related point, please bring it to my
attention. I will do the same with you. Such problems can interfere greatly with our work. They must be worked
out openly and quickly. I will assume that our agreed-upon fee-paying relationship will continue as long as I
provide services to you. I will assume this until you tell me in person, by telephone, or by certified mail that you
wish to end it. You have a responsibility to pay for any services you receive before you end treatment.
Health Insurance Coverage and Payments
Because I am a licensed psychologist, many health insurance plans will help you pay for therapy and other
services I offer. Because health insurance is written by many different companies, I cannot tell you what your
plan covers. Please read your plan's booklet under coverage for "Outpatient Psychotherapy" or under "Treatment
of Mental and Nervous Conditions." Please call your health plan’s office to check your coverage carefully by
asking the following questions:
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Do I have mental health benefits? If so, do I need pre-approval from my primary care physician?
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What is my deductible and has it been met?
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How many sessions per calendar year does my plan cover?
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How much does my plan cover for an out-of-network provider?
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What is the coverage amount per therapy session?
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If your health insurance will pay part of my fee, I will try to help you with your insurance claim forms. Please
keep two things in mind. First, I had no role in deciding what your insurance covers. Your employer decided
which, if any, services will be covered and how much you (and I) will be paid. You are responsible for checking
your insurance coverage, deductibles, payment rates, copayments, and so forth. Your insurance contract is
between you and your company; it is not between me and the insurance company. Second, you—not your
insurance company or any other person or company—are responsible for paying the fees we agree upon.
If You Have a Managed Care Contract
If you have health insurance with managed care, decisions about the kind of care you need and how much of it
you can receive will be reviewed by the plan. The plan has rules, limits, and procedures that we should discuss.
Please bring your health insurance plan's description of services to our first meeting, so that we can talk about it
and decide what to do.
In order to help you with any health insurance benefits, I will have to send information about you to your
managed care company (if you have one) or to an agent of your insurance company. These companies are
increasingly asking for more information about clients and will want to know about your problems, symptoms,
family and work life, and so forth.
Reasons to Consider Self-Pay
It may be beneficial for you to pay for your treatment out of pocket, rather than through your health insurance.
1. Billing insurance for treatment requires you to (give consent to) release private health information, including
diagnosis, to your insurance company. Your insurance company adds this information to your health care
record and may make this information available to the Medical Information Bureau (MIB). Such records
could interfere with your ability to get current or future life, health, disability, or long-term care insurance. If
you choose to self-pay your treatment remains completely private (except in certain circumstances in which I
am required by law to release information without your consent, such as in cases of serious suicidal ideation
or of a court order). No record of treatment will exist outside my practice. If, on future applications for
insurance, employment, etc., you are requested to provide information about your treatment history, you will
be able to choose what information to reveal. Your written permission would be required before I could
release any information.
2. Self-pay gives you the most control over the kind of treatment you may have and the frequency and length of
your treatment. Certain types of therapy (such as group therapy) and treatment for some problems or
disorders may not be covered by your insurance.
Other Points
 Although I share this office with other therapists, each of us works independently, and each alone is
responsible for the quality of the care he or she provides.
 If you ever become involved in a divorce or custody dispute, I want you to understand and agree that I will not
provide evaluations or expert testimony in court. You should hire a different mental health professional for any
evaluations or testimony you require. This position is based on two reasons: (1) My statements will be seen as
biased in your favor because we have a therapy relationship; and (2) the testimony might affect our therapy
relationship, and I must put this relationship first. 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 testimony.
 If, as part of our therapy, you create and provide to me records, notes, artworks, or any other documents
or materials, I will return the originals to you at your written request but will retain copies.
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Statement of Principles
I fully abide by all the rules of the American Psychological Association (APA) and by those of my state license.
(The APA's rules include its Ethical Principles, its Standards for Providers of Psychological Services, and its
Guidelines for Delivery of Specialty Services by Clinical Psychologists.)
Problems can arise in our relationship, just as in any other relationship. If you are not satisfied with any area of
our work, please raise your concerns with me at once. Our work together will be slower and harder if your
concerns with me are not worked out. I will make every effort to hear any complaints you have and to seek
solutions to them.
If You Need to Contact Me
I cannot promise that I will be available at all times. I do not take phone calls when I am with a client.
Additionally, I am in private practice on a part time basis, generally Tuesday and Thursday evenings and some
Saturdays. When you call the main office number, 412-519-9549, you will always get the voice mail. You can
always leave a message and I will return your call as soon as I can. Usually I am able to return messages daily
except on weekends, holidays, and during vacations.
I cannot guarantee availability of crisis treatment. If you have an emergency or life-threatening crisis (such as
thoughts of harming yourself or others, or recent assault/trauma), and I am not immediately available by phone,
you or a family member/friend should go to the nearest emergency room or call 911. In any urgent situations
where you may want to speak to someone immediately, you are welcome to contact Resolve Crisis Services, a
free, 24/7 hotline operated by Allegheny County and Western Psychiatric Institute and Clinics. The toll-free
number for Resolve is 1.888.7.YOU CAN (1.888.796.8226). Resolve Crisis Services is available to anyone who
identifies him/herself as being in a crisis situation, regardless of whether you are in therapy with me, another
provider, or not at all. They are there to help with whatever you feel is a crisis for you- no matter how “small.”
If I Need to Contact Someone about You
If there is an emergency during our work together, or I become concerned about your personal safety, I would
like to have your permission to contact someone close to you—perhaps a relative, spouse, or close friend. I would
also contact this person, or the authorities, if I become concerned about your harming someone else. Please write
down the name and information of your chosen contact person on the Intake Questionnaire (set 3 of the
documents I ask you to bring with you to your first appointment). Please write, “I don’t want to give a name,” on
that form, if that is your choice.
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