Information for Clients
Welcome to my practice. I appreciate your giving me the opportunity to help 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 we are trying to do. This brochure will give you an outline of the following topics:
A copy of this brochure will be given to you to keep. Please read all of it and make note of any questions or concerns you have; we will spend some time discussing this during our first meeting.
I practice a branch of psychotherapy that is rooted in behavioral theory and philosophy and incorporates cognitive-behavioral techniques (called “CBT”). In fact, I am board certified in Cognitive and Behavioral Psychology. As such, the treatments that I may recommend for particular problems are strongly supported in the scientific literature, showing good evidence for effectiveness and success for many people. In particular, I specialize in exposure and response prevention, which is the therapy showing the most success for many different types of anxiety problems such as generalized anxiety, panic attacks, phobias (including social phobia), and obsessive-compulsive disorder. I also practice acceptance and commitment therapy as well as behavioral activation for individuals struggling with depressive symptoms. Both of these therapies also have very strong scientific support for being effective.
The basic assumption in behavioral philosophy is that we can change how we think and feel by changing what we do. Often times, people think that they must first believe that they can do something in order to do it, or feel safe before they can do it. This natural belief often traps people because, in actuality, we have limited control over our minds and our feelings. If you are struggling with anxiety or depression, you already know this. To give you an example of the uncontrollability of our thoughts, try spending the next thirty seconds not thinking about a pink elephant.
Instead, behavioral therapy works to help people realize that they can do whatever they want in spite of what their minds or their feelings are telling them, which means letting go of our attempts to control them. For example, a person struggling with intense fear in social situations may have thoughts like “you are going to make a fool of yourself” or “you will never make any friends.” People in this kind of situation will often want to wait until they feel safe or wait until they believe that they can socialize successfully before trying it. Behavioral therapy helps people confront their fears directly and learn from their experiences, not their beliefs. After all, when your mind tells you that you can’t do something, it is really guessing about what the outcome will be before it actually happens. This may cause you to avoid doing something that you really want to do. Behavioral therapy helps you realize that you can go to social events even if you are feeling scared or doubtful. You don’t have to be ruled by your fears. In my opinion, this is the real definition of freedom.
And, of course, what usually ends up happening is that while it may be scary facing our fears the first few times, it gets less and less scary each successive time. It is very similar to how we overcome many other things for the first time: we may stumble in the beginning, but practice makes perfect and things get easier.
Making Goals for our Work
I strongly believe that you should feel comfortable with the therapist you choose and hopeful about the therapy. In addition to finding a therapist with whom you can form a strong working relationship, therapy is most likely to be helpful to you when you are an active participant in the development of the goals of therapy. As such, I work strongly to include your opinions of how your therapy is going and what direction—and at what pace—we go.
Psychotherapy is not like visiting a medical doctor. It requires your very active involvement. It requires you to put forward your best efforts to change, complete any tasks or assignments that are recommended, and commit to the sessions as scheduled. Your honesty is also essential for our work. For example, I want you to tell me about important experiences, what they mean to you, and what strong feelings are involved. This is one of the ways you are an active partner in therapy. I make a very strong and unwavering commitment to your care. Your similar commitment to yourself and to our working relationship will make ideal conditions for your success.
Please note that I do not perform evaluations. This is not part of the services that I offer. This includes evaluations that may be required of third parties such as disability, fitness for duty, or child custody.
Duration of Treatment
Behavioral treatments are typically short-term; many problems can be helped in 10-20 sessions, sometimes shorter and sometimes longer depending on many factors. No guarantees can be made about the number of sessions required to address your specific problem. Also, it is not uncommon for people to work through one problem and then wish to start on another. Sessions once per week is usually the best rate of therapy, especially in the early stages.
The process of ending therapy, called “termination,” can be a very valuable part of our work. Stopping therapy should not be done casually, although either of us may decide to end it if we believe it is in your best interest. If you wish to stop therapy at any time, I ask that you agree now to meet then for at least one more session to review our work together. We will review our goals, the work we have done, any future work that needs to be done, and our choices. If you would like to take a “time out” from therapy to try it on your own, we should discuss this. We can often make such a time out be more helpful.
The Benefits and Risks of Therapy
As with any powerful treatment, there are some risks as well as many benefits with therapy. You should think about both the benefits and risks when making any treatment decisions. For example, in therapy, there is a risk that clients will, for a time, have uncomfortable levels of sadness, guilt, anxiety, anger, frustration, loneliness, helplessness, or other unwanted feelings. Clients may recall unpleasant memories. These feelings or memories may bother a client at work or in school. In addition, some people in the community may mistakenly view anyone in therapy as weak, or perhaps as seriously disturbed or even dangerous. Also, clients in therapy may have problems with people important to them. Family secrets may be told. Loved ones may become uncomfortable with increased assertiveness or other changes in behavior. Therapy may disrupt a marital relationship and sometimes may even lead to a divorce. Sometimes, too, a client’s problems may temporarily worsen after the beginning of treatment. Most of these risks are to be expected when people are making important changes in their lives. Finally, even with our best efforts, there is a risk that therapy may not work to help your problem.
While you consider these risks, you should also know that the benefits of therapy have been shown 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 schooling, and in the ability to enjoy their lives. I do not take on clients I do not think I can help. Therefore, I will enter our relationship with great optimism about our progress.
If you could benefit from a treatment I cannot provide, I will help you to get 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 an evaluation for 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 for an evaluation. As a responsible person and ethical therapist, I cannot continue to treat you if my treatment is not working for you. 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.
What to Expect from Our Relationship
As a professional, I will use my best knowledge and skills to help you. This includes following the standards of the American Psychological Association, or APA. In your best interests, 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.
State laws and the rules of the APA require me to keep what you tell me confidential, or secret. You can trust me not to tell anyone else what you tell me, except in certain limited situations (see “About Confidentiality” below). Because I want to protect your privacy about receiving treatment, I will not say hello or acknowledge you if we meet on the street or socially. Please understand that I am not trying to be rude! Imagine you are with someone else and we meet somewhere outside of my office and I said hello. 1.) You may be in an awkward situation if you don’t want the person you are with to know you are in therapy and you have to quickly make up a story about how you know me. 2.) If the other person knows that I am a psychologist, they may guess that I am your therapist. To protect your privacy, I will not initiate any contact with you outside of my office if we meet in a public setting.
In your best interest, and following the APA’s ethical standards, I can only be your therapist. I cannot have any other role in your life. I cannot, now or ever, be a close friend to or socialize with any of my clients. I cannot be a therapist to someone who is already a friend. I can never have a sexual or romantic relationship 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. Even though you might invite me, I will not attend your family gatherings, such as parties or weddings. Please also understand that you do not need to give me gifts and, in many circumstances, I will be unable to accept them because of ethical guidelines. I do enjoy it when clients wish to express appreciation, and this can always be done through a greeting card.
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.
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 kept private. That is why I ask you to sign a “release of information” form before I can talk about you or send my records about you to anyone else. I will not even reveal that you are receiving treatment from me. In all but a few rare situations, your confidentiality (that is, your privacy) is protected by federal and state laws and by the rules of my profession.
Here are the most common cases in which confidentiality is not protected:
There are two situations in which I might talk about a part of your case. I ask now for your understanding and agreement to let me do so in these two situations.
If your records need to be seen by another professional, or anyone else outside of what is described above, I will discuss it with you first and obtain your permission. Your permission can be withdrawn at any time, though please note that disclosures made prior to withdrawing your permission cannot be undone.
About Our Appointments
Because I work full-time as a university professor, my practice is part-time and my availability is limited. As such, I ask that you respect scheduled appointments and make a commitment to timeliness so that we can maximize our work together.
If you must cancel an appointment, please do so at least 48 hours ahead of time. Not showing up to an appointment or canceling within 5 hours or your appointment will result in a $50 fee. This policy is firm.
I request that you do not bring children with you if they are young and need babysitting or supervision, which I cannot provide. I do not have toys, but I can provide reading materials suitable for older children. You will be responsible for any damage to, or theft of, property in this office by you or anyone for whom you are legally responsible. I cannot be responsible for any personal property or valuables you bring into this office.
Fees, Payments, and Billing
Payment for services is an important part of any professional relationship. This is even more true in therapy; one treatment goal is to make relationships and the duties and obligations they involve clear. You are responsible for session fees as agreed upon at the time of the appointment. Meeting this responsibility shows your commitment and maturity.
My current fee is $140 per 50-minute session. Please pay for each session at its end. I have found that this arrangement helps us stay focused on our goals, and so it works best. Other payment or fee arrangements must be worked out before the end of our first meeting. Because I expect all payment at the time of our meetings, I do not send bills.
Telephone consultations: I believe that telephone consultations may be suitable or even needed at times in our therapy, particularly for contact between sessions when I do not have access to a physical office. If so, I will charge you our regular fee, prorated over the time needed. This includes voicemail messages that you leave longer than five minutes. Of course, there is no charge for calls about appointments or similar business.
I will assume that our agreed-upon fee-paying relationship will continue as long as I provide services to you or until otherwise arranged. 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 the relationship.
Depending on your financial circumstances and total medical costs for any year, psychotherapy may be a deductible expense; consult your tax advisor. Cost of transportation to and from appointments and fees paid may be deductible from the client’s personal income taxes as medical expenses.
If you think you may have trouble paying for sessions, or your circumstances change, please discuss this with me. I offer a reduced fee to accommodate lower income levels. In order to qualify for reduced fees, you must provide your 1040 tax return forms for the previous two years.
I can accept cash, check, and credit/debit cards (Visa, Mastercard, American Express, and Discover). A fee of $30 will be applied when checks are returned because of insufficient funds. Client’s paying by credit or debit card must understand that “Ryan Sharma, Psy.D.” will appear on your statements.
There is a $50 fee for missed sessions or late cancels (see above).
Because of ethical issues, I will not be able to schedule sessions for clients missing more than one payment for any fee. Please talk to me if you find yourself in this situation; if you are still having problems, we may be able to work out an agreement or find you alternative sources of professional help.
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, so they must be worked out openly and quickly.
I am not a member of any health insurance plans or panels. Health insurance is a contract between you (or your employer) and your insurer; I am not part of that contract. However, I will supply you with an invoice for my services with the standard diagnostic and procedure codes for billing purposes, the times we met, my charges, and your payments. You can use this to apply for reimbursement.
If You Need to Contact Me
Because I work full-time as a university professor, I cannot promise that I will be available at all times. I may be teaching classes, in meetings, or at conferences at any time during the week. I also do not answer the phone when I am with other clients. Please do, however, contact me if you need assistance as I generally monitor my voicemail and office phone throughout the week. I try to return phone calls within five hours, though I cannot promise that I will.
If you are having an emergency, go to your local emergency room or dial 911.
Email: Please feel free to use email for scheduling appointments or other general requests or business items. Please do not use email for personal disclosures or to talk about problems we are discussing in therapy. First of all, email cannot be assumed to be completely secure; emails can be hacked, messages can be sent to the wrong person, and other people using your computer may see your messages if you mistakenly leave them up on the screen. Second, such sensitive topics can be misread because they do not carry with them the non-verbal communication that you get when speaking about them (such as tone of voice and emphasis). These topics are best discussed in person or over the phone.
Statement of Principles and Complaint Procedures
It is my intention to fully abide by all the rules and guidelines of the American Psychological Association (APA) and by those of the State of California’s Board of Psychology.
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 feel that I (or any other therapist) have treated you unfairly or have even broken a professional rule, please tell me. You can also contact the state or local psychological association and speak to the chairperson of the ethics committee. He or she can help clarify your concerns or tell you how to file a complaint. You may also contact the state board for psychologists, the organization that licenses those of us in the independent practice of psychology.
Board of Psychology
2005 Evergreen St., Ste 1400
Sacramento, CA 95815
Ryan Sharma, PsyD, ABPP
1280 S. Victoria Ave, Ste 230
Ventura, CA 93003
License # 22160
In my practice as a therapist, I do not discriminate against clients because of age, sex, marital/family status, race, color, religious beliefs, ethnic origin, place of residence, veteran status, physical disability, health status, sexual orientation, or criminal record unrelated to present dangerousness. This is a personal commitment, as well as being required by federal, state, and local laws and regulations. I will always take steps to advance and support the values of equal opportunity, human dignity, and racial/ethnic/cultural diversity. If you believe you have been discriminated against, please bring this matter to my attention immediately.
Ryan Sharma, PsyD, ABPP is in independent practice and is not associated with any other professionals.