Therapy is an experience involving education and treatment. The procedure does take considerable time to unlock old patterns and develop new more effective patterns of behavior. People use the services of a therapist just as they would any other professional (medical doctor, attorney, etc.).

Marriage and Family Therapist are relationship specialists who treat persons involved in interpersonal relationships. They are trained to access, diagnose and treat individuals, couples, families and groups to achieve more adequate, satisfying and productive marriage, family and social adjustments. The practice also includes premarital counseling, child counseling and divorce or separation counseling.

Therapeutic Approach

My approach is to have clients explore their conscious and subconscious attitudes which dictate their decisions and behavior. We are then able to modify behavior by understanding and modifying attitudes. At times the modification of attitudes will be accelerated by changing ones behavior first. As behavior becomes more effective so does the quality of the
person's interpersonal relationships, and a greater amount of happiness is experienced.

Treatment requires the client to explore areas that may have been and may still be painful for them. Homework may be assigned from time to time in order to have the client try new and more effective behaviors. If the client does not do homework assignments, then it will take longer to complete the therapeutic process.

Normally during the first few sessions we will identify the problem(s), speculate on the duration of treatment, complete an intake questionnaire, identify the therapeutic goals, and sign a contract for services. The use of applied therapeutic techniques may require acknowledgment and
confrontation of experiences and ongoing processes that may cause distress and pain, including the outcome of relationships which may not end the way the client wants. Finally we will go through a termination phase of the
treatment. From time to time during the course of treatment together, we will evaluate the progress of the treatment.

Prior to our first meeting the client is requested to write down the issues that they wish to explore.  If the client is seeking martial therapy then both parties are requested to write down the issues that they wish to work on including possible compromises.  This simple task of writing down your concerns will save time and money.  

The fee for one hour counseling session is $____________,
and additional time will be charged at the same rate, if the therapist is available to continue beyond the scheduled session. If you have a joint therapy session with another client, the billing will be divided equally.

Clients will be charged for the full hour whether they come late or leave early. If the client is late, a full hour session will be provided if the therapist's schedule will permit, and the client will be charged for the additional time over the scheduled hour. If the therapist is late, the client will receive a full hour. If the therapist is more than 15 minutes
late for a scheduled appointment, then the client will receive a free one hour session.

Missed Appointments: Unless the client provides a minimum of 24 hours notice, missed appointments will be charged and billed at the agreed hourly rate. Counseling session conducted on the phone will be charged the agreed hourly rate.

Emergency sessions will be scheduled as soon a possible. An hourly rate of $100.00 will be charged for appointments held between 8.00pm Friday and 8:00am Monday. These sessions can be held on the telephone.

All fees will be paid by the client at each session. Reimbursement from insurance companies is the responsibility of the client. I will assist in the completion of any forms at no additional charge, however, any
requested reports will be charged at the agreed hourly rate. Non-payment of fees will result in an automatic $5.00 late fee added to the charge each session that the bill goes unpaid. If it becomes necessary to proceed with legal action to collect fees owed, then the client agree to pay any and all court costs.

The tapering off and ultimate termination of counseling is expected and welcomed, but if for any reason, you choose to leave counseling without my consent and agreement, a letter stating so will be sent to you and kept on file. If you have been referred by another professional or organization for purposes of treatment, and you have sign a Confidentiality Release, a copy of the letter will be sent to them. In your therapist is an intern Termination of therapy may occur as a result of your therapist concluding his/her placement. In this event you may be considered for transfer to another therapist here, transfer with your therapist or be referred outside this agency.

According to state law, all communication between client and therapist is both confidential and privileged between the clients of psychologists, psychiatrists, licensed clinical social workers, and marriage, family, and child counselors. The client must give permission to release any written or oral material to any other organization or individual, except
when the following situations occur: 

1) The client intends to take harmful or dangerous action against another human being, or against themselves.

2) The client has/is/has been/is being abused, and/or neglected and/or sexually molested/ing.

3) There is a court order for your therapist to appear or produce records.

4) In the review of progress notes by your therapist’s supervisor if your therapist is a student MFCC Intern.

5) Case consultations the therapist/intern has with other licensed therapist in regards to your treatment plan.

6) In utilizing a HMO, Insurance Company or other third party payers for whom the client has signed a release giving access to reports and files.

7. If informed of sexual relationships between a person 21 years and older and a person 16 years and younger.

Signature _______________________ Date:_____________

Signature Date:__________

__

I have been given a copy of Earl T. Wylie's Therapeutic
Approach, Fees for Service, Payment of Fees and Confidentiality
statements, have seen his credentials and licenses on the wall;
and received a business card. I understand the scope of his
practice and feel that I will benefit from therapy from him.
I have read and understand the terms in these documents and
promise to pay the charges listed below. I hereby give my
consent for therapy for myself and/or for my dependent children
or wards.

I, __________________________________________ on ___/_____/_____

(name) (date)

have contracted for the services of Earl T. Wylie, Ph.D. or MFCC Intern ____________________________at the fee of ____________ per hour for individual counseling and/or fee of _____________ per hour for group and/or fee of _______per hour for family therapy.

Signed:___________________________________Dated:________________

Signed:___________________________________Dated:________________

Signed:___________________________________Dated:________________

Signed:___________________________________Dated:________________

Print Name and Address _________________________________________

_________________________________________

____________________________Zip__________

Home Phone____________________ Work Phone ______________________

Signature of Therapist ___________________________Date__________