Questions & Answers

What should I do if feel like hurting or killing myself or someone else?

Anyone who feels suicidal or homicidal should seek immediate help to stay safe.

Whenever you are in danger, regardless of whether or not you are in therapy, PLEASE visit the nearest Emergency Room, call 911 or to contact the Suicide Hotline if you experience suicidal or homicidal thoughts. Life is precious, and even when YOU cannot see it, help is available.

1-800-SUICIDE (1-800-784-2433)

• 1-800-273-TALK (1-800-273-8255)
• TTY: 1-800-799-4TTY (1-800-799-4889)

You may also visit these websites (links provided.)

Veteran’s Suicide Hotline

Suicide prevention lifeline

Texas Suicide & Crisis Hotline Services

Other options include:

1. Call 4-1-1 and ask for suicide prevention crisis intervention
2. Dial 0 and ask for hotlines [crisis or suicide] Ask for help contacting a community crisis center, a county mental health center, or a hospital mental health clinic.
3. Or, call 9-1-1 and ask for help.

   Tell the operator immediately if you or someone else is in suicidal or other life-threatening danger.

Mustard Seed Journeys / Leslie LaRo Hayes does not operate as an emergency service provider and is not available to clients 24-hours per day. Dr. Hayes tries to return phone calls within 24 hours under typical circumstances, although this is not always possible.

So how will I know if I or someone I care about may benefit from therapy?

• If you struggle to understand yourself, and important others in your life [past or present], therapy may be helpful in gaining a wider perspective.
• If you have experienced events in your life which keep “popping back up” and causing distress in current relationships or pursuits, therapy may be of benefit to you.
• If you have lost someone close or if transitions in your life have not been fully processed and you believe you just “can’t move forward” because you seem stuck in the past, consider therapy.
• If your relationships with your spouse, children, in-laws, family of origin, co-workers, or any other person you value, are difficult to maintain and everyone has a different opinion about what “you SHOULD do”, therapy can help see things more clearly and make positive changes.

• If your own personal efforts at addressing the problem are proving ineffective, or even making things worse, then it can be very helpful to get the help of an objective professional to help you and/or your family move in a healthier direction.

• If it’s time to crack open the seals, take doors off hinges, swing open the shutters and let the LIGHT in, consider therapy. It’s not a miracle “cure-all” or a sure-thing bet, but participating in therapeutic processes with a professional provider who cares about your well-being can make an enormous difference to the rest of your life.

Choosing a professional who is a ‘good fit’ for you is the first step. You must be willing to take ownership of your choices in the past and the ones you will make from this day forward, including whether and from whom to ask for help. It is likely that if you are researching this topic, something has developed in your life or in your system you’d like to see changed.

Finding someone who has experience with your situation or concern, but who also has a passion for what they do, can be a complicated process. You must be willing to do some background work to find a good fit for you and your loved ones. Remember, bad never gets better all by itself.

How do I find a therapist who will be a good fit for me/my relational needs?

Although cost and convenience of travel to a health professional are certainly considerations in finding help, there are also other important factors to think about when seeking therapeutic help.

1st: Potential clients are encouraged to consider what they want to accomplish in treatment and to try to find a professional with expertise in that area. Many mental health workers (counselors, social workers, psychologists, marriage and family therapists) are in settings that force them to attempt to work with almost any kind of clients who seek their services. However, finding a clinician with experience working with needs similar to yours can significantly increase chances for success.

2nd: It is important all system members in treatment be comfortable with the therapist, who, like all people, has different experiences, values, personalities and styles of working. It is your right and responsibility to determine if a given provider is one who can help you accomplish your goals for treatment. If one or more members of a family system do not feel heard or accepted, yet they are expected to participate in the process, it is unlikely the overall situation will improve in lasting ways.

3rd: Challenge to assumptions and personal belief filters is a hard but important option for addressing difficulties. Your provider should be invested in your improvement, not their need to be liked by all clients. Paying someone to tell you you’re right and everyone else is wrong, seems silly. You probably have a “friend” who will do that for free! Echo chambers rarely produce lasting growth—they may be temporarily comforting, but clearly something is distressing about your present circumstances or you would not be exploring therapy options. The best therapist for you may not be the one who agrees with everything you have done and your reasons for doing them, but may be the one who says, “Maybe there are different ways to have handled those things. Let’s look at all dimensions and form a plan for what you may do differently next time.”

Last: Doing exactly the same things while expecting “something” to change is a recipe for getting exactly what you’ve always gotten–like treading heavily on a hamster wheel. If it feels like you are working so hard to help others change, but see no actual progress being made, the provider you choose should help you look at your efforts as well as the motivations for those efforts, to see what other options should be considered. Expecting someone else to make changes to please you may also be part of the problem.

A provider who promises to change you or someone else in your system, is to be avoided. If you have tried therapy in the past and found it unhelpful, you may have chosen the wrong professional or you may have had unrealistic expectations of that person or of the process. Choosing someone just because they take your insurance or are close to your home is not the best filter for therapeutic success.

Did you catch that very important phrase in the previous paragraph? One of the most significant and consistent causes of human misery is UNREALISTIC EXPECTATIONS. This is true of all human relationships with other people, with the self, and actually, the expectations you may develop for your [a] therapist. Although it is true that the Person of the Therapist is the most powerful tool any clinician has in the ol’ toolbox, it is far more important that clients be informed from the start, of what NOT TO EXPECT of the process and the person guiding it.

I may not be the best fit for you if all you want is more of the same – venting is a good thing in context of change–it’s hard to find the source of a problem without some venting of the pressures that have been building. In a water heater, that’s a very dangerous thing, without a tiny, but powerful little doohickey called a “release valve.” If it gets stuck, you have a problem. Maintenance on that little piece of metal is pretty important.

In the therapy process, that’s the first thing I examine: what historically causes the pressure, and how does the client typically discharge the steam? What is feeding the pressure–what is the client believing to perpetuate the patterns? But before clients let me anywhere near their valves, they must trust not only my intentions, but also my plan of action.

No magic wand can wave off the damage and decay of a sense of self, but intentional exploration of where that identity developed, what is true and what is not, and what needs to be adjusted before the mechanism can function in healthy and secure ways, moving into the future. If a practitioner cannot develop a strong rapport with a client fairly quickly, the momentum of the process can become like a “drag line” and slow the chances for growth. To be of any use to clients, I must take my own self-care [my release valve] very seriously.

Research examining predictors of positive outcomes for therapy clients has repeatedly shown the quality of the relationship between the client and therapist is the most important part of the process. If you begin working with Mustard Seed Journeys, I will regularly seek feedback from you to ensure our therapeutic relationship continues to meet your needs. I will not continue a therapeutic affiliation I believe may be ineffective or harmful to a client because to do so would be unethical.

I don’t sugarcoat anything. I respect the experiences people bring to my space, and I am interested in understanding if the individual is motivated to work for their own changes, OR if the individual is really content with where they are and prefers not to change a thing. If the first is true, maybe we can work together. If the 2nd is the case, even if the individual states otherwise, it’s likely I will offer my observations and then referrals to other providers who may consider simple listening to be the sharpest tool in their backpack.

Don’t get me wrong, listening is a fine skill, quite rare in today’s social environments, but unless it is actively practiced to discern areas badly in need of some light and focus, I don’t find it any more/less valuable than telling your day’s worries to your Golden Labrador Retriever.

You may discover much of what you have believed are lies about you in the world—all of your life! That’s very hard to accept. When you find out other people usually are NOT completely responsible for your difficulties, it means you have work to do. It’s difficult to believe change is not possible, but inevitable, with a good deal of reflection, determination, diligence, courage, and conclusions that support mechanisms of change. Those whose lives have been a series of traumatic boulders, crashing down around and on top of, any sense of agency they may have ever tried to develop, can experience an entirely new perspective. New perspectives bring fresh ways to receive and perceive whatever the world brings to the doorstep next. People often hurt others as they have been hurt, in cycles that must be stopped to be clearly seen.

My way of being with clients can seem to move at glacial speeds, but what’s happening underneath the shelf of ice, is absolutely priceless!

People do what people do, and frequently their acts impact others. In focusing an entire life on the “unfairness” of it all, and how you were never understood as a child, or how your parents pushed you into something you did not choose, adults abdicate all responsibility for their own failures, miseries, and obstacles. But that act of pushing responsibility off on some person or treatment that was, by all accounts, truly unfair or unhealthy, does not change anything. What a tragic set of circumstances, particularly if the person stalls at that “it’s not my fault” gate.

Choosing a provider who is content to privilege venting, emission, and advocating only for emotional expression, for the sake of ‘getting it all out’, may certainly be what you are looking for. Be aware that simple expression of a thing does nothing to bring that thing under control or create ways to utilize it for ongoing and consistent benefit of the person who is expressing. After awhile, you may get tired of hearing the same narrative emerge from your mouth, with no new endings in sight.

Discouragement and self-pity are not ingredients in ANY story of success and triumph! At some point, the focus on the “why” of people’s behavior must shift to the “now what” of our own. When you concentrate on developing new, healthier responses to the decisions of others, your need to know “why” may diminish significantly. If you are willing to turn your WHY into “what am I going to do about it”, change can happen.

“Why” is a question that may never meet an answer.

What’s with the Mustard Seed in the name of your business?

My practice is called Mustard Seed Journeys because of the significance of a tiny seed of faith in any life in which it’s planted. Faith, when lived out loud, can spread so quickly and deeply, it becomes a force multiplier in any human effort.

A mustard seed is a tiny piece of possibility the bible discusses as a benign grain which can, with very little effort, invade an entire garden, until everything else withers and dies. We are encouraged to have faith the size of a mustard seed because properly planted and cultivated, this faith can move mountains, change lives, and impact generations of the future. I offer a faith-based framework for my work with clients, depending upon their level of comfort with spiritual topics and application of related themes to the goals identified by the therapy team as needs.

What should I look for in a strong therapist?

Seeking help is a first step to real change in your life, yet it can be quite painful and frightening. Therapy may be able to help open some doors you never knew existed within your circumstances. Some doors have been painted shut and have blended into the walls and halls of your daily life, so you may have missed them completely. Finding a trustworthy, thorough, and skilled outside facilitator can help identify what you have been missing on this leg of the journey.

A good therapist does several things well.

• Represents herself clearly and accurately from the start: She will determine whether she has the training/expertise to address your particular area of struggle. She will work with you to see if the “fit” between you is likely to help or hinder your needs. She will refer you elsewhere if she determines she is likely to delay your progress for whatever reason.
• Monitors the therapeutic journey: He will work to maintain an ethical and professional stance in his dealings with you. If he believes something in the relationship is hindering your forward movement on the part of either party, he will disclose that as appropriate in an effort to protect your work together. If he finds this impossible, he will terminate the work and offer help finding more effective services for you.
• Listens with purpose: She will evaluate your current state based upon attention to your past; family, friends, educational and employment background, medical history and current physical health, emotional and mental health, relationship history, and your goals. This comes from critical questioning and listening to what is said or left out of an answer. The “intake” process will cover all relevant areas of functioning to be assured nothing important is missed.
• Asks challenging questions: He will ask pertinent questions designed to uncover how you think, what you believe, and what you have tried. He may ask questions about experiences and emotions which make you uncomfortable. Not all questions have answers but they should make you think about things you have never considered before in the same way. The asking of such questions may seem odd, if not irrelevant, yet sometimes it is the question left unasked that holds a key to areas previously unconsidered, which unlock the change you have been seeking.
• Refuses to give a “quick-fix” answer: When you ask her what you “should do” to make it better, she will not claim to have “the answers” or the “prescription for what ails you.” She will question and listen so that she may offer possibilities to consider. The ANSWERS come from you. The strength to make changes also comes from you. Knowing the questions to ask and what to do with the answers, is the domain of the provider. She should be engaged, active, and include you in the overall process of change. This is not something done “to you,” it is accomplished “WITH” you.
• Helps you set achievable goals for treatment: He will ask what you want to see different in your life and will help you formulate a therapeutic plan for getting the change you identify. He will not work counter to that on his own agenda. If he thinks he cannot help you attain YOUR goals, then he should offer you referrals to someone else.
• Ends the relationship when the race is won (or if it stalls at the gate): She will not continue to use resources in unhealthy, unhelpful, or non-productive ways. She will discuss termination with you, including the reasons for it, as she begins, and throughout the process. This frees you to continue your journey to good health in another way. A strong therapist knows when the process has come to an end and should review the factors contributing to the closing of therapy with you prior to that end. This is only possible if the provider is given that opportunity.

During the first phase of work together, the following items may be used to evaluate the effectiveness of your therapist.

A better description of the assessment of your therapist’s work with you can be found at Ryan Howes Psychology Today page. It’s worth a look!

• How well does the therapist listen?
  • How open is she to answering questions about her methods, strategies, and observations?
• Are her observations and recommendations easy to understand?
• Does she take adequate time to explain methods, expectations, policies, & frameworks?
• Does she observe and nurture healthy boundaries?
• Does she seem to care about your experience as you share it?
• What has been the most helpful contribution she’s made to your progress?
• What have others in your life noticed about you since starting therapy?
• If you could change anything about her approach, what would it be?
• How do you feel when you come to an actual therapy session?
• When you leave sessions, do you think about what you learned or is the experience forgettable?
• Do you feel safe talking to your therapist about your issues, especially times you have not met an expectation?
  • Do you ever feel like you must hide some important issue because you are afraid of her reaction?
  • Do you feel free to disagree with her or believe that you can tell her when you have been hurt or angry by something she said or did?
• Is your work far too shallow or comfortable to be useful, or perhaps too intense?

What do you have to offer at Mustard Seed Journeys?

I hope anyone visiting this site will get a sense of what Mustard Seed Journeys, P.A., may offer [the HOME page offers very specific explanations of my actual services]—if we are a “good match” for each other. I am one of a relatively small number of licensed mental health professionals located in the Medina County, Texas, area. I can honestly say I am unlike any other provider, anywhere.

Not better, necessarily, but different.

I have been described in many ways, not all of them completely kind or positive. One theme that re-emerges in how others perceive me is sincerely passionate. I have developed a balance between toughness, compassion, and distance. My heart breaks multiple times a day, yet I am not expected or able to rush in to rescue the broken-hearted all by myself. Knowing and accepting this brings a level of relief: I can only do what I can do in any given moment, evaluate the results to learn what needs attention, then try again. This helps my work with hurting people, primarily because it releases me (and them) from having to produce immediate answers to long-enduring questions.

I live in the tension between knowing and wondering, the definite and the ethereal, caution and curiosity, the inside and the outlier state. I am good with either side and I try to teach clients to rest more peacefully in whatever state they find until they muster the direction and motivation to shift their trajectory, then apply the skills to move to the next lily-pad. I know how loneliness and intimacy feel, as well, so like most humans, I have felt the swing between these extremes and been left confused and hurting. I have had times when I obsessed about how others considered me, and times when I didn’t really worry about others’ opinions. I have enjoyed enormous success and endured miserable failure, times of troubled spirit and the gentleness of peace.

The human story is constantly changing, shifting from one side of the pathway to the other and some unseen Hand guides us with loving correction, if we allow it. I am unconventional in many ways, yet ridiculously traditional in others; I think this is an asset in joining clients wherever they are when they make the first call. My self-acceptance models the same state for clients: what I cannot change, I must learn to manage or accept. With healthy boundaries, increased self-management skills, and a safe place to form a new relationship with elements of the past, most people can learn to let go of what they cannot change. This is a large part of my offering to clients.

Due to my lengthy professional experience in the public school sector as a special educator, I have exceptional skills in working with families who struggle with all manner of developmental trials, as well as relational struggles related to typical parenting issues. I am not a “one-shop-stop” for all mental health concerns. I maintain a limited number of slots on my schedule so I may focus full attention on the clients I have, and not spread my resources too thin to make a difference to the clients I see.

My passion for helping couples become strong allies for each other, thus forming dynamic families who create the basis for healthy communities, makes me an “advocate of the family” in very positive ways.

I have received training in research-based methods for working with individual adults and children, couples, and families who desire to improve their relationships with others both inside and outside their family units. About half of my practice is relational–it includes more than one member of a system [couples, parent-child, multi-generational, family]. I see individual adults, as well as children and adolescents in the context of a family system (ongoing parental supports), yet alone for specific focus on skills development.

I invite you to call and discuss your specific circumstances to see if you feel comfortable with my approach to your situation. The initial phone consultation is free and can help narrow your search. You may feel immediately at ease, or you may believe I am a “nut.” Either is fine with me. It’s your life and you must be comfortable with the person “digging around in your pasture”.

So what are some of the risks of participating in therapy?

• Lack of progress. Some clients do not appear to improve in therapy. For example, depression or anxiety may become worse. It is vital that you keep your practitioner informed of what is happening with you as you work together. If needed, she may recommend a different form of care or may provide referrals to other providers, including medical.

• Upsetting insight. Therapy may lead to insight into your own behavior or choices of others which clients find upsetting. Some may wish they had not discovered certain things about themselves or others. Of course, once aware of new information, there is no going back. Your therapist will monitor your feelings with you and discuss these concerns if they arise, but you must notify the provider first.

• Feelings of distress. Discussing personal concerns can be distressing by itself. Clients may experience feelings of sadness, anger, anxiety, loss, or depression in talking about what brings them to therapy. They may have disturbed sleep as dreams or nightmares surface as a result of talking about concerns. Part of therapy often involves learning to handle these more effectively when they occur.

• Negative change in relationships. Although behaviors and moods may change in a way the client appreciates, others in the client’s life may not like the changes and may not adjust easily or at all.

• Improvements in client’s self-esteem, self-assertion, or sense of self-control may represent threat to others.

In systems of any kind, changes in the functioning of the system can result in two things:

1. the system adjusts to accommodate the change
2. the system attempts to force a reversal so status quo is maintained. This is referred to as “homeostasis”. Systems can approach a change in ways that may appear threatening to anyone within it who wishes to renegotiate the “way things are.”

The biggest lesson of therapy is self-determination. Learning this lesson includes accepting that all functional human beings have, to some extent, control over their own choices and actions. This can feel overwhelming and difficult to grasp in day-to-day relational exchanges.

~ Talk therapy can lead to conflict in marriage or other family relationships.
~ Therapy may also lead, in rare cases, to deterioration of work relationships and can result in a decision to change professions or positions.
~ Additionally, other individuals with whom the client has a relationship may initiate changes when the client does not want to do so.

Your therapist will work closely with you to address these events with new skills and belief structures. However, no one can predict all interpersonal conflicts that may result from therapeutic change.

What are some of the ways therapy can be helpful?

1. Improved understanding of self and others: The objective viewpoint of the therapist helps many clients better understand their own feelings and behaviors as well as those of others. Awareness is both an internal and external process in discovering personal identity.
2. Progress toward defined goals and objectives: In collaborative systemic therapy, client and therapist work together to set specific goals and objectives. A way may be identified to measure progress toward those goals. Most clients can clearly identify changes in thoughts, feelings, and behavior they make through therapy.
3. Greater sense of control over mood and behavior: As clients measure progress and identify the tools used to make headway, they often gain feelings of power over moods and behavior. Again, this can be a gradual process, not always an immediate one.
4. Improved self-worth: With greater self-control, clients often improve their self-concept. Confronting and managing one’s difficulties often leads to improved self-regard.
5. Improved self-assertion: Many clients increase their ability to champion themselves in healthier ways. As self-value and control improve, they feel more able to stand up for their own needs without infringing on the dignity of others. This is where boundaries are planted and nurtured.
6. Improved relationships with others: By reducing unwanted behaviors and increasing more desirable decisions, clients often improve relationships with family members or co-workers and friends.
7. Improved capacity for independence: Before therapy, many clients have depended on others for their sense of well-being and value. They have believed they MUST be liked by EVERYONE or MUST say YES to anyone who asks for their help. Therapy may lead to an increased ability to meet one’s own needs and to feel confident in their own intrinsic value as a human being. At the very least, therapy can help you develop gentle and respectful ways to say “No, thank you. I’ll let someone else have the chance to step into that role.”

Will therapy records be considered confidential?

Generally, the law protects the confidentiality of all communications between a client and therapist. Under normal circumstances, information may not be disclosed without prior written permission from the client.

Minor clients may expect reasonable confidentiality (even from parents or legal guardians) provided they understand the limits of confidentiality which apply to all clients, regardless of age.

Custody issues are frequently detrimental to the well-being of minor clients. If a parent is separated from the child’s other parent and seeks therapy for/with their child, I may ask to communicate with the other parent to be sure he/she does not object to our work.

I am not required to do this, but if I believe that not doing so may have a harmful impact on the child’s well-being, I will offer the other parent the opportunity to have input into the process on behalf of the child.

If one (divorced) parent brings a minor child for treatment, I will request the most recent custody/divorce documents to determine the rights of both parents regarding the child’s care and who has authority to obtain mental health services for the minor child. I will sometimes require both parents to sign consent forms for treatment to begin for the minor child. A therapist’s participation in divorce-separation discord between parents is not often helpful to the well-being of the child(ren). I will avoid such participation if at all possible to avoid harming the therapeutic effectiveness for the children. Professional standards require MFTs to terminate therapeutic relationships once their roles have shifted to participation in legal proceedings–it undermines the relationship between the principles in the process.

I provide therapy to a minor child or adolescent with ongoing input from the adults who create the child’s daily structure and support. This does not mean every session includes the parent or guardian, but to effectively help a minor child/adolescent, I must have the cooperation of any adult in the system who can help create and maintain long term change for the minors in therapy.

Sometimes parents/guardians call for therapy to focus on a single child/adolescent and don’t believe their participation is necessary to achieve their goals. After all, “the child is the one with the problem”…ah, no. As a systemic therapist, this separation of the child (problem) from the context and source of their distress (always relationally-based) presents a significant obstacle to client potential for success.

No child lives in a vacuum; they are necessarily impacted by many factors over which they have no control. I typically decline to participate if parents or guardians refuse to do anything more than pay the fees and transport the minor client. I can work alone with a child/adolescent with the input / participation of the important adults in the system–the specifics of those sessions can remain confidential from parents or guardians, yet there is no expectation of privacy in the event any one is in danger, inside or outside that family system. This is something I discuss clearly before therapy begins.

If I have reason to believe a minor individual, an elder (65yr+), or someone with a disabling condition is being (or has been) harmed, neglected, or abused, I am REQUIRED to notify the appropriate authority to help ensure the safety of that individual in need of care. There are a number of other factors involved in whether an individual’s information can be kept confidential.

Generally, if someone is being harmed, has been harmed or threatened with harm, a crime has been committed / is being investigated, a judge orders release, fees are unpaid, or if a provider is defending their livelihood or reputation against a complaint or suit, such information is not likely to be held in confidentiality. Clients may sign consent for release of records (within certain guidelines) to any entity they wish, but beyond the limitations allowed or required by law, most information shared in therapy is considered confidential. This issue is one that should be addressed before any therapy processes have begun so that an individual may make an informed decision about whether to engage in treatment.

What if I want Dr. Hayes to participate in court proceedings on my behalf?

Ethical and legal standards established by mental health professional licensing boards prohibit therapists from testifying as expert witnesses on behalf of established clients, as the nature of the therapist-client relationship inherently biases the therapist regarding the client and any testimony can be damaging to the therapeutic relationship.

Therefore, it is not the purpose of Mustard Seed Journeys to participate on behalf of clients in current or potential court proceedings, for example, custody hearings or visitation disputes.

This is an area I feel strongly about—if you are involved in a situation which has the potential to go to court, or you need an independent, objective psychological or custodial assessment for court purposes, please let me know so that I can offer you an appropriate referral. Being required to attend and participate in a court proceeding will disrupt scheduled appointments of other clients and will absorb my personal and professional resources in ways which will not be beneficial to my clients. Time spent in court or preparing/waiting for court is time spent away from other clients. This disrupts my ability to make a living, and exhausts my personal resources, in the process.

In the event that I am subpoenaed to testify in court on your behalf, you/lawyer will be charged a considerable retainer for my availability. This applies to time in or awaiting court and/or time needed to prepare client records that are subpoenaed. This fee does not include copying costs and affidavits of accuracy and summary, which will be an additional hourly fee. No part of a request for court participation will be undertaken until the retainer has been paid in full. Anything expected or requested then will be charged at the hourly fee. These fees are addressed in the policies document all clients receive and review before our work begins.

If I am induced to participate directly in a legal matter for a client, it will change the therapy relationship, and I will terminate our work. The client’s well-being will be jeopardized by the shift in focus for our relationship.

What about confidentiality in couples/family work?

Confidentiality and privacy become more complex when working with a couple or in a family therapy context. I review this information with clients very clearly in the context of the first session. However, it is important for clients to understand that confidentiality for couple therapy is considered to be held within the couple, not with each individual. This stance is intentionally taken in order for the therapist to avoid being asked to keep secrets between one partner and the other because the “client” in couple work is the RELATIONSHIP between the partners, not the individuals involved in the work.

A similar stance is taken in the family therapy process- if a member of the couple or family shares information with the therapist individually that is important for another family member to know (incident of infidelity, substance abuse problems, self-harming behaviors, potentially harmful ‘teen secrets’, etc.), the therapist will work with the individual to determine the best way for the information to be shared to keep parties safe.

If this becomes cloudy or if the relationship begins to deteriorate, the clinician must terminate the work and refer the partners to other providers. The exception to this may be if the couple decides to end therapy and all parties agree that one of them could benefit from continuing the work individually with the clinician, a very clear end to the original couple work will be created and a new therapy agreement with clear understandings of limits of confidentiality will be created. Muddying these waters can be harmful to the individuals involved in the process.

I do not keep critical secrets within a system, especially those which represent harm to the “client”—in relational work, that is typically more than one person. If a couple is seen for treatment together and one of them requests a copy of therapy records, both parties must consent (in writing) to the release of the records. If one party requests records of their own health information, and if the records contain data about a 3rd party who has not consented to the release of that data, I will comply with the request after all protected data about the 3rd party has been redacted.

How does an “MFT” differ from other provider types? Do you only see married couples and families?

Excellent and common question–short answer: No.

Marriage and Family Therapy is one of the five major core mental health professions recognized by the U.S. federal government (others are psychiatry, psychology, social work, and psychiatric nursing). The presence of “Marriage and Family” in the title of our profession can be ambiguous. MFTs are fully qualified to provide assessment, diagnosis, and treatment for individuals, couples (engaged, married, or otherwise committed) and families.

For more information about qualifications of MFTs published by our professional association, the American Association for Marriage and Family Therapy has a website that offers a good deal of data about the profession.

What makes MFTs distinctive is primarily the approaches we use when working with clients, whether the ‘client’ is an individual, a relationship, or a family. We recognize and value the powerful impact of connections in human life. We recognize “individual” problems (anxiety, depression, trauma, life transitions, etc.) are both affected by, and have an impact on our significant relationships. Therefore, MFTs try to consider the individual’s context, vital relationships, and family of origin [FOO] history even in the treatment of individual issues in therapy.

When working with couples and families, MFTs are uniquely trained to balance complex relationships and needs together within the therapeutic process. We are also trained to understand how the interactions within a couple or family are shaping and are shaped by the problems brought to therapy, as well as realities of prior experience with other relationships. These are referred to as “systems” of interactions.

All individuals living in community with others are a part of various relational frameworks which operate mostly outside the awareness of the people within the frame. A change in any part of a system will impact other parts of the system in ways sometimes hidden from our awareness, and so conflicts may pop up which we may not know how to resolve.

Marriage and family therapists look carefully at the relational structures and patterns of reactions to see what changes in the system may help tackle the obstacles which bring the client to therapy. Many other clinician types offer “marital” or “family” counseling, yet they may not have had the same coursework and supervision in systems as anyone earning a license in marriage and family therapy. If this is important to you, it is a good idea to ask a potential provider about the percentage of couple or family work they had during their supervised training phase, and how much of their current practice is made up of systemic client work.

Why might Couples seek help from an MFT, rather than another provider?

• Either partner feels unheard or invalidated by the other
• Sexual intimacy is at risk or completely gone-usually means the friendship has been damaged
• Infidelity in (or suspected in) the relationship
• Life transitions have altered the nature of the relationship and a “new normal” is needed
• The couple is struggling with managing resources (financial, time, energy) effectively
• A loss or traumatic event has disrupted the couple’s feelings of unity-distance is growing between them
• Parenting/co-parenting issues have caused a rift in the friendship
• Blended family issues are creating stress and divisions are appearing in the fabric of the family
• Parents or children discover distance growing between them, increasing chances for unsafe behaviors to develop and the potential for chaotic parental reactions
• Communication has deteriorated into full-time conflict which seems un-resolvable to the couple
• Contempt or relational aggression has begun to surface and the partners need to redefine safety for their family
• Members of the system experience unloving interactions that threaten the structure underlying family functions
• Domestic aggression* is beginning to appear and the couple may want to address this before it escalates into violence

*NOTE: If domestic violence is actively present in the relationship, marital therapy may not be wise. If minor children or other vulnerable members are exposed to unsafe exchanges in the family context, therapy must focus on creating a safe place for all members of the family system to exist, despite sources of stress. Until all parties are in control of their emotional responses and behavioral choices, amidst outside events (loss of job, financial stresses, legal troubles, etc.), then use of marital therapy techniques may not be a safe, or effective method of addressing the real issues. Under such circumstances, anger management, substance abuse counseling, or other individual type treatments are more likely the best options as the ‘first step’ to a healthy family unit. Couples experiencing such challenges will receive referrals to other resources for these services. When all parties are safe, the therapist may work on the underlying structure of the relationship with the couple.

What about military families? Do you serve those with military background?

These continue to be complex times for military service members and their families. With deployments to, and homecomings from distant lands, service members and their families face unique challenges in their careers and personal lives.

I offer services to military couples/families and am knowledgeable about the dynamics and reintegration challenges of the military lifestyle. I completed coursework and training during my graduate work at St. Mary’s University under the Military Family Services program (TRIAD grant). I have had the pleasure of working therapeutically with military service personnel and their families for a number of years and am pleased to offer a sliding scale discount to all active duty military (including Activated Reservists), or recently separated military personnel and their families.

I have a good deal of experience working with survivors of traumatic experiences–if referral for targeted PTSD treatment becomes a necessity, I will refer the client for specialized services to treat severe PTSD symptoms. I can continue to work with the client/system on impacts of the condition on the well-being and effective functioning of the relationships among members of the family.

Does Mustard Seed Journeys accept insurance?

At this time, Mustard Seed Journeys (Leslie Hayes, PhD, LMFT) is not associated with any third-party payment system, including insurance companies. {insert groan here}

WHY NOT? Did you know that all insurance companies require a mental health diagnosis be assigned to you or someone in the family unit seeking help (couple or family) in order to reimburse for services? Because most of what I do is not covered by third party payment panels, I’d be required to decide which member of a system is the “identified patient” and provide a diagnostic code that may or may not be helpful.

Additionally, all third party payers have the right to audit client records to maintain control over the kinds of treatment options to be offered, length of services, and specifically for what parts of the services they will pay. They are free to use this information in any way they may deem fit, which means the client and clinician have NO CONTROL over the disposition of the information contained in the therapy record. Insurance providers also control how many sessions of treatment they’ll approve and any sessions beyond this number must be pre-authorized before a client can be seen for additional therapy.

This leaves the decision for type, number, and focus to an entity not knowledgeable about the struggles of a particular client (system), rather than the therapist and client treatment team. This convinces some clients to pay for therapy personally and not to utilize their health benefits. Others just keep looking until they find someone on the panel of their insurance provider, even if that provider is not a good fit for their needs. I am concerned about client privacy and it is impossible to maintain that privacy when a third-party entity may obtain the contents of therapy records and use them in any way they choose. This is primarily the reason I do not belong to insurance panels.

I will not file insurance documents for clients and offer no guarantees related to being able to provide the required information your company requests for reimbursement. For a reasonable fee, I can provide a document of sessions, expenses paid during a given period of time, and a brief summary statement about the reason for each session. This kind of information may be used for tax records, although without a diagnostic code, there is the possibility that your insurance company will decline to reimburse for all or part of your expenditures for services.

I will provide data you request to the best of my ability, but I cannot provide a diagnostic code simply for reimbursement purposes. Should a diagnosis be indicated, I will discuss this with the client prior to recording it in the file. Once information is contained in the file, I cannot remove it. I can correct mistakes, clarify where needed, and add to the record, but I cannot alter the record without violating professional standards.

If you find the cost of therapy prohibitive due to insurance issues, it may be beneficial to talk to me about whether you qualify for adjusted fee options or to find another service provider. I maintain a certain percentage of openings for clients who need a reduced fee to be able to participate in their work.

How does Mustard Seed Journeys charge for services?

This process is one by which I make my living, therefore, I require payment for services when services are rendered. I accept cash, money order, or a check at the time of service. In addition to fees for intake and regular sessions, both of which will be discussed/disclosed prior to starting work together, there are other fees that are addressed in the Policies/Consents document all potential clients receive before services begin.

These fees are for:

• Late payment
• Late or no cancellation 24-hrs prior to the scheduled session (waivers for emergencies will be considered)
• Fee for client simply not showing for a scheduled session
• Fee for check returned for insufficient funds, in addition to the late payment fee (cash or money order will be required as payment following an NSF return)
• I will put services on hold if two weeks passes with increasing fees-I will not be a cause of increased financial stress beyond the second week, but I will broach the subject of financial strains as they impact the therapy work.
• For documentation of service provision / payment, there is a small hourly fee for preparation of data to be submitted by the client to the requesting entity

Mustard Seed Journeys offers some adjustment for services to those with diminished economic status, full-time students, active duty members of the U.S. Armed Services/Activated Reservists, those aged 65 years or older, and those with significant and well-documented disability. I set aside a percentage of my schedule for clients who are offered reduced fees for services. When I reach that threshold, I will offer to place those who choose to wait, on a waiting list. If you think you may meet conditions for reduced fees, discuss this with me prior to starting services. I do not provide reduced services for reduced fee status. All clients receive the highest level of services I can provide. Any client, regardless of fee level, who does not participate fully in the process or who misses sessions frequently, may be referred to other providers so that I may make full use of my resources with other clients.

How does MSJ handle assessment? Referral or in-house?

Fees for assessment instruments used during the process depend upon the measurement method used; this will be discussed prior to administration of the assessment tool. More in-depth assessment for complex psychological or medical issues will be referred out, if such issues appear to be keeping the client from reaching therapeutic goals.

What is the cancellation / termination policy of Mustard Seed Journeys?

There are a number of reasons therapy may be discontinued.

These include (but are not limited to) successful achievement of client goals or purposes, client request to end the work, change in therapy relationship, therapist illness or inability to maintain practice, client circumstances prevent continuation of the work, or the therapist believes that the process is not helping or may be harming the client in some way.

Clients who do not show up for scheduled therapy appointments but have not cancelled or rescheduled at least 24 hours in advance of the missed session, will be asked to pay half their normal session fee at the next session. This policy may be negotiated if I believe emergency circumstances warrant it. I appreciate receiving this information as quickly as the client knows the appointment will be missed so that I can make best and safest use of my resources.

Clients may leave therapy at any time. Discussion about reasons for their decisions would be helpful–it may help me provide better services to other clients, if something about my approach has been unhelpful in some way. If clients don’t see improvement soon enough or feel overwhelmed financially, we may be able adjust the treatment plan and/or cost to help clients continue with treatment. Sometimes clients are embarrassed to admit financial stress. It is part of a healthy relationship to be able to identify obstacles to client growth and initiate a plan to address the obstacle. It is appropriate to speak with me about this if it becomes an issue BEFORE simply stopping therapy.

Clients have the option of seeking other sources of assistance (autonomy). If clients have decided to end therapy, I can provide referrals to other professionals for consultation or treatment. Clients whose therapy issues are outside my expertise or training/experience will receive referrals to other providers who may be able to meet their needs more effectively. Please understand that because of the shortage of qualified mental health providers in Medina and some nearby counties, referrals provided may be at some physical distance from a client’s location. However, many providers are utilizing the Tele-mental Health option to provide their services online in secure video environments. Clients are advised to be sure they are fully comfortable with the lack of in-person connection with the provider prior to deeply engaging in that process.

If an account with Mustard Seed Journeys is overdue two weeks, I will ask about the feasibility of continuing treatment. Since this is my livelihood and I value financial accountability, it would be unethical and unhelpful to the relationship to maintain a line of credit beyond this time frame. I will not assist clients in incurring a considerable level of debt, which adds anxiety, and works against their well-being. Overdue payment beyond this time frame may result in termination of services and referrals to other service providers. The pressure of knowing the client owes money for past services undoubtedly creates tension in the therapy bond that will deteriorate the effectiveness of the work. For this reason, I require payment at the time of service every week.

If a client includes me as a party to a legal suit, such as a divorce, custody, or other grievance, this would constitute the start of a “dual relationship” and would cause our therapy tie to be altered in potentially harmful ways to the client’s well-being. If such an issue arises, I will terminate the therapeutic relationship and offer referrals to other providers.

I may terminate the therapy relationship for reasons related to progress, safety of any party, attendance and effort, or for conditions under which a dual relationship appears to be forming. Any of these will impact the quality of services I provide, and it would be unethical for me to continue our work. If a client decides to end treatment by simply not appearing for a scheduled appointment, I will try to contact them to be sure they are safe. If I receive no feedback the week following the last attended session, I will discontinue treatment, and provide a closure letter by either post or email (depending on the identified client preferences). I make multiple efforts [all documented] to contact the client before closing the work. I do believe, however, that all behavior is communication, so if a client does not use words to communicate an end to their participation, I will accept the meaning behind the absence, respecting client autonomy and agency.

I do not have a way to put services “on-hold” for an indeterminate period of time. Behavior is communication, so failure to attend sessions and a decision to disregard my efforts to be sure you are safe and ascertain your status for the next week’s session, certainly communicates an end to the client’s devotion to the process. Upon successful completion or achievement of goals, some clients (individuals, couples, parent-child dyads) request to be placed on “follow UP status” and will come back for a periodic “check up” for their continued application of the attitudes and boundaries developed in their work before closure. It is a time of gentle accountability, encouragement, and re-emphasis on the skills the client showed at lease partial mastery, so it’s like a tune-up for their relational vehicle. Old habits are very hard to break so sometimes, a tweak, a tuck, and a snip, are in order to strengthen client function.

Multiple cancellations, long stretches between sessions, or frequent lateness to appointments may be indicators of a deeper issue related to therapeutic stalling—if these should become a pattern, I will address it in the process to see if adjustments are needed. One such adjustment may be referrals to other potential sources of help. Clients who begin to find reasons not to attend sessions or to complete therapy tasks are communicating a level of disconnection with either the process or with therapist that must be addressed to maintain an ethical and client-focused stance.

In most circumstances, as we wrap up the work accomplished, clients will be provided a summary of their services, discussion of the focus of the work, along with my recommendations related to their seeking further treatment, and outlines reasons for closure of services. It will be sent either by portal email attachment or by postal service to the last address provided by the client, unless the client has requested other methods of communicating written documents.

What happens to client records after therapy is closed?

Disposition of Records

Client therapy records are kept securely for a period of seven [7] years beyond the final session. If clients were of minor age at the time of treatment, those records will be maintained for a period of 7 years beyond the date of the client’s 18th birthday. In the event of my death or incapacitation, client records will be transferred to another mental health professional specified in my estate.

Any client who receives services with me will sign agreement for that entity to contact you about referral needs and disposal of your records in the event of my incapacitation or death. This will necessitate a limit to client confidentiality.

Client desiring a copy of their (or their minor child’s) therapy records must submit that request to me directly in writing (I have a form outlining the necessary information to meet that request), and I will respond to the request to be sure I am clear on what is requested, why, and in what format it is requested. The information contained in the record belongs to the client, while the actual file belongs to me. Clients may receive a redacted file if information from or about a third party who has not consented to the release of that information is contained in the record. Any data that did not originate with me may not be provided in what I release to the client. The client may choose to request that information directly from its source.

There will be a reasonable fee for copying the file, redacting/compiling, and saving to a portable format (pdf or memory device), as well as the labor/time involved in complying with the request. This assumes that the person requesting the records is legally-authorized to obtain the data; I will require documentation of that authorization.

What about medicine? Do you prescribe or monitor medications?

No. In the state of Texas, only psychiatrists/medical doctors and other specially-trained advanced practice nurses and physician assistants can prescribe medications, including those for serious mental health conditions. I am not a medical doctor, a psychiatrist or psychologist. I am not trained in medical treatment for serious mental health issues and do not monitor medications for treatment of such illness.

However, if you are already seeing a psychiatrist or other qualified medical professional for medical treatment of a mental health disorder and you are stabilized and taking your prescriptions appropriately, I can offer to coordinate therapy efforts with your doctor, with your written consent.

If your medication is not monitored by a physician in an ongoing manner or if you are not stabilized in using your medications properly, I will be unable to provide services to you. Without stable medical intervention, monitoring and compliance with treatment, you may not be in a position to make sound decisions about your overall health and your behaviors may be impacted in a detrimental way—neither of which will help you achieve therapy goals with Mustard Seed Journeys. Clients who need, but who are not consistently stable using, their medications may not be able to provide “informed consent”—a primary requirement of the ethical practice of therapy.

Use caution in seeking mental health treatments for yourself or your family. Anyone may call themselves a “psychotherapist” but not be licensed by the state to provide quality services or be accountable to any licensing board. The state of Texas requires at least a master’s degree in a counseling or mental health field, along with a license issued by the Texas Board of Examiners for that provider type, of any person providing mental health services. The license is issued following a lengthy supervised internship (3,000 hours) and a satisfactory score on the state’s licensing examination.

I completed extensive training and graduate/post-graduate education at the St. Mary’s University Counseling and Human Services program in San Antonio, Texas. I earned a doctoral degree in Marriage and Family Therapy at St. Mary’s, and am a duly Licensed Marriage and Family Therapist (LMFT lic. #201353), qualified by the Board of Examiners in Texas to provide mental health services and education to individuals and couples/family units or other groups.

I received advanced training while at St. Mary’s in providing Neurofeedback, Play, and Rehabilitation Therapies and have had additional supervised experience in the Neurofeedback and the Play Therapy areas.

I have received additional post-graduate training as a Level I Gottman (relational therapy) provider and as a Level II Rapid Trauma Resolution Therapist (trauma processing). I maintain continuing education credits as required of my license to stay current on topics related to providing quality services.

What forms will I need to have/complete to begin therapy with MSJ?

Consent and Policy Notification Forms

The appropriate consent and policy notification forms will be provided prior to our work together when the portal account has been opened by the client [from invitation]. Those policies, practice procedures, privacy considerations, limits to confidentiality, technology-assisted processes, risks/benefits of therapy or use of digital devices, and specific data required to be provided to clients when initiating services.

Information about the No Surprises Act will be included in the document packets, all connected to one another. Be aware the length of these documents is extensive, but the information is very important in being informed about your rights and expectations for the services and the therapist.

Every main element of MSJ policies and consents will be reviewed and signed with the client before treatment may begin. Clients are advised to read them carefully and to bring any questions about them to the intake session or to ask by email or phone prior to the first session. It is my policy to review the consents, limits of confidentiality, HIPAA rights, fees, your expectations for “success”, how technology-based services may look, and to answer questions before the process formally starts.

You will find an additional document related to the No Surprises Act, in accordance with federal guidelines to safeguard client rights and provide financial accountability information, to inform clients or patients of estimated costs of service. This attention to detail is part of obtaining “informed consent”, required by the ethics code of my profession. I will gladly address any related questions that arise as the process unfolds.

I will NOT rush through this piece of the process; it is my professional responsibility to be sure all clients fully understand what they are consenting to.

Intake Forms

After a brief consultation call, I can better recommend the kind of treatment option specific to the potential client and will send the corresponding files prior to starting the intake process. I am unable to guess how long treatment may last or how many sessions a client may need to achieve success, though this is a common question. The answer depends upon a number of factors I have little to no control over. There is no accurate way to make such a determination, so I won’t even try.

The intake files used with each potential client are designed to be filled out electronically and submitted to the therapist by portal. Please be aware that I utilize a secure service for my email exchanges with clients or potential clients. This will require the client to create a login the first time we interact about starting services. This opportunity to obtain quite a volume of data for starting the process in the most relevant direction, means clients will provide a LOT of Personal Health Information (PHI).

If you reach out to me through any other means, such as by text or phone call, I cannot guarantee your data will be as secure as it would be using the portal. Clients can waive the use of encryption for the protection of information sent between client and therapist, but will be asked to do so in writing (I have a form). Unless there is absolutely no clinical data contained in a message I may want to share, I will use the secure portal for most exchanges.

Clients are asked to notify me if they have emailed something through the portal–I don’t check my email obsessively throughout the day; in fact, there’s no assurance I will open it at all for a few days at a time.

Exceptions to this would be scheduling changes, announcements, reminders for bringing or doing a given task, and answering neutral questions from clients. If a topic is likely to contain more personal data, I will advise the client to open an email through the portal–all to safeguard client privacy. I use initials or other truncated identifiers in my exchanges with clients –this is in case the text is sent to anyone other than the intended party, the information contained in the text would be so cryptic as to be confusing and meaningless to anyone other than the intended recipient.

The intake forms I use request information through form fields / drop down menus / check boxes about functioning relevant to the therapy process. The documents are lengthy so please give plenty of time to consider your responses carefully. The kinds of intake forms provided to you will depend upon the kind of therapy you are seeking. There are different forms for individual adults, children/adolescents, and relational clients. Sometimes, a combination of these intake forms are part of the process. The intake forms for couples and family systems are extremely detailed, and clients will be given a document outlining recommendations for how to complete and submit the intake forms with as little distress as possible. There are a number of factors involved in that part of the process, any one of them can create a ‘bump’ in the road.

Forms are updated as changes in the field (rules and documentation requirements) occur. All intake documents and signed policies and consents become personal health information (PHI) included in your file when we start services. Clients who have no access to email or for whatever reason cannot complete digital versions of the intake documents, may be asked to complete those forms in written form or with me in early sessions; this will considerably lengthen the time we spend in the intake process, but none of the time or the information will be wasted–all pieces of information are potentially helpful to illuminating the full picture.

All intake documents become part of the client’s record, along with consents, releases of information, emails, texts, client tasks, photographs, tasks, and consultation notes.

What are the HIPAA-required notifications for Mustard Seed Journeys, P.A.?

Privacy Notices – Personal Health Information [HIPAA Information Notice]

Mustard Seed Journeys, PA, is a Health Care “covered entity” required to provide a notice describing how medical information about how client data is stored, managed, and how it may be used and disclosed. This notice outlines how clients or others can access this information. Clients of Mustard Seed Journeys, P.A., are asked to review it carefully and keep a copy of it for their records. It is provided because the law requires it.
It is updated and effective as of March 2022. For more info, please visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html or www.hhs.gov/ocr/privacy/

It is my duty to keep client personal data safe. Client digital records are stored on a password-protected drive filed under a unique client ID code. Paper records are kept under double physical locks. I do not store client records on clinic premises to further protect confidential data. I typically use email encryption to provide more secure digital interactions, when PHI is included in the body. Since it does involve an extra few steps in digital (email) interaction with me, clients may opt out of that service in writing. I must follow the duties and privacy practices described in this notice and give clients a copy of it.

Elsewhere, I exercise reasonable care to make sure client data is kept confidential. For example:

• I restrict who can access both paper and electronic files.
• I do not hold confidential phone conversations where others may overhear the subject matter.
• I do not leave client info in clinical space overnight, nor do I maintain a computer containing client information on clinic premises.
• I do not use answering services or scheduling programs to make or adjust appointments with clients.
• I do not utilize billing services or other business management services.

None of these steps guarantee no compromise of client data, but they help minimize the risk. Should there be a disclosure of client data apart from what is allowed or requisite, I am obligated by federal law to promptly alert clients whose PHI has been “breached” by unauthorized disclosure.

Client confidential Personal Health Information (PHI) may be found in all of these: Communications between a client and a health professional, written clinical records, consultation notes, voice communications, and electronic files. I maintain records of each time we hold a session, interact electronically (texts, emails, voicemail) or talk on the phone (other than scheduling). These records include a brief synopsis of conversations along with any observations, recommendations, or plans as a result of the consultation. If clients have any questions about this, they are invited to ask me.

Client clinical records may contain: Records of client identity, contact data, & payment history • Info about diagnoses or clinical impressions • Assessment results, therapy tasks (photos, journal entries, audio-video clips, project results) & consultation notes • Notes about sessions with the therapist {Session or Progress Notes} • Other supplemental communication, such as phone/text messages or emails • Treatment information / therapy goals / progress toward goals / termination recommendations or decisions • Records from other professionals about previous assessment, diagnosis, and treatment

HIPAA Rights, Decisions, & Disclosures

» Clients have the right to know how and with whom their health information is shared by a provider; I will notify clients of all disclosures except for those about treatment, payment, and health care operations, and other disclosures requested. I’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if asked for another one within 12 months.

» Clients can alert me if there is information they do not want shared (though I may not comply with their preference, particularly if it affects client well-being).

» Clients can request to be contacted in a specific way (such as by email or only on a cell phone). I will endeavor to comply with client request, provided safety is not compromised by the restrictions

» Clients can choose someone to act on their behalf- if a client has given someone medical power of attorney or if someone is their legal guardian, that person can exercise client rights and make choices about client health information. I will make sure the person has this authority and can act for the client before I take any action.

» Clients have the right to decide how I refer to them (summons) when greeting them before sessions. They can choose to be called by a first name, full name, or a surname with formal title (Mr., Mrs., Miss). We determine this at the first intake session.

» Clients have the right to grant access to certain individuals who have responsibility for minor children, such as co-parents, step-parents, grand-parents, or other legally-connected adult with a potential interest in aspects of a minor child’s therapy process.

In these cases, I cannot share client information without written permission:

• Uses and disclosures of PHI for marketing purposes

• Disclosures that constitute a sale of client PHI

• Mental and behavioral health [psychotherapy notes] records

• Records of drug, alcohol, or substance abuse treatment

• Records regarding HIV or AIDS diagnosis and treatment

• Genetic information (including Genetic Tests)

Clients have the right to access and amend their treatment records, with some possible restrictions.

a. Parents/guardians may access the treatment record of their minor child with certain restrictions on what may be released, with respect to the well-being of the minor.

b. Clients may, in writing, request electronic or paper copies or a summary of their own treatment record. In the state of Texas, I have 15 days from the day I receive client petition to respond to that written request. I will charge a reasonable fee (per printed pg,or flat fee if the record is considerably dense) to cover costs of copying or for media required to provide digital versions of records or preparing summary reports/affidavits, apart from simply copying the record and including a cover sheet. I may not be permitted to provide copies of, or alter other providers’ assessment instruments/tools- clients may request those from the original provider(s). When payment for the copies is received, the record will be provided to the client. If a client has offered updated contact information along with the request, this will expedite efforts to comply with requests for copies of records.

c. If I determine that access might be harmful to client well-being, I may deny access to parts of a client treatment record. If I choose to deny access, I must provide a written statement of the reasons for the decision, provided the client has requested their records in writing from me.

d. If records are part of family/relational/marital work, I will not release information about other parties in the treatment without their written consent. I will redact all data from the record which involves others who have not consented to the release of their information before providing requested records. This will increase the time needed to prepare records for release and result in an incomplete version of the records requested.

e. If I deny access, the denial can be reviewed by a licensed healthcare professional who was not directly involved in the denial of the request, and who may provide guidance to the client on interpretation of the contents of the record. I require signed / written consent to release records related to a client’s PHI to another provider.

f. If a client believes part of their PHI/record is factually inaccurate, they may submit (to me) a written description/correction of the proposed inaccuracy. The client must provide support for corrections in their request. The client’s statement of concern and correction request will become a part of the treatment record but not replace/erase it. Be aware I am not obligated to agree with, or substantiate any statement or corrections. Ethically, I am not able to remove or alter any records already apart of the client file, thus the reason for adding to, rather than replacing parts a client may object to, or challenge.

How may client personal health information (PHI) be used by my practice?

» I can use health information and share it with other professionals who are treating the client.

» I can use and share client health information to run my practice, improve client care, and for contact when necessary.

» I can use and share client health information to bill and get payment from health plans or other entities.

» I can use client PHI if they have given specific written permission to disclose confidential information

» In marital or relational (family) therapy sessions, all adult clients must give written consent to disclose confidential information before such disclosure/release is made, in most circumstances. Because most sessions in relational / family / marital therapy include multiple parties, all adult individuals must give permission to disclose information pertaining to other parties. The ‘client ’ is the relationship between parties.

» I may share information for legal proceedings affecting the parent-child relationship, court order, subpoena, warrant, summons, etc.

» If a client sues me or for licensure complaints to my professional State Board of Licensing Examiners, release is permitted for purposes of my defense, or response to the complaint.

» If the client shows a probability of imminent harm to self or others or if a client is in potential danger of harm from others, even if the client is not physically present with the provider but there is potential for harm if no action is taken.

I am allowed or required to share client information in other ways – usually in ways that contribute to the public good, such as public health and research. I have to meet many conditions in the law before I can share client information for these purposes. Most will never occur but I am required by law to inform of the possibility for release.

» Help with public health and safety issues, including preventing disease

» Helping with product recalls

» Reporting adverse reactions to medications

» Reporting suspected abuse, neglect, or domestic violence

» Preventing or reducing a serious threat to anyone’s safety or well-being

» Assisting in health research

» I will share information about clients if state or federal laws require it, including with the Department of Health and Human Services if it wants to ensure I’m complying with federal privacy law.

» I can share health information with a coroner, medical examiner, or funeral director when an individual dies.

» I can use or share health information about client:

• For workers’ compensation claims

• For law enforcement purposes or with a law enforcement official

• With health oversight agencies for activities authorized by law [audits, investigations, inspections, & licensure inquiries]

• For special government functions such as military, national security, and presidential protective services

» Respond to lawsuits and legal actions: If clients are involved in a lawsuit or a dispute, I may disclose PHI in response to a court or administrative order

» I may provide PHI if asked by a law enforcement official, if the information is:

• in response to a court order, subpoena, warrant, summons or similar process

• limited information to identify or locate a suspect, fugitive, material witness, or missing person

• about the victim of a crime even if, under certain very limited circumstances, I am unable to obtain client consent

• about a death believed to possibly be the result of criminal conduct

• about potentially criminal conduct at either my business office or the building housing my clinical space

• in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime

*If clients have any questions about how PHI is used, protected, or restricted, please ask me (Dr. Leslie Hayes, LMFT). I may be reached by email or by phone @ 210) 218-2152 (leave a voicemail for a return call. I am typically the only person who accesses my voicemail messages, emails, and texts.

Complaints & Concerns

*If clients have serious concerns about the ethics or quality of my services, they are asked to address them directly with me as soon as they develop an issue.

On a semi-regular basis, I invite clients to evaluate their experience with me and the process. I do this so clients have an opportunity to reflect and comment on their perceptions of progress, during the process, rather than abruptly ending the work without an effort to work through uncomfortable circumstances for the benefit of the client (and to help the provider improve services). I am interested in the experiences of my clients and will make an effort to respectfully receive and resolve any concerns they may develop.

If we are unable to resolve reservations between us, either side may opt to terminate therapy, when one or both sides believe it’s the best option. I make an effort to reduce the “surprise” effect in ending therapy work without a chance to process the ending as well as the reasons for it. Clients may develop a sense of being ‘abandoned’ if there is little to no discussion about what constitutes an end of the work. There is a difference between “abandonment” and “termination”; that difference is the participation of both sides in discussion of the issue and efforts to resolve obstacles to client growth and well-being.

*If clients believe their privacy rights have been violated, they may file a complaint:

» with me directly

» with the Texas Behavioral Health Executive Council (online at https://www.bhec.texas.gov/discipline-and-complaints/index.html

» with the U.S. Department of Health and Human Services Office for Civil Rights by

• sending a letter to 200 Independence Avenue, SW, Washington, D.C. 20201

• calling 1-877-696-6775, or

• visiting www.hhs.gov/ocr/privacy/hipaa/complaints .

I will not retaliate against clients for filing a complaint, though it will necessitate immediate termination of the therapeutic relationship and I will offer referrals to other potential providers. This is because a need to protect my livelihood will absolutely impact my ability to provide services which place the client’s need at the forefront; I am required to safeguard client well-being by reducing or addressing therapeutic distractions which may impact their interests. Clients (or potential clients) should be advised that I may use information contained in client therapy records to defend my licensure and ability to practice my profession, so this will constitute a violation of client confidentiality. I will disclose information needed to adequately support my clinical decisions and actions with regard to client services.

What impact does the new law [No Surprises Act] have on how MSJ provides services?

Ever been afraid to ask what something may cost? Ever really had to weigh the benefit against the bottom line? Yeah, me, too.

So, before any real decision is made about whether or not an individual or couple plans to start therapy with Mustard Seed Journeys, I am very forthright about my fees. This is discussed before an opening is offered in my schedule just to be sure nothing will derail us before we even begin. I have been ahead of the game, apparently, because the vast field of medicine needed some [ahem] guidance to strongly recommend that patients be alerted to how much things are going to cost, give or take a little bit. Nobody likes surprises that cost them money.

At times, governmental agencies with legislative authority, require additional information to be provided TO clients/patients, and requested FROM clients/patients. One of those is the recent addition (as of January 1, 2022) of the “No Surprises Act”. This legislation seeks to ensure “patients” are not taken by surprise by invoices or financial additions to expected costs, for any procedure or service they obtain.

As a mental health provider, I am obligated to offer what is known in this statute as a “Good Faith Estimate” of the approximate cost of your therapeutic services. For individuals who either don’t have, or are not choosing to use insurance to pay for the cost of therapy, which in my case is all clients, because I do not participate in third party payer agreements, you have the right to have a reasonable way to determine what you can expect to pay for services.

The only difficulty with how this impacts what I offer to clients, is that there is no way for me to predetermine how many sessions a client will need to meet goals and objectives for treatment. If I were to try to guess this number, it would likely add pressure to both sides–on the part of the client, the dread of thinking “am I going to be finished in time?”, and on the part of the therapist, wondering how to speed the process up in order not to exceed the good faith estimate provided at the start of services.

I can’t know what I don’t know – I have no way of guessing how long each unique individual, or couple, or family, will take to gain the insights, learn the skills, and apply them independently of the process I provide, for a given period of time. I have learned this lesson: you cannot rush growth –real developmental changes take as long as they take.

Some people are so motivated, they move too quickly through the steps but then later, forget what they have learned and slide back into former habits that yield familiar results. They may rightfully conclude that ‘therapy was a waste of time and money.’ Others are less certain about making the changes or accepting things we excavate from their families of origin soil.

Or they may really invest in not only learning the tools, but also integrating the skills through a period of practice, within the framework of therapy, so that they can receive guidance, reminders, and encouragement, as they begin to find patterns they brought to therapy diminish. It is gratifying to observe client satisfaction and confidence increase, enabling them to face familiar challenges in future relational ‘dances.’

The process length is frankly determined by FEET. No, not measured IN Feet, as in distance. Client feet. That is, if a client is getting a value from the time spent, and activities completed, with me, their feet bring them back the next week. If not, they begin to find reasons not to return and thus communicate, they are finished with what I offer. Satisfied feet return. Dissatisfied feet find other avenues to pursue.

So how do I comply with the new law? I am up front about what things cost. I don’t answer the question “what do you charge?’ with a simple number. Instead, it depends upon several factors– the age, status, identity of the client: [discounts may apply for specific categories of client- see the earlier question about fees.] I do not bill clients. I do not provide super-bills to clients for reimbursement for portions of the costs. There are good reasons for this, but mainly it’s related to confidentiality, equity, and devotion of resources.

My thorough review of practice policies and procedures, includes specific coverage of what therapy costs, along with a list of any other fees that may be asked and why each of them exist. I don’t require clients provide credit card numbers to hold against a client not showing up, running late, or for cancellations within 24-hours of the scheduled session. Any of the reasons for additional fees which surface in our professional relationship, will have already been discussed, as well as the clear guidelines within my policy documents, on when and how to address payment of those fees and the time frame within which they are expected to be paid. Clients may ask questions about these things at any time. They are welcome to request an additional written explanation of the policies related to the “Good Faith Estimates” and the No Surprises Act.

The bottom line is this: take the number of sessions attended, multiply that number by the fee agreed upon at the very first conversation we had about clients beginning therapy–that’s what you can expect to pay.

Because all clients pay at the time of services [or pay a late payment fee], there should be NO confusion or ‘surprises’ about what you may pay for services. I believe trying to guesstimate how many times you can be expected to attend, when that decision is nearly exclusively your own, borders on unethical, given how I structure my process with clients. Fees for other events are fairly straightforward, too. Not showing up for a scheduled session, not paying the full amount of the session fee on the same calendar day of the session, writing a check that is returned for insufficient funds, not cancelling an appointment within 24-hours of the scheduled session - unless the fee is waived in light of a client emergency -this will be my decision to offer.

The only reasons I would close services are:

1. client completion of goals/objectives /or client requesting to end [or just stops coming to] therapy
2. client fails to attend or communicate reasons for absence or, fails to respond to my efforts to contact them two straight weeks in a row
3. habitually not participating in therapy tasks as agreed in the first session, and in discussion of the consents– without attendance and participation, growth and benefit are not possible
4. sporadic attendance, impacting achievement of success as agreed upon early in the process
5. failure to pay fully for services rendered for two weeks in a row, or a growing pattern of late payments, including payment of extra fees as applied
6. development or indication of an attitude that suggests a lack of confidence in, or intention to engage, in the work as I have organized it for the client
7. if I were to become incapacitated or unable to meet the clinical needs of the client as agreed to when consents were obtained-
8. to address any event or experience of significance about a client’s lack of respect for boundaries, policy guidelines, or their own/others’ safety; Certainly, this would include an complaint against my licensure or other accusation of wrongdoing on my part. To safeguard the client’s well-being and to be sure the client is safe and their needs addressed, it would become necessary to close the account and provide referrals for other providers.

Any changes in the nature and fabric of the therapeutic relationship in which either or both parties battle strong emotional reactions to actions taken by the other, particularly related to legal involvement, and cases involving a parent-child relationship, in which the therapy relationship has been altered irrevocably, closing services and attempting to refer the client to other providers, who do not have any preconceived filters that may impact how the client is treated, would be the expected response on my part.