Last edit of this page 01/06//08
'Mere thinking will never avail. Thought is a beautiful and proud occupation (where) study is concerned. But you can never think your way (out) of difficult emotional problems. Something else needs to be done. You have to make yourself passive and listen. Get into touch with that little piece of eternity inside of you.' Etty Hillesum
1.0 Link to office location, hours of operation and fees.
This content rich website is my thinking out loud about the work.
Face to face I am as thoughtful but less talkative.
Client feedback : 1. 'that guy will never make a buck because one session with him is worth six with any other'. 2. 'no one needs to see you since they can learn it all from your website'. 3. 'Psychology fees; wise help with some of life's deepest difficulties, from a loved and trusted therapist - priceless.'
Testimonial: 'I am really well and life is good. PTSD assails me less and less, and has decreasing effects when it does. Grief over our lost son continues from time to time. Meanwhile, my lost soul has long since reappeared, and all that hard work to build skills has brought reward beyond measure. I laugh heaps these days, and no longer feel I have to control anything at all. What a burden to be relieved of! And I have gained such strength out of allowing myself to be more vulnerable. I suppose you could say I’m comfortable in my own skin, a great place to be. Stephen similarly well. We still play some of those co-dependency games but decreasingly often, and when we do we can generally identify them, stop them quickly and have a good laugh. There’s nothing like a bit of reflective analysis, and it generally works! More than anything, life is more fun than I can EVER remember it. And if you wish to put all this somewhere as a client testimonial, please do, because we owe so very much to your assistance.' Jane Mugford
1.1 What I do in a session
A session is time to speak and think freely, to feel clearly, to sense truly and reach for all that is best in you and your life. A session is both playful and earnest; light hearted and at times poignant; confronting and revealing. I am basically an educator disguised as a therapist.
I provide a space for robust problem solving in which you can work without too many theory based pre-conceptions. Context is everything in the meaning we take from events. Meaning reveals our values.
Sometimes even one session can kick start a simple life change or a small shift in perception, meaning and values, which though private and subjective, can nevertheless impact on those significant others, colleagues, friends, children and even pets who are not directly engaged in the process. This needs to be considered, as others can help and hinder your intentional change process.
My skill derives from on-going training; life experience; the enjoyment of working with people; a natural ability to listen carefully, understand and to communicate clearly, and the evidence of successful work with previous clients. Clinical psychology has taught me how to think about people in context, how to think ahead and to value a thorough enquiry.
My job is to get clear on your expectations, including how you think about change, and the history of changes in your life, and the impact of change in your intimate relationships. I take responsibility for the session's process, you take responsibility for content; I witness your and/or your relationships journey; validate your experience and provide new information and strategies for integration and growth.
1.2 Does it work?
Even friends of long standing who know me quite well ask, 'but does it work?' One of our teenage baysitters voiced the same doubt. I used to rely on the glib 'would I spend 30 years doing something that doesn't work' as an answer but the questioner just glazes over. So each time I come up with a better answer, especially when the person asking is a new client in the building trade - a guy who wants a plan that works. Often the best answer is to tell a story about how it worked for someone else a bit like them.
Truth is it works most of the time amazingly well because of the effort clients put into it, rather than because of anything I do. As I get smarter at the work, I find the less I do the better it works out. That is confounding - how can getting out of people's way be more effective than working my butt off cleaning up their mess and setting them on the right path.
I think the best thing I can do is to name the issue they are struggling to come to grips with, provide information about it and suggest a new way around it. One of my clients described this moment as having been in a dark room looking for a black cat. All I did was notice and name the cat and point to the door. Of course it helps to have a lot of experience finding invisible cats.
And now here is my secret, a very simple secret: It is only with the heart that one can see rightly; what is essential is invisible to the eye. 'The Little Prince'
1.3 Symptoms
I view symptoms as solutions rather than the result of problems. I work with the body in mind but do not provide body therapy. I do not work with long duration, high intensity mental disorders that have resulted in or are likely to result in hospitalisation. (More about risks at 4.0 below.) I do work with chronic, debilitating or terminal illness within a relationship framework.
During a session there is a subtle and ongoing process underneath our conversation. I watch our breathing patterns, listen to voice qualities, notice shifts in facial coloration, muscle tone and body language as each unfolds your story. I meet those movements with some of my own for example, synchronise my breathing with yours, mirror your postures, animate my voice to reflect similarities in culture and language. I pace and I lead and I interrupt, and the change process continues with a small, taoist footprint.
1.4 If you are partnered and want to come for individual work without them, I will ask you to explain your choice.
I am likely to insist you bring them along for one or two sessions at the outset of our work together and then occasionally as we proceed with your issues. This responsibly includes them in your change process. It is almost nigh impossible to undertake an effective individual psychotherapy or behaviour change process without implicating an intimate partner in some way. I think most people would like to be included in and consent to the likely effects of your changes in their lives. It is my duty to provide that opportunity. To not do so would risk incompetence. Besides, as a veteran therapist I am a bit jaded with the intimate conversation of one to one long term psychotherapy.
There are few problems individuals bring to therapy/counseling whose treatment would not be enhanced by involving the clients primary relationship or significant other in the change process. There is now a substantial body of research in support of this observation - so convincing that I am led me to wonder why do indiviudal therapy/counselling at all whenever a client is partnered.
If it is for relationship work or marriage guidance that you wish to employ me and you request to initially come alone in order to work on your marriage without your partner, I am even more likely to insist they come and decline to provide a service in their absence.
Were I to see you alone in that circumstance, I would hear only one side of two family stories. Every intimate relationship is founded and founders in its history. The ongoing work of loving someone is located inside one's own head and there are two of those locations in a marriage.
In addition, the influence of our family of origin on how we think and perceive the world is not without significance in the growth of personal and relationship problems. Both partners share equally in that process too.
If I were to see you in your partner's absence, anything I might say or not say about your relationship, could later be fedback to them in the framework of your family history and your brain's inner love work, rather than in theirs. This is a potential source of harm to your relationship in my name. At the very least it would put me on the back foot were I later to see you and your partner together and found that 'I' had sent a prior message that required correction.
Where I have agreed to see only one member of a couple after testing what my client really wants (leaving open the option of their partner attending later) I almost always do so on the basis that I have their blessings to later draw on anything they tell me when later their partner attends.
At that time I pray to god I have prepared the ground well enough. For example, in a situation where your partner asks you point blank, are you having an affair with Jack? and you deny it - I am free to question you. Especially where you have previously led me to the conclusion that you are involved with Jack. I might say, I think it completely reasonable that Jane would come to the same conclusion that I have, that you are indeed having an affair with Jack. It doesn't have to be sexual for your involvement with Jack to have a detrimental effect on your primary relationship.
If your partner refuses to attend I will decline to offer my services if, in my professional opinion, to provide it would harm your primary intimate relationship. I will offer my how to mend a broken relationship as a guide and suggest alternative services.
1.5 If you come as a couple I teach, show and coach you in how to:
- stand in each other's shoes
- communicate empathy and build a map of each other's world realizing that
- each has a subjective experience of the relationship different from the other with
- a coherent internal logic that makes the world sensible to them because of
- a set of values not always well expressed or understood by self or other.
- accept that happy couples struggle to love as well; struggle to manage their anger and disappointments in love and struggle to protect their partner from knowlege of the inner love work required to achieve a harmonious, cooperative, enduring connection.
- weaken the effect of habitual stereotyping and family labeling
- soothe emotional arousal when it's appropriate or get upset when that's important
- catch and manage the monsters that cruel intimacy - criticism, defensiveness, contempt and stonewalling.
- I will remind you of the difference between what you think you do and what you actually do in relationship
- I act as a traffic cop when you talk over each other or don't hear the internal logic of the other's position, and
- as a fire officer to cool things down so that we can get back to work and advise you on fuel management.
- I will usually give homework tasks and follow them up in our next session.
Second, if there's a specific problem, I may invite you to describe the problem, maybe even ask you to teach me how I might do the problem in your situation or if I were in your relationship and notice the times/places you don't do the problem perfectly. We do problems except when we don't.
Third, if I know of a proven recipe for the situation you describe, I will tell you and instruct you in its use or refer you to the expert who can. In each of the following sessions we review the outcomes and adjust the process and content.
Fourth, clearly therapy and coaching are non-reciprocal processes with a power imbalance. I rarely if ever show my vulnerabilities.
How to choose a therapist on site.
2.0 Objectives of assistance
I keep an occasional web log of typical issues clients bring to sessions. Different people seek different outcomes from a consultation. Because of this, it is important to talk to me about what you are expecting, or hoping. I can give you an estimate of the number of sessions required to achieve the results you want and a guide to some observable indicators of progress toward your goals. But I can't help if you're a therapy tourist, come under external duress or withhold information vital to our work together.
To get the best out of sessions the following guidelines may be useful:
1. Aim to attend every scheduled appointment
2. Keep a therapy diary or journal for yourself and reflect on it. If the client is a relationship, this does not mean record your surveillance of the between session couple behaviour. It means keep a diary of your personal journey. I will revisit the between session couple transactions when and how I think it would be effective.
3. If you wish, make an audio and/or video record of each session or take notes during it, or ask me to write you a summary on the day. All these suggestions are also useful for couple sessions.
4. Develop healthy support networks and draw on them to grow your inner and your relationship process. If the client is a couple, this may mean negotiating boundaries with people that hinder your growth. Or accessing friends and family who can give you breaks from family duties to spend quality time together.
5. At the next session, be prepared to share your observations, thoughts, feelings and your between session experiences openly with me. Read widely and think critically about the ideas that come up.
6. Complete any homework tasks negotiated with me. When unsure, ask for clarification, information or for further reading about any of the activities being recommended or undertaken.
7. Ask any question, discuss any doubts, and raise any concerns you have at any time
8. This is a process that is also governed by your learning and my teaching styles
2.1 Can the benefits be guaranteed?
It is an interactive process, which relies heavily upon you or your relationship. For example, your responses and openness; the particular issues and the personal resources available, and the timing of and readiness for change. No one can guarantee that a therapeutic process will meet the expectations of the person being treated. Many people experience positive and constructive outcomes but not everybody does. [Also see 'Risks' item 4.0 below]
Because we are all unique human beings and all have different perceptions and expectations of what we are seeking, the outcomes can vary as widely as the individual expectations and personal meanings of those who seek my services. I cannot promise any particular outcome, benefit or result from or time frame for the process.
For more information and up to date research on what works and doesn't work in therapy I recommend the talking cure site as a starting point. And the following link featuring a discussion of incompetent relationship therapy.
Few people ask me what my model of health is or how my personal history has influenced the way I perceive life. These may be important questions to answer before engaging a consultant whom you are paying to influence you.
3.0 FACTS ABOUT MY ROLE
Qualifications and expertise
I am a registered psychologist with thirty five years experience of applied clinical psychology, working with individuals, couples, families and community groups. I attend regular, applied training in my fields of interest and undertake monthly peer supervision of my own process. I am a member of the Australian Psychological Society, which is a professional body with its own Code of Ethics [found on the APS web site] and of its College of Clinical Psychology. My expertise is in Clinical, Relationship, Health and Transpersonal Psychologies.
I am subject to a wide range of professional and ethical requirements, imposed both by ACT statutory bodies, National Privacy Principles and the national professional association. Here are the NH&MRC has guidelines covering sensitive health information.
The effect of these dictates include that my duty to you will remain that of client and psychologist in perpetuity; that I cannot engage in dual business or social relationships with either you or your family, and neither can I accept gifts from you. I will always have more knowledge about you than you will have about me. I am bound to guard those confidences and the consequent imbalance of power in our relationship.
I have attempted to address some of the information imbalance with this web site and biography and by declaring a little of how I work through composite client vignettes and in my analects pages.
Methodology and approach
I use recognized and effective methods in our work together but they are not without risk. The outcome of psychological treatment is not good for everyone - at the very least not all individuals benefit to the same degree. And some individuals are worse off following a treatment program than they were before.
Consequently, if you have any questions or concerns about the approach that I am taking at any time, please do not hesitate to raise these with me and only proceed after you are completely satisfied with my explanation and your reading of the material I may refer you to.
4.0 The risks of psychological treatment
While people seek and derive many positive benefits from clinical psychology there are also risks. These arise from the effectiveness of the process as well as from a less than adequate fit of the process with the particular client or couple. Even in the context of a University research trial to test the effectiveness of a treatment process, conducted with world's best practice and safeguards, some people may be worse off after the treatment trial, even when the majority experience significant improvement.
From a scientific viewpoint it is not possible to determine whether the individual who did not improve in the intended way was actually harmed by the psychological treatment. But from a legal point of view it matters not.
If a psychologist does not engage their client proactively in a frank discussion about treatment risks, and warn of the possibility of deterioration during treatment s/he might be held to have caused the deterioration even where there is no scientific or logical evidence of a causal link. Read: 'Tell your clients you might hurt them.' O'Brien-Maloney & Diamond - Australian Psychologist Vol. 41 No 3 November 2006 page 164.
It's the very nature of a therapy to work and to work with issues and areas of people's lives that may expose, or be a catalyst for exposing those involved to a wide range of healing, joyful and challenging thoughts; of clarifying attitude changes that demand a re-think of long established patterns; of strong emotions, reactions and interactions; of mood and life changes.
Sometimes people have both positive and negative mood swings within and between therapy sessions. These may last a moment or hours and even days. These include experiences of joy and sorrow; of grief and anger; willfulness; despair; spaciousness and kindness; guilt and fear; love and hope; isolation and confusion; connection or temporary disorientation.
Others discover a loss or change of direction and/or a loss or change of motivation that has been bubbling under the surface for a long time. Some find old issues with spouses, family or friends re-surface, despite their best intentions to avoid the issue or move on.
There can also be physical signs and symptoms, including alteration in sleep patterns and in appetites; lack of or excess of energy; unusual or confronting sensations, thoughts or feelings. Sometimes headaches, rashes, dizziness, nausea, breathlessness and gastrointestinal upset can also occur. Mind and body are isomorphic.
When the client is a relationship or a family, its dysfunctional equilibrium, chronic adverse patterns and reciprocal interactions (e.g. blaming) can be disturbed or interrupted both for good and for ill. This might be experienced at times, as the relationship getting worse before there are sure signs of it getting better or of it being too hopeless to repair. Whilst these occurrences are hard to predict and to prepare for, the my job is to maintain a robust, well-contained and resourceful anchorage during these transitional phases of the process.
Sometimes these feelings, reactions and experiences can be very severe - to the point that they are quite debilitating in terms of the clients' daily life, their personal and professional commitments and their intimate relationships.Consequently, it is important that you let me know at the beginning and at any time thereafter, whether you have any current personal or professional issues pending, which could be seriously affected if any of the above risks arose. Likewise if you are likely to be facing any such issues during the period of your treatment and beyond, which could be seriously affected if any of the above risks arose. For example, do you have any job interviews, significant business or financial transactions, legal matters, family engagements, surgery, training or examinations or important employment related issues which, if you are seriously affected by a therapy process, could mean that you face unacceptable outcomes, including financial loss?
While relatively rare, it is also possible for the process to be a catalyst for reactions and feelings that lead to the desire for self-harm and/or for harm to others and/or to damage significant relationships. Therefore, it is very important that you share with me if you have ever experienced those feelings before and that you immediately raise those thoughts and feelings with me should they ever arise.
Each person is different, so it is impossible to exhaustively list every possible adverse effect. If you're at all concerned about the potential risks and impact of a change process at this junction in your life, then you should consider whether now is the right time and place to proceed. You can always come back after that important personal or professional issue has been dealt with.
Go to my Links and Self-help pages for useful information here and on the web. You can fill out my new client agreement form if you wish.
5.0 TERMS AND CONDITIONS UPON WHICH MY SERVICES ARE PROVIDED, INCLUDING THE FEES PAYABLE
Hours of practice
I am available on Tuesdays & Wednesdays from March to mid December except June and part July from 10.00 am to 6.30 pm. At other times I may be reached by telephone or email to which you can expect a response within 24 hours.
I do not provide an emergency service outside the ordinary hours of practice or the limited after hours service. The ACT mental health emergency team is on (+61) 6205 1065 or (+61)1800 629 354 and Lifeline is on (+61) 13 1114. I am not in a position to provide any warranties or recommendations in relation to the above or any alternative service providers.
As my resources are limited I may not be available at short notice even within ordinary business hours or within the limited after hours sessions.
5.1 Fees
My fees are in return for the time I spend with you so that you are not indebted to me as one would be to a friend who provided a skillful, non-reciprocal relationship. The fee gives me the discretionary time to live a full and personally enriching life. That more than anything provides a healthy foundation in which to work with you or choose not to work with you.
My professional fees are as follows:
In person, by telephone or email: $170 per hour
Internet based coaching and mentoring on a pro rata basis - time spent to read and respond.
All related expenses are included subject to the exceptions set out below.
Missed appointments/sessions may be charged at the following rate:
48 hours or More Notice - No Charge
24 to 48 Hours Notice - 50% of Minimum charge
Less than 24 hours Notice - 100% of Minimum Charge
The Minimum Charge for a missed appointment or session is for one hour.
The terms of payment are either on the day of the session or, within fourteen days of the issue of an invoice. I reserve the right to charge an invoice fee of $20 per invoice per week on overdue accounts and to cease providing services unless payment is made promptly.
Top cover of a number of Private Health Funds rebate both individual and relationship sessions. Link to list of Private Health Insurance rebates.
5.2 Medicare Provider No. 2768391A. Clinical Psychologist Medicare items are: 80000 to 80020.
Medicare may refund $110 ($158 if you have reached the safety net) with a medical referral for an assessed mental disorder under the GP Mental Health Care Plan for up to 12 sessions per year. Medicare rebate fact sheet in .pdf
The mental disorder must be one managed by your GP or from a psychiatric assessment and management plan; or on direct referral by a psychiatrist or pediatrician from an eligible Medicare Benefits Schedule (MBS) service. An 'assessed mental disorder' might be Adjustment Disorder: European criteria, USA Criteria. Other disorders are listed on those links.
Note: Medicare rules state that, 'Psychologists must provide a written report to the referring medical practitioner following the first six services and/or on completion of the course of treatment. The written report should include information on: any assessments carried out on the client; any treatment provided, and recommendations on future management of the client's disorder.'
5.3 Referrals
I will not attempt to assist you in areas beyond my expertise or outside my current area of interest. In such cases I will, if appropriate, refer you to another professional with the relevant skills. In that case, by signing the agreement, you will be authorizing me to contact another practitioner on your behalf and provide that practitioner with any information he/she reasonably needs to assist you. You can review this authority with me at any time.
5.4 RecordsThe records created by me in relation to you are for me to be able to responsibly assist you and in order to reflect reasonably what has occurred in the client relationship. They are securely stored in my computer. I am the only person who has access to them. The National Privacy Principles contain special provisions applying to such sensitive information see www.privacy.gov.au or call the Office of the Federal Privacy Commissioner on(+61) 1300 363 992 or visit the NH&MRC web site.
At all times the records and their contents remain my intellectual property. A copy will normally be available upon request by you and a small fee is payable. Subject to any statutory requirements and Privacy Principles, I reserve the right to provide you with a summary of your client record. Generally, I retain the records for 7 years but also I reserve the right to responsibly dispose of records at any time after the termination of our client relationship.
5.5 Confidentiality
Subject to the Agreement you may sign and the terms of the consent contained within it, all information in relation to you will be treated as confidential. However, it is not privileged information in the legal sense and can be subpoenaed. An ABC law report discussion of doctor-patient confidentiality. At times you may find a fragment of your story, presented out of context and in conjunction with fragments of other clients' stories in a composite characterization on the weekly analects page in this site. If even the possibility of this is likely to disturb you, please tell me immediately.
5.6 Complaints
It is the nature of any service provider that clients may, from time to time, have concerns about some aspect of the service being provided. Should you have a concern about any aspect of my services, please raise it with me in the first instance. If, after raising it, you are still not satisfied with the outcome, I will recommend the Conflict Resolution Service [(+61) 02 6295 5998] as the next step for us both to take. In the unusual event that you still remain unsatisfied, you will no doubt consider contact with the Commissioner for Community and Health Services Complaints and the ACT Psychologists Registration Board.
© 2005, 2006, 2007 ZPJ Fox All Rights Reserved www.peterfox.com.au
Source for the idea of this page: "Risky Practices - a counselors guide to risk management in private practice' by Nigel McBride and Michael Tunnecliffe, Bayside Books 2001.
