Notice of Privacy Practices
General Information
This form applies to any of the therapists listed below for Integrated Therapy and Recovery:
Benjamin Raskin – AMFT #144342, exp 1/31/2026

Associate Marriage and Family Therapist, will be providing therapy under the supervision of LMFT Alex Lerza #83946

APPOINTMENTS, CANCELLATIONS AND NO SHOWS
Please remember to cancel or reschedule 72 hours in advance. You will be responsible for the entire fee if cancellation is less than 48 hours. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time.
You have the option to sign up for text and email reminders. In the event you do not show up for the first 10 minutes of a session (without notifying me that you will be late) I will send an email. If I don’t hear from you 15 minutes into the session I will count it as a NO SHOW which will incur the full cost of the session and will cancel the rest of the meeting time.
Cancellations must be sent in writing to my email even if verbally expressed in session in order to be confirmed cancellations.
The standard meeting time for psychotherapy is 45 minutes. It is up to you, however, to determine the length of time of your sessions and to manage the time. Sessions that go over time will incur a prorated expense based on the current fee.

LEGAL/ADMIN WORK/EMERGENCIES
If you become involved in legal proceedings, or any other situation that requires what I consider to be legal or administrative work of any kind on my part, this work will be billed at your current fee per 45min. For legal and/or court related work there is a retainer fee of $1500 which needs to be paid prior to the commencement of any work on your behalf and needs to be replenished each time it is exhausted. Legal work requires extra time, special care, and outside professional consultation to ensure that proper procedure is followed. Therefore this fee applies to all work performed outside of therapy sessions, including but not limited to telephone calls, reviewing documents, preparing reports, consultation with legal representation, travel and appearing in court. For emergency sessions that require work on a holiday or weekend there is a 1.5x-2x pro rata/min charge based on the current fee.

TELEPHONE ACCESSIBILITY
If you need to contact me between sessions, please leave a message on my voice mail. I am often not immediately available; however, I will attempt to return your call within 24 hours. Please note that face- to-face sessions are highly preferable to phone sessions. However, in the event that you are out of town, sick or need additional support, phone sessions are available. If a true emergency situation arises, please call 911 or any local emergency room.

SOCIAL MEDIA AND TELECOMMUNICATION
Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.

ELECTRONIC COMMUNICATION
I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email regarding scheduling or cancellations, I will do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.
Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of California. Under the California Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that:
(1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.
(2) All existing confidentiality protections are equally applicable.
(3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee.
(4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent.
(5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel
costs. Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to the therapist’s inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally the therapist.

GROUPS
Group consist up to 8 people. There are many benefits to a group experience but there are also some risks. One risk is the loss of confidentiality. While confidentiality is encouraged, it cannot be promised. Also, difficulties may arise in group that require 1-on-1 time with a therapist. Individual therapy is therefore a requirement for any group member (weekly or every other week is permitted). Payment for group is due the first group meeting of every month for the entire sum of all group sessions that month.

MINORS
If you are a minor, your parents may be legally entitled to some information about your therapy. I will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.

TERMINATION
Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with you and a termination process if I determine that the psychotherapy is not being effectively used or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.
Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.
Confidential Messages: If you have a private clinical message you would like to leave for me you can call at my number listed in my email signature or email me at braskin@integratedtherapyandrecovery.org. I will return your call and/or email as soon as possible.