Individual Face-To-Face Consultations
Coming Late To Appointments
Your First Consultation
When you first come to see me, you probably have a lot you want to tell me. Before we start though, I am required by law to inform of your rights as patient. (See Confidentiality.)
Once we get through that, I'll ask you to tell me why you've come to see me. I won't interrupt! If you're shy or reluctant to tell me what's wrong, I'll try to make it easier for you.
Tell me what you think has led to your problem and what you've already tried. Tell me about your family, other people in your life, your job or your school. When you've finished telling your story, I will probably ask you lots of questions to get a better understanding of you and your situation. I will give you several questionnaires and check-lists to take home and fill out, as well as one to complete right there.
Then it's your turn to find out about me. You can ask me anything you want. Ask about my background. Ask about how I might go about helping you. Ask for information about your problem. I will do my best to answer so that you can decide whether you want to see me on a continuing basis.
At the end of your initial consultation, I will ask you whether you wish to come back. If the answer is, "yes," I will then ask you to commit to coming for a certain number of sessions (usually three). We also will discuss about how many sessions it might take for you to reach your goal. If you've decided not to come back, I will ask what your reservations are and I will help you find another therapist.
If you've decided to come back, bring back all your completed questionnaires and check-lists to your second appointment. That way, I can sift through all the information you've given me, and come up with a plan to help you. I'll explain this plan to you in detail along with the rationale behind it.
The first order of business is to help you clarify just exactly what you want to accomplish, in observable terms that can be measured. What do you want to see yourself doing more of or doing less of? What thoughts or feelings or beliefs or attitudes do you want to change? How could you keep track of them to see if they really are changing? How can you measure your goal so you know whether you're getting anywhere? I may provide you with graph paper or some kind of chart on which you can record your daily behaviors, thoughts or feelings.
After you've clarified your goals and you've come up with a way to measure them, I will help you start to uncover the reasons why you don't want to achieve the very goals that you say you want to achieve. Sounds nutty? Go to my page on My View Of Behavior and read the section on "Resistance."
At the same time, I will help you discover what you might do differently to reach your goals. This means change, taking risks, trying out new thoughts and new behaviors. It means tinkering with your usual way of acting and thinking until you find a new way that is more satisfying and relieves your distress.
Sometimes, the experiences you undergo with me during the consultation hour will help you see things differently or remove blocks to your progress.
But most of the real gains will be made because of changes you make in-between our sessions, rather than in the hour you spend with me. I'll probably ask you to do something differently each week, to make some small change in your way of handling things. I'm the "coach" who can help you, the "player," see the whole picture more clearly and discover what you must do differently to "win the game."
Only medical doctors, certain psychiatric nurses and military psychologists can prescribe psychiatric medication. (Psychiatrists are medical doctors. Any type of medical doctor--a primary care provider, an internist or even a dermatologist--is authorized to prescribe psychiatric medication.) I'm a civilian psychologist. If you need medication for either emotional or physical problems, and you don't have a psychiatrist or other medical doctor, I'll help you find one.
How can you know whether I'm the right person to help you? After your first three sessions, ask yourself how you feel about coming to see me. Are you comfortable around me? Are you hopeful about solving whatever is bothering you? If so, make yourself a commitment to continue for another set number of sessions (maybe ten?) If you're not comfortable or hopeful, tell me! I'll try to change my approach so that it suits you better, and if that doesn't work, I'll help you find someone else to see.
Report Card Time
Every tenth session or so, you and I will evaluate how far you've come. We'll take a good look at your graph or charts. If you see you've made some progress since the last evaluation, we can plan further on how to reach your goal. You may wish to change your goals as time goes on.
If you see you've made no progress at all, say so! We can then work together to find some other way to help you progress. If that can't be done, I'll help you find another therapist.
Cancellations & No-Shows
If you can't make a scheduled appointment, please call me on my cell phone at least one day before to cancel. You may leave a voice mail
message at any time of day or night. You may cancel as often as you need to, as long as you give me that one-day notice.
But no one is perfect. Everyone has an emergency now and then, or
a "senior moment" (where you forget an appointment). You are allowed
one such "same-day cancellation" or "no-show" per year, with no penalty.
However, after your first "freebie", there will be a penalty.
Starting with the second "same-day cancellation," you will be charged
an amount equal to your co-payment for the missed session. Starting
with the second "no-show," you will be charged an amount equal to twice
your co-payment for the missed session. These penalties must be paid in
full before you can schedule another session. Your insurance will not
If your sessions are covered by a government-sponsored program
(such as Quest, Tricare, Medicaid or Medicare) and you have no
co-payment, then your penalty takes a different form. Starting with the
second "same-day cancellation," you will be asked to come to my office
and sit in my waiting room for one hour, before you can schedule
another session. Starting with the second "no-show," you will be asked
to sit for two hours. During this time, you will have to do some
repetitive writing, as in, "I will phonel Dr. Nada as least one day
before to cancel or change my appointment." (25 times for a "same-day
cancellation;" 50 times for a "no-show.") Yes, I know it sounds like
being in third grade, but I'm not allowed to charge you a financial
penalty, and these are the only consequences I could come up with.
Most therapists will simply tell you not to come back at all, if
you repeatedly miss appointments. I have never asked anyone to leave.
As long as you're willing to pay the penalty, I'm willing to continue
seeing you. I will make three attempts at phoning you, after a
"same-day cancellation" or "no-show." If I can't get in touch with you,
or you don't call back, I will send you a letter, asking if you intend
If, however, after one month, you have not replied to my letter or paid the penalty, I must assume that you have chosen not to return, and I will close your file. You are welcomed to come back at any time in the future--once you have paid your penalty.
Coming Late To Appointments
I will wait for you for 20 minutes past your appointment time. If you haven't come by then, I may leave the office. Even though you may come afterwards, it will count as a "no-show." If you come before I leave, I will see you for whatever time is left.
When you know you're going to be late, phone me from where ever you are, if you can. With this advance notice, I will be glad to see you for the full hour if I do not have another appointment right after yours.
Whenever I'm not available on my office landline (808-682-5808), leave a voice mail message on my cell phone. If it's an emergency, be sure to say so. When I call you back, I won't identify myself as "Doctor" or say anything that would give away your privacy.
There is no charge for short phone consultations (under five minutes) or for phone contact involving scheduling.
I will try to phone you the day before your appointment, to
verify the time and date. I usually phone between 8 p.m. and 9 p.m.,
although sometimes I will call earlier. And sometimes I will not be
able to call at all. So don't rely on my "reminder call'!
It is still your responsibility to remember your appointment! (If
you don't want me to call, let me know.) Sometimes I make my "reminder
calls" from a number other than my office landline or cell phone.
Please do not just hit your "call-back" button if you need to talk to me. Please use my cell phone number.
Nada Mangialetti, Ph.D.
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