Practice Policies

SERVICES

Tohwikeli offers a range of clinical services from individual, couples, and group psychotherapy to EMDR intensives and retreats. Tohwikeli provides clinical supervision and consultation to therapists, and training and consultation to organizations.

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The combination of these three areas of service supports Tohwikeli’s mission to light the way to healing and peace for individuals, groups, and communities by intentionally using available internal and external resources through therapy, education, supervision, and consultation.
 
PSYCHOTHERAPY SESSIONS
METHODS
Various evidenced-based therapeutic modalities, or treatment approaches, may be used to make progress on your goals. This could include eye-movement desensitization & reprocessing (EMDR) and other body-based methods shown to be effective for the treatment of trauma, among other issues.

BENEFITS
Emotional Healing: Therapy provides a safe and supportive space to explore and process your emotions related to traumatic experiences. It allows you to express and validate your feelings, helping you gain control over overwhelming emotions.
Post-Traumatic Growth: Through therapy, you can learn to transform your perspective of trauma into one of personal growth and resilience. Discovering new strengths can lead to increased self-esteem and a more positive outlook on life.
Regulation Strategies: Therapy equips you with effective regulation strategies to regulate emotions, reduce triggers, and enhance your overall well-being.
Self-Awareness: Therapy promotes self-awareness by helping you understand the impact of trauma on your emotions, thoughts, body, behaviors, and relationships. It encourages self-reflection and empowers you to make healthier choices.
Improved Relationships: By addressing the effects of trauma in therapy, you can enhance your communication and relationship skills. You'll be better equipped to create healthy, meaningful connections with others.
Reduced Symptoms: Therapy can lead to a significant reduction in trauma-related symptoms, such as nightmares, hypervigilance, and intrusive thoughts. As symptoms improve, you'll experience a higher quality of life.
Empowerment: Therapy empowers you to regain a sense of control over your life, allowing you to make choices aligned with your values and goals. You'll feel more capable and confident in addressing challenges.
Decreased Isolation: Trauma often leads to feelings of isolation and disconnection. Therapy provides a space to connect with a compassionate and understanding professional. It can reduce feelings of loneliness and offer a sense of belonging.
 
LIMITATIONS/RISKS
Emotional Discomfort: Discussing traumatic experiences or deeply personal issues in therapy may bring up intense emotions. This can be distressing in the short term, but it is often part of the healing process.
Uncomfortable Self-Reflection: Therapy may lead to introspection, which can be uncomfortable as you confront challenging aspects of your life, relationships, behavior, or thought patterns.
Revisiting Trauma: In trauma therapy, you may need to revisit and discuss traumatic events, which can temporarily increase distress. However, this is typically part of a therapeutic process aimed at reducing trauma-related symptoms.
No Quick Fixes: Therapy is not a quick fix. It requires time and commitment. Some issues may take longer to address, and progress may not always be linear.
Risk of Misalignment: If you and your therapist don't have a good therapeutic fit, it can hinder the effectiveness of treatment. It's essential to communicate openly with your therapist about any concerns or dissatisfaction.
Confidentiality: While therapists are bound by confidentiality, there are legal and ethical exceptions. In situations where there's a risk of harm to you or others, therapists may need to breach confidentiality to ensure safety.
Financial Cost: Therapy can be expensive, and not everyone has access to affordable mental health care. The financial aspect can be a significant barrier to receiving ongoing treatment.
Stigma: There is still some social stigma associated with seeking mental health treatment. This can lead to concerns about judgment from others, which may discourage individuals from seeking help.
Dependency: Developing a strong therapeutic relationship is essential, but there is a risk of becoming overly dependent on the therapist. Therapy should empower you to become more self-reliant.
Unresolved Issues: In some cases, therapy may not lead to a complete resolution of all issues. You may need additional support or other forms of treatment to address all your needs.
Different Therapy Styles: There are various therapy approaches, and what works for one person may not work for another. It may take time to find the right therapeutic modality and therapist for your unique needs.
Potential Rare Ethical Issues: Although rare, there have been instances of ethical misconduct by therapists. It's crucial to ensure that your therapist is licensed, reputable, and adheres to ethical guidelines.

SPACE
In-person sessions occur in a safe, private, and comfortable place with minimal distractions. Tohwikeli maintains a physical office located in Round Rock, Texas. This office suite is shared with other professionals providing an array of services.  A security camera is located in the waiting room, facing the front door. Additional space outside of Round Rock may be secured for EMDR intensive therapy and retreats.

The physical space where you are during your virtual session should be safe, private, comfortable and have limited distractions. Your camera set up is best when your therapist can fully see your face, preferably from shoulders up at least.  If your therapist has concerns about the space you are in, a plan to increase safety, privacy, and/or comfortability may be discussed.
 
LENGTH
The standard meeting time for a psychotherapy session is 50 minutes. It is what is referred to as a clinical hour. Tohwikeli offers extended individual and couples psychotherapy sessions that last 80 minutes. EMDR intensive therapy sessions may last up to 6 clinical hours. It is up to you to determine the length of time of your sessions when you schedule them. In-session requests to extend sessions will not be honored. 
 
UNEXPECTED INTERRUPTIONS
Things like technology, communication in the environment, and outside noise can unexpectedly interrupt sessions. It is important that both you and your therapist make necessary preparations to minimize interruptions while also recognizing the uncontrollability of some interruptions.
 
In virtual sessions, your therapist may request certain actions to make your space more private, or help you troubleshoot problems. You may also request actions from your therapist to minimize interruptions.
 
TREATMENT PLANNING
Understanding what is happening during treatment is important. Within a reasonable period of time after starting treatment, your therapist will discuss their working understanding of your issues, a suggested treatment plan and therapeutic objectives, and expected outcomes of the therapy. If you have questions about any of the modalities or interventions used during your treatment, their possible risks, your therapist's expertise in facilitating or utilizing them, or about the treatment plan in general, please ask. You also have the right to ask about other possible treatment methods for your condition and their risks and benefits. If you could benefit from any treatments that your therapist does not provide or is out of their scope of practice, they have an ethical obligation to assist you in obtaining those treatments.

TERMINATION
Ending relationships can be difficult. Therefore, it is important to have a termination process in order to experience a healthy, therapeutic ending and achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment, but generally it lasts around three sessions. During that time, your progress is reviewed and an aftercare plan is developed for your continued healing.
 
It may be determined by your therapist that psychotherapy is not the most appropriate treatment method at this time, or it is not being effectively used. Another reason your therapist may terminate treatment is if you commit violence, verbal or physical, against your therapist, Tohwikeli, the physical space of sessions, or your therapist's family. The therapeutic relationship will not be terminated without first attempting to discuss and explore the reasons and purpose of terminating.
 
You may terminate the therapeutic relationship at any time, for any reason. We will provide you with a list of qualified therapists to explore and you may also choose someone on your own or from another referral source.
 
If you do not schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, the professional relationship must be considered discontinued. At that time, you will be disenrolled from any financial RELIEF Programs. You are welcome to schedule an appointment in the future and resume services.
 
APPOINTMENTS AND CANCELLATIONS

SCHEDULING
Tohwikeli prefers when appointments are scheduled using the Client Portal through Sessions Health. A quick link to the Client Portal is at the top right of Tohwikeli’s website. Other ways to schedule include email and phone call.

Tohwikeli cannot guarantee any scheduling due to unforeseen events, and it’s particularly true when it comes to scheduling within 48 business hours. If an appointment is needed within 48 business hours of scheduling, we ask that you call for availability. If no appointments are available at that time, you may be placed on a cancellation wait list and contacted if an appointment becomes available in the next two days. You may then choose to accept or decline the appointment. 

WAIT LISTS
If capacity does not support timely and/or quality service, you may be placed on a waitlist for any of the services offered. When capacity allows for service, you will be contacted. You may then choose to accept or decline services.

CLIENT CANCELLATIONS
You are respectfully asked to cancel or reschedule sessions at least 24 business hours in advance. You will be charged a $50 fee if cancellation is less than 24 business hours. This is necessary because a time commitment is made to you and is held exclusively for you. Canceling in advance also helps others. They may be waiting for an appointment to become available.

THERAPIST CANCELLATIONS
In addition to unforeseen events such as personal crises, your therapist may also cancel appointments out of concern for your safety, confidentiality, and boundaries.  You will not be charged for appointments cancelled by Tohwikeli therapists.

If you have an outstanding balance, all existing appointments will be cancelled, and future appointments are not guaranteed.

NO-SHOWS
If you are late for a session, you may lose some of that session time. Your therapist will remain in your video session for 15 minutes.

After the first 15 minutes, the session will be canceled as a no-show. You will be charged a $50 fee if you do not join the session within the first 15 minutes. This is necessary because a time commitment is made to you and is held exclusively for you.

TIME OFF
Occasionally, your therapist will take time away from work. It is their responsibility to prepare you for this absence and discuss what impact, if any, it could have on your treatment.

CONFIDENTIALITY
Your information and session content are private, and we invest in digital security going above HIPAA requirements. Tohwikeli does not share your information with outside entities unless one or more of the exceptions below apply.

EXCEPTIONS
-       If you are in danger of hurting yourself or others
-       If a child, older adult, or person with disabilities is being hurt or neglected
-       If we receive a subpoena
-       If you want us to and sign an authorization to release information detailing what, who, why, and how we can share information

Information about you may be shared between Tohwikeli therapists when therapists are receiving supervision or consultation for the purposes of licensure requirements and/or improvement in service provision.

Occasionally your therapist may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name or other identifying information.

MINORS
If you are a minor, your parents may be legally entitled to some information about your therapy. Your therapist will discuss with you and your parent(s) what information is appropriate for them to receive and what is more appropriately kept confidential between you and your therapist.

REAL WORLD ENCOUNTERS
When therapists work and live in the same community as their clients, there is a chance that clients may see their therapist in the real world. To protect your confidentiality, your therapist will not acknowledge you and will wait to take your lead. You may ignore your therapist all together. Additionally, we ask that if you do engage in conversation with your therapist, do not use that time to discuss therapeutic content.

CLIENT RESPONSIBILITY
Clients are not bound by the same laws and regulations concerning privacy and confidentiality. You may share whatever you’d like with whoever you’d like however you’d like. You are encouraged to take reasonable steps to protect yourself and the work you are doing.

See more in our Privacy Practices.

TREATMENT RECORDS

Tohwikeli keeps records of treatment in accordance with local, state, and federal law. You may request to review your records at any time, and you have the right for your therapist to help you understand them.

ABBREVIATIONS
Tohwikeli uses common abbreviations in client records. If records are requested, a full list of approved abbreviations will be provided.
 
COMMUNICATION
TELEPHONE ACCESSIBILITY
If you need to contact your therapist between sessions, the best method for that is email or leave a message on our voicemail. Therapists are often not immediately available; however, we will attempt to respond within 24 business hours. In the event that you need additional support, phone sessions are available for crisis individual therapy sessions. If a true mental health or medical emergency arises, call 911 or go to any local emergency room.
 
EMAIL AND TEXT MESSAGES
The confidentiality of any form of communication through electronic media, including text messages, cannot be 100% ensured. Tohwikeli uses a HIPAA compliant email encryption service. Appointment reminders via email and text message are provided by a HIPAA compliant record keeping service called Sessions Health. While Tohwikeli tries to return messages in a timely manner, we cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for crises.
 
MAIL
Tohwikeli is a primarily virtual-based business and therefore does not maintain a business street/physical address. Tohwikeli’s mailing address is:
PO Box 116
Mc Neil, Texas 78651
 
THERAPEUTIC RELATIONSHIP
Your therapist will do their best to provide you with the most effective psychotherapy and ensure that you are fully informed about the methods used to help you reach your goals.  Often a close emotional relationship will develop between the client and therapist.  However, it is important that your therapist sets and maintains appropriate boundaries. You and your therapist will not have a relationship outside of therapy sessions. For example, your therapist will not attend events you invite them to, and they will not agree to see you for any other reason than therapy.
 
SOCIAL MEDIA
Social media sites are not secure. Due to the importance of your confidentiality and the importance of minimizing dual relationships, Tohwikeli employees do not accept friend, follow, fan, or contact requests from current or former clients on any personal social networking site (Instagram, Facebook, Twitter, LinkedIn, TikTok, etc). Tohwikeli employees do not open or respond to private messages on social networking sites. Engaging with clients on these sites can compromise their confidentiality, respective privacy, and healing progress. It may also blur the boundaries of the therapeutic relationship. If you have questions about this, please bring them up with your therapist and talk more about it.
 
Tohwikeli, as a professional business, has a social media presence and maintains a blog. Clients are welcome to view that content with the understanding that not everything will apply to their healing journey. Tohwikeli will not friend, follow, fan, or contact you back and will not use social media as way to engage in therapeutic content. It is not a regular part of Tohwikeli’s practice to search for clients on the internet. However, in extremely rare and potentially life-threatening situations, it may be necessary to search social media sites to ensure your safety. This is a last resort if other means of normal communication are unsuccessful. If an internet search is required, the actions will be documented in your record and discussed with you the next time you meet with your therapist. 
 
Should concerns related to social media arise, your therapist may discuss it and its potential impact on your healing with you. 

GIFTS
Gift giving and receiving is generally permitted with the understanding that gifts may negatively impact the therapeutic relationship, especially if preferential treatment is sought by the client or provided by the therapist. Gifts may not exceed the value of $25.00 except for Tohwikeli’s Restore Retreat welcome bags. The acceptance of gifts may depend on the nature and current condition of the therapeutic relationship.

TELETHERAPY
Tohwikeli provides services primarily via video. Teletherapy is broadly defined as the use of information technology to deliver therapeutic services and information from one location to another.
 
When you and your therapist 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 teletherapy session 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 teletherapy session to researchers or other entities shall not occur without your consent.
5.    There are potential risks, consequences, and benefits of teletherapy. 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 physical visual disabilities, apparent height and weight, body type, presentation relative to social and cultural norms or standards, gait and motor coordination, posture, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including dress, eye contact (including any changes in the previously listed issues), gender, 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 they would consider important information, that you may not recognize as significant to present verbally the therapist.

Tohwikeli uses HIPAA compliant Sessions Health for therapy. Read their Trust Statement here: support.sessionshealth.com/article/188-sessions-health-trust-statement.
 
RATES & PAYMENT
All payments are due at time of service, unless otherwise arranged through a payment plan and services will be suspended for nonpayment. Bills are created the morning of your appointment and payment is accepted in the Client Portal through Sessions Health. A quick link is available on our website in the top right-hand corner. If payment is not received at time of service, Tohwikeli will attempt to charge the credit card on file overnight for the full balance. Tohwikeli accepts major credit cards, HSA/FSA, and CVC. Tohwikeli does not accept cash or checks.

STANDARD RATES - THERAPIST
Individual Therapy
   -Clinical Hour: $175.00
   -Extended: $265.00
Couples Therapy
   -Clinical Hour: $200.00
   -Extended: $300.00
Group Therapy
   -Process: $40.00
   -EMDR: $150.00
EMDR Intensive Therapy
   -$1,275.00/day

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STANDARD RATES - SUPERVISED THERAPIST

Individual Therapy   

   -Clinical Hour: $125.00   

   -Extended: $187.00

Group Therapy 

    -Process: $40.00

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COURT FEES
If you become involved in legal proceedings that require your therapist's participation, you will be expected to pay for your therapist's professional time, services, and travel even if they have been subpoenaed by opposing counsel or a judge. Because of the difficulty of legal involvement and the interruption to regular practice, the fee is $250 per hour for preparation and attendance at any legal proceeding. A timecard and travel log will be provided along with an invoice and payment is expected upon receipt unless otherwise agreed upon.
 
INSURANCE
Tohwikeli does not accept commercial insurance and is considered an out of network provider but will gladly provide what is commonly known as a superbill if requested. You may submit this superbill to your insurance for reimbursement. Some or all of your fees may be reimbursed by your insurance company if you have out-of-network benefits. However, not all insurance companies reimburse for all conditions/diagnoses that may be a focus of psychotherapy. It is your responsibility to verify and understand your coverage.
 
REDUCED RATES
Tohwikeli offers two Financial RELIEF Programs to help offset the cost of treatment during difficult times. One is based on income and the other is based on hardship. Both have reduced fees and session limits. Total enrollment in RELIEF Programs is capped at 40% of the therapy caseload and clients may be placed on a wait list. For additional details, or to request financial relief, contact us. If we are unable to accommodate your financial situation, we will provide you with additional referrals. 

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A different reduced rate my be agreed upon between the client and therapist by taking extenuating circumstances into account. These rates typically exceed the RELIEF Programs rates.

*if you are submitting for reimbursement from your insurance company (receiving superbills from us), you are ineligible for reduced rates*

COMPLAINTS
All therapists are committed to a code of ethics and a standard of practice that attempts to ensure the essential ingredients in a helping relationship.  If you have questions or concerns about the treatment you are receiving, you can contact the Texas Behavioral Health Executive Counsel which oversees all licensees in the state of Texas. 
 
Texas Behavioral Health Executive Counsel
333 Guadalupe St. Tower 3, Ste. 900
Austin, Texas
Complaint Line: 1-800-821-3205
Main Line: 512-305-7700