Navigating Life's Challenges

Professional Disclosure Statement

Your Rights as a Client:

You are entitled to information about any procedure, methods of therapy, techniques and possible duration of therapy. If you desire, we will explain our usual approach as well as our qualifications.

  1. You have the right to decide not to receive therapeutic assistance from us or to seek a second opinion from another therapist. We will provide you with the names of other qualified professionals whose services you might prefer.
  2. You have the right to end therapy at any time without any moral, legal, or financial obligations other than those already accrued.
  3. In a professional relationship such as ours, dating, romance or sexual intimacy between therapist and client is never appropriate.
  4. You have the right to expect confidentiality within the limits described here. There are certain situations in which we are required by law to reveal information obtained during therapy without your permission. These situations are: (a) if you threaten bodily harm or death to yourself or another person; (b) if a court of law issues a legitimate court order (signed by a judge); (c) if you reveal information relative to physical abuse, sexual abuse, or neglect of a child, elder or disabled person in the past as well as the present; or (d) if you are in therapy by order of a court of law.
  5. If you request in writing, any records can be released to any person or agency you designate (note that in the context of couples or family therapy, consent from all clients in treatment is needed for a release of records). Also you may authorize us, in writing, to consult with another professional about your therapy.

Code of Ethics & Supervision:

MAPS clinicians are committed to the professional and ethical standards established by the State of New Hampshire and our individual professional associations. Copies of our professional codes of ethics are available upon request, along with guidelines for submitting complaints or reports of possible ethical violations. You may also request information from your therapist about their training, license and other relevant credentials.

MAPS clinicians and staff work to provide the highest standard of ethical and professional service. If at any time you feel that your rights may have been violated, or you are dissatisfied with the services you have received, we suggest you take the following steps.

  1. Speak with your therapist about your concerns. This typically resolves the great majority of concerns or misunderstandings.
  2. Ask to speak with our Executive Director (ext. 8104) or document your concerns in writing and mail them to our Executive Director. He will investigate any concerns you may have and help find an appropriate resolution.
  3. If you continue to feel that your rights were violated and resolution is not possible, or if you feel that something illegal or  unethical has occurred, you may notify the Board of Mental Health Practices in Concord, NH. They will guide you through the steps of an investigation.


MAPS’ clinicians will schedule their appointments directly with you. While each therapist has their own schedule and availability, the MAPS business office is open weekdays from 8:00 am until 5:00 pm. Many therapists see clients beyond 5:00 pm.

  1. We respectfully ask that you give us 24 hours notice if you need to cancel or change an appointment for anything other than an emergency. Failure to give such notice may result in your being charged 50% of the full fee for the missed appointment. If an emergency occurs, please contact us as soon as possible to avoid being charged. Multiple failed visits may result in limitations being placed on subsequent appointments, and may even lead to the termination of services.
  2. If you are late for a session, your therapist may either cancel your appointment or meet with you for a briefer session. Either way, your therapist may charge you for the full session. Charges for missed or late sessions are your responsibility and may not be billed to your insurance. If an emergency situation causes you to be late, please explain this to your therapist.
  3. Your therapist may also need to cancel an appointment at the last minute due to an emergency or illness. Every attempt will be made to contact you as soon as possible, but there may be times that we are unable to reach you prior to your arriving for your appointment. Please be sure that MAPS has all contact information in the event we need to reach you on short notice.

Although we strive to find the best possible match between our clients and therapists, there are times when the “chemistry” is not right or the therapist may not be the most qualified to help you achieve your specific goals. You have a right to ask for a change in therapist. Your therapist is ethically bound to end care that is not effective, and to help you find a therapist that is better suited to meet your needs.

Financial Considerations:

  1. Our standard fee for individual, couples and family therapy is $140 per 50-minute session. The fee for an initial evaluation is $160. If we agree to longer or shorter sessions, your fee will be adjusted accordingly. Other services, such as Group Therapy or Psychological Testing have their own fees and may be discussed with the therapist.
  2. Payment in full for services provided is expected at each session. This includes the cost for self-pay (uninsured) services, co-payments, deductibles and late fees. Checks should be made payable to “MAPS”. Returned checks are subject to a $25 service fee. MAPS also accepts payments by cash, money order, or credit card. For your convenience, a copy of your credit card may be given to the business office and, with your permission, be used to pay for your services.
  3. If you are uninsured, and you are unable to afford our usual fee, you may be eligible for a sliding fee (fee reduction). Please speak with your therapist about this if you think you may qualify. Our sliding fee is not available to extend services when you have exhausted your insurance benefits or as an alternative to insurance when MAPS is not an authorized provider. MAPS is also able to provide significant discounts to clients who receive services from an intern.
  4. Prior to your first session, MAPS will contact your insurance company and obtain any necessary authorization for services. Your therapist will also be responsible to seek re-authorization for approval of more sessions, if necessary. You are not responsible for fees that result from our failure to obtain appropriate authorizations. You will be responsible, however, for any fees that result from your failure to inform us of any insurance you may have, any changes in your insur­ance, or your failure to comply with your obligations to your insurance company. We strongly encourage you to contact your insurance company to verify;
  • That the services have been authorized and the number of sessions approved.
  • That the provider is considered “in network”.
  • The amount of any deductible and/or co-payment.
  • The potential limits on number of sessions that may be authorized.
  • Any restrictions on the kind of services or problems that they cover.
  1. Payment for services by a third party (e.g. Family, friend, another agency) will only be approved with a written and signed commitment by that party. Verbal agreements are not acceptable.
  2. Your participation in psychotherapy is usually a privileged (confidential) relationship. If you choose to share this information with an attorney or the court and this results in a demand for the therapist’s involvement, you may be charged $140/hr. for any subsequent court or related demands for the therapist’s time. This may include the cost of consultation with attorneys, court appearances, letter or report writing, or preparation and travel time. MAPS clinicians do not typically act as expert witnesses. If you anticipate court involvement, or you are seeking an evaluation for legal reasons, please discuss this with your therapist prior to beginning treatment.
  3. MAPS may also bill you for other services that require your therapist’s time but are not billable to insurance. This may include completing an assessment or evaluation, participating in a meeting, or any other activity that is not considered psychotherapy. Our fee for these services is $140/hr.
  4. Your insurance company may require confidential information as a prerequisite to authorization of services. This may include your diagnosis and a description of the problems that bring you to therapy. In rare occurrences, insurance companies may choose to review entire records and retain copies for their files. You will be notified by your therapist if this ever occurs.
  5. Failure to pay for services may result in our need to postpone rescheduling future appointments until payment of fees is arranged. MAPS will make every effort to discuss with you any problems you may have with an unpaid balance, including working out a reasonable payment plan if necessary. However, MAPS retains the option of submitting unpaid balances to a collection agency if all other efforts have failed

Risks and Benefits of Psychotherapy:

All therapists are ethically bound to inform you that there are potential risks associated with psycho­ther­apy. Occasionally people may report feeling worse as therapy progresses; especially as unresolved or repressed issues are identified. Therapy may bring up old memories, buried thoughts or feelings, and the pain associated with them. Couples or family therapy may increase tension or conflicts between people as each begins to be more open about their feelings or dissatisfactions. It is important that you tell your therapist when­ever this happens. You have the right to discontinue or change any therapy that you feel is harmful or ineffective. Your therapist will be able to ex­plain the risks/benefits of any therapy they are recommending. There is no guarantee that therapy will be effective, or that it will help you achieve all of your goals.

Confidentiality & Records:

You are entitled to review your record and, if requested, we will provide you with a copy of your record. MAPS charges $1/page to copy your record with a maximum of $25 for the first copy. Please refer to MAPS’ “Notice of Privacy Practices” pamphlet for detailed information regarding confidentiality and maintenance of records.

Clinical Emergencies:

MAPS has a therapist on call 24 hours a day, seven days a week, to respond to urgent calls from MAPS clients. To reach our on-call therapist, call 603-355-2244 and then press #6 and follow the instructions. Leave your name, the name of your therapist, your phone number and a brief description of the reason for your call. You should receive a return call from the on-call clinician within 30 minutes. If you call during work hours, the on-call clinician may be with another client and will call you at the end of that session. If you are unable to reach us, or if your situation requires an immediate response, please call 911 or go to the nearest hospital emergency room. Please note that MAPS’ emergency service is for urgent problems only. Questions about services, or problems that can best be resolved during your next session should not be directed to our emergency service. To pass a message to your therapist, please use their voice mail.

If you are feeling suicidal, and you are unable to wait for the urgent care clinician, you may also call The Samaritans, toll free at 1-877-583-8336 for their suicide hot-line, or the emergency service at  Monadnock Family Services at 603-357-4400.

Please note that the MAPS’ emergency service is for urgent problems only and for MAPS clients only. Questions about services, or problems that can best be resolved during your next session should not be directed to our emergency service. To pass a message to your therapist, please use their voicemail.