Disclosure Statement

As a mental health provider, it is my responsibility to inform you of your rights as a mental health consumer and provide you with information related to my professional qualifications, therapeutic orientation, treatment methods, and business practices in order to assist you in selecting a mental health professional who best suits your needs and purposes. Please read this statement thoroughly as a part of your consent for treatment. If you have any questions or concerns, please feel free to make me aware and I will be happy to discuss them with you.

Professional Qualifications

I received my master’s and rigorous degree in Psychology from Charles University, Prague, Czech Republic with specialization in Clinical and Health Psychology. My education contained over 1000 hours of supervised internship work under the guidance of different specialists. Furthermore, I am accredited as a social worker in crisis intervention according to 108/2006 Sb. in the Czech Republic (certificate number: 4/113 060). Further on, I received master’s degree in Cognitive Behavioral Therapy at Center of Cognitive Psychotherapy in Cancún, Mexico, accredited by the Academy of Cognitive and Behavioral Therapies, and I specialized in Schema Therapy. Included in my CBT education were: Psychopathology, Cognitive Behavioral Therapy of Mood, Anxiety and Personality Disorders, Addiction and Substance Abuse, Anger Management, Couples, Children, and Methodology. Other approaches used in my training were: Schema Therapy, Motivational Interviewing, Positive Psychology, and Emotionally Focused Therapy. My education contained over 100 hours of supervision. Currently, I continue working under the supervision of the Center of Cognitive Psychotherapy and participate in additional education trainings, supervision, and clinical consultation with other health professionals to ensure that my skills remain up-to-date. Being based in Iceland, I follow the laws of my country of residence. Therefore, I hold a professional psychological license issued by the Department of Health in Iceland, Landlæknir (license number: 2601226). In the helping process, I utilize evidence-based techniques while recognizing the necessity of individual approach to express the needs of each client. Being fluent in Czech, English, and Spanish, I am providing my services in the aforementioned languages. Nevertheless, I am aware of cultural differences that can arise during the therapy process and need to be addressed.

Orientation and Treatment Method

I use evidence-based Cognitive Behavioral approach with techniques from Schema Therapy, Positive Psychology, or Third Wave CBT. I also focus on development of the method of Expressive Writing. In therapy, I perceive the client as a holistic personality and not only in the context of his problem, but also with regard to his background.

Confidentiality

You may rely on me to maintain confidentiality regarding our work together with these few exceptions:

1. Suspected abuse or neglect of a child, dependent adult, or developmentally disabled person will be reported.
2. If you threaten to harm yourself or others. If that threat is perceived to be serious, the proper individuals will be contacted: this may include the individual against whom the threat is made.
3. In the event of a court order, therapists may be required to disclose information in the presence of a judge.
4. In the event of a medical emergency, emergency personnel may be given necessary information.
5. If you bring a complaint against me, information will be released as necessary to respond to the complaint.
6. In the event of your death or disability, the information may be released if your personal representative or the beneficiary of an insurance policy on your life signs a release authorizing disclosure.
7. If you choose to use a third-party pay or bill your union.

In order to provide the best possible treatment, I regularly consult with other professionals regarding clients with whom I am working. These consultations are conducted in such a way that confidentiality is maintained to the best of my ability. In online therapy, I use private room via the platform for video conferencing Whereby.com. I chose this provider as it is not asking any personal data information from the client, though it can save cookies. Then, while presenting some techniques, I may use services of Google Drive or Miro Whiteboard. If any of this is a concern of privacy or security, please, let me know so we can find other solution. All client information pre-session and in-session will be held to confidentiality between therapist and client above the age of 12.

Billing, Fees, and Business Practices

My standard fee for psychotherapy is 17 000 ISK per 50-minute individual session. Payments are made online before each session. An invoice will be emailed to you from the address no-reply@dk-one.is and payments will appear in your bank account under unpaid invoices. If you are unable to keep your appointment for any reason, you must give at least 25-hours advance notice of cancellation. Otherwise, you will be personally responsible for paying the fee for that session. It is considered a “no-show” if no communication is made 15 minutes into your scheduled time and the session is automatically cancelled. Every year in the month of January, I may increase my rates by 500 kr or based on cost-of-living increase and expectations from the tax authorities. Clients will be notified of any increases or changes at least 65 days in advance of the change in fee. I do offer a limited number of grants to support clients in financial hardship. You may inquire about availability and more details regarding these offers. My services are reimbursable by many unions and associations but not all of them. Investigation of such options is client’s responsibility.

Association Information

According to the European directive 2005/36/EC defining the recognition of professional qualifications I am a psychologist in the Czech Republic. Furthermore, I hold a valid license issued by the Department of Health in Iceland which authorizes me to practice the regulated profession of a psychologist in Iceland (license number: 2601226). By being a member of the Czech Association for Psychotherapy that is a part of the European Association for Psychotherapy (identification number: 62688419) and the Icelandic Association for Psychotherapy SALM
I commit to honor the ethical codex of this profession in European cultural modification. I am also a member of the Czech Family Planning Society. Nevertheless, in any case you would suspect that my conduct has been unprofessional in any way or you are not satisfied with the therapeutic process, my hope is that you will talk to me so I may respond to your concerns.

Transfer of Client Records

I maintain client records in a safe location. You may request to see your records at any time and I may suggest that we review these together in order to facilitate your thorough understanding of the information.

Medical Information

Please inform me of any medical conditions you are being treated for that you think I should know as well as any medication you are taking, including psychiatric medication.

Acknowledge, Consent for Treatment, Statement of Financial Responsibility, and Release of Information

Upon reading the information presented on this page and knowing that this information is available at anytime to you on the website (deXpre.art), you are informed and willfully consent to treatment under the terms described above.

• You hereby give consent for psychological consultation and treatment.
• You agree to be financially responsible for all charges that accrue from consultation and treatment.
• You agree to be financially responsible for cancelled appointments within 25 hours of agreed appointment time.
• You agree to be financially responsible for not showing up or “no shows” on agreed appointment time.
• You agree that the information you provide is true to the best of your knowledge and ability.