Mission Compassionately working together with our clients to reach tangible goals that lead to a healthier mind and life beyond therapy.

Vision Normalizing mental health therapy as an available resource for people from all walks of life, especially those without access.

What This Looks Like in Practice

• Clients are aware of and actively engaged in their treatment and progress. This includes understanding their diagnosis and symptoms (unless clinically contraindicated).

• We focus on symptom reduction to help clients successfully graduate from therapy within a reasonable and appropriate timeframe.

• We normalize symptoms as part of the human experience and believe getting therapy should be as simple as getting coffee.

Company Values

• Treatment Focused Working with our patients to be on track to be free of symptoms.

• Shared Humanity Treating people as equals no matter where someone comes from by relating to them through personal experiences.

• Democratize Access to Mental Health Therapy Ensuring everyone can have access to the support they need to live a fulfilling life outside therapy.

• Representation of Community Serving the communities we are tied to.

Value Propositions

• We provide affordable mental health services for the Coachella Valley region, accepting insurance and providing flexible options with the therapist that matches your needs.

• Our therapists reflect the communities we serve in order to remain relatable to our clientele and further build and foster trust — we are our community.

• Our clients are regular people: your barista, friend, neighbor, teacher, waiter, or little cousin. We provide support for anyone whose mental health is negatively impacting their jobs, relationships, sleep, and overall well-being.

• Our practice focuses on empowering our clients to learn about their symptoms with no labels or judgment.

• We start therapy with the primary goal of ending therapy. This means we prioritize a therapy approach where we target and track symptoms to successfully complete therapy with the tools necessary to live and be your best self.

• We focus on cities that have a shortage of mental health providers to make sure everyone can have access to the support they need in their community.

2025 Goal Establish ourselves as the leading therapy destination for both clients and therapists at this level of care.

Our bodies are truly remarkable. They possess an innate ability to guide us towards survival and well-being. Consider the last time you felt the urge to use the restroom. How did you know it was time? Or the moments when thirst or hunger struck? Your body communicated these needs to you effortlessly. Yet, when it comes to emotional signals, many of us were never taught how to recognize or manage these messages. As a result, over the years, we've inadvertently neglected our emotional well-being. We didn’t realize we were doing this, and for many, the consequences manifest as anxiety, panic attacks, depression, sudden bursts of anger, and even overall dissatisfaction with life.

​

However, the incredible thing about our bodies is their capacity to heal.

​

This is where EMDR comes into play. EMDR (Eye Movement Desensitization and Reprocessing) has been around since 1987, offering a groundbreaking approach to healing. It utilizes the body's natural mechanisms to process past, recycled emotions, beliefs, and events. EMDR intensives offer a pathway to emotional rejuvenation—a detox for the soul. EMDR facilitates the environment that your body needs to heal and process the emotions it's been trying to communicate with you. EMDR offers what your body has been yearning for all along: awareness, validation, and safety. Embracing this process can be the transformative change you've been seeking.

The Child/Elder Abuse and Neglect Reporting Act (CANRA) requires a mandated reporter to make a report whenever the mandated reporter, in their professional capacity has knowledge of or observes a child whom the mandated reporter knows or reasonably suspects has been the victim of child abuse or neglect.

APS reporting contact #: 1-833-401-0832

CPS reporting contact # 1-800-442-4918

• Mandated reporters must report by phone as soon as possible and follow up with a written report within two days via fax or email. Please upload report to client files on simple practice.

When client discloses abuse that has already been reported and they have been court mandated to attend services due to report, therapist must still report to follow legal standard of care. When doing the CPS/APS report, therapist notifies the CPS/APS worker who takes the call that abuse has already been reported and we are just following agency protocol and documenting accordingly on our end. We take case worker name and ID #.

Clinical Policy: Reporting and Documentation of CPS & APS Reports

At Desert Insight, the safety and well-being of our clients are our top priorities. When making a report to Child Protective Services (CPS) or Adult Protective Services (APS), therapists must follow these steps to ensure proper protocol is followed:

1. Consultation Before Reporting
   

   • Before making a CPS or APS report, always consult with your immediate supervisor.

   • If your immediate supervisor is unavailable, contact another supervisor on the team for guidance.

1. Emergency Situations
   

   • If a client is in imminent danger, call 911 immediately before taking any other steps.

1. Reporting Guidelines
   

   • Reports should be made to only one agency: CPS, APS, or law enforcement—not multiple agencies for the same concern.

   • If unsure which agency to report to, consult with a supervisor before proceeding.

1. Thorough Documentation
   

   • After making a report, document all relevant details in the client’s chart, including:
     

     • The reason for the report

     • The consultation with a supervisor

     • The agency contacted and the name of the representative spoken to

     • Any follow-up actions recommended

1. Confidentiality & Professionalism
   

   • Reports should be made discreetly and professionally, maintaining client confidentiality to the extent possible while ensuring their safety.

   • If you have any doubts about whether a situation warrants a report, consult with a supervisor for guidance.

Following these steps ensures compliance with legal and ethical obligations while prioritizing client safety.

EMDR is different than talk therapy, not better. Talk therapy on its own is very powerful because it can provide a safe space to heal deep issues - safety alone can be healing grounds. In many cases, clients gain great insight from talk therapy and are able to readily implement learned skills from talk-therapy. But when talking about it hasn't been cathargic enough, EMDR provides a platform that that allows the body to heal recycled feelings and beliefs that continue to affect the way we live. In this manner, EMDR can then complement talk -therapy because after processing irrational beliefs and stuck-feelings, you can finally implement the valuable lessons that you've learned about through talk therapy, podcasts and books.

EMDR intensives are like therapy sessions, but they happen all in one week instead of spread out. This means you get to focus on your feelings without waiting in between. It's like having a clear start and finish line, so you know what to expect. Plus, after an intensive, you might want to keep talking about things in regular therapy sessions.

What's cool about EMDR is how it works with both your thoughts and how your body feels. By doing this, it helps you process your emotions in a different way, making it easier to talk about tough stuff without feeling overwhelmed by your body's reactions. So, EMDR intensives can be a powerful way to deal with deep emotions and make progress in "regulra" therapy or "talk" therapy.

At Desert Insight, we maintain ethical and professional standards regarding the documentation we provide to clients. To ensure clarity and consistency, our therapists do not provide the following types of letters or documentation:

• Emotional Support Animal (ESA) letters

• Medical excuse letters (including work or school-related medical notes)

• Letters for disability claims (such as those for Social Security or workplace accommodations)

• Immigration-related letters (including hardship waivers or asylum support letters)

• Legal letters (including custody evaluations, court-ordered assessments, or character references for legal proceedings)

• Fitness-for-duty evaluations (assessing ability to return to work or perform specific tasks)

• Letters for academic accommodations (such as 504 plans or Individualized Education Programs (IEPs))

However, we do provide the following clinical documents upon request:

• Attendance letters (confirming participation in therapy)

• Progress reports (summary of treatment progress)

• Treatment plans (outlining therapeutic goals and interventions)

• Discharge summaries (summary of treatment upon completion or termination)

If clients require documentation outside of what we provide, we recommend consulting the appropriate medical, legal, or specialized professionals.

EMDR Intensives Process

1. Preliminary Intake Questionnaire: Complete our questionnaire to assess if EMDR Intensives are suitable for you. No charge or commitment required. Based on your responses, we'll determine if it's a good fit and schedule your treatment plan.

2. Carolin's Consultation: After reviewing the intake questionnaire, Carolin will reach out to discuss next steps. This could include proceeding with the 5-hour intensives or appropriate clinical recommendations.

3. Treatment Plan Session: Meet with Carolin to develop your personalized treatment plan for 5 hours of intensive EMDR sessions. We'll identify targets for processing, discuss expectations, and self-care. We might focus most on early life experiences, specific traumatic events, triggers in your current life, or how you envision meeting challenges in your future. The process is entirely customized and specific to you.You have the option to not proceed with treatment at this time. *$150 nonrefundable fee.

4. EMDR Processing Sessions: Over three days, you'll have sessions: 2 hours each on Day 1 and Day 2, and 1 hour on Day 3. These sessions focus on guiding you through healing and growth.

Faxing Mandated Reports

1. Forms
   

   • Available on Google Drive: Google Drive > Desert Insight > Mandating Reporting

1. Report Completion
   

   • Download and complete the required form.

   • Print, sign, and scan the form for submission.

1. Submission via Faxage
   

   • Login
     

     • Website: Faxage

     • Username: desertinsight

     • Password: Please use the Yellow Binder for the password

• Steps
  

  • Enter company code: Please use the Yellow Binder for the company code

  • Click on SEND at the top of the page.

  • Choose Manually Specify.

  • Enter the necessary recipient information.

  • Upload the signed file.

  • Click Send to complete the submission.

1. Intake Process

• The intake coordinator does not conduct pre-session screenings. Clients are informed that the first session is an assessment to determine whether Desert Insight can meet their needs.

• Clients are informed that this session is aimed at establishing compatibility and assessing the appropriate level of care.

2. Assessment Session

• In the initial session, therapists will evaluate the client’s suitability for Desert Insight by assessing:
  

  • Scope of Practice: Ensuring that the client’s needs align with the therapist’s training and competencies.

  • Therapeutic Goals: Verifying if Desert Insight’s services align with the client's therapeutic needs.

  • Risk Factors: Conduct assessments for suicidal/homicidal ideation, substance use, and any psychotic symptoms such as hallucinations or delusions.

  • Specialized Support: Identify if the client requires specialized care (e.g., eating disorders, ADHD, OCD, personality disorders). Refer them out as needed for specialized support.

3. Referral Process

• If Desert Insight is not the best fit, the therapist provides a referral list to more appropriate providers.

• With client consent, therapists may submit referrals on the client’s behalf to support a seamless transition.

4. Continued Care at Desert Insight

• Clients suitable for Desert Insight may continue services with specific conditions, such as medication compliance or attendance requirements.

• Therapists may decide to continue treatment if these conditions are met and the client aligns with the practice's scope and focus.

5. Additional Considerations

• If another therapist at Desert Insight may be better suited for the client’s needs, this option will be discussed and offered if available.

• Clients will be asked if they are open to additional psychiatric services, support groups, or complementary programs (e.g., AA, NA, SMART Recovery) if relevant.

• Collaboration is emphasized as therapists explain the importance of flexibility with treatment modalities to enhance the client’s therapeutic journey.

After 5 hours of EMDR Intensives, here's what you might experience:

1. Feeling better about tough memories: EMDR helps make bad memories less upsetting.

2. Less feeling down or anxious: People often feel happier and less worried after EMDR.

3. Handling feelings better: EMDR teaches ways to deal with emotions, so you can cope with stress easier.

4. Understanding yourself more: You might figure out why you feel a certain way about things.

5. Feeling more confident: EMDR can boost your self-esteem, making you feel better about yourself.

6. Getting along better with others: EMDR can help you communicate better and have healthier relationships.

7. Changing physical reactions: EMDR can make your body react differently to past trauma, making it easier to handle tough situations without feeling overwhelmed.

Overall, after 5 hours of EMDR Intensives, you'll probably feel happier, stronger, and more ready to handle life's challenges.

The need for more than one intensive session can vary based on different factors, including the types of traumas you've experienced and how safe you feel to proceed. Some individuals may find that one intensive session helps them make substantial progress, while others may require additional sessions to address deeper issues.

It's crucial to consider both the emotional safety and the therapeutic needs of each person. Your therapist will work with you to determine the best approach, ensuring that you feel comfortable and supported throughout the process. Together, you can discuss your traumas, your progress, and any concerns you may have, allowing for a tailored treatment plan that prioritizes your well-being.

Maintaining ethical standards and prioritizing client confidentiality.

At our practice, we are committed to ethical guidelines that prioritize each client’s confidentiality and well-being. As part of this commitment, one therapist will not provide individual therapy to two members of the same family. This policy applies to individual therapy only and does not affect family therapy or couples therapy, where shared sessions are appropriate.

This policy ensures:

1. High Standards of Care: Each client receives care without potential conflicts of interest.

2. Clear Boundaries: Individual therapeutic relationships remain confidential and focused solely on that person’s needs.

By following this policy, we strive to provide each client with the most effective, personalized, and ethical support possible.

We offer three different options for payment:

$433 - three (3) monthly payments of $433

$600 - two monthly payments of $600

$1,100 - one-time payment of $1,100

We accept most credit cards and debit cards.

Helping clients document attendance for external needs.

• Request Timeline: Please remind clients to request attendance letters at least one week in advance.

• Process: When a client requests an attendance letter, please email Vanessa and [Your Supervisor/Manager's Name] to inform them of the request.

• Content of Letter: The letter will include only the start date and number of sessions completed.

• Delivery: Vanessa and your supervisor/manager will prepare the letter and send it directly to the client.

We don't bill insurance for EMDR intensives due to billing limitations. However, we can offer a superbill for you to submit to your insurance provider for potential reimbursement if they allow it.

Guidelines for sharing specific information with authorized parties.

If a Release of Information form is required, you can send it directly to the client via SimplePractice. Here’s how:

1. Navigate to Client Profile
   

   • Go to the client’s profile in SimplePractice.

1. Access Release Form
   

   • Click on the FILES tab (located next to Measures).

   • Click the blue Actions button.

   • Select Share with Client.

   • Choose the client’s name.

1. Form Selection
   

   • Scroll down the list to find Release of Information for Therapists.

1. Client Instructions
   

   • Inform the client to fill in their information and specify the name or organization to which they’re granting permission.

   • Once completed, review the form to ensure it contains all necessary details.

In the event of a first late cancellation or no-show, the therapist is responsible for sending the Attendance Contract to the client and reviewing it with them during a subsequent session. This process is not managed by the admin team and should be completed solely by the therapist.

Steps to Send the Attendance Contract via SimplePractice

1. Navigate to Client Profile
   

   • Go to the client’s profile in SimplePractice.

1. Access the Files Tab
   

   • Click on the FILES tab, which is located next to Measures.

1. Select the Actions Menu
   

   • Click on the blue Actions button.

1. Share the Contract
   

   • Choose Share with Client and select the client’s name.

1. Form Selection
   

   • Scroll down the list and find the form labeled ATTENDANCE CONTRACT.

   • Ensure only the Attendance Contract is selected; make sure no other forms are included.

   • Verify that the contract is not being sent to any contact or emergency contact attached to the client’s profile.

1. Review During Session
   

   • Once the contract is sent, review it with the client during their next session. This conversation provides an opportunity to clarify the policy, answer any questions, and discuss the importance of maintaining consistent attendance.

This process aims to reinforce the attendance policy and ensure the client is fully informed about their responsibilities regarding cancellations and no-shows. By addressing it directly in session, we also ensure clients feel supported in understanding and adhering to these guidelines.

Our focus remains on directly supporting the family.

Provide the client with a copy of their treatment plan and offer psychoeducation to help both the client and their family advocate for themselves. This includes empowering the client to present strategies that work for them to the school, examples: breathing techniques, extra time for testing, or specific seating arrangements etc.

We can assist them in preparing for these discussions and also provide parents with the necessary information like encouraging them to submit requests in writing so that there is a paper trail at the school.

If the school requests further involvement, we refer the case to an ADHD specialist or agency (or learning disability agency, whatever is appropriate). In the event that the school isn't responsive to the family's advocacy efforts, we can discuss together in ways to support the client differently so that they are not left without support. This of course is the exception and not the rule.

Minor clients who are signed up for individual services with parental/caregiver consent must have a parent/caregiver present at time of intake. If not present, we may offer a reschedule when parent is available. This will be requested by admin at time of making the appt. Therapist must check in with parent in the first or last 10 min of session at least 1-2x a month as part of Treatment to provide transparency and meet standard of care.

Discuss expectations around minor confidentiality and level of involvement for minor and parent, and document accordingly.

General rule: The older the minor, the more confidentiality is held, the younger the minor, the more parental involvement is expected as part of treatment.

Clients w/ESA, we can’t deny services, ask clients to bring in ESA letter if they ask to bring in ESA

At Desert Insight, our practice focuses on providing high-quality mental health support for a wide range of conditions. However, we do not provide treatment for substance abuse or substance use disorder diagnoses.

Policy Guidelines

1. Referral for Substance Abuse Needs: If a client presents with a substance abuse or substance use disorder diagnosis, our policy is to refer them to specialized treatment providers. Our team is committed to helping clients find the appropriate care, and we will guide them toward professionals or facilities that specialize in substance abuse treatment.

2. Client Disclosure and Assessment: In cases where substance use concerns arise during sessions, clinicians are encouraged to discuss these concerns openly with clients, emphasizing the importance of specialized support. The clinician will then facilitate a referral to a substance abuse specialist or treatment program.

3. Ongoing Support for Dual Diagnoses: If a client is receiving specialized substance abuse treatment but seeks support for a co-occurring mental health issue, our team can provide ongoing care specifically for that mental health need. This approach allows for comprehensive support in collaboration with substance abuse treatment providers.

4. Resource List for Substance Abuse Referrals: To ensure a smooth referral process, we maintain a list of trusted substance abuse treatment providers and organizations. Clinicians should offer this list to clients as needed or work with the client to identify a suitable referral based on their unique needs.

At Desert Insight, the safety and well-being of our clients are our top priorities. When making a report to Child Protective Services (CPS) or Adult Protective Services (APS), therapists must follow these steps to ensure proper protocol is followed:

1. Consultation Before Reporting
   

   • Before making a CPS or APS report, always consult with your immediate supervisor.

   • If your immediate supervisor is unavailable, contact another supervisor on the team for guidance.

1. Emergency Situations
   

   • If a client is in imminent danger, call 911 immediately before taking any other steps.

1. Reporting Guidelines
   

   • Reports should be made to only one agency: CPS, APS, or law enforcement—not multiple agencies for the same concern.

   • If unsure which agency to report to, consult with a supervisor before proceeding.

1. Thorough Documentation
   

   • After making a report, document all relevant details in the client’s chart, including:
     

     • The reason for the report

     • The consultation with a supervisor

     • The agency contacted and the name of the representative spoken to

     • Any follow-up actions recommended

1. Confidentiality & Professionalism
   

   • Reports should be made discreetly and professionally, maintaining client confidentiality to the extent possible while ensuring their safety.

   • If you have any doubts about whether a situation warrants a report, consult with a supervisor for guidance.

Following these steps ensures compliance with legal and ethical obligations while prioritizing client safety.

At Desert Insight, we are an outpatient therapy practice providing individual therapy sessions at a frequency of one session every two weeks for 60 minutes (CPT code 90837). While we strive to support our clients within this framework, there are situations where a client’s needs exceed the level of care we can ethically and effectively provide. In such cases, a higher level of care referral may be necessary to ensure the client receives the appropriate treatment.

Criteria for a Higher Level of Care Referral

A referral to a higher level of care may be considered if a client meets any of the following criteria:

1. Increased Safety Risk
   

   • Active suicidal ideation with intent and/or plan that cannot be managed at the outpatient level.

   • Homicidal ideation with intent and/or plan that poses a risk to self or others.

   • Frequent self-harming behaviors that require medical intervention.

   • Recent psychiatric hospitalization with ongoing acute symptoms.

1. Severe Mental Health Symptoms Impacting Daily Functioning
   

   • Persistent psychosis (hallucinations or delusions) that interferes with reality testing.

   • Severe mood instability (e.g., bipolar disorder with rapid cycling or unmanageable depressive episodes).

   • Disabling anxiety, panic, or OCD symptoms that prevent basic functioning.

   • Severe eating disorder symptoms (e.g., significant weight loss, purging, or medical instability).

1. Substance Use or Co-Occurring Disorders Requiring Intensive Support
   

   • Active substance dependence that interferes with daily functioning and requires detox or rehabilitation.

   • Co-occurring mental health and substance use disorder requiring specialized dual-diagnosis treatment.

1. Therapy Needs Beyond Outpatient Frequency
   

   • Client requires multiple therapy sessions per week to stabilize symptoms.

   • Client requires case management, medication monitoring, or group therapy not offered in our setting.

   • Family or relational issues require intensive therapy (e.g., inpatient family programs, residential treatment).

1. Lack of Engagement or Responsiveness to Outpatient Treatment
   

   • Minimal progress over an extended period despite appropriate interventions.

   • Frequent missed sessions or inability to engage in therapy due to symptom severity.

   • Client needs structured, intensive interventions beyond what can be provided in biweekly outpatient therapy.

Examples of Higher Levels of Care

If a client meets any of the above criteria, the therapist will discuss appropriate referrals, which may include:

• Intensive Outpatient Programs (IOP) – Typically meets 3–5 times per week, offering therapy, group support, and psychiatric care.

• Partial Hospitalization Programs (PHP) – Day programs providing structured care without inpatient admission.

• Inpatient Psychiatric Hospitalization – 24/7 care for clients in crisis or at immediate risk.

• Residential Treatment Centers (RTC) – Live-in facilities providing comprehensive mental health care.

• Detox or Rehabilitation Programs – Structured support for substance dependence.

Higher Level of Care Referral Process

When a therapist identifies that a client may require a higher level of care, the following steps should be followed to ensure a smooth and ethical transition:

1. Discussion & Consent:
   

   • The therapist will discuss concerns with the client and, if appropriate, their support system.

   • Before submitting a higher level of care referral, the therapist must obtain verbal consent from the client.

1. Supervisor Consultation:
   

   • A supervisor must be consulted before finalizing and submitting the referral to ensure clinical appropriateness and best practices.

1. Immediate Support & Crisis Resources:
   

   • The therapist should always provide the client with information about the Urgent Crisis Center (available 24/7) and encourage them to go for an immediate assessment and evaluation, as this can help link them to services more quickly.

1. Referral & Transition Assistance:
   

   • The therapist will offer the client referral options and additional resources to support their transition to the appropriate level of care.

   • If the client is insured through IEHP, they should be offered a Health Care Worker who can assist in coordinating the transition of services.

1. Client Declines Referral:
   

   • If a client declines the recommended higher level of care and continues to meet criteria for a referral, termination of services may be considered for ethical reasons.

   • This ensures that clients receive the most appropriate and effective care based on their needs and that therapists practice within their ethical and clinical scope.

Client Termination and Discharge Documentation Policy

Purpose: This policy outlines the process for client termination and discharge at Desert Insight, ensuring that all necessary documentation and steps are followed to maintain accurate records and provide consistent support to clients as they transition out of therapy.

Scope: This policy applies to all therapists at Desert Insight involved in client termination, whether it is client-initiated, clinician-initiated, or due to other reasons such as financial or insurance issues.

Client Termination Checklist

Therapists must complete the following steps before finalizing a client’s termination:

1. Complete Documentation in SimplePractice
   

   • Admin Note: Document the reason for discharge to inform support staff.

   • Treatment Plan Update: Include the final status of the client’s goals.

   • Discharge Note: instead of the Desert Insight note, Complete the discharge note, making sure to refer to the treatment plan update as needed.

2. Fill Out the Google Form

• Access the Client Exit Form: https://docs.google.com/forms/d/e/1FAIpQLSdYK00ewlv_8a6IKo-m9wUB-Pk9QsJZtel_s099JGVT1ek2rg/viewform?usp=preview

3. Ensure Proper Communication & Referrals

• Provide Resources or Referrals: If applicable, offer clients any necessary referrals or community resources.

• Notify the Admin/Billing Team: Inform them of any financial or insurance issues affecting the client’s discharge.

• Communicate with the Client: Discuss the termination plan with the client, and inform them that they can return in the future if needed.

Overview

This guide provides three structured options that you can use with clients at the end of their therapy journey. Each option is designed to help clients honor their progress, rewrite limiting narratives, and connect with a supportive community. Use these as a flexible toolkit to match each client’s unique path.

Option 1: Thank You Card to Self

Purpose: Encourage clients to acknowledge their hard work and resilience by writing a heartfelt thank-you card that they receive two months after graduation. This delayed delivery reinforces ongoing growth and self-compassion.

Steps for the Therapist:

1. Initiate Reflection:
   

   • Ask the client to reflect on their therapy journey, considering the challenges overcome, strengths discovered, and changes experienced.

1. Provide the Card Template:
   

   • Distribute a thank-you card template. Instruct the client to write a note to themselves that includes:
     

     • Acknowledgment of their courage and effort.

     • Encouraging words for future challenges.

     • A brief mention of the new narrative they are embracing.

1. Sealing & Submission:
   

   • Instruct the client to seal the card and place it in the designated mail drop box in the office.

1. Follow-Up:
   

   • Explain that the administrative staff will mail the card to the client two months after graduation, giving them a future moment of reflection and affirmation.

1. Record Keeping:
   

   • Track the process using a simple spreadsheet noting the client’s name, card-writing date, and scheduled mailing date.

Option 2: “My Story” Narrative Exercise

Purpose: Help clients identify and challenge old, limiting narratives while crafting a new, empowering story that aligns with their current strengths and aspirations.

Steps for the Therapist:

1. Introduce the Concept:
   

   • Share the reflective prompt: "There is only one cause of unhappiness: the false beliefs you have in your head..." – Anthony de Mello

   • Explain that over time, we form stories about ourselves based on past experiences, and some of these stories may no longer serve us.

1. Explore the Old Story:
   

   • Ask the client to write down one old story or belief that has held them back.

   • Encourage them to consider how this narrative influenced their behavior and limited their growth.

1. Craft a New Narrative:
   

   • Guide the client in writing a new story that reflects:
     

     • The growth and change they have experienced.

     • New, empowering beliefs that support a healthier, more vibrant future.

1. Sharing and Reflection:
   

   • Offer the option for the client to share their new story with you, or to keep it as a personal record. Emphasize that the exercise is for their benefit—rewriting their internal dialogue in a way that promotes hope and self-compassion.

Option 3: Graduation Box or Jar with Notes of Pride and Advice

Purpose: Build community by inviting clients to contribute anonymous notes that celebrate personal achievements and offer supportive advice for future clients.

Steps for the Therapist:

1. Distribute a Note Template:
   

   • Provide a simple template with two prompts:
     

     • “What are you most proud of about your journey in therapy?”

     • “What one piece of advice would you give to someone just starting therapy?”

1. Encourage Honest Reflection:
   

   • Emphasize that notes are completely anonymous, ensuring the client feels safe to share their genuine reflections.

1. Submission:
   

   • Instruct the client to place their completed note in the designated jar or box located at the office, ideally during their final session.

1. Utilize the Community Wisdom:
   

   • Once a sufficient number of notes are collected, consider sharing selected messages with new clients via a display in a common area or as part of a welcome packet. This serves as a tangible connection between past experiences and future hope.

• Any time a minor client reports self-harm, it will be considered a safety issue due to the outpatient nature of Desert Insight’s services.

• Unlike Intensive Outpatient Programs (IOP), we do not see clients frequently enough to monitor self-harm behavior closely.

• Parental notification will occur unless it is clinically contraindicated (e.g., if notifying the parent would put the client in danger).

• The therapist must assess the severity of self-harm and determine if a higher level of care is necessary.

At Desert Insight, we deeply value the time and commitment of both our therapists and clients. When a session is scheduled, it represents a dedicated time slot reserved specifically for you. To ensure fairness and respect for everyone’s time, please review our attendance policy below:

Cancellation Policy

• Advance Cancellation: Clients are encouraged to cancel sessions with more than 24 hours' notice to avoid any scheduling disruptions.

• Late Cancellation: Any cancellation made within 24 hours of a scheduled session is considered a late cancellation.

• No-Show: Failing to attend a scheduled session without notifying your therapist is considered a no-show.

Client Attendance Policy for Scheduled/Recurring Sessions

1. Allowed Incidents:

• No-Shows: Clients are allowed one (1) no-show.

• Late Cancellations: Clients are allowed two (2) late cancellations.

2. Consequences for Exceeding Allowed Incidents:

• A second no-show OR a third late cancellation will result in the termination of services.

3. Termination Procedure:

• If a client exceeds the allowed number of no-shows or late cancellations, they will be removed from the therapist’s schedule due to attendance issues.

• The therapist must document this in the client’s file by adding an admin note (yellow section at the top of the file) stating: Client has been removed from the schedule due to attendance issues. CEO approval is required before rescheduling this client.

• Clients outside of IEHP insurance will be charged a $60 late cancellation or no-show fee. This fee applies to all non-IEHP clients and is signed off on at the beginning of therapy.

Clinical documentation: Notes

1. Start and End Time of Session

   • Always include the time the session began and ended (e.g., 10:00 AM - 10:50 AM).

2. Client’s Diagnosis and Symptoms

   • Clearly state the client’s diagnosis and how symptoms were addressed during the session. Avoid overly personal details or unnecessary specifics.

3. Purpose of the Session

   • Document the session’s goals, whether addressing a treatment plan objective or managing an acute situation.

4. Interventions Used

   • Detail the specific therapeutic interventions used, such as CBT techniques, psychoeducation, mindfulness exercises, or skill-building activities.

5. Client’s Response

   • Record how the client responded to the interventions. Include their progress, struggles, or insights without over-personalizing.

6. Progress Toward Goals

   • Reference the treatment plan and document progress or any barriers encountered.

7. Plan for Future Sessions

   • Include next steps, homework assignments, or adjustments to the treatment plan.

8. Signature and Date

   • Ensure your name, credentials, and date are included at the bottom of the note.

9. Timeliness

• Complete notes within 48 hours of the session to ensure accuracy and compliance.

Sample note for MDD 90837

Data: The session was held from 10:01 AM to 10:55 AM. Client reported a persistent low mood, lack of energy, and difficulty concentrating, especially at work and in personal relationships. They rated their mood as a 4/10, stating they felt "stuck" and "overwhelmed" by daily responsibilities.The client shared a recent situation at work where they experienced heightened feelings of inadequacy and self-doubt. During the session, the therapist utilized CBT to help the client identify and reframe three negative thought patterns related to perceived failure and inadequacy. A 5-minute mindfulness grounding exercise was introduced to help the client manage anxiety in real time. Psychoeducation was provided to explain the thought-feeling-action connection, enhancing the client’s awareness of how their cognitive distortions contribute to emotional distress. The client responded with moderate engagement, actively identifying negative thoughts and attempting to reframe them with therapist guidance. They expressed initial skepticism about the mindfulness exercise but reported feeling slightly calmer after completing it.

Assessment: Client showed moderate engagement throughout the session, with some hesitation when discussing cognitive distortions. Client is presenting with more insight regarding depressive symptoms.

Plan: The client will practice the grounding mindfulness technique daily and journal one instance of reframing negative thoughts. The next session is scheduled in two weeks.

Sample 90847 note

D: The session was held from 10:01 AM to 10:55 AM. The session included the client and their spouse, focusing on family dynamics contributing to the client’s symptoms of persistent low mood, irritability, and withdrawal. Client reports these symptoms continue to impact motivation, concentration and sleep on a daily basis. The client shared feelings of being misunderstood by their spouse, citing specific instances where communication broke down. The spouse expressed difficulty navigating the client’s emotional needs, reporting frustration and confusion. Both identified heightened tension during conflict, which often escalates due to miscommunication.Family dynamics contributing to the client’s depressive symptoms were explored, with the focus on improving understanding and support within the marital relationship. The therapist facilitated communication by implementing active listening techniques and guiding the couple in expressing emotions and needs clearly. Psychoeducation was provided on how depressive symptoms impact interpersonal relationships, helping the spouse better understand the client’s experience.The session concluded with improved mutual understanding but highlighted ongoing challenges with consistent communication.

A: Client is presenting motivated for the therapy as evidenced by their active engagement in identifying triggers,while the spouse demonstrated willingness to learn strategies for de-escalating conflict.

P: Both the client and spouse will practice active listening techniques using "I" statements during disagreements. The couple was assigned to create a list of specific actions they can each take to foster emotional connection and reduce misunderstandings. The next session will focus on reviewing progress and introducing strategies for conflict resolution. Next session is scheduled in two weeks.

English Voicemail Script

Hello, you've reached the confidential voicemail of [therapist's name] at Desert Insight. Thank you for calling. If this is an urgent matter or you're experiencing a crisis, please call 911 or the Mental Health Urgent Care Center at (760) 424-5602, available 24/7 at no cost, regardless of insurance. Please leave your name, phone number, and a brief message, and I will get back to you within a business day. Thank you.

Spanish Voicemail Script

Hola, ha llegado al correo de voz confidencial de [nombre del terapeuta] en [nombre de la práctica]. Gracias por llamar. Si esto es un asunto urgente o está experimentando una crisis, llame al 911 o al Centro de Atención Urgente de Salud Mental al (760) 424-5602, disponible las 24 horas, los 7 días de la semana, sin costo, independientemente del seguro. Por favor, deje su nombre, número de teléfono y un breve mensaje, y me comunicaré con usted dentro de un día hábil. Gracias.

At Desert Insight, we are committed to providing ethical, honest, and high-quality mental health care while also maintaining sustainability within our business model. As part of this commitment, our standard practice is to use CPT code 90837 (53+ minute individual psychotherapy session) for the majority of our clinical sessions.

Why 90837?

CPT code 90837 aligns with our model of care, which values deep, intentional work in each session. This time frame allows both therapist and client to engage in meaningful exploration, skill-building, and progress toward goals. This model also supports our operational structure and long-term sustainability as a practice.

When Sessions Fall Short of 53 Minutes

If a session consistently falls under 53 minutes, this should not be ignored. Instead, it may be an opportunity for a deeper clinical conversation. Consider exploring:

• The client’s motivation and engagement in therapy

• Whether this is the right time in their life for therapy

• Their commitment to weekly sessions

• If it may be appropriate to step down to biweekly or monthly sessions

• If the client may be nearing termination and no longer requires ongoing support

This is not about pressuring anyone to meet a quota—it's about being intentional and therapeutic in how we understand and respond to client behavior and needs.

Ethical Standards

We uphold the highest ethical standards in all documentation and billing. We never falsify session length or details. If a session does not meet the 53-minute requirement for 90837, therapists should honestly reflect that and code accordingly (e.g., 90834).

However, we also encourage therapists to remain mindful of our model. Regularly falling short of 53 minutes may indicate a pattern worth discussing in supervision or peer consultation.

Please note, the following CPT codes to reflect the time accordingly:

1. 90837: 53+ minutes

2. 90834: 38–52 minutes

3. 90832: 16–37 minutes

4. 90847 (Family Sessions): 26+ minutes

At Desert Insight, it is the responsibility of each therapist to actively manage and maintain their calendar. This includes:

• Keeping availability accurate and up to date, including any planned time off or changes in working days.

• Ensuring each session is correctly labeled with the appropriate CPT code.

• Marking the client's attendance status—whether it was a "Show," "No Show," or "Late Cancellation"—as soon as possible after the scheduled session.

Important: Appointments must be updated within one hour of the scheduled time. If a session status is not updated within that window, the system may automatically bill the session incorrectly. While these errors can sometimes be corrected, they create unnecessary delays and confusion.

To support the efficiency of our billing and scheduling teams, therapists must keep their calendars accurate and up to date. This allows the admin team to proceed with billing and client communication without needing to follow up individually with the therapist.

We appreciate your attention to this detail, as it ensures smooth operations, accurate billing, and timely client care.

No-Show Procedure

1. Confirm the client has signed the new no-show policy.
   

   • Check under "Files" in their profile to make sure it’s been signed.

1. Notify the client by phone or voicemail: “Hello, this is [Your First Name] from Desert Insight. I’m calling to let you know that due to our no-show policy, you’ve been removed from the schedule. If you’d like to return for services with me or another provider, please give us a call at 442-307-3395.”

2. Document with an admin note:
   

   • Write: “Client was removed from the schedule in accordance with the no-show policy.”

1. Remove the client from the schedule.

At Desert Insight, we are committed to providing high-quality outpatient care. As an outpatient practice, our model is designed for clients to receive support during their scheduled therapy sessions. Communication outside of sessions should be limited and purposeful to maintain clinical boundaries and ensure the appropriate level of care.

General Guidelines

• Desert Insight is an outpatient level of care, which means clients should be able to manage their needs between sessions with the support of regularly scheduled appointments.

• If a client consistently reaches out with concerns or symptoms between sessions, therapists should assess whether the client may require a higher level of care (e.g., IOP, PHP, or crisis intervention services).

• Therapists are expected to monitor for patterns that indicate increased symptom severity or decreased functioning.

Text Messaging Policy

• Texting is reserved solely for scheduling and attendance purposes. It should not be used to discuss clinical content, provide therapy, or manage emotional concerns.

• Text messages must be kept brief, professional, and non-identifiable. Avoid names, clinical details, or sensitive information.

Examples:

• Appropriate: “Hello, this is [Therapist First Name]. Would you be available to reschedule for Monday at 1 PM?”

• Inappropriate: “Hi Maria, I know you were really struggling last session—do you want to talk before next week?”

Responding to Client Texts

• For non-urgent matters related to clinical issues:
  

  • “Thanks for reaching out. We will talk more about this during our next session.”

  • Alternatively, wait until the next session to acknowledge the message and gently reinforce communication boundaries.

• For urgent matters:
  

  • Call the client directly and assess for safety; provide resources as needed.

Phone Calls Between Sessions

• Brief phone calls may be used for urgent or crisis-related matters. These should be rare and not used as ongoing support in lieu of therapy sessions.

• If phone calls become frequent or indicate a need for additional support, therapists should initiate a care coordination conversation and consider referring the client to a higher level of care.

Documentation

• All clinically relevant communication outside of session (texts or calls) should be documented in the client’s chart, noting the reason, response, and follow-up plan.

At Desert Insight, we are committed to protecting client confidentiality and maintaining professional boundaries in all forms of communication. As part of our outpatient level of care, email correspondence with clients must remain limited, clinically appropriate, and compliant with HIPAA standards.

Purpose of Email Communication

Email may be used only for the following purposes:

• Scheduling or rescheduling appointments

• Sharing practice-related information (e.g., office closures, updated forms)

• Providing brief, one-way resources (e.g., handouts, referrals, links to support services)

Email is not appropriate for:

• Processing clinical material or therapeutic conversations

• Addressing urgent or crisis-related matters

• Discussing confidential or sensitive topics

If a client begins to use email to process or share emotional content, therapists should redirect them to bring these concerns to their next scheduled session.

Clinical Documentation

• All email communication with clients must be documented in the client’s chart.
  

  • Include the content (or a summary) of the message, the therapist’s response, and any follow-up plans.

• Emails are considered part of the client’s medical record and may be included in any future chart review, audit, or legal request.

Boundaries and Expectations

• Therapists are expected to check and respond to client emails within a reasonable time frame, not exceeding the expectations of standard outpatient care.

• When responding to client emails, therapists should:
  

  • Refrain from discussing any clinical information beyond the scope of scheduling or resource sharing

  • Maintain professional language and tone at all times

Sample responses:

• “Thanks for reaching out. Let’s discuss this further during our session.”

• “Attached is the referral list we discussed. Please let me know if you'd like help identifying which option may be a good fit.”

Confidentiality Reminder

Even when using secure systems, email is not entirely risk-free. Clients should be informed during intake that email is not a confidential way to communicate and should never be used in place of a session.

At Desert Insight, while we generally do not write progress reports for outside entities, we make an exception for Social Security Administration (SSA) requests—only when we receive the request directly from them.

Here's What to Do:

1. Check for the Request: If you receive a Social Security report, you will get an email from our admin team with instructions. SSA usually includes their own ROI (Release of Information), but we still require our Desert Insight ROI to be on file for documentation purposes.

2. Client ROI: Please ask your client to fill out our Desert Insight ROI. For instructions on how to send an ROI, visit www.desertinsight.com/policy and "How to Request a Release of Information Form".

3. Do Not Change the Client’s Schedule:

No changes to the client’s appointment schedule should be made for this request.

The report is not urgent and should be completed after your next regularly scheduled session with the client.

1. Complete the Note: Once the ROI is received, you will be asked to complete a "Treatment Plan & Goals Note" (found in the progress note dropdown menu). ➤ Do not use the Desert Insight template for this note.

2. No Special Training Needed:

This does not require any special training or documentation process. It is simply a progress note using a different template. Please treat it like you would any other clinical note—objective, clear, and clinically sound.

5. Stay Clinically Impartial:

• We do not take a stance on whether the client is being honest or should receive benefits.

• Our role is to document the client's symptoms, goals, and progress as you normally would for any other client during any session.

6. Remember: This is a courtesy service, not a requirement or legal obligation. You are not expected to do anything beyond submitting the requested clinical note using the correct template.

7. Sample Note for Reference:

To guide you in completing the "Treatment Plan & Goals Note", we’ve included a sample for your reference. Please use it as a clinical example only—your note should reflect your actual session content and observations. Link: https://drive.google.com/file/d/1yajgL0xtycMgX_wdpKl7dBd_bFsZpFGJ/view?usp=drive_link

8. Need Support? If you have questions or would like 1:1 guidance, please reach out to Vivian directly.

If a client attends a scheduled intake or first session and it becomes clear that the service they are seeking is outside of what Desert Insight offers—or was scheduled incorrectly (e.g., they are seeking services for autism assessment, psychiatric medication management, were expecting a different therapist, or need a service not currently available)—please follow the steps below:

Therapist Action Steps:

1. Clarify the Client's Needs: Gently explore what the client was expecting or needing from the session. Validate their experience and thank them for coming in.

2. Determine Mismatch: If the services they are seeking are clearly outside of what Desert Insight provides, or if there was a scheduling or referral error, kindly inform the client that we may not be the best fit for their needs and that we want to help get them to the right place.

3. Document the Encounter:
   

   • In your progress note, briefly state that the client arrived for the appointment but it was determined that the services requested were outside the scope of what we provide.

   • Do not complete a standard intake or therapy note.

1. Change the Note Type to "Clinician Canceled":
   

   • Update the appointment status to “Clinician Canceled” so it does not count against the client or billing.

   • This protects the client from being penalized and allows us to keep accurate records.

1. Communicate Internally:
   

   • Write it as an ADMIN note so that all staff can see. Notify the scheduling coordinator (or supervisor) so that appropriate follow-up or referrals can be provided if needed.

1. Support the Client with Next Steps:
   

   • If possible, offer a referral or suggest where they might find the support they're looking for.

Desert Insight is primarily an insurance-based practice, but we also accept private pay (cash) clients. We aim to be one of the most affordable therapy options in the Coachella Valley, and we welcome clients who prefer or need to pay out of pocket.

1. Credit Card Payments (Most Common)

• Most private pay clients provide a credit or debit card, which is billed automatically through our secure billing system.

• No therapist involvement is needed for these transactions—billing is handled entirely by the admin team.

2. If a Client Wants to Pay in Cash

• If a client prefers to pay in cash:
  

  • Accept the cash payment.

  • Immediately submit the cash and a completed receipt to the designated drop box.

  • If the receipt book is unavailable, simply write a note with the client’s initials, date, and amount paid, and submit it with the payment.

3. Where Therapists Can View Payment Details

• The scheduling team includes the session fee and payment type (e.g., "Private Pay" or "Cash Pay") at the top of the Admin Note in the client’s profile.

• Therapists can view this by opening the client’s chart and locating the Admin Note section at the top of the profile.

• This helps therapists stay informed about the client’s payment method, especially if they are paying in cash.

At Desert Insight, we value transparency—especially when it comes to money. We believe that understanding how things work behind the scenes helps us all stay grounded in trust, clarity, and shared purpose.

Posted Rates vs. Insurance Billing

On our website, each therapist’s rate is publicly listed, and you’ll notice these are based on the 90834 code. This shorter session format is intentionally chosen to keep therapy more affordable and accessible for our cash-pay clients.

That said, the majority of our insurance sessions are scheduled as 90837, which reflects the longer 53+ minute sessions most therapists provide, typically every two weeks which is clinically appropriate for most of our clients. We always ensure we are remaining ethical and legal.

Why Your Hourly Rate Looks Lower Than What We Bill

We know it can feel confusing (or even frustrating) when you see a session billed at $125 or more, and then compare that to your hourly rate. You're not alone—this is one of the most common questions we get, and it deserves a transparent answer.

The reality is that running a successful, ethical, and supportive group practice is expensive. We don’t just pay out your rate—we also cover everything that makes this work sustainable and worth doing:

• Quarterly bonuses

• Holiday pay, PTO, and sick time

• Retirement matching

• Health, dental, vision, and life insurance

• Weekly clinical supervision and ongoing training opportunities

• Office rent, supplies, and utilities

• Full administrative support—including billing, scheduling, and coordination

• Therapist wellness activities

• A collaborative team culture with community-based, heart-driven therapists

It is also important to note that many insurances pay less than what we bill, and sometimes they don’t pay at all. One of the benefits of working at Desert Insight is that you never have to carry that burden—we absorb the risk and handle all billing issues so you can focus on your clients.

Comparison to Other Platforms

Many online therapy platforms charge higher rates, but therapists are left to pay 20–30% in taxes, with no benefits, no admin support, and no clinical community. Here, we work as a team. You receive full support both clinically and administratively, and you get to work alongside mission-driven therapists who are deeply rooted in the community.

Annual Budget Transparency

Once a year, we release a practice-wide budget report, so you can see exactly where the money goes. We prioritize people over profits and remain committed to doing this work with heart and integrity.

If you ever have questions about pay, billing, or how the practice operates behind the scenes, please don’t hesitate to ask. You’re part of something intentional, ethical, and people-centered—and we’re incredibly grateful to have you here.

With gratitude, Desert Insight Admin Team

The “Clinician Cancelled” status should be used only in the following scenarios:

1. Clinician Emergency or Illness
   

   • The therapist is unexpectedly unable to attend a session due to a personal emergency or being sick.

1. Session Unable to Proceed Due to Client Condition
   

   • The session was not held because the client:
     

     • Was visibly under the influence of substances,

     • Refused to engage in session,

     • Presented in a way that ethically or clinically made it inappropriate to proceed.

1. Inappropriate Fit or Level of Care Identified During Intake
   

   • During a new assessment, the clinician identifies that the client is not a fit for:
     

     • The therapist’s clinical expertise (e.g., autism-specific care, medication management, etc.),

     • The level of care offered by Desert Insight (e.g., client needs a higher level of care or specialized services we do not provide).

Documentation Requirements:

• Clinician must document the reason for cancellation clearly in the client’s chart, using neutral, factual, and professional language.

• If the client is not appropriate for treatment at Desert Insight, include recommendations for referral or next steps.

Planned Time Off:

• If you are cancelling sessions due to planned time off (vacation, paid or unpaid PTO), please follow the Time Off Request Policy and do not mark these sessions as "Clinician Cancelled." These should be removed from your calendar in advance.

At Desert Insight, we offer free 10–15 minute consultations for potential new clients. These consultations are usually held over video and serve as a brief opportunity for both the client and therapist to get a feel for the fit—to see if it feels like a good match before committing to a full session.

What to Do During the Consultation:

• Briefly introduce yourself and your therapeutic style.

• Ask the client what they’re hoping to work on.

• Share what types of clients or concerns you work best with.

• Answer any questions they may have about therapy or the process.

• If it feels like a good fit, let them know next steps for getting started.

A Few Important Notes:

• This is not a full clinical assessment or intake.

• Therapists should not feel pressured—a consultation is not a reflection of your abilities as a therapist. It's simply a check-in to see if there's a good mutual fit.

• If it doesn’t feel aligned, it’s okay to kindly share that and let the client know our admin team can help match them with someone else.