Practice Policies
For every prospective and current client of this practice | What to Expect Before, Between, and After Sessions with a Licensed Psychologist
Every policy at Alafiora exists for a reason rooted in clinical integrity, mutual respect, and the durability of the work itself. These policies form the structure that makes depth-oriented, attachment-centered psychological care possible, sustainable, and safe for every client holding a place in this practice. Reading this page in full before a first appointment is worth the time it takes. Questions are welcome at the consultation, or at a first session for anyone already certain and ready to begin.
- Attendance and Scheduling
- Attendance Continuity
- Punctuality
- Between Sessions
- Virtual Care
- Minors: Clients Sixteen and Seventeen
- Records and Documentation
- Endings and Transitions
- A Final Note
- Common Questions About Practice Policies
No section by that word. The menu holds the complete site.
Attendance and Scheduling
Cancellation, Rescheduling, and No-Show Policy
48-Hour Notice and the Quarterly Grace Cancellation
A scheduled session at Alafiora is reserved for one client and one client alone. It is never double-booked and never offered to someone else in the meantime. The hour a client holds is a deliberate allocation of clinical time and attention, and this policy asks that it be honored with the same intentionality Dr. Lapite-Garrett brings to holding it, while still making room for the fact that life is not always orderly.
- Cancellation or rescheduling with 48 hours or more of notice: no charge. If the session is rescheduled within the same week, the fee is not collected until the rescheduled session is actually completed.
- Late cancellation, under 48 hours' notice: the full session fee applies.
- No-show: the full session fee applies.
- Emergency no-show: handled case by case, with real room made for genuine emergencies as they actually arise.
Every client receives one complimentary cancellation per quarter, with no charge and no explanation required. Quarters run January through March, April through June, July through September, and October through December. This grace period is built into the structure on purpose, in direct recognition that life occasionally requires it, and a thoughtful practice plans for that reality from the start.
Attendance Continuity
The Four-in-Four Continuity Policy
The Clinical Case for Consistent Attendance in Therapy
The cancellation terms above cover what happens to a single missed session. A separate, deeper concern is what repeated absence does to the work itself over time. Consistent attendance at Alafiora is treated as a genuine clinical requirement, built directly into how this depth-oriented work actually functions. Trauma-informed, depth-oriented therapy builds cumulatively, session on session, and gaps in that cumulative work erode what has already been carefully built. The policy below protects both the integrity of treatment and the sustainability of the therapeutic relationship itself.
- Four or more sessions cancelled, rescheduled, or missed within any four-month period constitutes a pattern that warrants a direct, honest clinical conversation.
- At the third cancellation inside that same four-month window, a conversation happens: what is going on, what barriers are actually present, and whether the structure of care itself needs to adjust, a move to biweekly sessions, a shift to week-by-week scheduling, or a brief, intentional pause.
- A fourth cancellation within that same four-month window, after that conversation has already taken place, closes the therapeutic relationship. The closing is handled thoughtfully and respectfully, and appropriate referrals are always provided.
- A client discharged under this policy is not eligible to return to Alafiora for six months. Return after that period is possible and is evaluated through a new consultation, with clear mutual expectations established again from the start.
Five total cancellations or no-shows within a single calendar year, regardless of which quarter they fall in, also result in discharge from the caseload, with referrals provided. This reflects a plain fact: the level of care Alafiora offers requires a level of engagement that makes that care possible to sustain. A structure this deliberate cannot hold what it is not permitted to hold.
A Note for Executive Concierge Retainer Clients
How the Standard Cancellation Policy Differs Under the Retainer
The fee-based cancellation and no-show policy above does not apply to clients enrolled in the Executive Concierge Retainer. Retainer clients receive priority scheduling with flexible rescheduling and no late-cancellation penalties, provided appointments are rescheduled within the same calendar month and within mutually available hours. The retainer agreement itself governs the fee mechanics of scheduling changes for enrolled clients, and its terms replace the standard fee-based policy described above for that specific purpose.
This exemption is about fees, not about the clinical safeguard described next. The four-in-four continuity policy exists to protect the cumulative integrity of the therapeutic relationship itself, and that clinical purpose applies to every client of this practice, including those enrolled in the retainer. A pattern of repeated cancellations, reschedules, or missed sessions still prompts the same direct, honest clinical conversation for a retainer client that it would for any other client, even though no late-cancellation fee is ever assessed along the way. The specific numeric thresholds described below are written for standard fee-for-service scheduling; how continuity is protected for a retainer client, given the retainer's own flexible scheduling structure, is addressed directly between Dr. Lapite-Garrett and the client as part of the retainer relationship, rather than by a fee schedule that does not apply to them.
Punctuality
Late Arrivals
The Fifteen-Minute Hold
Attendance covers whether a session happens at all. A related, narrower question is what happens when a session starts a few minutes late. Sessions begin at their scheduled time. A client who arrives late is worked with for whatever time remains, and the session still concludes at its originally scheduled end. The full session fee applies regardless of arrival time. This structural policy protects the clinical boundaries that make focused, effective work possible for every client whose time is held with equal care.
A client anticipating a late arrival is asked to send a brief message through the secure client portal before the session begins. The space is held for fifteen minutes. If no message has arrived and the client has not arrived or connected by fifteen minutes past the scheduled start, the session is considered a no-show and the full fee applies.
Between Sessions
Communication and Between-Session Contact
Why These Boundaries Exist, for Standard and Retainer Clients Alike
Scheduling covers what happens inside a session's own time. Just as much needs to be said about what happens in the space between sessions. The boundaries around between-session contact exist to protect the integrity of the therapeutic space and to keep the support a client receives genuinely clinical. Alafiora is a specialized private practice built around scheduled clinical work, and the quality of care Dr. Lapite-Garrett provides depends in part on the clarity of these boundaries. Clinical support between sessions is addressed through the specific channels described below, since standing, always-on availability outside scheduled care sits outside how this practice is structured.
For standard clients:
- Between-session communication is conducted through the secure client portal during standard business hours, Monday through Friday, 9am to 6pm.
- Messages are appropriate for scheduling, administrative matters, and brief logistical updates related to care.
- Clinical questions, processing of session material, and requests for support between sessions are held for the session itself, or addressed through a scheduled Clarity Session.
- Non-urgent messages typically receive a response within three business days.
- Clinical support, crisis intervention, or therapeutic processing is not provided by message, email, or phone outside of scheduled session time.
For clients enrolled in the concierge retainer:
- Secure messaging access is included within the retainer during standard business hours, Monday through Friday, 9am to 6pm.
- Messages are reserved for scheduling, brief clinical check-ins, and treatment-adjacent logistics as defined in the retainer agreement.
- Non-urgent messages typically receive a response within three business days.
- Messaging is not monitored continuously and is not appropriate for emergencies or imminent risk.
This practice does not provide emergency or crisis services through any communication channel, for standard or retainer clients alike. Anyone in crisis, experiencing a mental health emergency, or at risk of harm to themselves or others should call 911, go to the nearest emergency room, or contact the 988 Suicide and Crisis Lifeline by calling or texting 988. A curated list of crisis resources is available on the Crisis Resources page of this website.
Virtual Care
Telehealth Requirements
Technical, Location, and Environment Standards for Video Sessions
Much of the contact described above happens through the same secure channels a virtual session itself runs on. Telehealth at Alafiora is treated as a fully clinically equivalent modality to in-person care, held to the same standard of quality and safety, and it carries its own requirements to be conducted well. Reviewing the following before a first telehealth appointment is worth the few minutes it takes.
Technical requirements:
- A stable internet connection sufficient for uninterrupted video.
- A device with a functioning camera and microphone: a laptop, a tablet, or a smartphone.
- Confirmed access to the secure, HIPAA-compliant telehealth platform Alafiora uses, set up prior to the first appointment.
- Headphones or earbuds, strongly encouraged for both privacy and audio quality.
If a technical disruption occurs mid-session, reconnecting through the platform is the first step. If reconnection is not possible within ten minutes, Dr. Lapite-Garrett will reach out through the client's preferred method on file to reschedule the remaining time. The session fee is adjusted proportionally based on the time completed before the disruption, provided the disruption was not foreseeable or preventable on the client's end.
Location requirements: A client must be physically located in one of the states where Dr. Lapite-Garrett is licensed to practice at the time of each session. A client whose location changes should notify Dr. Lapite-Garrett before the session begins.
Environment requirements: Sessions require a private, quiet space free of the risk of being overheard or interrupted. A car with the windows up, a locked room, or a private office all qualify. A shared space, a public location, or any setting where confidentiality cannot reasonably be maintained does not.
Minors: Clients Sixteen and Seventeen
Care for Sixteen- and Seventeen-Year-Old Clients
Guardian Co-Signature and Age-Appropriate Treatment
The scheduling and communication policies above apply to every client, and one age group carries an additional requirement on top of them. Alafiora serves individuals sixteen and older. A client who is sixteen or seventeen requires a parent or guardian's co-signature on intake paperwork before care begins. All three of this practice's specialty areas, sexual trauma, love addiction and obsessive attachment, and compulsive sexual behavior, apply to clients in this age range, with treatment paced and explained to fit a sixteen- or seventeen-year-old's developmental stage rather than an adult's. Full detail on how a parent or guardian is involved during the consultation and intake lives on the Getting Started page.
Records and Documentation
Records, Documentation, and Releases of Information
How Clinical Records Are Maintained, Accessed, and Shared
Everything discussed in a session eventually becomes part of a record, and that record has its own set of protections. A client's clinical record at Alafiora is maintained with the same discretion, precision, and care that governs every other part of this practice. It is stored securely, accessed only as clinically necessary, and never shared without the client's explicit, informed, written consent, except where mandated by law.
- Session notes are maintained in an encrypted electronic health record and are not accessible to insurers, employers, or any third party without the client's written consent.
- Superbills and receipts are available upon request; the Payment Options page covers the specifics.
- Evaluation reports are prepared as clinically indicated.
- Support letters are prepared as clinically indicated.
- Releases of information are required before any third-party disclosure not otherwise mandated by law.
- Mandated disclosures are made only as required by law.
Every client has the right to request access to their own clinical record, to request correction of information that is factually inaccurate, and to receive an accounting of disclosures made on their behalf. These rights are established under HIPAA and honored fully at Alafiora. Record requests should be submitted in writing through the secure client portal.
Endings and Transitions
Termination and Referral
How and Why a Therapeutic Relationship Concludes
Records exist because a therapeutic relationship is expected to run long enough to accumulate one. Eventually, every relationship reaches some kind of ending, and how that happens matters as much as anything that came before it. Every therapeutic relationship at Alafiora is held with the intention that it reaches a natural, well-prepared conclusion: a point where the work has done what it set out to do and a client is genuinely ready to move forward without this particular structure of care. That kind of ending is planned together, with adequate time and attentive care. It is never something that happens abruptly or without a client's full participation.
There are, however, circumstances under which a therapeutic relationship may need to conclude before that natural endpoint is reached. In those moments, the same care and intentionality apply, and no client is ever left without a path forward.
Circumstances that may prompt a clinical discharge or transition:
- Attendance falling below the threshold set by the four-in-four continuity policy, described above.
- A presenting concern that evolves beyond the scope of Dr. Lapite-Garrett's clinical specialization, where a different provider would serve the client more precisely.
- A level of care need that requires a higher or more intensive level of service than outpatient private practice can safely provide.
- A boundary violation or safety concern that cannot be clinically resolved within the therapeutic relationship.
- Non-payment of fees after reasonable, documented attempts to resolve the matter.
- A determination, reached jointly or independently, that the therapeutic relationship is no longer clinically productive or safe for either party.
In every circumstance, termination is handled with dignity, transparency, and a genuine commitment to continuity of care. Where referrals are appropriate, they are thoughtfully provided. Where a planned transition is possible, it is structured to honor the work already done and to prepare the client for what comes next.
Before an unresolved balance is ever referred to collections or pursued through any legal measure, a client is notified directly that this step is being considered and is given a genuine opportunity to resolve the balance first; referral or legal action follows only if that opportunity does not resolve the matter. A disputed or fraudulent chargeback is handled the same way, addressed with the client directly and documented as part of the client's own record, rather than acted on without the client's knowledge.
A client is free to end the therapeutic relationship at any time, for any reason. The only ask is that the decision be communicated directly, in session or through the secure client portal, so the work can be closed with the same intentionality it began with. A brief closing session is always available to any client who wants to mark the ending thoughtfully, and it is genuinely encouraged.
A Final Note
The work itself is what matters most at Alafiora. These policies exist to make that work possible, sustainable, and worthy of the trust a client brings to it. A question raised by anything on this page is worth bringing forward, and something that feels unclear or unexpectedly activating is worth naming too. This structure is designed to be discussed openly, at any point along the way.
Common Questions About Practice Policies
What Clients Ask Before a First Session
Scheduling, Telehealth, and Records Questions
What happens if I need to cancel a session with less than 48 hours' notice?
Often, this means the full session fee applies, though every client is extended one complimentary cancellation per quarter with no charge and no explanation required, and a true emergency no-show is handled case by case rather than by the standard late-cancellation rule.
Does the cancellation policy apply the same way to concierge retainer clients?
Not exactly. Executive Concierge Retainer clients are exempt from the standard cancellation and no-show policy; they receive priority scheduling and flexible rescheduling as long as changes happen within the same calendar month and within mutually available hours, governed entirely by the retainer agreement rather than by the policy that applies to standard fee-for-service clients.
Can I text or email Dr. Lapite-Garrett between sessions if something comes up?
Yes, for scheduling, administrative matters, and brief logistical updates, through the secure client portal during standard business hours. Clinical questions and support between sessions are not addressed by message, email, or phone; they are held for the session itself or for a scheduled Clarity Session, since this practice is not structured as a crisis line.
Is telehealth actually as effective and secure as an in-person session?
Yes, and this is a common and reasonable question to ask before a first virtual appointment. Telehealth at Alafiora runs through a secure, HIPAA-compliant platform and is treated as a fully clinically equivalent modality to in-person care, with its own technical, location, and environment requirements described above to keep sessions private and effective.
What happens if I miss too many sessions in a short period of time?
This is where the four-in-four continuity policy comes in: four or more cancellations, reschedules, or missed sessions within any four-month period triggers a direct clinical conversation, and a fourth cancellation after that conversation closes the therapeutic relationship, with referrals provided and a six-month waiting period before returning to the practice is considered.
Will my therapy records ever be shared with my insurance company or employer?
No, not without a client's own explicit, written consent, except where disclosure is mandated by law. Session notes stay in an encrypted electronic health record, and every client can request access to their own record, request a correction, or receive an accounting of any disclosures made on their behalf.
Begin a Confidential Conversation
Reading this page in full is exactly the kind of preparation this practice hopes every prospective client brings to a first conversation, whether the next step is a consultation to ask questions first or a first session for anyone already certain and ready to begin. The consultation is a brief conversation, held in confidence within the legal and professional limits of confidentiality any licensed psychologist explains before clinical work begins, where these policies, or anything else about how this practice works, can be asked about directly. Those already certain they are ready are equally welcome to begin directly with a first session.
For anyone who wants the specific numbers behind these policies, exact session rates, and the retainer structure before reaching out, the Rates and Fees page covers that ground directly, and this page can always be bookmarked, or the QR code in the footer scanned, to keep this practice's policies close until the timing feels right.
Every session at Alafiora is held by one licensed psychologist
Dr. Esther Lapite-Garrett is the founder and sole practitioner of Alafiora. There are no associates, no rotating providers, and no case handoffs: the person who reads a client's history in the first session is the same person still holding it two years later. She is licensed in New Mexico and Indiana, with additional state licensure underway.
Her training is doctoral-level, which typically extends several years beyond a master's-level license in assessment, diagnosis, and the treatment of complex, overlapping presentations. She keeps a deliberately small caseload so that depth is possible, participates in ongoing peer consultation and clinical training, and maintains her own personal therapy.
Whatever brought someone to this page today is never put on trial here
A consultation is a brief conversation with no obligation attached. Those already certain they are ready are equally welcome to begin directly with a first session.