All information disclosed within sessions is held confidential by me, Karen Ouse, and is not given to anyone outside of the context of clinical consultation without your permission except where disclosure is required by law (i.e. where there is reasonable suspicion or possibility of child or elder/dependent adult abuse, actual or potential; where you present a danger of grave violence to another; or where you are likely to harm yourself unless protective measures are taken). In couples therapy, I maintain a no-secrets policy.

I require a minimum of a full 24 hours notice by 2 forms of communication (phone, text, or email) to make sure the message is received for cancellations or your need to reschedule. If you call and email with less than a full 24 hours to cancel/reschedule, or if you miss/forget your appointment, you will be responsible for the full fee.

Please note that the 24 hour cancellation notice does not include weekends or holidays. Please understand your regularly scheduled appointment is reserved exclusively for you, and no one else is given that time.  If you think you are going to be ill, or miss your appointment for any other reason, please let me know in advance of the notice required, in order to avoid the fee that will be charged.  The only exception to this 24 hour cancellation policy is death of an immediate family member or serious life-threatening emergency. If over a short period of time you are having to cancel or reschedule your regularly appointed time frequently, I will discuss it with you and we can explore whether or not it is the right time for you to be investing in therapy.

I offer a sliding scale rate of $175-$210 for a 50-minute session, $180-$220 for a 60-minute couples session. Should my fee increase, you will be notified a minimum of 4 weeks in advance of the increase. 

Telephone consultations/additional phone time with me between office visits are welcome with the following understanding: you will be charged for phone time at the rate per hour in accordance with my fee. I am also available to speak with you in 15-minute increments based on the hourly fee. Fees for phone time are not applicable to voicemails or scheduling/cancellation issues.

You may leave confidential voicemail messages for me at (831) 689-7676. You may also email me at Please note that calls received after 5 pm or on weekends or holidays will be returned the next working day. If your call is time sensitive I will call you back as soon as I am able. If your call is an emergency, please call the Santa Cruz Behavioral Health Crisis Line at 600-2800, or 911.

You may pay for your sessions by cash, check, credit card, money order, or PayPal. Please pay at the beginning of your session (or before if using PayPal) to avoid distraction before you leave. Payments must be made before another appointment is scheduled. There is a $10 charge for returned checks. After two returned checks, a different form of payment will be required. Although I do not accept insurance, I am happy to provide you with a statement or super bill for your records or for you to submit to your insurance provider. Because I cannot guarantee reimbursement, you will need to call your insurance company to determine the rate of reimbursement for seeing an out of network provider. Also, check with your health plan to see if a doctor's referral is required in order to receive reimbursement. Please note that insurance plans do not pay for missed appointments and you will be responsible for full payment.