CLIENT-COUNSELOR SERVICE AGREEMENT
Counseling is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As a client in counseling, you have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights that you should be aware of. As your counselor, I have corresponding responsibilities to you. These rights and responsibilities are described in the following sections.
Goals of Counseling
There can be many goals for the counseling relationship. Some of these will be long term goals such as improving the quality of your life, learning to live with mindfulness and self-actualization. Others may be more immediate goals such as decreasing anxiety and depression symptoms, developing healthy relationships, coping with trauma, changing behavior or decreasing/ending addictive behavior. Whatever the goals for counseling, they will be set by the clients according to what they want to work on in counseling. I may make suggestions on how to reach that goal but you decide where you want to go.
Appointments
Therapy sessions are by appointment only. Appointments will ordinarily be 50 minutes in duration, once per week at a time we agree on, although some sessions may be more or less frequent. If you need to cancel or reschedule a session, I ask that you provide me with 24 hour notice. If you miss a session without canceling, or cancel with less than 24-hour notice, you will be required to pay a cancellation fee for the session (unless we both agree that you were unable to attend due to circumstances beyond your control). It is important to note that insurance companies do not provide reimbursement for cancelled sessions; thus, you will be responsible for the cancellation fee. In addition, you are responsible for coming to your session on time. If you are late, your appointment will still need to end on time.
Payment Policy
The client is responsible for payment in full at the time of each session via personal check, cashier's check or cash. A $25 administrative fee will be charged on all checks that are returned for non-sufficient funds.
Risks/Benefits of Counseling
Counseling is an intensely personal process which can bring unpleasant memories or emotions to the surface. There are no guarantees that counseling will work for you. Clients can sometimes make improvements only to go backwards after a time. Progress may happen slowly. Counseling requires a very active effort on your part. In order to be most successful, you will have to work on things we discuss outside of sessions. However, there are many benefits to counseling. Counseling can help you develop coping skills, make behavioral changes, reduce symptoms of mental health disorders, improve the quality of your life, learn to manage anger, learn to live in the present and many other advantages.
Confidentiality
In general, the law protects the privacy of all communication between a patient and a counselor. I can only release information about our work to others with your written consent on a release form, which I can provide. In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if the judge determines that the issue demands it.
There are some situations where I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a patient’s treatment. For example, if I believe that a child, elderly person, or disabled person is being abused, I must file a report with the appropriate state agency. If I believe that a patient is threatening to do serious bodily harm to him/herself or another person, I am required to take protective actions. These actions may include notifying the potential victim, contacting family members who can help provide protection, contacting the police, or seeking hospitalization for the client. This is not a common occurrence in my practice yet I will make every effort to fully discuss it with you before I take any action should a situation like this arise.
Confidentiality for Minors
If you are under the age of 18, please be aware that the law may provide your parents the right to examine your treatment records. I do my best to maintain this privacy for you yet this is your parent’s legal right. Information that is provided to your parents will be a general overview of our work together, unless I feel that there might be a risk that you will seriously harm yourself or someone else. In this case, I will notify your parents with my concerns. Before giving them any of this information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have with what I am prepared to discuss.
Confidentiality and Group Therapy
The nature of group counseling makes it difficult to maintain confidentiality. If you choose to participate in group therapy, be aware that I cannot guarantee that other group members will maintain your confidentiality. However, I will make every effort to maintain your confidentiality by reminding group members frequently of the importance of keeping what is said in group confidential. I also have the right to remove any group member from the group should I discover that a group member has violated the confidentiality rule.
Confidentiality and Technology
Some clients may choose to use technology in their counseling sessions. This includes but is not limited to online counseling via Skype, telephone, email, or text. Due to the nature of online counseling, there is always the possibility that unauthorized persons may attempt to discover your personal information. I will take every precaution to safeguard your information but cannot guarantee that unauthorized access to electronic communications could not occur. Please be advised to take precautions with regard to authorized and unauthorized access to any technology used in counseling sessions. Be aware of any friends, family members, significant others or co-workers who may have access to your computer, phone or other technology used in your counseling sessions.
Record Keeping
I will be keeping records of your counseling sessions and a treatment plan, which includes goals for your counseling. These records are kept to ensure a direction to your sessions and continuity in service. They will not be shared except with respect to the limits to confidentiality discussed in the Confidentiality section. Should a client wish to have their records released, they are required to sign a release of information, which specifies what information is to be released and to whom. Records will be kept for at 5 years in accordance with mandates from my licensing board. Records will be kept either electronically on a USB flash drive or in a paper file and stored in a locked cabinet in my office.
Contacting Me
I do not offer a 24 hour service. Should a clinical emergency arise, please call 911 or go to your nearest emergency room. Should you wish to reach me to discuss scheduling please be aware that I only answer calls during office hours. I ask that you please refrain from texting me unless it pertains to scheduling. I do my best to return calls within a 24 hour period. Please understand that my practice is quite busy and not only am I the clinician, I am also the secretary and calls cannot always be returned as promptly as I would like.
Email
Please be aware that my email is reserved for communication pertaining to scheduling. Should you send me documentation for review or email me between sessions to discuss issues that we are working on in therapy, there will be a charge for document review.
There can be many goals for the counseling relationship. Some of these will be long term goals such as improving the quality of your life, learning to live with mindfulness and self-actualization. Others may be more immediate goals such as decreasing anxiety and depression symptoms, developing healthy relationships, coping with trauma, changing behavior or decreasing/ending addictive behavior. Whatever the goals for counseling, they will be set by the clients according to what they want to work on in counseling. I may make suggestions on how to reach that goal but you decide where you want to go.
Appointments
Therapy sessions are by appointment only. Appointments will ordinarily be 50 minutes in duration, once per week at a time we agree on, although some sessions may be more or less frequent. If you need to cancel or reschedule a session, I ask that you provide me with 24 hour notice. If you miss a session without canceling, or cancel with less than 24-hour notice, you will be required to pay a cancellation fee for the session (unless we both agree that you were unable to attend due to circumstances beyond your control). It is important to note that insurance companies do not provide reimbursement for cancelled sessions; thus, you will be responsible for the cancellation fee. In addition, you are responsible for coming to your session on time. If you are late, your appointment will still need to end on time.
Payment Policy
The client is responsible for payment in full at the time of each session via personal check, cashier's check or cash. A $25 administrative fee will be charged on all checks that are returned for non-sufficient funds.
Risks/Benefits of Counseling
Counseling is an intensely personal process which can bring unpleasant memories or emotions to the surface. There are no guarantees that counseling will work for you. Clients can sometimes make improvements only to go backwards after a time. Progress may happen slowly. Counseling requires a very active effort on your part. In order to be most successful, you will have to work on things we discuss outside of sessions. However, there are many benefits to counseling. Counseling can help you develop coping skills, make behavioral changes, reduce symptoms of mental health disorders, improve the quality of your life, learn to manage anger, learn to live in the present and many other advantages.
Confidentiality
In general, the law protects the privacy of all communication between a patient and a counselor. I can only release information about our work to others with your written consent on a release form, which I can provide. In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if the judge determines that the issue demands it.
There are some situations where I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a patient’s treatment. For example, if I believe that a child, elderly person, or disabled person is being abused, I must file a report with the appropriate state agency. If I believe that a patient is threatening to do serious bodily harm to him/herself or another person, I am required to take protective actions. These actions may include notifying the potential victim, contacting family members who can help provide protection, contacting the police, or seeking hospitalization for the client. This is not a common occurrence in my practice yet I will make every effort to fully discuss it with you before I take any action should a situation like this arise.
Confidentiality for Minors
If you are under the age of 18, please be aware that the law may provide your parents the right to examine your treatment records. I do my best to maintain this privacy for you yet this is your parent’s legal right. Information that is provided to your parents will be a general overview of our work together, unless I feel that there might be a risk that you will seriously harm yourself or someone else. In this case, I will notify your parents with my concerns. Before giving them any of this information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have with what I am prepared to discuss.
Confidentiality and Group Therapy
The nature of group counseling makes it difficult to maintain confidentiality. If you choose to participate in group therapy, be aware that I cannot guarantee that other group members will maintain your confidentiality. However, I will make every effort to maintain your confidentiality by reminding group members frequently of the importance of keeping what is said in group confidential. I also have the right to remove any group member from the group should I discover that a group member has violated the confidentiality rule.
Confidentiality and Technology
Some clients may choose to use technology in their counseling sessions. This includes but is not limited to online counseling via Skype, telephone, email, or text. Due to the nature of online counseling, there is always the possibility that unauthorized persons may attempt to discover your personal information. I will take every precaution to safeguard your information but cannot guarantee that unauthorized access to electronic communications could not occur. Please be advised to take precautions with regard to authorized and unauthorized access to any technology used in counseling sessions. Be aware of any friends, family members, significant others or co-workers who may have access to your computer, phone or other technology used in your counseling sessions.
Record Keeping
I will be keeping records of your counseling sessions and a treatment plan, which includes goals for your counseling. These records are kept to ensure a direction to your sessions and continuity in service. They will not be shared except with respect to the limits to confidentiality discussed in the Confidentiality section. Should a client wish to have their records released, they are required to sign a release of information, which specifies what information is to be released and to whom. Records will be kept for at 5 years in accordance with mandates from my licensing board. Records will be kept either electronically on a USB flash drive or in a paper file and stored in a locked cabinet in my office.
Contacting Me
I do not offer a 24 hour service. Should a clinical emergency arise, please call 911 or go to your nearest emergency room. Should you wish to reach me to discuss scheduling please be aware that I only answer calls during office hours. I ask that you please refrain from texting me unless it pertains to scheduling. I do my best to return calls within a 24 hour period. Please understand that my practice is quite busy and not only am I the clinician, I am also the secretary and calls cannot always be returned as promptly as I would like.
Please be aware that my email is reserved for communication pertaining to scheduling. Should you send me documentation for review or email me between sessions to discuss issues that we are working on in therapy, there will be a charge for document review.