Informed consent
This page contains my informed consent document, which has more detailed information about counseling, my practice, and my policies and procedures. If you choose to work with me, we will discuss this information in our first session and answer any questions you have.
Informed Consent for Counseling
Counseling Overview
Counseling is a process in which a counselor and one or more people, called the client(s), meet regularly to discuss the concerns and successes of the clients, with the goal of addressing concerns and strengthening successes in the clients life. Counseling can help clients deal with problems related to mental health, problems in their daily life, relationship concerns, substance use, and a variety of other problems. Counseling is a strength-based form of treatment: counselors utilize the capacities and skills of the clients, and areas in which they wish to grow skills and abilities, to help the client deal with concerns and problems in their life. Counselors believe that you have it within yourself to address your problems. For this reason counselors help you in the form of guidance, companionship, and support, rather than in terms of solving problems for you. Our appointments are your time: the topics, issues, and problems we discuss are largely up to you as the client. I may identify other areas and potential blind spots that you may benefit from addressing, and I will discuss these with you. Nonetheless, with few exceptions, the focus of counseling is your choice.
Counseling can take many forms, but it should always focus on the needs of the client. I will not discuss myself, my life, or my concerns except when it is directly in service to you as the client. Among the forms counseling can take, many people choose to focus either on solving immediate problems in their life, and/or on addressing deeper underlying problems and patterns that have caused, and may continue to cause, problems in their life. Often, I work with clients to address current problems before moving into deeper patterns.
Counselors cannot provide medication or other medical interventions, but I will help you to connect with providers that can provide these services as needed.
Counseling works best when the relationship between us is warm, trusting, goal-oriented, and emotionally intimate. If you identify any barrier to having this kind of relationship with me, please bring it up for us to discuss. The goal of counseling is to support you to be able to live in a way where you no longer need counseling – when you reach this point, I will be excited for you and it will be time to discuss terminating the relationship.
Counseling may be done in an individual, couples, or family format. It is often helpful to shift between these formats when dealing with problems: for an individual to bring in their partner, for me to see the whole family after seeing a member of the family for some time, or for members of a couple to come in individually. I may suggest this at times, or if you are curious about doing this, we can discuss it. It is also sometimes appropriate to bring in other significant figures in the life of the person, couple, or family. This may include friends, faith leaders, and others with close relationships to you. Be advised that confidentiality faces limits when doing this, so before making any of these changes, we should carefully discuss what is and is not safe to share with others joining the counseling setting.
Client and Counselor Rights and Responsibilities
As a client, you are entitled to several rights. These include a right to confidentiality, a right not to be harmed, a right to be benefitted by counseling, and a right to accurate information about mental health, well-being, and counseling in general.
Confidentiality refers to the process of keeping what we discuss in counseling private between us. I will not share topics we talk about in counseling with anyone, with a few exceptions. As an LMHCA, I am required to have weekly supervision of my counseling to ensure I am providing competent and professional care. I may discuss you and your treatment with my supervisor, Tim Donovan LMHC. Mr. Donovan is required to maintain confidentiality regarding information I discuss with him. The law also describes several instances in which confidentiality must be broken to protect the welfare of clients and the general public. These limits to confidentiality include:
Imminent risk of suicide: if I determine that you are very likely to kill yourself in the immediate future, I may be required to break confidentiality by referring you to a hospital or other institution that can help keep you safe
Imminent risk of harm to others: if I determine that you are likely to seriously harm a specific person or group of people in the near future, I have a ‘duty to warn’ that person or persons that you are at risk of harming them.
Current abuse of vulnerable populations: if I learn that there is physical or sexual abuse, or neglect, being done to a person in a vulnerable population, I am required to notify the state of these events so they may protect the victims. Vulnerable populations include children, the elderly, disabled adults, and prisoners.
In some cases when working with minors, I may be required to break confidentiality by notifying parents of extremely risky behaviors including risky sexual behavior, substance use, violent behavior, and self-harm
I may be subpoenaed by the courts to testify in court cases. I will make all reasonable efforts to resist a subpoena or other mandate to testify in court in an effort to protect confidentiality.
In the event any of these concerns come to pass, we will discuss my need to break confidentiality and you will be prepared for what to expect. I will make all appropriate efforts to avoid breaking confidentiality if possible, such as developing a plan to avoid imminent harm or suicidality. Keep in mind that things that happened in the past are generally safe from needing to be disclosed.
You may sign a release of information to allow specific other persons or organizations to have access to information about counseling. You are not required to sign a release of information unless legally mandated.
Included in things protected by confidentiality are treatment records. I keep notes of our appointments to help track progress in treatment and for legal and professional accountability. No one besides me will have access to your records unless you explicitly give written permission for someone to see them. You are entitled to access to your records at any time by asking me, but be advised that the records may include my professional judgments that may be sensitive to you.
You have a right not to be harmed by counseling. However, counseling comes with some risks. Discussing difficult issues may cause negative emotions and may worsen some negative behaviors. If this occurs, it is generally a good sign that you are making progress in therapy. I am prepared to help you endure difficult times like this. In general, if you feel harmed by anything I do or say, please discuss it with me. You are also entitled to issue a complaint to the counseling licensing board (https://www.in.gov/pla/file-a-complaint/). To protect you from risk of harm, I am forbidden from and will not pursue any kind of personal relationship with current or past clients, including friendships, romantic or sexual relationships, and relationships involving a serious conflict of interests (i.e. relationships in which your interests as a client are threatened by an incentive I have to treat you a certain way due to another relationship we have).
You have a right to benefit from counseling. I will utilize my best knowledge and skillset to ensure you benefit from our relationship. If you feel you are not being helped, please discuss this with me. We can arrange a different approach to treatment, or I can refer you to a clinician that may better help you.
You have a right not to be abandoned as a client. I will not end treatment with you prematurely, barring some exceptions. If I must end treatment with you before you are ready, you are entitled to referral to another clinician. Exceptions that may warrant premature termination of counseling include inappropriate shifts in the counseling relationships, lack of payment, and frequently missed appointments.
Your responsibilities as a client are to attend scheduled sessions, pay fees within a reasonable time (within a month of bill received), and to engage in treatment to your fullest capacity, including by making use of our time together and by completing assigned ‘homework,’ that is, tasks to work on betweens sessions.
My responsibilities are to protect your rights as a client, and to provide competent and helpful counseling in a reliable, predictable manner.
Telehealth
If we have a telehealth appointment, it is required that you have the appointment in a confidential location. If you are unable to do this I am entitled to refuse to have an appointment via telehealth. Please have a stable internet connection and a quiet space so we can work together most effectively.
Scheduling and Missed Appointments
We can agree on appointment dates and times over phone, text, and email. It is best to keep a regular appointment time. If we are unable to find a mutually agreeable time, I may ask other clients if they are willing to change times to fit you in. If this is not possible, I will put you on a waitlist and regularly check-in to identify an agreeable time.
Appointments are typically 50-60 minutes and usually begin on, or shortly after, the hour. You may end a session early if you wish, but you are accountable to the full hour fee. It is rare I can have sessions longer than 65 minutes so as to not keep the next client waiting. Longer sessions are possible with prior discussion, but are not guaranteed, and may be liable to a higher fee. If you are more than 25 minutes late, it may not be possible to have a session on that day, and you are accountable to a missed appointment fee.
The first appointment or two is typically an initial evaluation in which I develop a sense of you, your concerns, and what is going well in your life. These evaluations may require me to ask questions and gather specific information about your life. You are entitled to decline to answer any questions at any time in treatment, but please discuss with me reasons you feel uncomfortable to disclose. Later sessions tend to shift focus to you leading the conversation.
Please keep regular appointments. This is critical for us to be able to maintain a consistent and effective counseling relationship. If you must miss an appointment, please give at least 24 hour notice. If you cannot make an appointment because of transportation concerns, I may be able to provide a telehealth appointment.
Except for circumstances outside your control, appointments that are missed or canceled with less than a 24 hour notice result in a missed appointment fee. The fee is equal to your copay, or 25$, whichever is greater.
I may take time off, or be unable to make an appointment due to illness or emergencies. You are not liable for a missed appointment fee at these occasions. When possible, I will give you at least two weeks' notice of upcoming changes to the schedule.
Payment Policies
The standard fee for my services is $120/hour. Sliding scale (reduced) fees are possible in instances of need. Please discuss this with me as early as possible if you may need this. I have the right to refuse to provide services at a reduced rate. Most insurance plans cover most concerns discussed in counseling. I cannot take Medicaid, HIP, or Medicare insurance, but can take most private insurances. It is important to determine if I am in network with your insurance provider, as being out of network may increase your deductible or make you ineligible for reimbursement for my services.
If you have a copay or are paying out of pocket, this payment is due at time of service. Missed appointment fees are due at the time of the next appointment. When billing insurance, it takes about one month between time of service and receiving a bill back from insurance. When this bill arrives, if you have not met your deductible, you are responsible for paying the deductible fee at the time of next session. If you have met your deductible, then you are responsible only for copays or coinsurance, if you have any.
After we terminate our counseling relationship, I may still receive insurance claims that have been processed after we terminated our relationship. If you have not met your deductible, you are accountable to pay these fees. I will contact you and arrange a way to make these payments.
If you must delay payment for any reason, please discuss this with me and we can identify an agreeable plan for when to make payments. I am also open to agreeing on a payment plan if an individual payment is too large.
In instances of regularly missed fees, I am entitled to charge interest on missed fees, and/or to bring this concern to small claims court. I would like to avoid this as much as possible, so please discuss any concerns around payment with me. In instances of need it is possible, but not guaranteed, to adjust fees or give you additional time to pay.
Supervision and Office Space
I receive weekly supervision in which I may discuss your case with my supervisor, who is also bound to confidentiality. This is done to best help me support you in attaining your goals in counseling.
I am currently sharing office space with other counselors. Please respect the space for their sake as well as for mine. Sharing space may result in some scheduling conflicts. I will notify you of this as soon as possible and we will identify an agreeable alternative, potentially including telehealth appointments.
I am not formally affiliated with any other counselors in the suites I utilize to perform counseling. My actions are my own, and no other counseling in the suites are liable to any issues you may bring to court or to the licensing board.
Legal Involvement
If you expect that you may be involved in a court case that may require me to testify in court, please notify me as soon as you are aware of this. If I am mandated to testify, I charge my standard fee per hour (120$) for all activities required to prepare for, travel to and from, and testify in court. The person asking or compelling me to testify is accountable to these fees; if the person compelling me to testify will not pay, the responsibility falls to my client. Be advised that if you ask me to testify in court, you waive your right to confidentiality.
I will resist all efforts to require me to testify unless breaking confidentiality by testifying is of considerable benefit to my client(s) involved in the case. If I must testify, I will provide as little information as possible to give an honest and accurate response to questions I am asked.
Diagnosis and Treatment Approach
It is my preference to avoid focusing on your problems and concerns in terms of a DSM-V-TR (Diagnostic Statistical Manual V Text Revision) diagnosis. This is a matter of professional preference: I believe diagnosis obscures the deeper context and meaning of problems you are having, and instead places the emphasis on a list of symptoms and concerns. If you have a diagnosis in mind when coming to our initial sessions, I will help you discuss this diagnosis and explore ways it seems to describe your problem. I may or may not agree with the diagnosis you have in mind. In lieu of using a diagnostic label, I will typically refer to specific problems you are having in the terms you use to describe them; this helps to keep our discussion grounded in your lived experience. For example, we are much less likely to talk about ‘depression’ than we are to talk about things like ‘low self-esteem’ or ‘feeling unmotivated,’ in terms that reflect your actual life.
To file insurance claims, I must issue a diagnosis or diagnoses to justify the medical necessity of treatment. If you are curious about what diagnoses I use, then please ask; however, be advised I will attempt to maintain the style of treatment described in the paragraph above.
In some cases, diagnoses are helpful, particularly for communicating problems you have with other people, or for understanding your own problem. If this is of considerable benefit to you, I may provide a diagnostic label for you for this reason.
If a formal diagnosis is required for a legal, medical, or other reasons, I am able to formally diagnose you with most DSM-V-TR diagnoses. The exceptions are diagnoses in the Developmental Disorders and Neurocognitive Disorders categories of diagnoses. This includes diagnoses like Attention Deficit/Hyperactive Disorder, Autism Spectrum Disorder, Intellectual Disability, and Dementia. We can still discuss and address concerns related to these diagnoses in treatment. If you require a formal diagnosis of one of these disorders, I can refer you to a psychologist or neurology doctor who can assist you with this.
I utilize an eclectic approach to counseling, meaning I draw on a number of theoretical models and treatment approaches to help my clients. I emphasize existential, humanistic, narrative, psychodynamic, and mindfulness-based cognitive behavioral approaches, though I may draw from others as well. If you have any questions about these modalities and how I may use them to support you, please ask. If you have a preference for a treatment modality, please discuss it with me and why you’d prefer it.
Counseling Minors
Some special limitations to confidentiality may apply when counseling minors. The parent or guardian is entitled to ask questions about the progress of treatment. I must answer honestly, but will provide as little confidential information as possible. Parents or guardians are also entitled access to my clinical records of their minor’s treatment on request. I may redact information that the minor does not wish you to see if I feel this is necessary to protect the counseling relationship and the minor’s well-being.
I strongly suggest asking both me and the minor as little as possible about treatment to protect the privacy and intimacy of the therapeutic space. Minors may be less willing to be honest with me about their concerns if they are concerned that the parent or guardian will know what we are talking about. This impedes a productive therapeutic relationship.
I may ask the parents or guardians questions to help better understand the context in which the minor is living. Do not take these questions as indicative of any particular diagnosis, concern, or problem: they are simply to help me paint a better picture of the minor’s life.
I am open to and usually encourage the occasional family session, particularly once I have built a strong relationship with the minor. This helps to address problems that the minor is having in a more systemic and holistic way. In such sessions I will discuss as little confidential information I have learned privately from the minor unless given explicit permission to share it.
Note on Social Justice and Equitability
It is of great importance that counselors work in ways that strive for social justice and equitability. This includes seeing a diverse array of clients with a wide variety of demographic and personal identity differences. I am committed to working with clients of all backgrounds. If relevant to my understanding of you, your problems, and our relationship, please feel free to talk to me about any aspect of identity that you may possess. I may also invite conversations about this if I feel it is relevant to your treatment. If you have any concerns about sharing these aspects of yourself, then please let us talk about that.
If socioeconomic concerns would otherwise prevent you from seeking regular counseling, please discuss this with me so we can agree on a tolerable fee. This is an aspect of social justice I prioritize in my practice. However, keep in mind that I’m entitled to refuse services at a reduced fee.
I am trained to support clients with different cultural backgrounds from my own, including people of a different ethnicity, national origin, religion, racial identity, sexual orientation, relational orientation (ie polyamory and other marginalized relationship styles), gender identity, immigration status, socioeconomic status, and other related identity differences. If you feel in any way that these differences or my failure to understand these differences in a respectful and empathetic way is a barrier to treatment, please discuss this with me. I’m particularly willing to discuss issues of prejudice or discrimination that you may have faced with previous therapists and how I can support you in resolving this so it does not interfere with our relationship.
Other groups I particularly wish to state my awareness of and support for are for people who engage in diverse sexual behaviors including kink and sex work; and people with current or past legal issues. I mention these identities specifically because they are identity domains often under-represented in efforts to increase diversity and inclusion. Please feel free to discuss any of these identities with me as necessary to your work with me in counseling.
Contacting Me
You may reach out to me at any time via email, which is the best way to reach me. You may also contact me via text for scheduling concerns or urgent crises. Please be aware that the counseling relationship works best when confined as much as possible to our appointment times. This is because the goal of counseling is to help you live a life where you do not need counseling. Involving me in more of your day-to-day life may lead to greater reliance on me in ways that detracts from this goal.
However, crises that may involve suicidality, homicidality, serious self-harm or risk-taking, and significant substance relapse are a good reason to reach out to me. Be advised I may not be able to respond to your email or text immediately. If you require urgent support, a crisis hotline like 988 may be more suitable.
Some treatment modalities for specific problems encourage greater communication between the counselor and client outside of usual appointment times. If I feel this may be helpful for you, I will explain what this will entail, what is appropriate communication and frequency of communication, and my rationale for including this as part of treatment. This is a rare intervention so do not expect this to be a part of our work together.
I am usually unable to accept phone calls due to being in appointments or in other obligations.