THERAPY CONSENT, POLICIES, & AGREEMENT

What to Expect in Therapy/Counseling

Benefits and Outcomes

The therapeutic process seeks to meet goals established by all persons involved, usually revolving around a specific complaint(s). Participating in therapy may include benefits such as the resolution of presenting problems as well as improved intrapersonal and interpersonal relationships. The therapeutic process may reduce distress, enhance stress management, and increase one’s ability to cope with problems related to work, family, personal, relational, etc. Participating in therapy can lead to a greater understanding of personal and relational goals and values. This can increase relational harmony and lead to greater happiness. Progress will be assessed on a regular basis, and feedback from clients will be elicited to ensure the most effective therapeutic services are provided. There can be no guarantees made regarding the ultimate outcome of therapy.

Expectations

In order for clients to reach their therapeutic goals, it is essential they complete tasks assigned between sessions. Therapy is not a quick fix. It takes time and effort, and therefore, may move slower than your expectations. During the therapy process, we identify goals, review progress, and modify the treatment plan as needed.

Risks

In working to achieve therapeutic benefits, clients must take action to achieve desired results. Although change is inevitable, it can be uncomfortable at times. Resolving unpleasant events and making changes in relationship patterns may arouse unexpected emotional reactions. Seeking to resolve problems can similarly lead to discomfort as well as relational changes that may not be originally intended. We will work collaboratively toward a desirable outcome; however, it is possible that the goals of therapy may not be reached.

Structure of Therapy/Counseling

• Intake Phase – During the first session, the therapeutic process, structure, policies, and procedures will be discussed. We will also explore your experiences surrounding the presenting problem(s).
• Assessment Phase – The initial evaluation may last 2-4 sessions. During this assessment phase, I will be getting to know you. I will ask questions to gain an understanding of your worldview, strengths, concerns, needs, relationship dynamics, etc. During this relationship-building process, I will be gathering a lot of information to aid in the therapeutic approach best suited for your needs and goals. If it is determined that I am not the best fit for your therapeutic needs, I will provide referrals for more appropriate treatment.
• Goal Development/Treatment Planning – After gathering background information, we will collaboratively identify your therapeutic goals.
• Intervention Phase – This phase occurs anywhere from session two until graduation/discharge/termination. Each client must actively participate in therapy sessions, utilize solutions discussed, and complete assignments between sessions. Progress will be reviewed and goals adjusted as needed.
• Graduation/Discharge/Termination – As you progress and get closer to completing goals, we will collaboratively discuss a transition plan for graduation/discharge/termination.

Length of Therapy/Counseling

Therapy sessions are typically weekly or biweekly for 45 minutes depending upon the nature of the presenting challenges. It is difficult to initially predict how many sessions will be needed. We will collaboratively discuss from session to session what the next steps are and how often therapy sessions will occur.

Appointment Insights: Scheduling, Cancellations, and Billing

Appointments and Cancellations

You are responsible for attending each appointment and agree to adhere to the following policy: If you cannot keep the scheduled appointment, you MUST notify our office to cancel or reschedule the appointment no later than 12:00am (midnight) the day of your appointment. You can cancel by calling or texting (314) 246-0480 or emailing liz@enlitens.com. If you do not attend the session, or if you cancel the same day, a late cancellation/no-show fee of $25 will be applied to your credit card on file. I will reach out to you prior to your card being charged. If you are able to reschedule within 3 business days (Monday – Thursday) the fee will be applied to your next session.

In an effort to maximize your therapeutic experience please arrive on time for sessions. If you do not arrive on time I will attempt to call you 5 minutes after the start of the session time. If you are unable to begin the session within 15 minutes of the session start time the session will be considered a late cancellation and the late cancellation fee will be applied.

If you are on a recurring schedule (e.g., every Monday, every other Thursday) and miss two consecutive sessions without contacting me, I will cancel your recurring appointment. I will reach out to you to attempt to get you scheduled at a time that works best for you.

I reserve the right to terminate the counseling relationship if more than 2 consecutive sessions are missed without proper notification. I will attempt to reach out to you to continue the therapeutic process if possible. You will be notified in writing if your services have been terminated due to missing appointments.

Psychotherapy is a uniquely personal service; therefore, consultations may be briefly interrupted. I may periodically take time off for vacation, seminars, and/or become ill. Attempts will be made to give adequate notice of these events. If I am unable to contact you directly, a colleague may contact you to cancel or reschedule an appointment.

Weather Policy

In the event of a weather emergency, your appointment may be canceled or rescheduled without any penalty. If local schools have been canceled (Lindbergh, Mehlville, Fox) you will not incur a fee for missing appointments. This also applies to any storm warnings applied to the 63128 zip code. You can also let me know that you are not comfortable with traveling in the weather and we can discuss canceling, transitioning to virtual, or rescheduling. Please reach out to me if you wish to cancel your appointment due to inclement weather as I will not automatically cancel any appointments.

There may be instances where I cancel appointments due to weather or the impact of weather on the safety of clients and myself. My goal is to give you as much notice as possible. I will typically reach out to you via text and email if this happens.

Billing

Fees: The fee for each 45-minute therapy session is $100, and there is also a sliding scale based on income that you can choose to use.

Payments: Payment is due at the time of service. Acceptable forms of payment are cash, check (insufficient-funds checks will require payment of the original amount plus $25 for any returned check), or credit/debit card. In the event that a scheduled appointment time is missed or canceled in less than 24 hours, please refer to the “Appointments and Cancellations” policy above.

If you would like to have your card on file charged for your session on a date different from the day you are seen, please discuss this with me. If your card is declined you will be notified via email. It will also be discussed in your next session. If you need to discuss a payment plan for any balance on your account, or if you need to discuss the cost of your sessions, please let me know. If your card is declined for two sessions in a row without a payment plan in place, services will be interrupted until a payment plan is arranged.

Insurance: Insurance availability varies based on the insurance company and your plan. My goal is to be able to make mental healthcare affordable, and I understand insurance is a large piece of that. Please visit our Using Insurance for Counseling page to learn more. Let me know if you would like to use insurance benefits for your services. As I am approved to work with additional insurance providers, I will notify you in case you would like to utilize these. If I am not able to accept your insurance directly, you may be able to utilize out-of-network (OON) benefits. These vary from each insurance plan. If you wish to use OON benefits, please let me know and I will create the documentation that you need to submit for reimbursement.

Trial, Court-Ordered Appearances, Litigation

Rarely, but on occasion, a court will order a therapist to testify, be deposed, or appear in court for a matter relating to your treatment or case. In order to protect your confidentiality, I strongly suggest not being involved in court. If I get called into court by you or your attorney, you will be charged $100 per hour to include travel time, court time, preparing documents, etc. Please consult with me if you anticipate court involvement.

Copies of Medical Records

Should you request a copy of your medical records, the cost is $0.63 per page as well as a handling fee of $25. Payment for your medical records will be due prior or upon receipt and can be picked up at the office. Please allow at least 2 weeks to prepare medical records. Please discuss with me if you would like to review your records, or if an alternative to your full records would meet your needs.

Phone Contacts and Emergencies

If you need to contact me for any reason, please call (314) 246-0480, leave a voicemail, and a return call will be made within 24 hours.

In case of an emergency, you can access emergency assistance by calling the National Suicide Prevention Lifeline at 988 or 1-800-273-8255. If either you or someone else is in danger of being harmed, dial 911. In a mental health emergency, you can contact BHR at 314-469-6644 or Mercy Behavioral Health at 314-251-0555 24 hours a day. If you need immediate mental health care, call 911 or visit the closest emergency room. There are also mental health urgent care centers in the area, and you can find these and additional local and national resources on my website at www.enlitens.com/resources.

Confidentiality in Therapy/Counseling: What You Need to Know

Anything said in therapy is confidential and may not be revealed to a third party without written authorization, except for the following limitations:

• Child Abuse: Child abuse and/or neglect, which include but are not limited to domestic violence in the presence of a child, child-on-child sexual acting out/abuse, physical abuse, etc. If you reveal information about child abuse or child neglect, I am required by law to report this to the appropriate authority. I will inform you when this is done.
• Vulnerable Adult Abuse: Vulnerable adult abuse or neglect. If information is revealed about a vulnerable adult or elder abuse, I am required by law to report this to the appropriate authority. I will inform you when this is done.
• Self-Harm: If threats, plans, or attempts to harm oneself are disclosed, I am permitted to take steps to protect the client’s safety, which may include the disclosure of confidential information. This will be done via a safety plan and discussed with the client.
• Harm to Others: If you threaten bodily harm or death to another person, I am required by law to report this to the appropriate authority.
• Minor Clients: Confidentiality applies to minors as well as adults. With minor clients under the age of 18, parents/guardians do have the right to request records and updates on treatment progress. Every effort will be made to protect the client’s privacy regarding the content of sessions; however, themes and progress towards goals may be shared with parents/guardians. Parents/guardians will be notified immediately of any safety concerns or any need to report abuse/neglect. When possible, client progress or concerns will be discussed with the client present to model advocacy and communication skills.
• Court Orders & Legal Issued Subpoenas: If I receive a subpoena for your records, I will contact you so you may take whatever steps you deem necessary to prevent the release of your confidential information. I will contact you twice by phone. If I cannot get in touch with you by phone, I will send you written correspondence. If a court of law issues a legitimate court order, I am required by law to provide the information specifically described in the order. Despite any attempts to contact you and keep your records confidential, I am required to comply with a court order.
• Law Enforcement and Public Health: A public health authority that is authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability; to a health oversight agency for oversight activities authorized by law, including audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or action; limited information (such as name, address DOB, dates of treatment, etc.) to a law enforcement official for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person; and information that your clinician believes in good faith establishes that a crime has been committed on the premises.
• Written Request: Clients must sign a release of information form before any information may be sent to a third party. A summary of visits may be given in lieu of actual “psychotherapy/process notes,” except if the third party is part of the medical team. If therapy sessions involve more than one person, each person over the age of 18 MUST sign the release of information before the information is released.
• Fee Disputes: In the case of a credit card dispute, I reserve the right to provide the necessary documentation (i.e., your signature on the “Therapy Consent & Agreement” that covers the cancellation policy) to your bank or credit card company should a dispute of a charge occur. If there is a financial balance on the account, a bill will be sent to the home address on the intake form unless otherwise noted.
• Dual Relationships & Public: Our relationship is strictly professional. In order to preserve this relationship, it is imperative that there is no relationship outside of the counseling relationship (i.e., social, business, or friendship). If we run into each other in a public setting, I will not acknowledge you as this would jeopardize confidentiality. If you were to acknowledge me, your confidentiality could be at risk.

Smart Therapy: Integrating Technology to Meet Your Goals

Social Media

I have social media pages where I post educational content about mental health. If you choose to interact with my posts, such as liking or commenting, please be aware that this might let others know your personal information and our connection through counseling. I keep my relationship with you professional by not interacting with your personal social media accounts. Please don’t use social media to send private messages; any messages sent via social media will not be responded to.

Electronic Communication

Please understand that texting and email are convenient but not confidential ways to communicate with me. They are not suitable for therapy and should not replace our scheduled sessions. I will respond to your texts and emails as promptly as possible. If the topic is too sensitive or complex for text or email, I will suggest discussing it during our next scheduled session. It’s important to know that in emergencies, texting and email are not appropriate—instead, you should call 911, 988, or go to an emergency room. Do not communicate sensitive medical or mental health information via text or email. Also, if you send an email from a work computer, your employer has the legal right to read it.

Recording

Recording sessions, in person or via telehealth, is discouraged. As your therapist, I will not record your sessions and ask that you do the same. If there is ever a time that you wish to record, or have a record of what we discuss, please let me know. We may be able to make arrangements for recording, or I can send you a summary of the session and the things we talked about.

Telehealth

If you schedule a telehealth session, a Google Meet link will be sent to you the morning of your appointment. This is a HIPAA-compliant platform that allows you to use audio and video in our session. If audio is not working, Google Meet also gives you the ability to dial into the meeting using a phone number relay.

Telehealth sessions are held to the same standards of confidentiality as in-person sessions; however, there are some restrictions based on the environment you choose to have your session in. I encourage you to meet in a private room with the door closed. If others are in your environment, they may overhear you.

Telehealth sessions cannot be held in a moving vehicle. If you choose to have your session from your car, I will ask that you show me that the car is parked and that you are alone. If you are unable to meet alone and without driving, the session will be rescheduled for your safety and confidentiality.

Any in-person session can be rescheduled to a telehealth session if needed. Please contact me via text at (314) 246-0480 to do so. You can also email liz@enlitens.com to request a telehealth session. There may be times where these session changes cannot be accommodated, however, I will do my best to ensure that you can safely and effectively keep your session.

Devices in Session

If you wish to use a smart device in session to reference something applicable to your therapy goals, please do so. Often people will keep notes on their devices or have information they need to share, and the use of technology is necessary. There may also be times where I utilize technology to share information with you. If devices become a distraction to the session, I will ask that we keep all devices set aside.