PSYCHOLOGICAL SERVICES CONTRACT FOR ADULTS

PSYCHOLOGICAL SERVICES

Psychotherapy is not easily described in general statements. It varies depending on the personalities of the psychologist and client, and the particular problems you hope to address. There are many different methods I may use to deal with those problems.

Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for therapy to be most successful, you will have to work on things we talk about both during our sessions and at home.

Psychotherapy can have benefits and risks. Because therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees as to what you will experience.

Our first few sessions will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and a treatment plan to follow, if you decide to continue with therapy. You should evaluate this information along with your own opinions about whether you feel comfortable working with me.

At the end of the evaluation, I will notify you if I believe that I am not the right therapist for you and, if so, I will give you referrals to other practitioners whom I believe are better suited to help you.

Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion.

MEETINGS

I usually begin with an evaluation that may take 1 to 5 sessions (depending on the package selected). During this period, we will determine whether I am the right professional to support your treatment goals.

If we agree to continue with psychotherapy, sessions will typically be scheduled once per week for a minimum duration of 45 minutes. Some sessions may be longer or held more frequently based on your needs.

CONTACTING ME

I am often not immediately available by telephone. Though I am usually in my office between [9.00AM and 5 PM], I probably will not answer the phone when I am with a client.

When I am unavailable, I will make every effort to return your call on the same day you make it. If you are difficult to reach, please inform me of some times when you will be available. [In emergencies, you can try me at my cell number.]

If you are unable to reach me and feel that you cannot wait for me to return your call, contact your family physician or the nearest emergency room and ask for the psychologist/ psychiatrist on call. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact, if necessary.

CONFIDENTIALITY

In general, the privacy of all communications between a client and a psychologist is protected by law, and I can only release information about our work to others with your written permission. But there are a few exceptions.

In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some legal proceedings, a judge may order my testimony if he/she determines that the issues demand it, and I must comply with that court order.

There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a client’s treatment. For example, if I believe that a child [elderly person or a person with disability] is being abused or has been abused, I must [required to] make a report to the appropriate state agency.

If I believe that a client is threatening serious bodily harm to another, I am [may be] required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client.

If the client threatens to harm himself/herself, I may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection. If a similar situation occurs in the course of our work together, I will attempt to fully discuss it with you before taking any action.

I may occasionally find it helpful to consult other professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my client. The consultant is also legally bound to keep the information confidential. Ordinarily, I will not tell you about these consultations unless I believe that it is important to our work together.

Although this written summary of exceptions to confidentiality is intended to inform you about potential issues that could arise, it is important that we discuss any questions or concerns that you may have at our next meeting. I will be happy to discuss these issues with you and provide clarification when possible.

If you need specific clarification or advice, formal legal advice may be needed, as the laws governing confidentiality are complex and I am not an attorney. [If you request, I will provide you with relevant portions or summaries of the state laws regarding these issues.]

TELEPSYCHOLOGY

Telepsychology refers to providing psychotherapy services remotely using telecommunications technologies, such as video conferencing or telephone.

BENEFITS AND RISKS OF TELEPSYCHOLOGY

Telepsychology, however, requires technical competence on both our parts to be helpful. Although there are benefits of telepsychology, there are some differences between in-person psychotherapy and telepsychology, as well as some risks. For example:

• Benefits of telepsychology: The client and clinician can engage in services without being in the same physical location. This can help ensure continuity of care if the client or clinician moves, travels, or is otherwise unable to meet in person. It is also more convenient and takes less time.
• Risks to confidentiality: Because telepsychology sessions take place outside of the therapist’s private office, there is potential for other people to overhear sessions if you are not in a private place during the session. On my end I will take reasonable steps to ensure your privacy. But it is important for you to make sure you find a private place for our session where you will not be interrupted. It is also important for you to protect the privacy of our session on your cell phone or other device. You should participate in therapy only while in a room or area where other people are not present and cannot overhear the conversation.
• Issues related to technology: Technology may stop working during a session, others might access our conversation, or stored data could be accessed by unauthorized parties.
• Crisis management and intervention: Usually, I will not engage in telepsychology with clients currently in a crisis requiring high levels of support. Before engaging, we will develop an emergency response plan.
• Efficacy: Research generally shows telepsychology is about as effective as in-person psychotherapy. Some therapists believe something may be lost by not being in the same room, including non-verbal information.

ELECTRONIC COMMUNICATIONS

We will decide together which kind of telepsychology service to use. You may have to have certain computer or cell phone systems to use these services. You are solely responsible for any cost to obtain necessary equipment, accessories, or software.

We plan to use the application Zoom Cloud Meetings for our sessions. Please read the privacy policy carefully when you use the application on your device.

For communication between sessions, I only use email communication and text messaging with your permission and only for administrative purposes unless we have made another agreement. This includes setting/changing appointments, billing matters, and related issues.

You should be aware that I cannot guarantee the confidentiality of any information communicated by email or text. Therefore, I will not discuss clinical information by email or text and prefer that you do not either. I do not regularly check email/texts and do not respond immediately, so these methods should not be used in an emergency.

Treatment is most effective when clinical discussions occur at your regularly scheduled sessions.

If an urgent issue arises, you may attempt to reach me by phone. I will try to return your call within 24 hours except on weekends and holidays. If you are unable to reach me and cannot wait, contact your family physician or the nearest emergency room and ask for the psychologist or psychiatrist on call. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact in my absence if necessary.

CONFIDENTIALITY IN TELEPSYCHOLOGY

I have a legal and ethical responsibility to make my best efforts to protect all communications that are a part of telepsychology. However, due to the nature of electronic communications technologies, I cannot guarantee that communications will be kept confidential or that other people may not gain access.

I will try to use updated encryption methods, firewalls, and back-up systems, but there is a risk that electronic communications may be compromised, unsecured, or accessed by others. You should also take reasonable steps to ensure security (for example, using secure networks and having passwords to protect your device).

The extent of confidentiality and the exceptions to confidentiality outlined earlier still apply in telepsychology. Please let me know if you have questions about exceptions to confidentiality.

APPROPRIATENESS OF TELEPSYCHOLOGY

From time to time, we may schedule in-person sessions to “check-in”. I will let you know if I decide telepsychology is no longer the most appropriate form of treatment. We will discuss options of engaging in in-person counseling or referrals to another professional in your location who can provide appropriate services.

EMERGENCIES AND TECHNOLOGY

Assessing and evaluating threats and other emergencies can be more difficult in telepsychology than in in-person therapy. To address this, we will create an emergency plan before engaging in telepsychology services. I will ask you to identify an emergency contact person near your location who I will contact in the event of a crisis.

If the session is interrupted for any reason (such as connection failure) and you are having an emergency, do not call me back. Call the nearest hospital or go to your nearest emergency room. Call me back after you have obtained emergency services.

If the session is interrupted and you are not having an emergency, disconnect and I will wait two minutes and then re-contact you via the agreed platform. If you do not receive a call back within two minutes, call me on the phone number I provided you.

RECORDS

The telepsychology sessions shall not be recorded in any way unless agreed to in writing by mutual consent. I will maintain a record of our session in the same way I maintain records of in-person sessions in accordance with my policies.