Consent to therapy
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Room To Talk at The Women’s Center of Southeastern Michigan
Consent to therapy
Emotional risks and benefits
Therapy has potential emotional risks. Confronting feelings or thoughts that you have tried not to think about for a long time may be painful. Changes in your beliefs or behaviors can be scary -- and sometimes disruptive of familiar patterns and relationships. Your relationship with your therapist may also be a source of strong feelings. It is important that you consider carefully whether these risks of changing are worth the benefits. Most people who take these risks find that therapy is helpful.
Rights and Responsibilities
Therapy works in part because of clearly defined rights and responsibilities held by both the client and the therapist. Participants who benefit most from psychotherapy/counseling commit to showing up on time ready to work on their identified goals. Knowing your rights and responsibilities contributes to the sense of safety and confidence that is vital to the process of growth.
A. Confidentiality
Health Care Information Act of 1992
With the exception of circumstances described below, you have the right to the confidentiality of your counseling information. It is essential that you feel free to share what's on your mind and in your heart when you're with your therapist. Your therapist will not speak to anyone on your behalf without your explicit written permission.
Under the provisions of the Health Care Information Act of 1992, a therapist may legally speak to another health care provider or a member of your family about you without your consent, but we will not do this unless the situation is an emergency. You may give written consent for your therapist to share information with whomever you choose, and you may revoke that permission in writing at any time. You may request anyone you wish to attend therapy with you, but we ask you to work with us to clarify expectations ahead of time.
Health Insurance Portability and Accountability Act
You are also protected under the Federal Health Insurance Portability and Accountability Act (HIPAA). Safeguards are in place to ensure confidentiality whenever we transmit your information electronically (for example, sending bills or faxing records). The HIPAA Notice of Privacy Practices details your rights under this law.
Confidentiality exceptions
Child or elder abuse. Therapists are legally required [under the "Duty to Warn" and "Duty to Protect" laws] to report any suspicions of abuse or neglect to the Protective Services division of the Michigan Human Services Agency. When possible, your therapist will support you in making the call; however, if you are unable to do so, s/he will make the report.
Serious harm to yourself. In the interests of protecting you from serious self-harm, your therapist may recommend hospitalization, notify family members, individuals, and/or agencies to help you through the crisis.
Harm to someone else. Likewise, if you indicate that you are about to harm someone else, your therapist is legally bound to contact the intended victim and/or agencies that will help you through the crisis.
Medical emergency. If you experience a medical emergency while in our office and are unable to communicate, we are obligated to give your name and any pertinent medical information to the emergency medical technicians.
Disability application. Your file may be requested as part of a disability claim. After you have reviewed your file and given your written permission, we can copy and mail your records to the appropriate agency. However, we prefer to use a Women’s Center form for this purpose that describes your ability to perform full-time work on an ongoing and independent basis.
Legal action. Although it doesn’t happen very often, a copy of your file could be legally requested (subpoenaed) by your attorney or someone else’s attorney in a civil or criminal case. It is critical that you review and sign off on your records before we release them. You have the right to challenge a records request under a law that protects confidentiality of communication between therapists and clients [Michigan Case Law, Section 333.18513]. Ask your attorney whether a refusal to submit the requested information will help or hinder your case. In rare cases, your records can be accessed by a court order without your permission.
And finally, it is important that you discuss with your therapist what procedures you will follow if the two of you see each other in a public place. In general, the therapist will not acknowledge your presence out of respect for your confidentiality (especially if either of you is with another person). Your privacy is important to us.
B. Diagnosis
If a third party such as an insurance company is paying for part of your bill, we are required to give you a diagnosis that merits “medically-necessary” intervention. A diagnosis is a cluster of symptoms that has been given a name by researchers who needed to be able to talk to each other about what they were observing.
We can only speculate on the underlying cause(s) of most mental health symptoms, as well as why some medications work and not others. Your therapist will discuss with you any diagnosis maintained in your file for third-party billing purposes. All of the diagnoses come from the International Classification of Diseases, which is accessible on the web. Your therapist can review this in further detail or point you to reputable resources if you wish to learn more about a diagnosis.
C. Insurance company rules
If your therapy is being paid for in full or in part by health insurance, there are usually further limitations to your rights as a client. The insurance company may limit the number of sessions available to you; determine the period within which you must complete your therapy; or require you to use medication if their reviewing professional deems it appropriate. Insurance companies may also require reports of your progress in therapy, and on occasion, copies of your case file. Your therapist does not have control over any aspect of insurance company rules. However, your therapist will help to maximize the benefits you receive by filing necessary forms and gaining required authorizations for treatment, and assist you in advocating with the managed care company as needed.
D. Medical referrals
We may suggest that you consult with a medical professional. Both traditional and complementary (homeopathic and Eastern medicine) practitioners can help with mental and emotional issues. Your therapist will be glad to discuss pros and cons of any of their recommendations. We may also suggest that you participate in a support group, skills-training group, or 12-step program. If another health care provider is working with you, it is helpful to us if you provide a signed release of information, so that we can give you the best possible coordinated care. You have the right to refuse our suggestions and referrals.
E. Ending therapy
Therapy typically ends when both you and your therapist agree that your treatment goals have been substantially met and/or when your therapist graduates from their university program -- anywhere from 9 months to a year or two. Depending on therapist availability, you may decide to continue working with another intern.
If your therapist feels that s/he is not the best qualified person to help with your particular issue, s/he will refer you to another therapist who is better able to meet your needs. If we have not heard from you for 90 days, we will assume that you are no longer interested in services and will close your file.
If you engage in harassing or violent behaviors or use abusive language with your therapist, staff, or other Soundings or Women’s Center clients, we reserve the right to immediately end your treatment. We will offer referrals to other resources, but cannot guarantee that they will accept you for therapy.
F. Other rights
You have the right to ask questions about anything that happens in therapy. "Autonomy-supportive therapy" means your therapist will always be willing to discuss how and why they have decided to use a particular approach and to look at alternatives that might work better. You can feel free to suggest trying something that you think will be helpful. You can also ask your therapist about their training for working with your concerns, and can request referral to someone else if you decide your therapist is not right for you. You are free to leave therapy at any time.
Your therapist will not engage in social or sexual relationships with clients or former clients as this is unethical, illegal, and an abuse of the power and trust involved in the therapeutic relationship.
We encourage you to find a therapist who is the best match for your personality and learning style.
If you do not wish to receive monthly email newsletters, please indicate:
______ Do NOT send me monthly email newsletters.
F. Consent to treatment
I acknowledge that I am voluntarily authorizing individual psychotherapy services for myself or my child at The Women’s Center.
I have been informed of:
a. Soundings policies regarding protected health information;
b. the purpose of treatment;
c. the service(s) that may be provided; the limits of confidentiality; and
e. any attendant benefits, risks, and/or consequences.
I am voluntarily authorizing individual psychotherapy services for myself or my child at The Women's Center.
Client name: ________________________________________________________________________
Client signature: _____________________________________________________________________
Are you the parent/guardian of this client?
Yes ______
No ________
Parent/legal guardian name (if applicable): _____________________________________________________
Parent/legal guardian signature (if applicable): __________________________________________________
Date: ____________________________________________________________________________________________
Welcome to Room To Talk
Room To Talk takes a gender-conscious, multi-cultural, strengths/empowerment approach to therapy. Our therapists use the latest evidence-based practices, which we strive to apply in culturally sensitive ways. We feel that it is important to consider your strengths and challenges in the context of your relationships, cultural/racial/ religious background, economic/employment situation, and physical health.
Common values and a shared space
Room To Talk is a program of The Women’s Center of Southeastern Michigan, a nonprofit agency that relies upon donors and volunteers for support. Room To Talk therapists are licensed to practice independently in Michigan and have been doing this work for quite some time. We hope that you will find that our shared mission of "inclusive, interactive, and intentional" contributes to a warm and welcoming space.
Our counseling approach
Room To Talk therapists use a variety of therapeutic approaches to find the best match for you and your goals. Techniques may include dialogue, interpretation, pattern identification, awareness exercises, drawing, self-monitoring experiments, visualization, journal-keeping, and reading books. If we propose a technique that you feel has some risks, we will explore those risks and benefits together.