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Rules of Engagement:

Limits of the Counseling Relationship – What Every Client Should Know

Psychotherapy is a professional service I can provide to you. Because of the nature of counseling, our relationship has to be different from most relationships. It may differ in how long it lasts, in the topics we discuss, or in the goals of our relationship. It must also be limited to the relationship of therapist and client only. If we were to interact in any other ways, we would then have a “dual relationship,” which would not be right and may not be legal. The different therapy professions have rules against such relationships to protect us both.

I want to explain why having a dual relationship is not a good idea. Dual relationships can set up conflicts between my own (the therapist’s) interests and your (the client’s) best interests, and then your interests might not be put first. In order to offer all my clients the best care, my judgment needs to be unselfish and professional at all times.

Because I am your counselor, dual relationships like these are improper:

• I cannot be your supervisor, teacher, or evaluator.

• I cannot be a counselor to my own relatives, friends (or the relatives of friends), people I know socially or business contacts.

• I cannot provide counseling to people I used to know socially, or to former business contacts.

• I cannot have any other kind of business relationship with you besides the counseling itself. For example, I cannot employ you, lend to or borrow from you or trade or barter your services (things like tutoring, repairing, child care, etc.) or goods in exchange for counseling.

• I cannot give legal, medical, financial, or any other type of professional advice.

• I cannot have any kind of romantic or sexual relationship with a former or current client, or any other people close to a client.

There are important differences between counseling and friendship. As your counselor, I cannot be your friend. Friends may see you only from their personal viewpoints and experiences. Friends may want to find quick and easy solutions to your problems so that they can feel helpful. These short-term solutions may not be in your long-term best interest. Friends do not usually follow up on their advice to see whether it was useful. They may need to have you do what they advise. A counselor offers you choices and helps you choose what is best for you. A counselor helps you learn how to solve problems better and make better decisions. A counselor’s responses to your situation are based on tested theories and methods of change. You should also know that counselors are required to keep the identity of their client’s secret. Therefore, I may ignore you when we meet in a public place, and I must decline to attend your family’s gatherings if you invite me. Lastly, when our counseling is completed, I will not be able to be a friend to you like your other friends.

In sum, my duty as counselor is to care for you and my other clients, but only in the professional role of counselor. Please note any questions or concerns during our first contact so we can discuss them.

The Benefits and Risks of Therapy

As with any powerful treatment, there are risks as well as benefits associated with therapy. You should think about both the benefits and risks when making any treatment decisions. For example, in therapy, there is a risk that clients will, for a time, have uncomfortable levels of anxiety, sadness, guilt, anger, frustration, loneliness, helplessness, or other negative feelings. Clients may recall unpleasant memories.

These feelings or memories may bother a client at work or in school. In addition, some people in your community may mistakenly view anyone in therapy as weak, or perhaps as seriously disturbed or even dangerous. Also, clients in therapy may have problems with people important to them. Family secrets may be told. Therapy may disrupt a significant relationship and sometimes may even lead to a divorce.

Sometimes, too, a client’s problems may temporarily worsen after the beginning of treatment. Most of these risks are to be expected when people are making important changes in their lives. Finally, even with our best efforts, there is a risk that therapy may not work out well for you.

While you should consider these risks, you should also know that the benefits of therapy have been supported by scientists in hundreds of well-designed research studies. People who are depressed may find their mood lifting. Others may no longer feel afraid, angry, or anxious. In therapy, you have an opportunity to talk things out fully until your feelings are relieved or the problems are solved. Your relationships and coping skills may improve greatly. You may get more satisfaction out of social and family relationships. Your personal goals and values may be come clearer and more likely to be achieved.

My clients may grow in many directions – as individuals, in their close relationships, in their work or schooling, on their spiritual paths, and in the ability to enjoy their lives. While there is hope that improvement will occur as part of the therapeutic process, there is no guarantee. However, I do not accept clients into my practice that I do not think I can help. Therefore, I will enter our relationship with optimism about our progress.

If you could benefit from a treatment that I cannot provide, I will try to help you to get it. You have a right to ask me about other such treatments, their risks, and their benefits. Based on what I learn about your problems, I may recommend that you consult with a physician. If I do this, I will fully discuss my reasons with you, so that you can decide what is best. If you are treated by another professional, I will coordinate my services with them and with your own medical doctor.

If for some reason treatment is not going well, I may suggest that you see another therapist or another professional in addition to me. As a responsible person and ethical therapist, I cannot continue to treat you if my treatment is not working for you. If you wish for another professional’s opinion at any time, or wish to talk with another therapist, I can help you find a qualified person and will provide him or her with the information needed.

Use of Technology

Many clients choose to use cell phones, cordless phones, faxes, email and computers to augment their counseling with me. It is important for you to know that these methods come with additional risks. These risks include but are not limited to the following:

• The possibility of technology failure resulting in messages / information not being received.

• The possibility of misunderstandings is increased with text-based modalities such as email due to the absence of nonverbal / visual cues.

• Use of email may result in various servers creating permanent records of these transactions.

• Many employers and government agencies review email archives on a routine basis, record letters typed on a keyboard, and / or engage in data mining programs to identify transmissions containing specified content.

• My email is not checked daily and may result in a possible lag in turnaround / response.

• Confidentiality may be breached at many points when using electronic communication including unauthorized monitoring / interception of transmissions from your computer and my own; it may also be breached as the information passes through the servers along the route to each other. This means that it is possible that third parties may access your records / communication.

• What is said on line may be viewed by others.

• Assessment / diagnosis often becomes more difficult without the benefit of face-to-face contact.

• Your insurance may not cover technology-assisted distance counseling.

• Your insurance company may also consider our electronic communication (in all forms) to be part of the medical record and request them.

• Our email communication is not encrypted. However, encrypted email messages can be decoded by motivated hackers.

For the above reasons, email is only to be used for business-related or logistical communication and is not to be used as a means of therapy. I cannot guarantee confidentiality when you and I are communicating via cell phone, cordless phone, fax, email or computer. These devices could compromise confidentiality. By understanding the inherent risks of the aforementioned devices, you can make an informed choice about when / where / how to use those tools.

Confidentiality in Therapy

I will treat what you tell me with great care. My professional ethics (that is, my profession’s rules about moral matters) and the laws of Connecticut prevent me from telling anyone else what you tell me unless you give me written permission. These rules and laws are the ways our society recognizes and supports the privacy of what a therapist and client talk about – in other words, the “confidentiality” of therapy.

However, it is important for you to know that I cannot promise that everything you tell me will never be revealed to someone else. There are some times when the law requires me to tell things to others.

There are also some other limits on our confidentiality. We need to review these, because I want you to understand clearly what I can and cannot keep confidential. You need to know about these rules now, so that you don’t tell me something as a “secret” that I cannot keep. These are very important issues, so please read these pages carefully and keep a copy for your records. At our next meeting, we can discuss any questions you might have about confidentiality.

When you or other persons are believed to be in physical danger, the law requires me to tell others about it. Specifically:

• If I come to suspect that you are threatening serious harm to another person, I am required to try to protect that person. I may have to tell the person and the police, or perhaps try to have you put in a hospital.

• If you seriously threaten or act in a way that is very likely to harm yourself, I may have to seek a hospital for you, or to call on your family members or others who can help protect you. If such a situation does come up, I will fully discuss the situation with you before I do anything, unless there is a very strong reason not to.

• In an emergency where your life or health is in danger, and I cannot get your consent, I may give another professional some information to protect your life. I will try to get your permission first, and I will discuss this with you as soon as possible afterwards.

• If I believe or suspect that you are abusing a child, an elderly person, or a disabled person, I must file a report with a state agency. To “abuse” means to neglect, hurt, or sexually molest another person. I do not have any legal power to investigate the situation to find out all the facts. The state agency will investigate. If this might be your situation, we should discuss the legal aspects in detail before you tell me anything about these topics. You may also want to talk to your lawyer.

In any of these situations, I would reveal only the information that is needed to protect you or the other person. I would not tell everything that you have told me.

In general, if you become involved in a court case or proceeding, you can prevent me from testifying in court about what you have told me. This is called “privilege,” and it is your choice to prevent me from testifying or to allow me to do so. I usually have no legal or ethical duty to report a crime that occurred in the past. However, there are some situations where the law, a judge or court may require me to report / testify. These include but may not be limited to the following:

• In any situations that involve the welfare of a child such as child abuse / neglect;

• In child custody or adoption proceedings, where your fitness as a parent is questioned or in doubt;

• In situations involving the physical violence exception of the “duty to warn and protect” statute;

• In cases where your emotional or mental condition is important information for a court’s decision

– including my duty to initiate a 72-hour hold for your evaluation because of imminent danger to yourself or others;

• During a malpractice case or an investigation of me or another therapist by a professional group;

• In a civil commitment hearing to decide if you will be admitted to or continued in a psychiatric hospital;

• When you are seeing me for court-ordered evaluations or treatment. In this case, we need to discuss confidentiality fully because you don’t have to tell me what you don’t want the court to find out through my report.

There are a few other things you must know about confidentiality and your treatment:

• I may sometimes consult with another professional about your treatment. This other person is also required by professional ethics to keep your information confidential. Likewise, when I am out of town or unavailable, another therapist may be available to help my clients. I must give him or her some information about my clients, like you.

• I am required to keep records of your treatment, such as the notes I take when we meet. You have a right to review these records with me. If something in the record might seriously upset you, I may leave it out, but I will fully explain my reasons to you.

Here is what you need to know about confidentiality in regard to insurance and money matters:

• If you use your health insurance to pay a part of my fees, insurance companies require some information about our therapy. Insurers such as Blue Cross / Blue Shield, Tricare, Medicare or managed care organizations ask for much information about you and your symptoms, as well as a detailed treatment plan.

• I will not send any statements or other information to your insurance company. I will only give such information to you. That way, you can see what your insurance company will know about our therapy. It is against the law for insurers to release information about our office visits to anyone without your written permission. Although I believe the insurance company will act legally, I cannot control who sees this information at the insurer’s office. You cannot be required to release more information just to get payments.

• If you have been sent to me by your employer’s Employee Assistance Program, the program’s staffers may require some information. Again, I hope that they will act legally, but I cannot control who sees this information at their offices. If this is your situation, let us fully discuss my agreement with your employer or the program before we talk further.

• If your account with me is unpaid and we have not arranged a payment plan, I can use legal means to get paid.

Children and families create some special confidentiality questions.

• When I treat clients between the ages of 15 and 18, I use my professional judgment to determine what information will remain confidential between the adolescent and myself and what information is appropriate to be shared with parents / guardians concerning treatment issues. . However, parents / guardians do have the right to general information, including how therapy is going and dates of service. They need to be able to make well-informed decisions about therapy. The law may also require me to tell parents or guardians some information about other family members that I am told. This is especially true if these others’ actions put the client or others in any danger.

• In cases where I treat several members of a family (parents and children or other relatives), the confidentiality situation can become very complicated. I may have different duties toward different family members. At the start of our treatment, we must all have a clear understanding of our purposes and my role. Then we can be clear about any limits on confidentiality that may exist.

• If you tell me something your spouse does not know, and not knowing this could harm him or her, I cannot promise to keep it confidential. I will work with you to decide on the best long-term way to handle situations like this.

• If you and your spouse have a custody dispute, or a court custody hearing is coming up, I will need to know about it. My professional ethics prevent me from doing both therapy and custody evaluations.

• If you are seeing me for couples counseling, you must agree at the start of treatment that if you eventually decide to divorce, you will not request my testimony for either side. The court, however, may order me to testify.

• At the start of family treatment, we must also specify which members of the family must sign a release form for the common record I create in the therapy or therapies.

Confidentiality in group therapy is also a special situation.

• In group therapy, the other members of the group are not therapists. They do not have the same ethics and laws that I have to work under. You cannot be certain that they will always keep what you say in the group confidential.

Finally, here are a few other points:

• I will not record our therapy session on audiotape or videotape without your written permission.

• If you want me to send information about our therapy to someone else, you must sign a “release of records” form. I have copies you can see, so you will know what is involved.

• Any information that you also share outside of therapy, willingly and publicly, will not be considered protected or confidential by a court.

The laws and rules on confidentiality are complicated. Please bear in mind that I am not able to give you legal advice. If you have special or unusual concerns, and so need special advice, I strongly suggest that you talk to a lawyer to protect your interests legally and to act in your best interests.

About Our Appointments

I am available to work with you at regularly scheduled appointment times. If you wish, I will be happy to reserve a regular standing appointment time for you into the foreseeable future. I also do this for my other clients. The very first time I meet with you, we will need to give each other much basic information.

For this reason, I usually schedule 1 ½ -2 hours for this first meeting. Following this, we will usually meet for a 50 minute session once a week for a while and gradually taper off to less frequent appointments. We can schedule meetings for both your and my convenience.

An appointment is a commitment to our work together. We agree to meet and to be on time. If I am ever unable to start on time, it will most likely be due to an emergency and I ask for your understanding. I assure you that you will receive the full time agreed to. If you are late, we will probably be unable to meet for the full time, because it is likely that I will have another appointment after yours.

I will consider our meetings very important and ask you to do the same. Your session time is reserved only for you. Please try not to miss sessions if you can possibly help it. A cancelled appointment delays our work. When you must cancel, please give me at least 24 hours notice. I am rarely able to fill a cancelled session unless I know at least 24 hours in advance. If you are unable to provide at least 24 hours notice when you cancel, you will be charged the full fee for your session unless I am able to fill it with another client. (You should note that insurance companies do not typically reimburse for missed appointments.) The only time I will waive this fee is in the event of serious or contagious illness or emergency.

Fees, Payments, and Billing

Payment for services is an important part of any professional relationship. This is even truer in therapy; one treatment goal is to make relationships and the duties and obligations they involve clear. You are responsible for seeing that my services are paid in full. Meeting this responsibility shows your commitment and maturity.

Your fees may be paid by cash, money order, or personal check through PayPal. Credit cards are accepted only by prior arrangement. As with other professions, all fees will be based on travel time portal to portal and the time involved in providing the service at my regular fee schedule.

Statement of Principles Complaint Procedures

It is my intention to fully abide by all the rules of the National Association of Social Workers, The National Association of Forensic Social Workers and The State of Connecticut Department of Public Health.

Problems can arise in our relationship, just as in any other relationship. If you are not satisfied with any area of our work, please raise your concerns with me at once. Our work together will be slower and harder if your concerns with me are not worked out. I will make every effort to hear any complaints you have to seek solutions to them.

If you feel that I, or any other therapist, has treated you unfairly or has even broken a professional rule, please tell me. You can also contact the state or local counseling association and speak to the chairperson of the ethics committee. He or she can help clarify your concerns or tell how to file a complaint.

In my practice as a therapist, I do not discriminate against clients because of any of these factors: age, gender, marital / family status, race, color, religious beliefs, ethnic origin, place of residence, veteran status, physical disability, health status, sexual orientation, or criminal record unrelated to present dangerousness. This is a personal commitment, as well as being required by federal, state, and local laws and regulations. I will always take steps to advance and support the values of equal opportunity, human dignity, and racial/ethnic/cultural diversity. If you believe you have been discriminated against, please bring this matter to my attention immediately.

Thank You

I truly appreciate the chance you have given me to be of professional service to you, and look forward to a successful relationship with you. If you are satisfied with my services as we proceed, I (like any professional) would appreciate your referring other people to me who might also be able to make use of my services.

YOUR RIGHTS AS A CLIENT IN COUNSELING

1. You have the right to be informed about the qualifications of your counselor including education, experience, professional counseling certification(s), and license(s).

2. You have the right to receive an explanation of services offered including methods of therapy, the techniques used, your time commitments, fee scales, and billing policies prior to receipt of services.

3. You have the right to be informed of the limitations of the counselor’s practice to special areas of expertise (e.g. career development, ethnic groups, etc.) or age group (e.g. children, adolescents, older adults, etc.).

4. You have the right to participate in identifying problems, setting goals and evaluating progress toward meeting them.

5. You have the right to know who to contact in an emergency.

6. You have the right to request a second opinion or seek a referral for a second opinion at any time.

7. You have the right to request that copies of medical records and reports be sent to other counseling professionals.

8. You have the right to end counseling at any time. The only thing you will have to do is to pay for any sessions you have already had. You may, of course, have problems with other people or agencies if you end counseling – for example, if you have been sent for therapy by a court.

9. You have the right to ask questions about the counseling techniques and strategies and be informed of your progress.

10. You have the right to contact the appropriate professional organization if you have doubts or complaints relative to the counselor’s conduct.

11. You have the right not to allow the use of any therapy technique. If your counselor plans to use any unusual technique, he will tell you and discuss its risks and benefits with you.


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