Informed Consent Psychotherapy can have benefits and risks. As with most other forms of treatments, results cannot be guaranteed. Participation in therapy can result in a number of benefits to you, including increased insight into your patterns of feeling, thinking, behaving and relating to others; improvement in your relationships; solutions to specific problems you bring forward in therapy; and improvement in symptoms of distress. Benefits to therapy require openness on the part of the therapy client. When information about your feelings, thoughts, behaviors, relationships, or other difficulties are withheld, it is not possible for the therapist to help you with them or to help you understand how they may be related (or not) to the issue for which you are seeking treatment. Benefits also require consistent attendance in therapy and work both in and outside of therapy sessions. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, helplessness, etc. When these feelings come up, it is important to talk to your therapist about them. They may be a natural, tolerable, and expected reactions to your work in psychotherapy. Other times it may be necessary or preferable to change the pace of your therapeutic work if the feelings are too uncomfortable. Or, if the treatment is not helping, it is important to talk about other treatment options. Discussion of treatment plan Your first session/s will involve an evaluation of your needs. While evaluation is ongoing, the initial phase of evaluation will result in a discussion of your therapy goals and recommendations about how you might reach those goals. You and your therapist will work together to reach a shared understanding of where your problems come from and what factors in your life contribute to keeping those problems in place. This information guides how you will move forward in resolving them. Should you or your therapist determine that the therapist, type of treatment she can offer, or the mode of treatment is not a good fit for you, your therapist will share recommendations for the right type of treatment and provider. Therapy may also involve recommendations or referrals to additional services that support your wellness (e.g. psychiatrist, neuropsychologist, physician). In some cases, these treatments are so vital and central to your recovery that your clinician is unable to ethically continue providing therapy without your concurrent treatment with these providers. Failing to follow these recommendations may result in impaired treatment progress, suicidal thoughts or actions, deteriorating medical condition, termination of treatment with this clinician or even death. Most often, however, these are recommendations not requirements. Limitations of Online Psychotherapy Video sessions have limitations compared to in-person sessions. It is important to consider if those limitations may impact your therapeutic progress and select an in-person provider if so. In some clinical situations, such as crises or suicidal or homicidal thoughts, in-person treatment may be the most appropriate treatment choice. Online psychotherapy providers, like many in-person providers, do not provide 24 hour crisis services. If a life-threatening crisis should occur, contact a crisis hotline, call 911, or go to a hospital emergency room. Should your clinician determine that you are at risk, he/she may call local police to assess your safety in person. Your therapist follows the laws and professional regulations of the state in which the provider is licensed, and the sessions will be considered to take place in the state in which the provider is licensed. Confidentiality: Confidentiality is the cornerstone of psychotherapy and psychological services. Your verbal and written communication with your clinician is held in the strictest confidence and will only be disclosed to other parties with your written authorization. (Please consider the limits of confidentiality in electronic communications.) Exceptions to this include your presentation of imminent danger to self or others; knowledge of suspected child abuse, neglect, or abandonment; knowledge of suspected elder/vulnerable adult abuse, neglect, or exploitation; naming your clinician, Lauren Poleyeff, Psy.D. in a law suit; claiming emotional harm or damages in a law suit with another entity; or by a court order signed by a judge (a subpoena alone will not result in disclosure). Additionally, communication with your clinician via any online or electronic means (e.g. email, text, video chat ) is limited in security and thus your confidentiality may not be guaranteed. In the event of an injury, illness, or other unexpected emergency situation that results in your clinician becoming unavailable, your basic contact information (name and contact numbers or email) may be provided to a fellow clinician or associated professional. This will allow for your timely notification of appointment cancellations, as well as provide you with an opportunity to obtain further information regarding your continued care. Confidentiality of Email, Chat, Cell Phone, Video, and Fax Communication If you choose to use your personal email account, please limit the contents to administrative issues such as cancellation or change in contact information. If you call, please be aware that unless we are both on landline phones, the conversation is not confidential. Likewise, text messages are not confidential. If you are working online, we ask that you determine who has access to your computer and electronic information from your location. This would include family members, coworkers, supervisors, and friends. You are encouraged to communicate through a computer that you know is safe (i.e. Wherein confidentiality can be ensured). Be sure to fully exit all online counseling sessions and emails before leaving your computer. Consultation: I consult regularly with other professionals regarding my clients; however, the client’s name or other identifying information is never disclosed. The clients’ identities remain completely anonymous, and confidentiality is fully maintained. Agreement Your signature indicates that you have read this contract; that you understand all that it contains; that you agree to abide by its terms; and that you voluntarily consent to treatment. Enter Email Address: