Welcome to Student Counseling Services!

Student Counseling Services (SCS) provides personal counseling services to Marymount University students. The information below provides details about SCS policies and procedures. Students requesting SCS services are asked to read this form and sign below to acknowledge that they have read and agreed to its terms. A copy of the forms will be available to you for your records. If you have any questions about these policies, please do not hesitate to discuss them with your counselor.

Privacy information: As a student, your use of SCS services does not become part of your academic record. Your use of SCS services is strictly confidential. However, there are limits to confidentiality as required by law. In rare circumstances, such as the following, information may be released: (a) when you sign a written request to have information released; (b) if you disclose intention to harm yourself or others; (c) if a counselor has reasonable suspicion that a child or dependent adult is being abused or neglected; or (d) if the court system orders that information be provided. In the event that information about you must be released because of one or more of the above exceptions to confidentiality, you will be informed fully.

Communication with on-campus providers of medical & psychiatric services: For all students, SCS staff may need to share information with Student Health Center (SHC) staff in certain appropriate situations. In particular, students who experience mental health emergencies and students who receive services from the SHC consulting psychiatric nurse practitioner should be aware that information will be shared between Student Health Center and Student Counseling Services staff members. The sole purpose of this communication is to ensure that students receive the most appropriate, efficient, and effective care and support possible.

Types and length of services: SCS provides individual and group counseling services, walk-in services, crisis intervention, and consultation. Individual counseling services are short-term--students are allotted up to 12 individual counseling sessions per academic year (For SCS, the academic year begins and ends in mid-May). Walk-in periods are available Monday through Friday from 2:00-3:00 pm. During walk-in periods, a counselor is available to meet with students on an unscheduled, brief, first-come, first-served basis. There is no limit on your participation in group counseling or your use of walk-in services. Please note, any regularly scheduled appointments must be canceled or rescheduled at least 2 hours prior to the appointment time. 

Telehealth: Virtual appointments are also available for students who reside in Virginia or DC. Please indicate your preference when prompted. There is a separate infomed consent for telehealth services. Please review it and sign acknowledging that you understand and agree.

Referral to off-campus mental health providers: If your counselor believes that your needs could be served more appropriately outside SCS, your counselor will work with you to ensure that you are connected with referrals to treatment providers in the community. Please note: In general, specialized, intensive, and/or long-term mental health treatment is considered a personal health-care responsibility, and is not a service provided by the University. SCS can assist you in connecting to whatever treatment, support, or assistance you need in the community.

Emergencies: We will try to respond as quickly as possible to any mental health emergency you may experience. If you have a mental health emergency and live in a residence hall, please call Campus Safety at (703) 284-1600 or contact your Community Advisor (CA) or Residential Services Professional on call if on campus. If you would prefer to speak with someone off-campus, an anonymous, confidential 24 hour hotline is available at (800) 273-TALK. NOTE: If you are experiencing an immediate emergency, please call 911 or go to your nearest emergency room.

Training & Supervision: All staff counselors receive regular supervision of their work from trained and licensed mental health professionals. In addition, SCS serves as a training site for advanced graduate students who are supervised closely in their counseling responsibilities. The goal of supervision is to enable counselors and counselors-in-training to provide the best services possible. Any information shared with supervisors is kept strictly confidential. You will be informed if your counselor is receiving supervision. In addition, trainees may request permission from you to record counseling sessions for the purpose of supervision. These recordings are kept strictly confidential. Only your counselor and their supervisor will have access to these recordings, which will be erased at the end of your counseling experience. Trainees will also, at times, sit in on a walk-in, crisis, or intake appointment provided by a senior staff member or have a senior staff member sit in on their appointments. This, too, is for training purposes and to ensure that the best services are provided to you.

Evaluation of services: To help us provide quality services, we may ask you to provide feedback about our services. We would appreciate your taking a few minutes to provide us with this important information in writing and/or online.

By typing my name below, I am indicating that I am said person, that I have read this Informed Consent Notice in its entirety, and that this shall serve as my electronic signature.

Social Support is an important part of maintaining good mental health. Please list one person as your identified support person you can reach out to readily to support your mental health and well-being.

Counseling sessions are confidential interactions but with limitations. One limitation arises if the counselor determines that a client poses a danger to himself or to someone else. In this event, the counselor needs to contact someone who can provide immediate assistance. This person could be the same as your above identified support person. Emergency contact must be at least 18 years of age.

Please complete each section below so we can provide you with the most helpful services.

Section 1.

Section 2.

If either of the above two points in Section 1 apply to you, once you are done with this form, please immediately call Student Counseling Services (SCS) at 703-526-6861 and indicate that you need to speak with a counselor now. If you are unable to speak to someone at SCS, please call 911 or go to the nearest emergency room.

I consent to participate in telemental health services with Marymount University Student Counseling Services as part of my psychotherapy. I understand that
telemental health is the practice of delivering clinical health care services via technology assisted media or other electronic means between a practitioner and a client who are located in two different locations. I understand the following with respect to telemental health:

1) I understand that I have the right to withdraw consent at any time without affecting my right to future care, services, or program benefits to which I would otherwise be entitled.

2) I understand that there are risks, benefits, and consequences associated with telemental health, including but not limited to, disruption of transmission by technology failures, interruption and/or breaches of confidentiality by unauthorized persons, and/or limited ability to respond to emergencies.

3) I understand that there will be no recording of any of the online sessions by either party. All information disclosed within sessions and written records pertaining to those sessions are confidential and may not be disclosed to anyone without written authorization, except where the disclosure is permitted and/or required by law.

4) I understand that the privacy laws that protect the confidentiality of my protected health information (PHI) also apply to telemental health unless an exception to confidentiality applies (i.e. mandatory reporting of child, elder, or vulnerable adult abuse; danger to self or others; I raise mental/emotional
health as an issue in a legal proceeding).

5) I understand that if I am having suicidal or homicidal thoughts, actively experiencing psychotic symptoms or experiencing a mental health crisis that cannot be resolved remotely, it may be determined that telemental health services are not appropriate and a higher level of care is required.

6) I understand that during a telemental health session, we could encounter technical difficulties resulting in service interruptions. If this occurs, end and restart the session. If we are unable to reconnect within ten minutes, please call me at 703 526 6861 to discuss since we may have to re-schedule.

7) I understand that my therapist may need to contact my emergency contact and/or appropriate authorities in case of an emergency.

 

Emergency Protocols

I need to know your location in case of an emergency. You agree to inform me of the address where you are at the beginning of each session.  I may the emergency contact you identified on the informed consent, on your behalf in a life- threatening emergency only. This person will only be contacted to go to your location or take you to the hospital in the event of an emergency

My signature below indicates that I have read and understand the information provided above; and that all of my questions have been answered to my satisfaction.