Distance Counseling Informed Consent Form
Distance Counseling (also referred to as Telepsych) occurs through video conferencing technology or by phone. Research studies have shown that Distance Counseling is effective, convenient, and affordable. Distance Counseling is helpful if you would like to see a mental health counselor that is not located in your geographic area, or if you obstacles to seeing your clinician in an office setting
1. RISKS AND BENEFITSLike all forms of counseling, Distance Counseling possesses both benefits and some risks. Risks may include—but are not limited to—experiencing feelings such as stress, sadness, guilt, and frustration. In addition, clients may not agree with a mental health counselor’s assessment, diagnosis, case formulation, or treatment.
Benefits of Distance Counseling may be comparable to those in traditional face-to-face counseling relationships —the building of a counselor-client therapeutic alliance designed to assist a client in his/her personal growth and life issues. However, with the use of telephone or video chat, a mental health counselor may be limited in that he/she is unable to take into account the visual or nonverbal cues of a client. Video conferencing is the preferred method of Distance Counseling, but it too might have some limitations associated with the clinician and client not being able to as effectively communicate feelings and emotions. You should weigh the benefits against the limitations of services before consenting to the distance counseling process.
2. CONFIDENTIALITY AND OBLIGATION TO DISCLOSELimits of confidentiality differ from state to state; however, the mental health counselors will abide by the laws of their practicing states in regard to reporting any necessary information. This may include the circumstance of a client, deemed to be a serious threat to him/herself or others, being reported to legal authorities or local social services.
It is also law in many states that any disclosure of homicidal threats, child abuse, abuse of a handicapped person, or abuse of an elderly person must be reported immediately to appropriate authorities.
3. PERSONAL MENTAL HEALTH DISCLOSUREAnyone considering Distance Counseling with CrossPoint Clinical Services, must meet/agree to the following conditions:
a) I am not experiencing active suicidal or homicidal ideation.
b) I have no significant history of chronic mental illness and recent psychiatric hospitalizations.
(If you have a significant mental health history you should see a clinician in your own geographic area or an office setting, as distance counseling is not recommended for you.)
c) I am willing to provide the mental health counselor with the name of a local resource (i.e., mental health professional, doctor, minister, or responsible family member/friend) who lives in my geographic area, that would be available in case of an emergency and I authorize the release of my personal health information to named individual(s).
NOTE: If you are suicidal, this is not the proper service for you. Seek immediate help by calling 911 and work with a mental health professional in your geographic area.
4. PAYMENT AND APPOINTMENT POLICY
Payment for counseling sessions is expected at the time services are rendered. Additional counseling sessions appointments cannot be made and held until all outstanding prior balances are paid in full.
Additionally, CrossPoint Clinical Services requires a 24 hour notice of cancellation in order for you to not incur a charge for the booked session. Should you miss your scheduled session, without prior cancellation, your counselor reserves the right to charge you a late cancellation fee of $50. It is your responsibility to notify your counselor of any cancellation or change in appointment date prior to the 24 hour cancellation policy.
5. LIABILITY AND WARRANTIESCrossPoint Clinical Services may use doxy.me or Google Meet for distance counseling sessions. Clients understand that although highly unlikely, there are some risks involved in using online communication technologies. You agree to enter the counseling session with one of our clinicians at your own risk and under the terms and legal laws or rules governing distance counseling. The counselor with whom you work will meet professional licensing standards for your state, but may not actually reside in your home state.
6. ENHANCING YOUR DISTANCE COUNSELING EXPERIENCEWith a little bit of preparation you will be ready to have a fantastic distance counseling experience. Here are a few factors that impact sound and video quality:
Audio- A headset is important to improve sound quality when communicating via your computer over the internet. You will also have the option of calling in on your phone, which provides one of the best sound quality experiences. If you do use your land-line or cell phone it is recommended that you use a bluetooth device or headset to increase comfort.
Video- We recommend that you use an external HD web camera during distance counseling sessions.
Internet Connection- If possible avoid mobile devices and mobile hotspots when engaged in distance counseling.
Computer- Since technology is frequently changing, using a desktop or laptop computer that is less than four years old will likely improve your distance counseling experience.
Preparation- Log in and set up your equipment ahead of time. Don't waste your time (and money) turning on your computer and setting up your equipment during your session. Oftentimes when we are hurried and rushed, our computers become "mysteriously" uncooperative which increases everyone's frustration.