Welcome to Counseling. Your investment in counseling can lead to a more rich and rewarding life. Here are the guidelines to our work together. If you have any questions regarding any aspect of your counseling experience, please feel free to ask. The information below covers a number of areas that protect you and let you know how we operate.
Confidentiality: Limits on Confidentiality. The law protects the privacy of all communications between a patient and a psychotherapist. In most situations, we can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements imposed by HIPAA. There are other situations that require only that you provide written, advance consent. Your signature on this Agreement provides consent for those activities, as follows: Your therapist may occasionally find it helpful to consult other health and mental health professionals about a case. During a consultation, we make every effort to avoid revealing the identity of the patient. The other professionals are also legally bound to keep the information confidential. If you don’t object, your therapist will not tell you about these consultations unless they feel that it is important to your work together. All consultations will be noted in your Clinical Record (which is called “PHI” in the attached Notice of Privacy Practices used to protect the privacy of your health information).
As a company, we employ administrative staff and use Independent Contractors to provide mental health services to our clients. In some cases, we need to share protected information with these individuals for both clinical and administrative purposes, such as scheduling, billing and quality assurance. All of the mental health professionals are bound by the same rules of confidentiality. All staff members have been given training about protecting your privacy and have agreed not to release any information outside of the practice without the permission of a professional staff member.
We also have contracts with a software billing company. As required by HIPAA, we have a formal Business Associate Agreement with our Independent Contractors, billing and email software company, in which they promise to maintain the confidentiality of this data except as specifically allowed in the contract or otherwise required by law.
When Disclosure Is Required By Law: In some circumstances the law requires that we report. These situations include: a reasonable suspicion of child, dependent or elder abuse or neglect; where you might be in danger of harming yourself, others, property, or are gravely disabled, or when your family members or other person(s) communicate to CSP (Counseling Services of Portland) staff or clinicians that the you present a danger to self or others.
When Disclosure May Be Required: We may also have to disclose if there is a legal proceeding by or against you. If you place your mental status at issue in litigation initiated by you, the defendant may have the right to obtain the therapy records and/or testimony by your CSP counselor. In couple and family therapy, or when different family members are seen individually, even over a period of time, confidentiality and privilege do not apply between the couple or among family members, unless otherwise agreed upon. Your CSP counselor will use his or her clinical judgment when revealing such information. Your CSP counselor will not release records to any outside party unless she or he is authorized to do so by all family members age 15 or over, who were part of the treatment.
Emergencies: If there is an emergency during our work together, or in the future after termination where your CSP counselor becomes concerned about your personal safety, the possibility of you injuring someone else, or about you receiving proper psychiatric care, he or she will do whatever possible, within the limits of the law, to prevent you from injuring yourself or others and to ensure that you receive the proper medical care. For this purpose, he or she may also contact the person whose name you have listed as your emergency contact.
Health Insurance & Confidentiality of Records: If you use your health insurance, we may need to disclose confidential information to your health insurance company HMO, PPO, MCO or EAP in order to process the claims. If you instruct your CSP counselor to bill your insurance, only the minimum necessary information will be communicated to them. Your CSP counselor has no control or knowledge over what insurance companies do with the information he or she submits or who has access to this information. Submitting a mental health invoice for reimbursement carries some risk to confidentiality, privacy or to future capacity to obtain health or life insurance or even a job. Mental health information is likely to be entered into insurance companies’ computers and is likely to be reported to the National Medical Data Bank. Accessibility to companies’ computers or to the National Medical Data Bank database is always in question as computers are inherently vulnerable to break-ins and unauthorized access. Medical data has also been reported to be legally accessed by enforcement and other agencies, which also puts you in a vulnerable position.
Consultation: Your CSP counselor consults regularly with other professionals regarding his or her clients; however, client’s identity remains completely anonymous, and confidentiality is fully maintained.
Litigation Limitation: Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters which may be of a confidential nature, it is agreed that, should there be legal proceedings such as, but not limited, to divorce and custody disputes, injuries, lawsuits, etc., neither you nor your attorney, nor anyone else acting on your behalf will call on your CSP counselor to testify in court or at any other proceeding, nor will a disclosure of your counseling records be requested unless otherwise agreed upon.
Emails, Cell phones, Computers and Faxes: Computers, e-mail and cell phone communication can be accessed by unauthorized people and can compromise confidentiality. E-mails, in particular, are vulnerable because servers have unlimited, direct access to all e-mails that go through them. Your CSP counselor’s e-mails are not encrypted. Faxes can be sent to the wrong address. Some texts are never received. Your CSP counselor’s computers are equipped with firewall, virus protection and password. All backups are stored securely. Please notify Your CSP counselor if you decide to avoid or limit the use of any or all communication devises. If you communicate confidential information via e-mail or text, your CSP counselor will assume that you have made an informed decision that such communication may be intercepted, and he or she will assume you desire to correspond on such matters via e-mail. Please notify us if you decide to avoid or limit, in any way, the use of any or all communication devices, such as email, cell-phone or faxes. Please, be aware that emails are part of your medical record. Please do not use e-mail, text or faxes for emergencies.
Email and Phone Consulting: Occasionally, a client will request counseling via phone or e-mail rather than in person in the therapist’s office. This has some complexities and disadvantages to the therapeutic process. We always recommend that you find a local therapist and meet face to face. If your CSP counselor is not aware of a local referral, call the local Psychological Association chapter, local NASW chapter or local LPC chapter for a referral. Treating clients exclusively via phone consultations or e-mails may put therapists at a disadvantage because we cannot detect nonverbal cues, may not be able to accurately diagnose, may not always be aware of the resources available locally and may not be able to intervene as effectively as necessary in emergency situations. So far there is no extensive or conclusive research on phone or online therapy. As was noted in the Termination section, if your CSP counselor assesses that he or she is not effective in helping you reach the therapeutic goals via the telephone sessions, he or she is obligated to discuss it with you and, if appropriate, to terminate treatment. For more information on the topic you can go to: http://psychcentral.com/best.
Records and Your Right to Review Them: Both the law and the standards of Your CSP counselor’s profession require that we keep appropriate treatment records for at least seven years. Unless otherwise agreed to be necessary, your CSP counselor retains clinical records only as long as is mandated by Oregon law. If you have concerns regarding the treatment records please discuss them with your CSP counselor. You have the right to review or receive a summary of your records at any time, except in limited legal or emergency circumstances or when Your CSP counselor assesses that releasing such information might be harmful in any way. In such a case your CSP counselor will provide the records to an appropriate and legitimate mental health professional of your choice. Considering all of the above exclusions, if it is still appropriate, upon your request, your CSP counselor will release information to any agency/person you specify unless your CSP counselor assesses that releasing such information might be harmful in any way. When more than one client is involved in treatment, such as in cases of couple and family therapy, your CSP counselor will release records only with the signed authorizations from all the adults (or all those who legally can authorize such a release) involved in the treatment.
Telephone & Emergency Procedures: If you need to contact your CSP counselor between sessions, please leave a message and your call will be returned as soon as possible. If an emergency situation arises, indicate it clearly in your message. If you need to talk to someone immediately, call the Multnomah County Crisis Line at 503-988-4888. For Kaiser, call the Emergency Psych Line at 503-331-6425. You can also go to your nearest emergency room. If you are under the influence of a substance or otherwise unable to drive, have someone else take you or call a taxi. Depending on his or her individual procedures, your CSP counselor may also give you an emergency contact number where he or she can be reached more immediately. Please do not use e-mail, texts or faxes for emergencies.
Payments & Insurance Reimbursement: Please prepare your payment in advance each week so we can devote every minute to you and your concerns. Unless otherwise arranged, payment or co-payment is due at each session. You can pay by check, credit card or cash. Checks can be made out to Counseling Services of Portland. Please have your payment ready before the session to save time. Initial intake session is $199. Standard rates are $180 per 55-minute session. If you need a reduced fee, ask your counselor to go over the “Reduced Fee Worksheet” to help make your therapy affordable for you. This will only apply if you are not using insurance for your sessions.
Telephone conversations, site visits, report writing and reading, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc. will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify your CSP counselor if any problems arise regarding your ability to make timely payments.
As a courtesy to you, CSP will bill and collect copays and deductibles for your insurance company as long as the provider you are seeing is In Network with your Insurance Provider. However, our services are provided and charged to you and not the insurance company, and you are ultimately responsible for payment. As was indicated in the section Health Insurance & Confidentiality of Records, please be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues, condition and problems which are dealt with in psychotherapy are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage.
Out of Network Insurance Billing: We do not bill Out of Network Insurance. We can, however, give you a superbill or receipt for you to provide to your insurance company if you need one.
Mediation & Arbitration: If a dispute arises we will seek mediation before, and as a pre-condition of, the initiation of arbitration. The mediator will be a neutral third party mutually agreed up by you and your CSP counselor. The cost of such mediation, if any, shall be split equally, unless otherwise agreed upon. In the event that mediation is unsuccessful, any unresolved controversy related to this agreement should be submitted to and settled by binding arbitration in Washington County, Oregon in accordance with the rules of the American Arbitration Association in effect at the time the demand for arbitration is filed.
The Process of Therapy and Scope of Practice: We see counseling as a cooperative effort geared to resolving problems or issues that you present. Your active participation with your thoughts, feelings and actions help to create success. Therapy is simply a means to an end and most beneficial when guided by your goals. We will regularly review your goals as well as your thoughts and feelings expressed regarding the therapy process. We like to begin by getting to know you and hearing about your concerns, what you have tried so far, what has not helped and what has improved your situation. Then we usually discuss what successful completion of therapy would look like for you. We then set a course to achieve your goals. Using this plan, we will know what you are achieving, and when you are done. Sometimes difficult emotions arise, and we have found that open and honest feedback from you can be a turning point in getting you the results you desire.
Therapy may result in decisions about changing behaviors, employment, substance use, schooling, housing or relationships. Sometimes a decision that is positive for you may at times be challenging for others in your life. We use a number of approaches to help you achieve your goals. These include: behavioral, cognitive-behavioral, cognitive, psychodynamic, transpersonal, Jungian, existential, system/family, developmental (adult, child, family), humanistic, SoulCollage®, Somatic Experiencing®, psychoeducational, guided imagery, hypnosis, EMDR, Gottman-method couples therapy and others. Your CSP counselor does not provide custody evaluation recommendations, medication or prescription recommendation or legal advice, as these activities do not fall within his or her scope of practice. Any communications regarding the above should in no way be construed as advice.
Therapy can be as short as one session, or as long as a few years, depending upon the breadth and depth of your goals, and your own personal change process. Research shows that 50% of patients make noticeable improvement after 8 sessions. And 75% of individuals in therapy improved by the end of 6 months. There are many people for whom therapy is a deeper, longer-term process that may require a longer course of treatment to achieve their goals. Additionally, many clients come for a course of treatment, finish up, and then return later to achieve other goals or for “tuneups.” This is a perfectly normal part of the therapy process and the therapeutic relationship.
Discussion of Treatment Plan: Once you’ve started, your CSP counselor will discuss with you the problem(s) that brought you to treatment, and together you will create a plan to reach your goals. The more active role you take in describing the problem and the goals you want to achieve, the better. We are the experts in the change process. You are the expert in “you”. If at any time you are uncomfortable with the way things are going, please let us know and together we can make a course correction.
Termination: After the first couple of meetings, we will assess if the therapy process can benefit you. We don’t accept clients who we are unable to help and we would like our counselors to be the best fit for your needs. If at any point during therapy your CSP counselor assesses that he or she is not effective in helping you reach your goals, he or she is obligated to discuss it with you and, if appropriate, to terminate treatment. If this happens we will give you a number of internal (CSP) or external (outside CSP) referrals that may be of help to you. If you request it and authorize it in writing, your CSP counselor will talk to the counselor of your choice in order to help with the transition. If at any time you want another professional’s opinion or wish to consult with another therapist, your CSP counselor will assist you with referrals, and if he or she has your written consent, he or she will provide the essential information needed. You also have the right to terminate therapy at any time.
Dual Relationships: A dual relationship happens when you have contact with your therapist outside the counseling office. Not all of these relationships are unethical or avoidable. However, therapy never involves a sexual or romantic relationship with a client. Your CSP counselor will assess carefully before entering into non-sexual and non-exploitative dual relationships with you. You may bump into someone you know in the waiting room or into your CSP counselor out in the community. Your CSP counselor will never acknowledge working with anyone without your written permission. Many clients choose their therapist because they know of him or her before they enter into therapy or are personally aware of his or her professional work and achievements. Nevertheless, your CSP counselor will discuss with you the complexities, potential benefits and difficulties that may be involved in dual or multiple relationships. Dual or multiple relationships can enhance trust and therapeutic effectiveness but can also detract from it and often it is impossible to know that ahead of time. Please let your CSP counselor know if the dual or multiple relationship becomes uncomfortable for you in any way. Your CSP counselor will always listen carefully and respond accordingly to your feedback and will discontinue the dual relationship if he or she finds it interfering with the effectiveness of the therapy or the welfare of the client and of course you can do the same at any time.
In-person visits during COVID-19 or any public health crisis: As of April 3rd, 2023, Counseling Services of Portland no longer requires you to wear a mask during your appointment. Oregon has lifted the Mask Mandate in Healthcare facilities but some facilities may continue to require the wearing of masks to minimize the spread of illnesses.
If you are sick with a cold, flu, covid or any communicable sicknesses, we ask that you ask your therapist to see you virtually. Masks will still be available at our locations if you need one.
Your therapist may however ask that you wear a mask in your session if they feel that it is necessary for you to do so. You may also ask your therapist to wear a mask, if you feel that it is necessary for you too.
If you need to cancel your appointment less than 24 hours of you scheduled time because you are sick, please email or call your therapist or call our main number at 503-342-2510 during business hours or email firstname.lastname@example.org.
Please consider wearing a mask in the situations below as per OHA’s New’s Release on March 3, 2023: “People at higher risk for severe disease, or who live with someone at higher risk, should still consider wearing masks in health care or any settings, to better protect themselves and those most vulnerable around them. Some health care settings may continue to require masks even after the requirement is lifted.
Masks remain an effective way to reduce transmission of respiratory viruses. People are recommended to wear masks when they are sick, and individuals – particularly those with health conditions that put them at high risk for severe illness from a respiratory virus exposure–should continue to wear masks wherever they feel comfortable.”
Tele-health or Tele-counseling: This involves the use of electronic communications to enable health care providers at different locations to share individual patient medical information for the purpose of improving client care. Providers may include any licensed mental health practitioners. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following:
• Client therapy records
• Live two-way audio and video
• Output data from computer or medical devices and sound and video files
Electronic systems used will incorporate network and software security protocols to protect the confidentiality of client identification and information and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.
You have the following rights under this agreement: You have a right to confidentiality with Telehealth under the same laws that protect the confidentiality of your mental health information for in-person psychotherapy. Any information disclosed by you during the course of your therapy, therefore, is generally confidential.
There are, by law, exceptions to confidentiality, including mandatory reporting of child, elder, and dependent adult abuse and any threats of violence you may make towards a reasonably identifiable person. You also understand that if you are in such mental or emotional condition to be a danger to yourself or others, your therapist has the right to break confidentiality to prevent the threatened danger. Further, you understand that the dissemination of any personally identifiable images or information from the telehealth interaction to any other entities shall not occur without your written consent.
While psychotherapeutic treatment of all kinds has been found to be effective in treating a wide range of mental health issues and disorders, personal and relational issues, there is no guarantee that all treatment of all clients will be effective. Thus, while you may benefit from Telehealth, results cannot be guaranteed or assured.
There are risks unique and specific to Telehealth, including, but not limited to, the possibility that your therapy sessions or other communication by your therapist to others regarding your treatment could be disrupted or distorted by technical failures or could be interrupted or could be accessed by unauthorized persons. In addition, Telehealth treatment is different from in-person therapy and that if your therapist believes you would be better served by another form of psychotherapeutic services, such as in-person treatment, you may see your therapist in the office if they have in-person office hours or you will be referred to a therapist at Counseling Services of Portland who may provide such services.
Cancellation: Since the scheduling of an appointment involves the reservation of time specifically for you, a minimum of 24 hours notice is required for re-scheduling or canceling an appointment. Unless we reach a different agreement, $130 will be charged for sessions missed without 24 hours notice. Insurance companies do not reimburse for missed sessions. If you are not able to meet your therapist in person, talk to them to see if tele-health is an option so that you do not miss your appointment.
Complaints: If you believe your privacy rights have been violated, you may file a compliant with Counseling Services of Portland (CSP) or with the Secretary of the Department of Human Services. To file a complaint with CSP, call 503-342-2510. You will not be penalized for filing a complaint.
CONTACT OFFICERS: Jonelle Richards, LCSW or Christine McCulloch, MBA, 7100 SW Hampton St, Suite 223, Tigard, OR 97223. This form is educational only and doesn’t constitute legal advice, and only covers federal law, not state law (August 14, 2002)