Dear Consultant/Supervisee/Mentee :
- I understand that these consultations do not constitute clinical supervision and that I remain completely responsible – ethically and legally – for the decisions, I make in my own clinical case situations.
- My consultant will provide me with an opportunity to discuss clinical cases and issues about which she may have some expertise, and she may help me consider options for responding, but the comments made for my consideration are not supervision mandates.
- The information provided is informed by the consultant’s training and experience but does not in any way constitute legal advice or take the place of legal counsel and/or accounting advice.
- I understand in the case of group consultation it is a confidential environment and there will be no recording of any kind (unless all group participants agree and sign releases). All information is held strictly confidential.
- It is acknowledged that difficulties concerning the therapist's self will certainly arise during the course of this process. You recognize that discussing these concerns is an essential element of the supervision and/or consultation process. These conversations, which may feel similar at times, are not to be mistaken for personal psychotherapy.
- I understand the potential limits of the confidentiality of this relationship. To the extent possible, my case presentations will provide no identifiable patient information. However, I understand that if I provide identifiable information about a situation regarding which my consultant has an ethical or legal obligation to report confidential information, she will inform me at the time and will give me the opportunity to make the report myself.
- I understand that if my consultant becomes aware that she knows or has a prior relationship with the presented client(s), or if she believes she has a potential conflict of interest in her relationship with me, she will notify me of that fact immediately and will cooperate in helping me find a different consultant.
- I understand that if I am required to track hours and complete certification forms, I should obtain the most recent forms from an accredited website and prepare them for submission to the association, organization, or governing board.
- If you are pre-licensed or under training, you must continue to collaborate with your primary clinical supervisor.
- Our relationship is secondary to that of your primary clinical supervisor. This is especially true if either supervisor has a specific clinical specialty or specialization (for example, Expressive Arts, Brainspotting, EMDR or Emotionally-Focused), which may require certification or professional development trainings.
- For example, if you receive different opinions from your clinical supervisor and me, you should always defer to your primary clinical supervisor, and further explore the differences in the perspective provided for your own developing therapy style.
Payment
I hereby acknowledge and accept the following payment terms:
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For individual supervision, mentorship, or consultation, the fee is $150.00 per hour, payable at the time of scheduling the meeting.
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For ET Modality Supervision, the fee is $75.00 per hour, payable for each scheduled meeting.
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Payment for each meeting is due either prior to or at the time of scheduling. Once you have confirmed your attendance, you are responsible for the corresponding fee. You will be prompted to complete the payment during the scheduling process.
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In the event that an error occurs during scheduling, and payment is not processed, you will receive an invoice for the meeting, and the payment must be made within 7 days of receiving the invoice.
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Please note that any bank fees associated with returned checks or card payments may be collected.
How to Schedule Meetings:
- It is strongly encouraged that recurring supervision and/or consultation meetings be scheduled ahead of time to avoid schedule conflict issues. For example, scheduling 2-3 meetings ahead to be consistent with attendance and commitment to time slot.
Reschedule/Cancellation Policy:
Please be aware of my reschedule-only policy, which necessitates that you reschedule your meeting with a minimum notice of 2 days. Failure to do so will result in the forfeiture of your payment. If you cancel a scheduled meeting with less than 2 days' notice, you will remain responsible for the agreed-upon fee, and there will be no refund unless the cancellation is due to unforeseen circumstances.
Technology Statement:
There are several ways we could potentially communicate and/or follow each other electronically in our ever-changing technological society. It is critical to me that I keep your confidentiality, respect your boundaries, and ensure that your relationship with me remains professional.
Breach of Privacy. Outside resources and companies (internet and software providers, public utilities, etc.) are used in technology-assisted counseling and consulting. All of these entities are vulnerable to their own security threats.
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By signing this agreement, you agree to evaluate and implement your own technological safeguards (strong passwords, secure networks, virus protection) and to indemnify any therapist, employee, owner, or other GroundingHearts, Inc associates from any blame or liability resulting from the hardware, software, and third-party technology providers you choose.
You also agree to all of the above statements about confidentiality and consultation participation.