This Informed Consent for Online Therapy contains important information focusing on doing Therapy using the phone or the Internet. Please read this carefully and let me know if you have any questions. When you sign this document, it will represent an agreement between us.
Benefits and Risks of Online Therapy
Online Therapy (also known as online counseling, telemental health, telehealth, etc.) refers to providing therapy services remotely using telecommunications technologies, such as video conferencing or telephone. One of the benefits of Online Therapy is that the client and clinician can engage in services without being in the same physical location. This can be helpful in ensuring continuity of care if the client or clinician moves to a different location, takes an extended vacation, or is otherwise unable to continue to meet in person. It is also more convenient and takes less time. Online Therapy, however, requires technical competence on both our parts to be helpful. Although there are benefits of Online Therapy, there are some differences between in-person Therapy and Online Therapy, as well as some risks. For example:
- Risks to confidentiality. Because Online Therapy sessions take place outside of the therapist’s private office, there is potential for other people to overhear sessions if you are not in a private place during the session. On my end I will take reasonable steps to ensure your privacy. But it is important for you to make sure you find a private place for our session where you will not be interrupted. It is also important for you to protect the privacy of our session on your cell phone or other device. You should participate in therapy only while in a room or area where other people are not present and cannot overhear the conversation.
- Issues related to technology. There are many ways that technology issues might impact Online Therapy. For example, technology may stop working during a session, other people might be able to get access to our private conversation, or stored data could be accessed by unauthorized people or companies.
- Crisis management and intervention. Usually, I will not engage in Online Therapy with clients who are currently in a crisis situation requiring high levels of support and intervention. Before engaging in Online Therapy, we will develop an emergency response plan to address potential crisis situations that may arise during the course of our Online Therapy work.
- Efficacy. Most research shows that Online Therapy is about as effective as in-person Therapy. However, some therapists or clients believe that something is lost by not being in the same room. For example, there is debate about a therapist’s ability to fully understand non-verbal information when working remotely.
Electronic Communications
We will decide together which kind of Online Therapy service to use. You may have to have certain computer or cell phone systems to use Online Therapy services. You are solely responsible for any cost to you to obtain any necessary equipment, accessories, or software to take part in Online Therapy.
For communication between sessions, I only use email communication and text messaging with your permission and only for administrative purposes unless we have made another agreement. This means that email exchanges and text messages with my office should be limited to administrative matters. This includes things like setting and changing appointments, billing matters, and other related issues. You should be aware that I cannot guarantee the confidentiality of any information communicated by email or text. Therefore, I will not discuss any clinical information by email or text and prefer that you do not either. Also, I do not regularly check my email or texts, nor do I respond immediately, so these methods should not be used if there is an emergency.
Treatment is most effective when therapeutic discussions occur at your regularly scheduled sessions. But if an urgent issue arises, you should feel free to attempt to reach me by phone. I will try to return your call within 24 hours except on weekends and holidays. If you are unable to reach me and feel that you cannot wait for me to return your call, contact your family physician or the nearest emergency room and ask for the psychologist or psychiatrist on call. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact in my absence if necessary. (see also Crisis Numbers in your Informed Consent for Counseling packet)
Location for Therapy
At the beginning of each session, please verify the address you are having the session from (such as your home address, or any other location). This is in case of emergency to know where to send help.
I do not do counseling sessions while driving – either myself, or while you are driving – due to safety issues. If you are driving somewhere during our session, I will ask you to find a safe place to park for our session and call me back (letting me know the address you are parked at), or we will need to reschedule. If we aren’t able to reschedule within the same week, you may be charged for a missed session.
Confidentiality
I have a legal and ethical responsibility to make my best efforts to protect all communications that are a part of our Online Therapy. However, the nature of electronic communications technologies is such that I cannot guarantee that our communications will be kept confidential or that other people may not gain access to our communications. I will try to use updated security or encryption methods, firewalls, and back-up systems to help keep your information private, but there is a risk that our electronic communications may be compromised, unsecured, or accessed by others. You should also take reasonable steps to ensure the security of our communications (for example, only using secure networks for Online Therapy sessions and having passwords to protect the device you use for Online Therapy).
The extent of confidentiality and the exceptions to confidentiality that I outlined in my Informed Consent for Therapy packet still apply in Online Therapy. Please let me know if you have any questions about exceptions to confidentiality.
Verification of Identity
At the onset of our therapy sessions, I will need to see your Driver’s License or similar ID (such as a passport) in order to verify your identity. Please hold it up to the camera lens so I can view it.
Subsequently, when you choose to contact me via electronic means – such as text or email – I am not able to verify your identity because I am not visually seeing you or hearing your voice.
To ensure your confidentiality and prevent someone else who may be using your device in your absence from finding out confidential information, we will have a Code Word that you will use anytime you choose to contact me via electronic means, that will verify that it is actually you in contact with me.
Please choose a word that you will easily remember and enter it at the bottom of this form.
Appropriateness of Online Therapy
From time to time, we may schedule in-person sessions to “check-in” with one another. I will let you know if I decide that Online Therapy is no longer the most appropriate form of treatment for you. We will discuss options of engaging in in-person Therapy or referrals to another professional in your location who can provide appropriate services.
Emergencies and Technology
Assessing and evaluating threats and other emergencies can be more difficult when conducting Online Therapy than in traditional in-person therapy. To address some of these difficulties, we will create an emergency plan before engaging in Online Therapy services. I will ask you to identify an emergency contact person who is near your location and who I will contact in the event of a crisis or emergency to assist in addressing the situation. I will ask that you sign a separate authorization form allowing me to contact your emergency contact person as needed during such a crisis or emergency.
If the session is interrupted for any reason, such as the technological connection fails, and you are having an emergency, do not call me back; instead, call 911, 988 (the California crisis hotline), The Crisis Intervention and Suicide Hotline (San Mateo Co.): 1-800-273-TALK (8255), or go to your nearest emergency room. Call me back after you have called or obtained emergency services.
If the session is interrupted and you are not having an emergency, disconnect from the session and I will wait two (2) minutes and then re-contact you via the Online Therapy platform on which we agreed to conduct therapy. If you do not receive a call back within two (2) minutes, then call me on the phone number I provided you (650) 996-2649.
If there is a technological failure and we are unable to resume the connection, you will only be charged the prorated amount of actual session time, or we will reschedule to make up the remainder.
Fees
The same fee rates will apply for Online Therapy as apply for in-person Therapy. However, insurance or other managed care providers may not cover sessions that are conducted via telecommunication. If your insurance, HMO, third-party payor, or other managed care provider does not cover electronic Therapy sessions, you will not be able to receive insurance reimbursement for the session. Please contact your insurance company prior to our engaging in Online Therapy sessions in order to determine whether these sessions will be covered.
Records
The Online Therapy sessions shall not be recorded in any way unless agreed to in writing by mutual consent. I will maintain a record of our session in the same way I maintain records of in-person sessions in accordance with my policies.
Informed Consent
This agreement is intended as a supplement to the general informed consent that we agreed to at the outset of our clinical work together and does not amend any of the terms of that agreement.
Your signature below indicates agreement with its terms