Please complete this form if your child is meeting with their therapist virtually, or in the event they decide to meet with their therapist virtually for any number of sessions.
This Informed Consent for Teletherapy contains important information focusing on doing psychotherapy using the phone or the Internet. When you sign this document, it will indicate that you understand the information delineated in this document. The Benefits and risks of teletherapy refers to providing psychotherapy services remotely using telecommunications technologies, such as video conferencing or telephone. One of the benefits of teletherapy is that the client and clinician can engage in services without being in the same physical location, whether it be to physical or mental disability, or temporary/permanent location change.
Risks to confidentiality: As a therapist I will engage teletherapy only in a secure location allowing for no visual or auditory information to be seen or overheard by others. It is important for you to make sure you find a private place for our session where you will not be interrupted or overheard or distracted. My provider is qualified to practice for clients in New York State at the time of session; sessions must be conducted while you are in New York State.
Issues related to technology: There are many ways that technology issues might impact teletherapy. For example, technology may stop working during a session. It is a legal requirement as a professional in the field of psychotherapy that a HIPAA compliant platform for communication that prevents any others from listening to the session material. Not all platforms have such compliance.
Crisis management and intervention: Teletherapy with clients who are currently in a crisis situation requiring high levels of support and intervention are generally not considered good candidates for such a medium. Should a crisis situation develop, it is necessary that an emergency contact person, who preferably is near your location. This will require a separate form with contact information.
Efficacy: Most research shows that teletherapy is about as effective as in-person psychotherapy, however some therapists 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: Computer or mobile phone with an optical device is used for teletherapy. For billing matters, and other related issues not required by HIPAA regulations you can contact South Shore Counseling at 516 785-0323. Confidentiality of any information communicated by email or text or phone cannot be guaranteed. If an urgent issue arises, the undersigned clinician can be reached by phone. Additionally, we have a 24/7 answering service that will contact either me directly or the director at South Shore Counseling. If, under unlikely circumstances, cannot reach us, you should contact the nearest emergency room or call 911.