Positive Path Mental Health - Teletherapy Informed Consent Form

Welcome to Positive Path Mental Health!

Therapist: Zona Petrelli, LCSW, CSW-G

Please read through the information provided below and feel free to ask any questions that you may have. Once you are ready to participate, please sign this informed consent form so that we have a record of your participation in the sesson and to show that you acknowledge having received this form.

WHAT IS MENTAL HEALTH TELETHERAPY

At Positive Path Mental Health, our therapist-led individual and group mental health teletherapy offers a supportive environment where individuals can share experiences, gain insight, and develop effective coping strategies for a variety of mental health challenges.

Whether you’re struggling with anxiety, depression, bipolar disorder, grief, or other emotional difficulties, our mental health teletherapy sessions provide a safe space to connect with others who understand your struggles.

Led by experienced licensed therapists, these sessions focus on building emotional resilience, improving communication skills, and developing practical tools for managing symptoms.

Group teletherapy is also available and fosters a sense of community and belonging, helping participants realize they are not alone in their journey toward healing and well-being. By engaging in group teltherapy, individuals can build confidence, learn new coping mechanisms, and find strength in shared support.

CONFIDENTIALITY

We respect each and everyone's right to privacy and confidentiality. However, please understand that this is not absolute and is limited as provided by law. Certain limitations are as follows:

• Threatening one's self or another that may result in physical harm;
• An act of physical or emotional abuse against a child or any person;
• Sexual abuse against a child where the child is living with the abuser;
  Whenever we are summoned by court order to disclose information against a participant. However, we shall notify you and let you exercise your privilege in the right to deny the disclosure of your records with us.
• Your prior written consent to release records.

CONDUCT AND RELATIONSHIP

For everyone's safety and well being, it is necessary that the following requirements be complied with by all members:

1. Discussions made within the group session are not allowed to be discussed outside with anyone and should maintain the practice of confidentiality in order to build trust with fellow members;
2. Members should maintain positivity and not induce disrespect amongst others;
3. Members should not be under the influence of any substances before or after therapy;
4. Maintain conduct that brings respect to fellow members' thoughts, emotions, or behavior.
5. Maintain an open dialogue with the therapist and other members in the group.
6. Be patient and understanding of other's life circumstances mand challenges.

THE THERAPIST

Zona Petrelli is a Licensed Clinical Social Worker and Clinical Social Worker in Gerentology. She has been practicing for over 10 years in private practice and has also worked for the VA as an LCSW, CSW-G for several years. If you have questions or concerns, please email her directly at zona@positivepathmh.com. Your information is held in strict confidence according to the laws of the states in which she practices.

WHAT TO EXPECT

Individual and Group mental health teletherapy sessions are highly effective for many people, offering unique benefits that enhance personal growth and healing. Research has shown that both individual and group teletherapy can lead to significant improvements in managing mental health conditions such as anxiety, depression, trauma, and substance use disorders. The shared experience of being in a group allows participants to realize they are not alone in their struggles, which can reduce feelings of isolation and increase emotional support. Additionally, group settings provide opportunities for individuals to practice new coping skills, receive feedback from others, and gain alternative perspectives on their issues. The sense of community and shared learning fosters accountability, emotional resilience, and a deeper sense of connection. Overall, individual and group teletherapy is an evidence-based treatment that can offer lasting improvements in mental well-being when combined with other therapeutic approaches.

CONSENT

I agree to adhere to the norms and expectations for individual and/or group mental health teletherapy as indicated above. I acknowledge that I have had the opportunity to ask questions and such questions were answered clearly and to my satisfaction.