Informed Consent

Prior to beginning a counseling relationship, it is important for you to familiarize yourself with my approach to treatment, your rights and responsibilities, and my office practices. You have received my Professional Disclosure Statement which outlines your right to confidentiality and privacy, and defines under what circumstances your protected health information may be released to another person(s) or agency.

Potential Risks of Therapy and Treatment:

There are some risks involved in therapy. For example, some people experience an increase in stress during the early stages of therapy. Some problems may seem to get worse before they get better because you are focusing more attention on them. In some cases, discussing long-standing, unresolved problems brings them to the surface and can seem to aggravate rather than help the problem. This often happens in couple or family therapy. You should be aware of them, but try not to be discouraged by them, as they will likely lessen as we continue on in therapy. Please feel free to discuss any questions or concerns you have about the potential risks for you or your family.

Counseling and Treatment Alternatives:

I am not able to treat all concerns and problems confronting my clients. As a result, I cannot guarantee successful treatment. If I determine that I cannot adequately treat you, I will inform you at the earliest opportunity and assist you in finding services that are more appropriate. This could include a referral to another mental health provider, a hospital/inpatient facility, or a substance abuse treatment program. Other referrals may also be appropriate. If at any time you have concerns about the effectiveness of your treatment, please discuss these concerns with me as soon as possible.

Legal Proceedings and Court Involvement:

If you are involved in or anticipate being involved in legal or court proceedings, please notify me as soon as possible. It is important for me to understand how, if at all, your involvement in legal proceedings might affect our work together. In the event you are seeing me because you have been asked to obtain an evaluation for a legal proceeding, it is important for you to know the difference between treatment and evaluation, and that treatment is not a substitute for an evaluation. Treatment is also not an appropriate way to obtain evaluation results. If you need an evaluation, I will assist you in finding a provider who offers this service.

It is also important for you to know that I will not be a part of any legal proceedings against current or former clients. I will work with you to support treatment goals, not to address legal issues that require an adversarial approach. Clients entering treatment are agreeing to not involve me in legal or court proceedings, or attempt to obtain treatment records for legal or court proceedings when marital or family counseling has not been successful at resolving disputes. This prevents misuse of your treatment for legal objectives.

In the event that you require my testimony or involvement in non-adversarial aspects for legal or court proceedings, I will do so only with your consent. I will be unable to disclose any information pertaining to other family members or parties in counseling without their specific consent.

Appointments and Cancellations:

Our sessions will be by appointment only and will usually be 60 minutes long. Please call my office immediately if you need to cancel or reschedule your appointment. A voicemail will take your message 24 hours a day. You will be provided a business card with my phone number. Full payment will be expected for cancellations made with less than 24 hours notice, with some exceptions.

Payment and Billing:

It is my policy that you pay for your treatment at each session. If full payment at the time of service is not economically feasible for you, other arrangements can be made on a case-by-case basis, but must be made and agreed upon in advance.

Emergencies:

In the event of an emergency related to your treatment with me, you may call my office number and leave a confidential voicemail. Please identify that you are having an emergency and leave a call back number. If there is a mental health emergency and I cannot be reached, please contact your physician, go to the nearest emergency room, or call the county crisis line:

• Multnomah County (503) 988-4888

• Clackamas County (503) 655-8401

• Washington County (503) 291-9111