When you register your child with us for counseling, you will be sent the informed consent information to sign as a part of the intake paperwork.

We want you to know that your child will receive free regulated healthcare services with Sarah Isenberg through Castleman Counseling.

Castleman Counseling INFORMED CONSENT for PSYCHOTHERAPY at Rocketown

COUNSELOR: Sarah Isenberg, Masters Level Intern at Castleman Counseling

GENERAL INFORMATION
The therapeutic relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with your assigned counselor. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.

THE THERAPEUTIC PROCESS
You have taken a very positive step by allowing your child to seek therapy. The outcome of their treatment depends largely on their willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. We cannot promise that behavior or circumstance will change. We can promise to support your child and do our very best to understand your child and repeating patterns, as well as to help bring clarity. You child will become the client to Sarah Isenberg until services have ended.

CONFIDENTIALITY
The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons.

Parents may request a summary of services.

Limitations of such client held privilege of confidentiality exist and are itemized below:

1. If a client threatens or attempts to commit suicide or otherwise conducts him/her self in a manner in which there is a substantial risk of incurring serious bodily harm.

2. If a client threatens grave bodily harm or death to another person.

3. If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.

4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.

5. Suspected neglect of the parties named in items #3 and # 4.

6. If a court of law issues a legitimate subpoena for information stated on the subpoena.

7. If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.

8. Confidential information must be accessible to any individual supervisor of counselors pursuing state licensure.

9. Confidentiality is limited if Castleman Counseling must engage in collection agencies for the purpose of receiving payment for services rendered.

10. Confidentiality is limited for purposes of professional consultation between counselor and other practicing therapists and/or for group supervision. Information about you may be shared in this context without using your child’s name.

If we see each other accidentally outside of the therapy office, I will not acknowledge your child first. Their right to privacy and confidentiality is of the utmost importance to us, and we do not wish to jeopardize privacy. However, if you acknowledge Sarah first, she will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.Description text goes here

Description text goes hereCastleman Counseling PRACTICE POLICIES

APPOINTMENTS AND CANCELLATIONS Please remember to cancel or reschedule 24 hours in advance. It is respectful to Sarah’s time.

FEES FOR SERVICE Counseling at Rocketown is a free service for the children who attend Rocketown.

ACCESSIBILITY If you need to contact your counselor between sessions, please text or email your contact your counselor directly. We are often not immediately available; however, we will attempt to return your call within 24 business hours. Please note that only in-person sessions are available. We will not provide telehealth.

SOCIAL MEDIA AND TELECOMMUNICATION Due to the importance of your confidentiality and the importance of minimizing dual relationships, we do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). We believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up with your child’s counselor to talk more about it.

ELECTRONIC COMMUNICATION We cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, we will do so. While we try to return messages in a timely manner, we cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

MINORS If you are a minor, your parents may be legally entitled to some information about your therapy. We will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential. If you would like to discuss a concern regarding your child, please schedule an appointment with us outside of your child’s appointment time. Parents of children under 18 will sign counseling consent forms. We do follow the parenting plan and will need a copy of the parenting plan if you are divorced/separated. Our clients who are 18+ are the ones we have to protect confidentiality with and will have to set appropriate boundaries on what is said to parents outside of session (if at all).

TERMINATION Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. We may terminate treatment after appropriate discussion with you and if we determine that therapy is not being effectively used or if you are in default on payment. We will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

SUBPOENA/ COURT If the relationship moves to termination through legal action and you need Castleman Counseling in any capacity, we will charge an hourly rate of $50.00 for any time we have to devote to preparing documents, talking to legal counsel (ours and yours) and time in court. A bill will be sent to you at the end of each week that includes hours incurred and payment will be paid through the credit card/ debit card on file. If no credit/debit card on file, then payment must be made within 3 days of receiving the bill.

COUNSELOR INCAPACITATION If Sarah Isenberg becomes incapacitated for any reason and cannot continue the therapeutic relationship with her clients, Lindsey Castleman has been given permission to access client’s contact information to make them aware of the circumstances and next steps. If Lindsey Castleman becomes incapacitated for any reason, Shonda Vaughn, LMFT has been given permission to access Lindsey’s client contact information to make them aware of the circumstances and next steps.

Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, we must consider the professional relationship discontinued.