Consent for Group Therapy

Welcome to The Counseling Center. Thank you for choosing us as your mental health care professionals. This document contains important information about our professional services and business policies. In addition, it explains some basic principles that will enhance the therapeutic process. Please read it carefully and jot down any questions you might have so that you can discuss them during your initial meeting with your therapist. Our mutual understanding and adherence to these ground rules and administrative policies will aid in the most effective use of our time and efforts. It may also minimize the possibility of future misunderstandings that might interfere with the therapeutic process. When you sign this document, it will represent an agreement between us.

ABOUT GROUP THERAPY

Group therapy helps people work through problems by interacting with a therapist and a group of individuals facing similar challenges. In a safe, confidential setting, each group member can share personal experiences, feelings, and issues, and receive feedback and support from the rest of the group. The therapist leading the session may draw from a variety of therapeutic approaches, such as cognitive-behavioral, psychodynamic and humanistic.

There are many different types of therapeutic groups, but most therapy groups can be divided into two main approaches. These approaches are psychoeducational group therapy and process-oriented group therapy:

• Psychoeducational groups provide members with information about specific issues. They may also teach healthy coping skills. These groups are led by a qualified therapist who directs sessions and sets goals. In this type of group therapy, the therapist takes on the role of teacher.
• Process-oriented groups focus on the group experience. While the therapist leads the group discussion, they act as a facilitator rather than an instructor.

Group members participate by engaging in group discussions and activities. Joining a group may sound intimidating at first, but group therapy provides benefits that individual therapy may not.

Groups can act as a support network and a sounding board. Other members of the group can help you come up with specific ideas for improving a difficult situation or life challenge and hold you accountable along the way. Regularly talking and listening to others also helps you put your own problems in perspective. Many people experience mental health difficulties, but few speak openly about them to people they don’t know well. Oftentimes, you may feel like you are the only one struggling — but you’re not. It can be a relief to hear others discuss what they’re going through and realize you’re not alone.

Diversity is another important benefit of group therapy. People have different personalities and backgrounds, and they look at situations in different ways. By seeing how other people tackle problems and make positive changes, you can discover a whole range of strategies for facing your own concerns. To gain the maximum benefit of group therapy, individuals must be willing to participate. The more open and honest an individual can be, the more they can get out of the experience.

GROUP TELETHERAPY

I understand that group therapy conducted online is technical in nature and that problems may occasionally occur with internet connectivity. Difficulties with hardware, software, equipment, and/or services supplied by a third-party may result in service interruptions. Any problems with internet availability or connectivity are outside the control of the therapist, and the therapist makes no guarantee that such services will be available or work as expected. If something occurs to prevent or disrupt any scheduled appointment due to technical complications, and the session cannot be completed via online video conferencing, I agree to call my therapist at: (317) 754-0808.

I AGREE TO TAKE FULL RESPONSIBILITY FOR THE SECURITY OF ANY COMMUNICATIONS OR TREATMENT MATERIAL ON MY OWN COMPUTER AND IN MY PHYSICAL LOCATION. I understand that I am solely responsible for maintaining the strict confidentiality of my user ID and password and not allow another person to use my user ID to access the Services. I also understand that I am responsible for using this technology in a secure and private location so that others cannot hear my conversation. I understand that there will be no recording of any of the online sessions and that all information disclosed within sessions, and the written records pertaining to those sessions, are confidential and may not be revealed to anyone without my written permission, except where disclosure is required by law.

LIMITS TO GROUP TELETHERAPY

I understand that teletherapy is not appropriate nor a substitute for in-person therapy during crisis situations (i.e. suicidal ideation). The Counseling Center, LLC requires emergency contact information for all teletherapy clients and parents to minor patients. Therapists of The Counseling Center, LLC are only licensed to perform services in the State of Indiana; therefore, teletherapy is not suitable for long-term treatment with clients outside of the State of Indiana. Furthermore, I understand that I must be physically located within the State of Indiana during group sessions.

THERAPEUTIC RELATIONSHIP

I will use my best knowledge and skills to help you. This includes following the standards of the American Counseling Association (ACA). In your best interests, the ACA puts limits on the relationship between a therapist and a client, and I will abide by these. Let me explain these limits, so you will not think they are personal responses to you. If we meet on the street or socially, I may not say “hello” or talk to you very much. My behavior will not be a personal reaction to you, but a way to maintain the confidentiality of our relationship. I can only be your therapist. I cannot have any other role in your life. I cannot, now or ever, be a close friend, or socialize with any of my clients. I cannot be a therapist to someone who is already a friend. I can never have a sexual or romantic relationship with any client during or after the course of therapy. I cannot have a business relationship with any of my clients, other than the therapy relationship.

I do not discriminate against clients because of age, sex, marital/family status, race, color, religious beliefs, ethnic origin, place of residence, veteran status, physical disability, health status, personal identity, sexual orientation, gender identity, or criminal record (unrelated to present dangerousness). I will always take steps to advance and support the values of equal opportunity, human dignity, and racial/ethnic/cultural diversity.

DURATION OF GROUP TREATMENT

Typically, groups meet for 1-2 hours each week and address specific concerns shared by group members. The minimum number of recommended sessions is often six, but many people attend for a full year. The type of group you participate in will influence the duration of the group. For example, psychoeducational groups are generally time-limited (i.e., 6 to 12 sessions and focus on a specific topic), while process-oriented groups are open-ended, ongoing, and may last for an extended period. The process of ending group therapy, called “termination,” can be a very valuable part of group work. Stopping therapy should not be done casually, although either of us may decide to end it if we believe it is in your best interest. If you wish to stop therapy at any time, I ask that you agree to meet for at least one more session to review our work together. We will reflect upon our goals, the work we have done, any future work that needs to be done, and our choices.

CONFIDENTIALITY

All aspects of your treatment are confidential. I will need your written permission if you wish me to discuss your treatment with anyone else. Without your written permission, I cannot reveal any information about you or your treatment. Even the fact that you are a client in our practice is protected by confidentiality. Confidentiality is strongly encouraged among group members. Issues discussed in group therapy are not to be discussed elsewhere, even if group members live in the same setting. Each group member has a personal responsibility to keep their fellow group members’ information private while being able to tell their personal stories to whomever they wish.

EXCEPTIONS TO CONFIDENTIALITY

1. If I believe, in my professional opinion, that you are an imminent danger to yourself or to someone else, then I must attempt to ensure the physical safety of those involved, even if this means breaking confidentiality.
2. If you give me information pertaining to the abuse or neglect of a child, an elderly person, or a disabled person, past or present, and the victim is identified, I am required to report this information to the local authorities, even without your permission. I am required to report even a suspicion of such abuse to the local authorities.
3. I may also be required to discuss aspects of your treatment without your permission if I am subpoenaed or court-ordered to do so. These situations rarely occur. If a similar situation occurs, I will make every effort to fully discuss it with you before taking any action.

CONTACTING YOUR PROVIDER

Providers are not often immediately available by telephone. Email is the quickest way to reach your provider. If you would like to speak on the phone, you may leave a message on our confidential voicemail. We will make every effort to return your call within 24 hours, except for weekends and holidays. Messages left on weekends and holidays will be returned the next business day.

EMERGENCIES

In the event of a psychiatric emergency, please call 911 or go to the nearest emergency room and ask to be evaluated by a mental health practitioner. The National Suicide Prevention Lifeline is also available 24 hours a day, 7 days a week at (800) 273-TALK (1-800-273-8255).

LIMITATIONS TO HIPAA AND 42 CFR PART 2 PRIVACY RIGHTS

The Counseling Center, LLC and its affiliates (“The Counseling Center”) provide an option for clients in group therapy to participate via teletherapy.

If you choose to participate in a group via teletherapy, you are hereby agreeing to the following:

The undersigned client (“Client”) hereby gives Client’s consent and authorization to participate in The Counseling Center, LLC and its affiliates’ (“The Counseling Center”) teletherapy program. While The Counseling Center’s teletherapy options, including Zoom, are privacy optimized, The Counseling Center may not have formal business associates agreements in place with those providers, which may create statutory privacy issues. Client consents to those third-party services acting as a conduit for Client’s protected health information and the potential for obtaining access to that information. Client also understands that if Client is not in a private location while accessing telehealth, others may see or overhear Client’s protected health information. Client thus hereby consents and authorizes The Counseling Center to disclose Client’s protected health information to its telehealth providers to the extent necessary to use The Counseling Center’s teletherapy services for the purpose of Client’s treatment. Client further agrees to waive all applicable federal and state privacy protections, including but not limited to, HIPAA protections and protections under 42 CFR Part 2, to the extent necessary to participate in The Counseling Center’s teletherapy options. This authorization will remain in place until revoked by the Client. Client may revoke this authorization at any time by contacting The Counseling Center’s compliance officer at Jason.Lynch@counselingmail.com or 317-754-0808.

OUR AGREEMENT

My signature below indicates that I have read and discussed this agreement. I understand that after therapy begins, I have the right to withdraw my consent to therapy at any time, for any reason. However, I will make every effort to discuss my concerns about my progress with my therapist before terminating treatment. I have read, or have had read to me, the information contained in this notice, which is also available on The Counseling Center’s website at www.TCC-INDY.com. I have discussed the points I did not understand, and have had my questions, if any, fully answered. I agree to act according to the points covered in this notice. I hereby agree to begin therapy with The Counseling Center, LLC, and to cooperate fully and to the best of my ability, as evidenced by my electronic signature below.

Effective Date:  December 12, 2020

Last Reviewed:  December 12, 2020

Next Review:   December 12, 2020

Approved By:  Jason Lynch, Owner/CEO