Relational Connections

Transcription

1 INFORMED CONSENT Relational consists of individual, couples, and therapy services provided in Minneapolis with the objective to promote growth in individuals, couples and families. These services are provided by Lyndsey R. Fraser, MA, LAMFT. This is form is to help provide clients with information regarding Relational. It is recommended that you read it closely and ask your therapist any questions that you may have. Services Relational provides a systematic approach to psychotherapy for individuals, couples, and families. This includes creating a unique approach to assist you in reaching your own personal goals. The main goal of Relational is to promote all clients to be as self-sustaining as possible through therapy. Relational consists of Lyndsey R. Fraser who is a Licensed Associate Marriage and Family Therapist (LAMFT) under the supervision of Steve McManus, MS, LMFT. Lyndsey R. Fraser is currently under the supervision of Steve McManus, MS, LMFT as she pursues the final requirements to become a Licensed Marriage and Family Therapist (LMFT). Lyndsey R. Fraser s has a copy of her license at all times and is able to display her license when requested by clients. There are always some risks and benefits in therapy. Process of Therapy Relational is aware that psychotherapy can be a difficult process for the clients we serve. It is normal to have some anxiety and fear when starting the counseling process. It is not unusual for clients to experience thoughts and feelings that one has never experienced before. The therapy process can often bring up areas in clients lives that have not been touched. As the individual changes throughout the therapy process, it is not unusual for relationships and other areas of the clients lives to be affected. Clients are encouraged to share these experiences with the therapist. This is to ensure that the experiences can be processed with the support of the therapist. It can be difficult for clients to go through these experiences alone. Therapy is intended to provide guidance to assist you in making major decision in your life. Therapists do not have the authority to make these decisions for the client, but will assist in the process. Relational therapists look at the system that is affecting the client. This can be a new approach for many clients. This includes looking at family of origin issues, current relational patterns, and societal patterns that affect the client. Relational make every effort to help all clients that are served. Statistics have shown that psychotherapy outcomes are beneficial to clients. Informed Consent 1 of 5

2 Psychotherapy is a professional service that the therapist can provide to you. Because of the nature of therapy, our relationship has to be different from most relationships. It may differ in how long it lasts, in the topics we discuss, or in the goals of our relationship. It must also be limited to the relationship of therapist and client only. If we were to interact in any other ways, we would then have a dual relationship, which would not be right and may not be legal. The different therapy professions have rules against such relationships to protect us both. My duty as therapist is to care for you and my other clients, but only in the professional role of therapist. Therapy termination is a collaboration process between the therapist and client. It is often agreed that therapy will end when all the goals have been met. The therapist will usually take the last few sessions to wrap up the counseling experience. Hours of Operation Hours of operation vary. All therapy appointments are set up directly with the therapist. Day and evening appointments are available. The therapist will check voic between 9am and 5pm during weekdays. All telephone calls will be returned within 48 hours of being received during weekdays, exception being if the therapist is on vacation. The voic will inform clients if Therapist is on vacation and when the therapist will return. Appointment scheduling and Length/Cancellation/Termination Appointment scheduling: Appointments and times are scheduled with your individual therapist. Typical appointments are scheduled once a week. Exceptions would need to be made with your individual therapist. Length of appointment: Appointments are available in 50 or 90 minutes in length. Cancellations: Appointments must be cancelled within 24 hours of the scheduled appointment time. Cancellations may left by phone call or . If the appointment is not cancelled within the 24 hours, the client will be charged the fee of the appointment. After missing an appointment it is the responsibility of the client to reschedule. The client is not guaranteed the day of the week or the time slot in future weeks after a missed appointment. If a client misses three appointments in a row, he or she will be discharged from therapy. Termination: Therapy termination is a collaboration process between the therapist and client. The length of therapy is dependent on each individual client s needs. The therapist will usually take the last few sessions to wrap up the counseling experience. Sometimes a client may wish to see a different therapist or a therapist may need to refer the client to a professional who specializes in the client s treatment needs. There may be other special circumstances that termination is required. In all cases the therapist will provide three referrals. Fees Relational is a fee for service agency. We do not accept insurance payment for services. Services may be reimbursed by your insurance company as an out-of-network benefits, health savings account, or flexible spending accounts. To inquiry about these benefits contact your insurance provider. Fees are $90 for 50 minute session after 3pm during the week or Saturday mornings, $70 for a 50 minute session before 3pm during the week, and $130 for 90 minute sessions. Informed Consent 2 of 5

3 Relational offers packages. These include 5 sessions before 3 pm for $300 and 5 sessions after 3pm and/or Saturdays for $400. All five sessions must be used before 90 days. Any sessions not used in 90 days will expire. No extensions or exceptions. There is also a sliding scale fee based on income. Sliding fee is subject to availability upon request. There are 4 slots for this need. When the slots are full there will be a waiting list for the next Your fee will be determined at the time of your intake. This fee includes individual, couples, and families sessions. Payment is required at time of service. The therapy session will not occur without payment. If check bounces for payment the client is subject to a $25 return check fee. If a check bounces three times the client will be discharged from therapy. If payment is not received after written notice has been sent the therapist reserves the right to use a collection agency for nonpayment. Client Records and Confidentiality All records are technically the property of Relational. Relational keeps all records private, confidential, and secured as required by the Minnesota Data Privacy Act. Only Lyndsey R. Fraser, MA, LAMFT will have access to records. Information can only be released to a third party with a signed release or court order. Clients have the right to access their own records. It is usually in the best interest of the clients if their therapist is present while reviewing files. This allows the clients to ask questions if needed. A fee of $50 per copy of file applies. Couples/Families records and confidentiality: All individuals and/or guardians of the couple and family must sign a release before any information can be given to a third party. If one individual signs the release and all others refuse the information can not be released. Minors: Guardian and/or responsible party must sign the release for information to be released to a third party for clients under 18. Minors Minnesota law requires written consent from a guardian or parent to see a therapist at Relational. Guardians and parents have the right to access any minor s records. Therapists at Relational encourage guardians and parents to allow a certain amount of confidentiality in the therapy session to encourage minors to experience the most in the therapy. Couples and Family Therapy Relational has a no secrets policy when working with couples and families. What this means is that whatever is discussed in confidence with the therapist outside or inside of therapy with not be kept from any members of the couple or family. When children are involved some information may not be appropriate to share with the whole family. The therapist and client will discuss when some information may be kept from children. In most cases no secrets are allowed from the couple or family during the therapy process. Informed Consent 3 of 5

4 Court Orders and Subpoenas Relational therapists are not experts in custody of children and/or divorce proceedings. If a Relational therapist is court ordered or subpoenaed to testify in a case it is very unlikely that the therapist will be able to help the case. If a client still decides that it is necessary to court order or subpoena a therapist there will be a $300 charge for the therapist to show up at court/lawyers office and a $250 charge for every hour the therapist needs to be at court/lawyers office. Duty to Warn Therapists at Relational are mandated reports. This means that under certain circumstances, we are required by law to release information without your consent. These circumstances are described below. 1)-If you make a specific threat to harm yourself or someone (and the risk of danger is deemed imminent), the therapist or staff member must take the appropriate steps to protect you or warn the appropriate parties. 2)-If your therapist suspects that you have physically abused, sexually abused or neglected a child or vulnerable adult, they must report it to the appropriate authorities. 3)-If you are pregnant and using controlled substance (heroin, cocaine, phencyclidine, Methamphetamine or their derivatives). Emergency and After Hours Resources Relational therapists are not available for after hours or emergency drop-in services. If a crisis should arise clients should contact one of the resources below: Therapists only communicate by telephone and voic . Electronic means is only used for appointment set up and intake paperwork to be br. Therapists will not respond to any , text message, or any other electronic means regarding questions, requests for release of information, or any other client need. This is done to protect the confidentiality of all clients that are served as electronic means can not be guaranteed secure. If is after business hours the following resources can be used in an emergency: -Acute Psychiatric Services (available 24/7) Walk-in Counseling Center Crisis Connection (available 24/7) Informed Consent 4 of 5

5 Client Bill of Rights Consumers of marriage and family services offered by marriage and family therapists licensed by the state of Minnesota have the right: 1)-to expect that a therapist has met the minimal qualifications of training and experience required by the state law; 2)-to examine public records maintained by the Board of Marriage and Family Therapy which contain the credentials of a therapist; 3)-to obtain a copy of ethics from the Board of Marriage and Family Therapy, 2829 University Avenue SE, Suite 330, Minneapolis, MN ; 4)-to report complaints to the Board of Marriage and Family Therapy by calling (612) ; 5)-to be informed of the cost of professional services before receiving services; 6)-to privacy as defined by rule and law; 7)-to be free from being the subject of discrimination on the basis of race, religion, gender, or other unlawful category while receiving services; 8)-to have access to their records as provided in Minnesota Statutes, section , subdivision 2, and; 9)-to be free from exploitation for the benefit or advantage of a therapist. Questions or Complaints Relational encourages clients to speak with his or her therapist. If you need assistance in making a formal compliant Relational will help with the process (see client bill of rights above). Steve McManus, MS, LMFT is the supervisor for Lyndsey R. Fraser, MA, LAMFT. He may also be contacted if a client has compliant. He can be reached at You may also contact the Minnesota Board of Marriage and Family Therapy Minnesota Board of Marriage and Family Therapy 2829 University Ave SE, Suite 330 Minneapolis, MN Phone: My signature below indicates that I have read and understand the information in this document. I agree to abide by these terms while receiving services at Relational. I was given a copy of this document. Client Signature: Printed Name: Date: Informed Consent 5 of 5