You have the right to end your family/child’s treatment at any time, but we do recommend at least one face-to-face graduation session with your counselor.

You have the right to ask questions on treatment with your counselor and to expect that we will work with you to meet your needs.

If your child sees a counselor individually, you have the right to expect that their counselor will communicate with you about your child’s therapy. However, to establish trust between your child and their counselor it is important for a successful therapeutic outcome, we ask you to keep in mind your child’s need for privacy.

If your child is seen in therapy, both parents may be asked to participate in the treatment. This may involve family treatment, parent meetings between you and your child’s counselor, or individual therapy for each parent. Your counselor may share information regarding issues that arise with each parent.

Therapy involves a partnership between counselor and client. Your family’s counselors will contribute knowledge, skills, and will do his/her best. The determination of success, is largely dependent upon your commitment to your family’s growth and care.

Note that our counselors, due to licensure restrictions, will seek to avoid dual relationships whenever possible, and will tend to avoid non-therapeutic relationships for some time after the client graduates from counselings.

If a court situation arises, please know it may damage the therapeutic relationship between counselor and client. The fees for any of the Solace counselors in legal matters (expert witness, therapy notes/summaries, speaking with attorneys, etc) will be billed at twice the normal hourly rate. There are many professionals able to be an expert witnesses in custody cases, divorces, or other legal situations. If necessary, we can be involved, but prefer to protect our client-counselor relationship.

Your signature below indicates that you have read and understand this information and you give permission for Solace Counseling Center to provide counseling services to you or your child. Your signature also indicates you have legal authority to consent to services provided at Solace Counseling Center.

Appointments are 53+ minutes and your family/child’s specific hour is held by their counselor from week to week. If your family/child is unable to keep an appointment, please contact our office as soon as possible. We reserve the right to suspend counseling if three or more appointments are scheduled and not attended. We ask for you to notify the office no less than 24 hours prior to the scheduled appointment. A late or No-Show charge will be applied if not notified.

Counselors hours vary between counselors. If you need to reach your counselor, please leave a message with the office. Messages left outside of normal business hours will be returned the next business day. If you have an emergency that needs immediate attention, please seek assistance at the nearest emergency center.

Communication between you and your counselor/child’s counselor is both privileged and confidential. This means that without your written permission the counselor cannot discuss your case orally or in writing, except with members of Solace Counseling and Anxiety Center licensed professional counselors and staff.

Your counselor has an ethical and legal obligation to break confidentiality under the following circumstances:

• If there is a reason to believe there is an occurrence to a child, elder or dependent abuse or neglect.
• If there is reason to believe that your child or a member of your family has serious intent to harm themselves, someone else, or property by a violent act they may commit.
• If you introduce a family member’s emotional condition into a legal proceeding or your counselor is subpoenaed to give testimony.
• If there is a court order for release of your records.

If at any time the client feels their rights have been violated or wish to file a complaint. You can reach the LPC Board at 1-800-942-5540 or by mail at Texas State Board of Examiners of Professional Counselors, PO Box 141369, Austin, TX 78756-3169.

Often, clients will request or initiate communication via email, text, phone calls, cloud-based platforms, or social media platforms. The counselor will carefully consider whether any such form of communication is in the best interest of the client once the client has communicated consent on this form. If the therapist finds that these forms of communication are therapeutically indicated and beneficial for the client, the counselor may respond to the client thus indicating that the communication has been considered therapeutically appropriate and beneficial for the client.

Even when communication outside of the counseling office is therapeutically beneficial to the client, it is important to recognize that no form of communication is 100% safe or protected from outside entities or unauthorized access. The counselor will take appropriate action and security precautions to prevent unauthorized access to protected health information as set forth by HIPAA. No efforts would ever be made to inappropriately break a client’s confidentiality in regard to any of these forms of communication. All other confidentiality agreements for counseling remain in full effect.

If at any point in time the counselor determines that these forms of communication are not therapeutically indicated or in the best interest of the client, the counselor may terminate electronic forms of communication. Similarly, the client has the right to terminate any or all forms of communication at any time, and for any reason.

The client understands that communication using email, text, phone call, cloud-based platforms, or social media is limited and may not be monitored. As such these forms of communication are not appropriate for emergency situations that may concern the immediate health or safety of a person and by signing below express their understanding to call emergency services in such an event.

Tele-therapy

A face-to-face counseling setting allows for in-depth communication including but not limited to non-verbals, tones of speech, clear eye contact, and other fine points of communication that are often lost in alternate forms of communication. In the case of tele-therapy some of these non-verbal cues may be lost. In these circumstances tele-therapy may be less effective than face-to-face.

All such analysis can be made with the client and the counselor together in deciding whether to engage in tele-therapy when it is deemed necessary.
While in-person if often ideal, tele-therapy may be useful in order to maintain continuity of care and employed as an option when therapeutically indicated and determined to be beneficial for the client.

Acknowledgement

By signing below I acknowledge that my therapist has reviewed the pros and cons of electronic communication with me and I understand the risks inherent to digital communication.

I also acknowledge and accept that despite precautions being taken by my counselor to maintain protected health information in accordance with HIPAA provisions, there remains some risk inherent to digital communication. I have been made aware of and accept this risk.

I further acknowledge that my therapist has reviewed the strengths and limitations inherent to tele-therapy and by signing below indicate my desire to use this service as needed.