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 the relationship with your therapist will work, and what you both can expect. This consent will provide a clear framework for the work with your therapist.

The Therapeutic Process

You have taken a very positive step by deciding to seek therapy. The outcome of your treatment depends largely on your 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. Overt and your therapist cannot promise that your behavior or circumstance will change. Your therapist can promise to support you and do their very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.

Records

The telehealth sessions shall not be recorded in any way unless agreed to in writing by mutual consent. Overt will maintain a record of our session in the same way Overt maintains records of in-person sessions in accordance with company policies.

In cases where there are multiple clients in a given session, counselors maintain separate files for each individual, none of which contains specific identifying information about any other individual. However, it should be noted that if one member of a session requested to have his/her own personal file released to any agency/individual, descriptions of joint sessions contained in that personal file may lead to the possible inferred recognition of another session member.

Location

I understand when participating in telehealth services, I must be physically in the state where my therapist is licensed. By engaging with Overt, you are acknowledging that you understand and agree to the following:

1. You must inform your provider of your location at the beginning of each session (if different than what is listed as your primary address).
2. You must identify on your informed consent form a person who can be contacted in the event that your provider believes your safety is at risk.
3. You understand that if your provider believes your safety is at risk, they may contact police to conduct a welfare check.

Risks

There are potential risks, consequences, and benefits of telemedicine. Chat features, including only using Chat Sessions, are included in the risks, consequences and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs.

Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences.

When using information technology in therapy services, potential risks include, but are not limited to the therapist’s inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. This may be impacted more if only using the chat feature. Potential consequences thus include the therapist not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally the therapist.

Another risk is that despite our best efforts to ensure that our video conferencing and health record services meet industry security and privacy standards, the transmission of your information could be disrupted or distorted by technical failures; the transmission of your information could be interrupted by unauthorized persons; and/or the electronic storage of your medical information could be accessed by unauthorized persons.

An additional consideration with teletherapy is that, depending on where you are, your sessions may be less private than in-person sessions. There is a risk of being overheard by anyone near you if you are not in a private room while participating in teletherapy.

Usage

Teletherapy services are not appropriate for all clients. Those who are experiencing suicidal ideation or altered mental status are better served by face-to-face therapy sessions. We reserve the right to refer individuals needing more intensive services to a therapist in the community.

Rights

The therapeutic relationship is a voluntary one and you have the right to end therapy or ask for a new therapist at any point in time. You have the right to ask questions about any aspect of the therapy process and about therapists’ training and credentials.

Termination

Overt reserves the right to terminate therapy at therapists’ discretion for reasons including but not limited to noncompliance with treatment recommendations, conflict of interest, failure to participate in therapy, or the problem at hand is outside the therapist’s scope of practice or competence.

Confidentiality

It is important to note that online therapy presents unique risks to client confidentiality. This includes variables on the participant’s end such as others in the vicinity overhearing the conversation, reading open chats, and captured internet transmissions. This risk can increase in a group setting.

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. 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/herself 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.

Occasionally your therapist may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name.

If you see your therapist accidentally outside of session, he/she will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to your therapist, and he/she does not wish to jeopardize your privacy. However, if you acknowledge your therapist first, he/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.

BY CONTINUING TO ENGAGE WITH OVERT, INC. YOU AGREE THAT YOU HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS CONSENT.