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Just A Thought Counseling, PLLC

5 Hutchings Dr., Suite 87

Hollis, NH 03049

603-321-6535

 

Treatment Information Notice to Clients and

Consent to Treatment Agreement

 

Welcome to Just A Thought Counseling.  This document contains important information about our professional services and business policies.  All licensed mental health professionals are required by the NH Board of Mental Health Practice to provide clients certain basic information.  To avoid confusion or misunderstandings, Just A Thought Counseling PLLC is providing additional important information about our practice for your review and agreement. 

 

Please read this document carefully, as once signed, this constitutes a binding agreement between us.  If you have any questions or concerns about any part of this, please discuss them with your counselor before signing.

 

Counseling

Mental Health Counseling varies depending on the personality of the counselor, the client, and the particular situation a client presents. The counselor/therapist (these terms are used interchangeably) will provide you with information about their education and training and will conduct an evaluation during the initial sessions(s). Using this information, the counselor will provide you with initial impressions of what the work will include and how your specific needs can best be addressed, including the rationale for treatment. There are a number of different approaches that can be used to address problems. Together, you and your counselor will discuss the issues that bring you to counseling and together you will develop a treatment plan that will work for you.

In order to be most successful, you will have to work both during sessions and at home. Counseling is a collaboration between you and your counselor. You and your counselor will discuss your needs and treatment goals, and together you can decide if the counselor is the best person to work with you. It is important that you feel good about the treatment plan and working with your counselor. If you have any concerns, or feel you would do better with a different counselor, you counselor would be happy to work with you to make the necessary changes, or refer you to another counselor. 

The Client/Counselor relationship: 

Counselors have a unique and special relationship with their clients. Counselors seek to build a positive, trusting, collaborative relationship in which the client can feel safe and valued. Although many of the same features are ideally a part of relationships with close friends or physically intimate partners, counselors are neither friends nor can we be physically intimate with clients. In a healthy friendship or physically intimate relationship, each individual plays a mutual role. Each invests in the relationship, and each expects to get something out of the relationship. There is give and take on both sides. 

The counseling relationship is different. It is a professional relationship, and we receive a fee for our services. Our professional code of ethics makes clear that our primary responsibility is to respect your dignity and promote your welfare. The entire focus during treatment, and even after treatment, is on what is best for you, the client. Keeping the focus on you is important. This will help your counseling be the most effective. For us it really is all about you. 

Dual Relationships 

​Dual relationships are when counselors and clients have another relationship besides just client and counselor. This could include being family members, neighbors, business associates, or in the same social circle, as well as others. Counselors try to avoid dual relationships whenever possible, not because we don't like you, but because we want to protect your confidentiality, and we don't want to even appear to be taking advantage of our special role as your counselor in any way. We want to make sure your counseling is all about you, which is more difficult if we are also in another type of relationship. We also want to avoid any situation that might be awkward for you, or that might interfere with your counseling. This is why, if we see you around town, we won't make any sign that we know you. You may not want to explain to others how you know us. We leave it up to you if you would like to approach us, be we encourage you to consider whether doing so is in your best interest. Your counselor would be happy to discuss this with you more.

 

Friending on Facebook

          and other social media

As counselors, we do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, Instagram, 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 any questions about this, please bring them up with your counselor, and together you can discuss this more.

What if something happens to my Counselor?

In case your counselor is suddenly unable to continue to provide professional services or to maintain client records due to incapacitation or death, your counselor has designated a colleague who is a licensed mental health provider as their professional executor. If they die or become incapacitated, their professional executor will be given access to all of their client records and may contact you directly to inform you of your counselor’s death or incapacity; to provide access to your records; to provide psychological services if needed; and/or to facilitate continued care with another qualified professional if needed. If you have any questions or concerns about this professional executor arrangement, your counselor will be glad to discuss them with you. 

Professional Boundaries and Conflicts of Interests

 

Actual or potential conflicts of interest may sometimes arise.  If it becomes apparent at some point that a conflict of interest exists in providing you treatment, the risks of continuing treatment, options for further actions, and ethical implications of different options, will be discussed with you and in colleague consultation.  It may be necessary to refer you to another therapist. Do not hesitate to raise any questions you may develop regarding professional boundaries or your treatment at Just A Thought Counseling.  If your question is not resolved to your satisfaction, you can access the NH Board of Mental Health Practice at https://www.oplc.nh.gov/board-mental-health-practice. 

 

Your Counselor’s Experience

 

Rebecca Jamison, M.A., LCMHC

 

I am a Licensed Clinical Mental Health Counselor in the state of New Hampshire (NH, # 1226). I am a Profession Member of the American Mental Health Counselors Association (AMHCA) and act as the current President-Elect for the New Hampshire Mental Health Counselors Association (NHMHCA). As a Clinical Mental Health Counselor, I am governed by the AMHCA Code of Ethics. I have a Master’s in Clinical Mental Health Counseling, 2013, from Rivier University in Nashua, NH. Before entering private practice, I worked with victims of trauma and domestic violence. I've had in-depth and ongoing training at the Beck Institute where Cognitive Behavior Therapy (CBT) was developed. I also use other well researched and empirically supported therapy approaches as needed. I've had training and experience in mediation as well. My Master's internship was at a drug rehab center working with both inpatient and outpatient clients. Currently, I provide individual therapy for a wide variety of difficulties. My main areas of focus are anxiety, depression, adjustment, and relationship issues. I work with adults and older teens as well as couples.

 

Just A Thought Counseling uses Cognitive Behavior Therapy as the framework for helping clients. Cognitive Behavior Therapy (CBT) is a time-sensitive, structured, present-oriented psychotherapy that has been scientifically tested and found to be effective in more than 2,000 studies for the treatment of many different health and mental health conditions. When implemented correctly, CBT helps individuals get better and stay better. Various other techniques and empirically supported therapy approaches may be used as a part of CBT as well.

 

Informed consent

 

New Hampshire and federal law protect the confidentiality of all communications between a client and a licensed therapist. These communications are privileged and confidential and may not be disclosed without specific written authorization. 

Client Rights and Responsibilities

 

You have the right to receive quality treatment. This includes being treated without discrimination on the basis of age, color, national origin, race, ethnicity, socioeconomic status, veteran’s status, disability, body size, health status, religion, gender or sexual orientation.   All mental health clients have certain rights.  A copy of the Mental Health Bill of Rights is on our website at www.justathoughtcounseling.com and has been included with your intake paperwork packet. Please review the Bill of Rights carefully and let you therapist know if you have any questions. 

 

Confidentiality

 

Unless otherwise required by law, information revealed by you during therapy will be kept confidential and will not be released to any other person or agency without your written permission, or in the case of a minor, the permission of a parent or legal guardian.  Current law requires information to be provided under the following circumstances:

 

  1. When abuse or neglect of a minor child or incapacitated adult is suspected, in which case the appropriate state authority must be informed

  2. When a client or other individual is seen as posing a serious threat of harm to themselves, others or real property, in which case a licensed therapist must warn the police or likely victim

  3. When ordered by a court

  4. When a client has waived certain rights when contracting for insurance coverage of services.

 

Parents have a right, with some limitations, to access and authorize the release of information on their minor child’s treatment. 

 

Some billing and other information may be transmitted electronically to your insurance company. The confidentiality of such communications cannot be guaranteed.

 

Records may also be subject to audit by regulatory authorities.

 

We may occasionally share information with a colleague for purposes of consultation.  During a consultation, every effort is made to avoid revealing your identity.

 

Pursuant to the federal regulation Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R Part 2, records and information pertaining to your alcohol and/or drug treatment are protected and cannot be disclosed without your written consent. 

 

Diagnosis and Treatment Plan

 

You and your counselor will discuss a plan for treatment together by the end of our third session.  This will include an applicable mental health diagnosis, assessments made, why these recommendations are being made, and the risks and benefits of this treatment, of treatment alternatives, and of doing nothing.  You are encouraged to ask any questions you may have about the course of your treatment, as those questions arise.  We will engage in ongoing evaluation of the progress of therapy, considering your treatment goals and moving forward only with your ongoing informed consent.

 

Records

 

Your record will be kept for seven years after you end treatment. If the client is a minor, records will be kept for seven years after they turn eighteen. You have the right to see the contents of your record and to add a statement regarding your situation or commenting on the services you received. You can have a copy of your record within 30 days of a written request, except as otherwise provided by law, and will be charged an established fee for copying. 

 

Treatment of Minors

 

Just A Thought Counseling cannot engage in the treatment of a minor without the written authorization of a parent or guardian.  In the treatment of clients under the age of 18, parents have a right to examine the treatment record and authorize the release of information relating to their child, provided parental rights have not been terminated or there is not a court order preventing us from doing so.    

 

When a minor turns 18, ownership of the record goes to him/her.  The parent then no longer has authority to access the record, as the 18-year-old now must sign for any release of record.

 

 

Couples Counseling

 

In couples counseling, typically most of the therapy time will be with the partners together. At times it is more helpful to meet separately, if both clients agree.  Since treatment records involving couple’s sessions will contain information about each party, both clients must sign this informed consent.  If either party requests a copy of the notes, both parties must sign a release. For couple’s work to be effective, it is sometimes crucial for the therapist to know if there are secrets. Ethical codes support that the therapist may not reveal any individual’s confidences to the partner without the prior written permission of that individual. However, not sharing a secret can at times impede progress in couple’s therapy.  The therapist could not share the secret directly without permission, but ethically and in good faith could not continue working with the couple while holding a secret with one partner that, in the therapist’s professional judgment, severely impedes progress.  In rare circumstances, a partner sharing the secret with his/her partner might be made a condition for continuing therapy.  The therapist in this circumstance would discuss and encourage the partner to make the disclosure. How to do this in the most helpful way would be fully explored.

 

Sometimes, during the course of individual therapy, the client and counselor may agree that having the partner attend sessions could be helpful to the client. This is not technically couples counseling since the client is an individual, the treatment is structured to focus on the individual, and the goals are individual goals, even though there may be goals to improve the relationship. In these cases, the notes belong only to the individual client.

 

Cancellations

 

If you need to cancel an appointment, please call (603) 321-6535 or send an email to becky@justathoughtcounseling.com as soon as possible before your next scheduled session. If you do not cancel before the start of your next scheduled session, you will be charged a $25 missed/late cancellation fee that will need to be paid before scheduling your next session.  This is not reimbursable by your insurance company. You will be contacted via email or phone to let you know you missed your scheduled session, and the next session will be tentatively scheduled. Tentatively scheduled sessions will not be charged missed/late cancellation fees.  If you miss two sessions in a row without contact, it will be assumed that you are at least temporarily unable to attend counseling sessions and no further sessions will be scheduled. You will be called or emailed to remind you of this. That particular session time will be used to schedule another client. Clients should feel free to call back in the future if they would like to continue with counseling.

 

Emergency Coverage

 

If you need to reach your therapist, please call (603) 321-6535 and leave a message. We are generally available to return calls during normal business hours.  We aim to return calls within 24 hours throughout the regular business week. If your number is blocked and you would like a return call from your therapist, please unblock the phone by pressing *87.  If your therapist is going to be unavailable due to a vacation, this will be discussed in session and, if needed, another licensed counselor will be provided. In the event of a mental health emergency, do not wait for a return call from your therapist. Instead, call the Greater Nashua Mental Health Emergency/Mobil Crisis team at 1-800-762-8191 for support or assistance. If your crisis involves immediate risk of harm to self or others, call 911 or go immediately to the nearest emergency room for an evaluation.

 

Fees For Services

 

Just A Thought Counseling fee is $ 75 per 50-minute session. Although Just A Thought Counseling reserves the right to change fees at any time, clients who are already in counseling will likely continue to pay their current rate. If these rates must be raised by Just A Thought Counseling, this will be discussed with current clients well in advance of any change. Payment for the session is due at the time of service.  We prefer to store your credit card (Master Card, Visa, Discover) information in our secure encrypted Therapy Notes system. The next session will be scheduled once payment has been made for the current session.

 

In addition to weekly sessions, Just A Thought Counseling charges a fee of $ 75 per hour for any additional professional services performed. Such services are not billable to your insurance company and may include, but are not limited to, telephone conversations lasting longer than 10 minutes, collateral telephone calls, preparation of records or treatment summaries or time spent performing any other service you may request.  Just A Thought Counseling will break down the hourly cost into 15 minute increments and charge accordingly for work performed in less than one hour. 

 

In circumstances of unusual financial hardship, it is important to notify your counselor so that a fee adjustment or payment installment plan can be discussed.  If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, Just A Thought Counseling has the option of using legal means to secure payment and can include utilizing a collection agency.  If such legal action is necessary, Just A Thought Counseling will only release to the collection agency client name, nature of services and amount due. 

 

Treatment is most effective when it is not made part of legal disputes.  If we are required to take part in any such actions the fee for any and all time participating in these actions is $200 per hour for all time spent, including but not limited to time preparing a treatment summary, report writing, trial preparation, travel time, and actual participation.  The charge will be for a minimum five hours to account for the rescheduling of a half-days’ worth of client sessions.  These charges are not covered by your insurance.

 

Insurance Reimbursement

 

Just A Thought Counseling is an out-of-network provider with insurance companies. Due to the rising costs of health care, insurance benefits have become increasingly complex.  Some plans now require advance authorization for mental health benefits.  If you would like to use your insurance benefits it is best to speak with a service representative at your insurance company to learn their policy on out-of-network behavioral health coverage.   If you choose to use out-of-network benefits, you will need to pay for services at the time of your session and seek reimbursement from the insurance company.  If your insurance company requires a preauthorization for sessions, it is important to obtain one prior to our first session, as you will be responsible for the full payment of any outstanding balance.  You should be aware that if you use your health insurance to pay for therapy, your insurance company will have access to information about your mental health, as most insurance agreements require that you authorize your therapist to provide a clinical diagnosis and sometimes, additional clinical information such as a treatment plan or summary, and at times insurance companies request a copy of your entire mental health medical record.

 

At Just A Thought Counseling, we believe that therapy is most effectively done face to face whether this is in person or via telemental health through a HIPAA compliant videoconference platform.  However, if we need to do a telephone session, please be aware that insurance may not reimburse for a telephone session unless the governor has ordered that they do so during a temporary emergency (such as Covid).  You may be responsible for payment for that telephone time. Check with your insurance to see if they reimburse for out-of-network telemental health.

 

Web Searches

It is understandable that you might choose to gather information about your therapist or Just A Thought Counseling by searching on the Web. There is an incredible amount of information available about individuals on the internet, some of which may be known to that person and some of which may be inaccurate or unknown. If you encounter any surprising information about your therapist or Just A Thought Counseling through web searches, or by another means online, please discuss this with your therapist during your time together so that your therapist can deal with it and its potential impact on your treatment.

It has become common for clients to review their health care provider on various websites. Unfortunately, it is difficult to respond appropriately to comments and to correct related errors because of confidentiality restrictions. If you encounter such reviews of your therapist or Just A Thought Counseling, please share it with your counselor or Just A Thought Counseling so you can discuss it and its potential impact on your therapy.

Various Communication Technologies

 

Secure and private communication cannot be fully assured utilizing cell/smart phones or regular email technologies. It is your right to determine whether communication using non-secure technologies may be permitted and under what circumstances. Use of any non-secure technologies to contact your counselor will be considered to imply consent to return messages to you, the client, via the same non-secure technology, pending further clarification by you. You may choose to use cell/smart phones, texts, and fax lines to contact or send information to your counselor. Just A Thought Counseling wants to make sure that you realize that these ways of communicating, while very convenient, are not secure and confidential and that there are risks involved.

 

At Just A Thought Counseling, we use text messaging, voicemail, and/or email to send appointment reminders. Please let your counselor know which you would prefer, or if you would like to opt out of receiving reminders.

 

Cell Phones

Cell phones are a convenient way for clients to contact their counselor. Cell phones may be use if the connection during secure video telehealth sessions is disrupted or if the connection is poor. Your counselor will discuss with you how to handle these situations. At Just A Thought Counseling, counselors have individual business cell phones that are used for client contact, scheduling and counseling sessions if the client prefers this to secure video conferencing. Counselor cell phones are for business only and are secured when not in use to help protect client confidentiality.

Please be aware that some cell phone applications access your mic and/or location for data collection purposes.  Just A Thought Counseling has no control over the applications you install on your electronic devices or the privacy setting you allow.  Therefore, we encourage you to power off your cell phone when you are in a video in-office counseling session and/or that you disable any apps that might access your mic in order to avoid any inadvertent recording of sessions.

 

By signing this document, you are acknowledging that as a client at Just A Thought Counseling, you are aware of the risks involved in using cell phones for contacting your counselor and for counseling sessions.

 

Email and Text Messages

 

Email is often used during the intake process to collect basic information; however, once clients are established, we discourage the use of email or texts for clinical purposes. While we make every attempt to protect information contained in email and text communication, email and text use poses inherent privacy risks, and we cannot guarantee that information contained in email will remain confidential.

 

By signing this document, you are acknowledging that as a client at Just A Thought Counseling, you are aware of the following risks and guidelines if you choose to email or text your counselor:

 

1) Email and texts are not a secure method of communication, and we cannot ensure that the information transmitted via email or text will remain confidential. Errors can occur when typing email addresses or cell numbers, which may cause the message to be received by an unintended party. We do not use encryption with our emails or texts.

2) Neither email nor text is to be used for urgent or emergency situations, and counselors are not expected to respond to emergency or urgent email or texts.

3) Email and texts are checked regularly but not always daily and cannot be guaranteed to be responded to within a given timeframe or after business hours.

4) Emails and texts may become part of your clinical record.

5) Emails in the computer system or texts in the cloud, even once deleted, cannot be guaranteed to be secure.

6) Once a counselor sends an email or text, Just A Thought Counseling has no control over what the recipient does with the information contained in the email or text.

7) Just A Thought Counseling does not provide email or text therapy. We discourage the use of email or text for communicating about personal, clinical information and if a client uses email or text for this purpose, we do not guarantee an email or text response.

8) For personal, private, or clinical issues, telephone, secure video, or in-person discussions are preferred due to increased confidentiality and clarity inherent in these methods of communication.

9) Email or text may be a convenient method to verify, cancel, or reschedule appointments, or for other business purposes as agreed upon with your counselor.

10) Email or texts may be initiated by your counselor if you have provided us with an email address, or have texted your counselor in the past, and if we cannot reach you by phone or USPS mail.

11) If you email your counselor from any email address, we assume that you are giving your counselor permission to reply to that message via that email address, unless you have specifically asked us not to. If you text from any cell number, we assume that you are giving your counselor permission to reply to that message via text as well.

12) If you do not wish to have email or text as a possible method of communication, please inform your counselor.

 

Telemental Health

Just A Thought Counseling provides web based video sessions (telemental health) to clients. At this time, telemental health sessions can only be conducted when the client/guardians are a resident of the state of New Hampshire and are physically located in NH at the time of the therapy session. 

 

By signing this statement, you are acknowledging that as a client of Just A Thought s, you are aware of the following risks and guidelines in using telemental health services as part of your treatment plan. 

 

1) Just A Thought Counseling uses a HIPAA compliant software for telemental health that has agreed to protect your health information in accordance with standard HIPAA rules. 

2) Clients/guardians recognize that Just A Thought Counseling agrees to follow all relevant HIPAA guidelines to protect confidentiality on the clinician’s end during telemental health sessions. 

3) Client eligibility for telemental health is assessed and approved on a case-by-case basis with the clinician.

4) The Clinician will talk with clients/guardians about recommendations to protect their privacy at the remote site. However, Just A Thought Counseling cannot control what clients/guardians do at the remote site. The client/guardian is solely responsible for protecting their own privacy at the remote site. 

5) Telemental health sessions are not to be used for urgent or emergency situations. If at any time the clinician’s assessment is that the client may be at risk of harm to self, other, or property, the clinician will take appropriate and necessary steps to protect the safety of the persons or property at risk. This may include ending the telemental session and using other methods of communication including telephone or in-person assessment, attempting to reach emergency contacts or contacting law enforcement and/or medical personnel. 

7) Telemental health sessions may be discontinued at any time and for any reason, at the discretion of the clinician or at the request of the client/guardian. 

8) If you do not wish to engage in, or continue to engage in telemental health sessions, please inform your clinician and appropriate referrals will be given.

9) If you have any questions about the use of telemental health, please ask your clinician. 

 

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