All therapists know the importance of obtaining informed consent before commencing clinical treatment. During this process, you must provide relevant information about your practice, approach, rights and responsibilities, potential benefits and risks, fees, and billing practices.
With that, informed consent also represents an ongoing process. You may need to review your policies periodically- especially if you change core features of your practice or work with clients who may not inherently understand the general structure of therapy.
But when was the last time you actually reviewed your informed consent document? If it's been some time, now may be the time to reevaluate your consent forms to ensure you have the following details covered.
In this article, we’ll pinpoint some crucial information you may want to consider adding to your practice documentation.
Parameters of the Therapeutic Relationship
The therapeutic alliance is unlike any other relationship, and you want to clearly articulate these professional limits. Your informed consent form should include details about how you will handle communication in between sessions.
For example, you might say, I only permit the use of email for session cancellations or rescheduling. If you need immediate support, please contact ___. If you have other policies about between-session communication, include them here.
Your informed consent agreement needs to state your guidelines about technology use within and outside of therapy. This includes your policy on email communication, text messaging, telehealth platforms, and the current security measures related to electronic communication.
In other words, clients shouldn't have to guess whether to text or email you if they need to reach out. Your informed consent process should clearly state the measures of communication, and you should reinstate these boundaries as needed throughout treatment.
This is where you should also indicate that you will not approach your clients if you you run into them outside of the office. Finally, make sure you indicate how you manage client crises. This means:
- Identifying what constitutes a crisis or emergency
- Outlining how clients can reach you during a crisis (if you permit this option)
- Providing alternative resources for clients during crises
Payment Information
Indicate when payment is due for each session. If you accept insurance, you might charge copays/coinsurance on the morning of medical treatment. Or, you may charge right after or at the end of the clinical day. In addition, you may set up a payment plan where clients can pay you directly before or after the session. However, this needs to be indicated.
Your informed consent also must outline what will happen if balances are carried. Consider adding a clause that says, “No balances will be carried. If a balance should occur, further sessions will be placed on hold until the balance is paid and a $10 late fee applied. Billing services are not available.”
Termination Process Information
The treatment process is not indefinite, and your informed consent should discuss how, when, and why you might discontinue treatment. Of course, these limits can, at times, be subjective and adhere to a case-by-case basis, but it's important to provide some general information on this topic.
Clients should be adequately informed about how termination might occur when seeking informed consent. This information should include:
- your standard procedures for terminating therapy
- details about how clients can voluntarily request to end treatment
- your policy for providing referrals to other qualified providers
Some clinicians also stick to a specific cancellation policy when it comes to termination. For example, you might write, If you cancel 4 sessions within 6 months, please note I may not be able to guarantee your standard clinical appointment. This is not necessarily indicative of termination, but it will mean that we will have to discuss revising our therapy schedule.
Minors and Parental Consent in Psychotherapy
Obtaining informed consent for minors entails parental involvement. With that, you need to state how your clinical practice honors the minor's confidentiality and also shares relevant treatment information with caregivers. Always refer to your local laws to determine any legal considerations concerning youth.
Consider adding a co-parenting agreement if you insist that separated or divorced parents agree and consent to therapeutic services.
If you work with families or couples and adhere to a 'no secrets' policy, your written informed consent document should outline this. Specify the parameters for this policy and when they might be enacted.
Legal Responsibilities
You may want to consider adding in your informed consent documents that you don't voluntarily get involved in legal matters. However, in some cases, legal involvement may be inevitable. If that's the case, you should indicate how much you charge (your hourly rate or more) for performing this kind of work.
Many providers provide informed consent that specifically states, 'It is agreed that should there be legal proceedings (such as, but not limited to custody disputes and divorce, injuries, lawsuits, etc.), I understand that neither I nor my attorney, nor anyone else acting on my behalf, will call on (therapist name) to testify in court, nor will disclosure of clinical records be requested.
No-Show and Late Policies
It is important to list your cancellation policies, particularly if you charge a session fee for late cancellations. 24 hours is the standard practice, though some providers have 48 or 72-hour rules. If you have any exceptions (i.e. sickness or emergencies, the ability to reschedule), list them. Indicate how much you will charge and when this charge will occur.
You should also consider specifying what "late" means when it comes to arriving at a session. Is it 10 minutes? 15 minutes? Longer? If they do not show up before that window, will you charge them? If they are only present for half the session, how will you charge?
Social Media Information
With more healthcare providers using social media to advertise their practices, it's crucial to have information about this within your informed consent procedure.
Consider including:
- Boundaries about social media interactions
- Risks associated with following or engaging with you on social media platforms
- How you (or your practice) use social media professionally
- Boundaries about accepting friend or follow requests on personal accounts
Professional Trust and Executor Information
Healthcare providers should also consider listing information about their professional trust administrator. If you have a professional will (and you should!), indicate who your executor is, how and when the trust may be enacted, and what clients can generally expect should you no longer be able to meet with them.
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