This page is intended as a reference point for clients of Growing Well Counseling and does not create a therapeutic relationship between provider(s) and readers and is not a substitute for a signed Consent to Treatment agreement within a client’s electronic health record.
2024 Information, Authorization & Consent to Treatment at Growing Well Counseling
Welcome to Growing Well, LLC Individual & Couples Counseling!
We are happy you are here and look forward to collaborating with you to improve your wellness, relationships, and life satisfaction.
This document contains important information about our professional services and summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights about your care, your privacy, and use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. A full copy of the HIPAA law is available upon request. Although these documents are long and sometimes complex, it is very important that you understand them and we are here to help.
*When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.*
Counseling is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As a client in counseling, you have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights that you should be aware of. Your therapist has corresponding responsibilities to you. These rights and responsibilities are described in the following sections. Although providing this document is part of an ethical obligation to our profession, more importantly, it is part of our commitment to you to keep you fully informed of every part of your therapeutic experience.
Background Information, Professional Disclosure & Client Participation
Every therapist at our practice is licensed in the State of Connecticut to provide mental health therapy, and at minimum has formal advanced clinical training in perinatal mental health. Every therapist maintains professional liability insurance and completes continuing education in perinatal mental health annually. Information regarding your therapist's educational background and experience may be found on our website under your therapist’s name. Please feel free to view that information at www.growingwellcounseling.com. You can also verify therapist licensure at anytime using the CT DPH License Lookup https://www.elicense.ct.gov/Lookup/LicenseLookup.aspx
We are all happy to answer questions about our perinatal training, supervision process and continuing education experience. Just ask!
In order for therapy to be most successful, it is important for you to take an active role. This means working on the things you and your therapist talk about both during and between sessions. This also means avoiding any mind-altering substances like alcohol or non-prescription drugs prior to your therapy sessions. Generally, the more of yourself you are willing to invest, the greater the return.
Furthermore, it is our policy to only see clients who we believe have the capacity to resolve their own problems with our assistance. It is our intention to empower you in your growth process to the degree that you are capable of facing life’s challenges in the future without your therapist. We also don’t believe in creating dependency or prolonging therapy if the therapeutic intervention does not seem to be helping. If this is the case, your therapist will direct you to other resources that will be of assistance to you. Your personal development is our number one priority. We encourage you to let us know if you feel that transferring to another provider or another therapist is necessary at any time. Our goal is to facilitate healing and growth, and we are very committed to helping you in whatever way seems to produce maximum benefit. If at any point you are unable to keep your appointments or we don't hear from you for one month, we will need to close your chart. However, reopening your chart and resuming treatment is a possibility for discussion- availability cannot be guaranteed but we try to accommodate returns to care whenever possible.
Goals of Counseling
There can be many goals for the counseling relationship. Some of these will be long term goals such as improving the quality of your life, learning to live with mindfulness and adapting to major life changes. Others may be more immediate goals such as decreasing anxiety and depression symptoms, processing a loss, improving close relationships, changing behavior or decreasing/ending unhealthy habits. Whatever the goals for counseling, they will be set by the clients according to what they want to work on in counseling. The therapist may make suggestions on how to reach that goal but you decide where you want to go, and how much effort you put forth.
Risks & Benefits of Counseling
Counseling is an intensely personal process which can bring strong and sometimes unpleasant memories or emotions to the surface. Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness and helplessness, because the process of psychotherapy often requires discussing the unpleasant aspects of your life. However, counseling has been shown to have benefits for individuals who undertake it. Therapy often leads to a significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness and insight, increased skills for managing stress and resolutions to specific problems. There are no guarantees that counseling will work for you. Progress may happen slowly. Counseling requires a very active effort on your part. In order to be most successful, you will have to work on things we discuss outside of sessions. Often, when things feel difficult, the most important work is being done- If you feel at any time counseling is too stressful, let’s discuss together what you are experiencing.
The Professional Relationship of Counseling
Your relationship with your therapist has to be different from most relationships. It may differ in how long it lasts, the objectives, or the topics discussed. It must also be limited to only the relationship of therapist and client. If you and your therapist were to interact in any other ways, you would then have a "dual relationship," which could prove to be harmful to you in the long run and is, therefore, unethical in the mental health profession. Dual relationships can set up conflicts between the therapist's interests and the client’s interests, and then the client’s (your) interests might not be put first. In order to offer all of our clients the best care, your therapist’s judgment needs to be unselfish and purely focused on your needs. This is why your relationship with your therapist must remain professional in nature.
Additionally, there are important differences between therapy and friendship. Friends may see your position only from their personal viewpoints and experiences. Friends may want to find quick and easy solutions to your problems so that they can feel helpful. These short-term solutions may not be in your long-term best interest. Friends do not usually follow up on their advice to see whether it was useful. They may need to have you do what they advise. A therapist offers you choices and helps you choose what is best for you. A therapist helps you learn how to solve problems better and make better decisions. A therapist's responses to your situation are based on tested theories and methods of change.
Additionally, since therapists are required to keep the identity of their clients confidential, as much as your therapist would like to, for your confidentiality they will not address you in public unless you speak to them first. Your therapist also must decline any invitation to attend gatherings with your family or friends. Lastly, when your therapy is completed, your therapist will not be able to be a friend to you like your other friends. In sum, it is the duty of your therapist to always maintain a professional role. Please note that these guidelines are not meant to be discourteous in any way, they are strictly for your long-term protection.
Sex Therapy at Growing Well Counseling
Several of our therapists have post-graduate training in Sex Therapy. Many sexual health and wellness issues can arise around conception, fertility challenges, reproduction, birth and postpartum. This is something we can absolutely discuss and we want to be sure you know what to expect. You may also engage in individual therapy with a perinatal therapist and see a Sex Therapy specialist for sexual health specific concerns if we all agree this could be appropriate.
We provide nonjudgmental and compassionate care in sexual wellness for individuals & couples. Services are available in the areas of relationship and sexual problems therapy, including but not limited to: low sexual desire/mismatched couple desire, infidelity, non-monogamy/other relationships, physical or emotional sexual pain, LGB & Transgender health services, erectile dysfunction, premature or delayed ejaculation, orgasm difficulties, low or absent pleasure during sexual activities, & sexual trauma.
If we agree that intensive [entire session focused] sex therapy could be helpful, you will be asked to complete an additional intake, our Sexual Health Client History. We will review this form during your consultation session and the remaining time will be spent talking about what brought you in for counseling. Your therapist will focus on hearing your story and asking questions to better understand your particular struggle and/or situation. This is also a time to measure how comfortable this feels and if this is a good “fit” between you and your therapist. By the end of your initial consultation, you can expect some feedback from the therapist and both of you will agree on a “game plan” for therapy. If you have any questions, feel free to ask your therapist during your appointment. Detailed financial responsibility will be provided following the consultation appointment.
Sex therapy is generally excluded from insurance coverage. However, your treatment may be covered if you have mental health benefits and are being seen for a mental health condition. For your convenience, we can provide you with an invoice that you can submit to your insurance carrier for possible reimbursement. This invoice will show the amount that you have paid, along with your diagnoses and the type of session.
Understanding Sex Therapy
As defined by the American Association of Sex Educators, Counselors, and Therapists (AASECT), “Sex Therapy is a subspecialty of psychotherapy, focusing on the specific concerns related to human sexuality.” What this means is that sex therapy is talk therapy, where the issues that you talk about are sexual concerns. Sex therapists have acquired scientific knowledgeable about sexual functioning, and are trained in ways of helping people deal with sexual problems. The goal in sex therapy is for you to be happy and satisfied with the sexual aspects of your life and relationships. Those seeking sex therapy often have co-morbid anxiety, depression, or trauma. We treat these issues along with your sexual concerns so that you not only achieve better intimacy with your partner, but the subsequent symptoms decrease or go away completely. -We will have clearly stated goals, and will be working to implement the specific changes that you would like in your life. Sometimes we will also communicate with other professionals involved in your care, such as your physician or other provider.
We will spend some time in the session talking about ideas and feelings about sex, but you will also have “homework assignments” that you will do in the privacy of your home. These may be written or communication exercises, behavioral interventions, or may be specific experiences that will help you to progress toward your goals.
One thing that will NOT occur: no nudity or sexual activity of any kind will occur in our office, nor will we see you outside the office, or ask you to video any sexual acts. Your will never be pressured to discuss anything you are not comfortable with, and all discussions will always be respectful and appropriate.
Confidentiality
The following information supplements The Growing Well Notice of Privacy Practices.
We will make every effort to keep your personal information private. If you wish to have information released, you will be required to sign a consent form before such information will be released. If you were referred to counseling by a health care provider, you will have the opportunity to sign a release of information today so that we may collaborate in your care. This is your choice and we will discuss what specific information will be shared with your provider (doctor, midwife, APRN, etc). We may consult with another licensed mental health provider in order to give you the best service. In the event that your therapist engages in supervision, no identifying information such as your name, age or location would be released.
There are some limitations to confidentiality to which you need to be aware; As State of Connecticut Mandated Reporters, all therapists are required by law to release information when the client poses a risk to themselves or others and in cases of abuse to children or the elderly. If we receive a court order or subpoena, we may be required to release some information. In such a case, we will first notify you, then consult with an attorney as needed to limit the release to only what is necessary by law. If for some unusual reason a judge were to order the disclosure of your private information, this order can be appealed. We cannot guarantee that the appeal will be sustained, but we will do everything in our power to keep what you say confidential.
Please note that in couple’s counseling, your therapist does not agree to keep secrets. Information revealed in any context may be discussed with either partner.
Confidentiality and CONNIE
In 2015, the Connecticut State Legislature passed Public Act 15-146 that Established a mandate for a statewide electronic health record. Public Act 15-146 was incorporated into the Connecticut General Statutes as C.G.S. 17b-59b to 17b-59g. The law now requires that any licensed healthcare provider within the State of Connecticut participate this statewide system by either providing access to your complete health record if the provider’s case management system interfaces with the system, or, if the provider’s case management system is not capable of connecting, the provider is required to establish a secure messaging system with the chosen manager of this system. The manager of this system chosen by the State of Connecticut is called “CONNIE.” [CONN Information Exchange] You can find more information about Connie at https://conniect.org/.
The design of this system is such that ALL your health records will be accessible to ANY provider who can attest that they have a reason for accessing your record. You cannot choose which providers will or will not have access to your records or choose what is shared between connected providers- this is an all or nothing arrangement. [See CONNIE FAQ’s Privacy Questions 2 & 3. https://conniect.org/frequently-asked-questions/ ]
Growing Well, LLC DBA Growing Well Counseling is required by law to participate in this system. At this time, Simple Practice which is classified as a “Practice Management System,” not an “Electronic Health Record/EHR” is not compatible with CONNIE and is stating that they do not intend to interface with CONNIE, however this could change in the future [and we will notify you if we hear of plans for them to do so]. A CT licensed healthcare providers, we MUST create an account with CONNIE to enable secure messaging with other CT healthcare providers. At this time uploading a ‘roster’ of current clients is optional, and we do not intend to do so unless/until mandated.
If Growing Well, LLC receives a request from any of your healthcare providers for information through CONNIE, our policy will be to contact you, the client, first. Client and therapist will decide together if and what to disclose and you will be asked to sign a formal release of information for that specific disclosure. If possible, we will fax that requested information to the provider rather than utilize this portal to protect your privacy from other providers who may not need access to that information.
Growing Well Counseling has ongoing concerns about how this information could be used, and how much could be disclosed. While we document clinical information about sessions with concern for privacy and caution, this information is yours and very different “medical information,” than a blood pressure reading or a notation of an allergy. We do not want your privacy to be compromised in any way.
While provider enrollment is mandatory, client participation is NOT. You do have the option to OPT OUT. If you opt out of participation with this system, CONNIE will remove your records from their system within five (5) days of receiving your opt out notice. To opt out, you can submit an online form at https://connect.conniect.org/OptoutForm or call Connie at 1.866.987.5514. More information can be found at https://conniect.org/for-patients/opt-out .
Growing Well Counseling cannot advise you to either opt out or participate with CONNIE. Please be aware that if you choose to participate, Growing Well Counseling CANNOT guarantee that your health record will remain confidential from other health care providers. Information may also be disclosed to third-parties for ‘research’ purposes per the CONNIE website. You are strongly encouraged to research CONNIE and determine if you wish to participate in this program.
This is not intended to provide legal advice or information, and Growing Well, LLC is not licensed to practice law.
Privacy and Technology
Some clients may choose to use technology in their counseling sessions. This includes but is not limited to contacting our team by telephone, email, or text. Due to the nature of internet and digital media, there is always the possibility that unauthorized persons may attempt to discover your personal information. We will take every precaution to safeguard your information but cannot guarantee that unauthorized access to electronic communications could not occur. Please be advised to take precautions with regard to authorized and unauthorized access to any technology used in counseling sessions. Be aware of any friends, family members, significant others or co-workers who may have access to your computer, phone or other technology used in your counseling sessions. While we offer the convenience of texting about non-confidential matters (scheduling, traffic etc), we ask that you leave generic messages on voicemail and we will discuss confidential or private information in person. Our Practice Management System, Simple Practice generates appointment reminders. These are digitally-generated and private/specific to the phone number and/or email you provide. You may opt out of this service at any time.
We want to remind you that text messaging is not a secure means of communication and may compromise your confidentiality. However, we realize that many people prefer to text because it is a quick way to convey information. Nonetheless, please know that it is our policy to utilize this means of communication strictly for appointment confirmations or resource provision- not therapeutic support. Please do not bring up any therapeutic content via text to prevent compromising your confidentiality. You also need to know that we are required to keep a copy or summary of all texts as part of your clinical record that address anything related to therapy.
Per HIPAA and HITECH health information security policies, we will not transmit your Protected Health Information (PHI) electronically for any purposes other than insurance reimbursement or treatment coordination. We will only use a secure practice management system for documentation purposes, and will notify you individually if there is any concern of a breach in security. We will not release private-pay client information to any health entity without client request, and at any time you may request your own records with a signed release of information.
Technology, Telehealth, Communication & Confidentiality
In our ever-changing technological society, there are several ways we could potentially communicate and/or follow each other electronically. It is of utmost importance to us that we maintain your confidentiality, respect your boundaries, and ascertain that your relationship with your therapist remains therapeutic and professional.
Telehealth is defined in Connecticut General Statutes as 1. interaction between a patient at an originating site and the telehealth provider at a distant site and 2. synchronous (real-time) interactions, asynchronous store and forward transfers (transmitting medical information from the patient to the telehealth provider for review at a later time), or remote patient monitoring.
Different forms of Technology-Assisted Communication Considerations
Cell phones:
In addition to landlines, cell phones may not be completely secure or confidential. There is also a possibility that someone could overhear or intercept your conversations. Be aware that individuals who have access to your cell phone or your cell phone bill may be able to see who you have talked to, who initiated that call, how long the conversation was, and where each party was located when that call occurred. However, we realize that most people have and utilize a cell phone. We may also use a cell phone to contact you, typically only for purposes of setting up an appointment if needed. Additionally, your therapist may keep your phone number in their cell phone, but it will be listed by your initials only without descriptors. If this is a problem, please let your therapist know, and your therapist will be glad to discuss other options. Telephone conversations (other than just setting up appointments) are billed at your therapist's hourly rate.
Email:
Email is not a secure means of communication and may compromise your confidentiality. However, we realize that many people prefer to email because it is a quick way to convey information. Nonetheless, please know that it is our policy to utilize this means of communication strictly for appointment confirmations and is not a confidential form of communication. Please do not bring up any therapeutic content via email to prevent compromising your confidentiality. You also need to know that we are required to keep a copy or summary of all emails as part of your clinical record that address anything related to therapy.
Telehealth Video Conferencing (VC):
Video Conferencing is an option for your therapist to conduct remote sessions with you over the internet where you may speak to one another as well as see one another on a screen. We Simple Practice telehealth with Doxy.Me as a backup. These VC platforms are encrypted to the federal standard, HIPAA compatible, and has signed a HIPAA Business Associate Agreement (BAA). The BAA means that Simple Practice and Doxy.me are willing to attest to HIPAA compliance and assume responsibility for keeping your VC interaction secure and confidential. If you and your therapist choose to utilize this technology, your therapist will give you detailed directions regarding how to log-in securely. We also ask that you please sign on to the platform at least 2-3 minutes prior to your session time to ensure you and your therapist get started promptly. Additionally, you are responsible for initiating the connection with your therapist at the time of your appointment.
We strongly suggest that you only communicate through a computer or device that you know is safe (e.g., has a firewall, anti-virus software installed, is password protected, not accessing the internet through a public wireless network, etc.).
Electronic Record Storage:
Your communications with us will become part of a clinical record of treatment, and it is referred to as Protected Health Information (PHI). Your PHI will be stored electronically by Simple Practice, a practice management company who has signed a HIPAA Business Associate Agreement (BAA). The BAA ensures that they will maintain the confidentiality of your PHI in a HIPAA compatible secure format using point-to-point, federally approved encryption. In accordance with state law, records are retained for seven years following your last treatment date.
Electronic Transfer of PHI for Certain Credit Card Transactions:
We utilize Stripe Card processing [in Mentaya or SimplePractice as the company that processes your credit card information. This company may send the credit card-holder a text or an email receipt indicating that you used that credit card at our facility, the date you used it, and the amount that was charged. This notification is usually set up two different ways - either upon your request at the time the card is run or automatically. Please know that it is your responsibility to know if you or the credit cardholder has the automatic receipt notification set up in order to maintain your confidentiality if you do not want a receipt sent via text or email. Additionally, please be aware that the transaction will also appear on your credit-card bill
Your Responsibilities for Confidentiality & Telehealth
Please communicate only through devices that you know are secure as described above. It is also your responsibility to choose a secure location to interact with technology-assisted media and to be aware that family, friends, employers, co-workers, strangers, and hackers could either overhear your communications or have access to the technology that you are interacting with. You agree we are unable to hold a telehealth session in a moving vehicle or in a public space. Additionally, you agree not to record any telehealth sessions.
In Case of Technology Failure
During a telehealth session, you and your therapist could encounter a technological failure. The next step would be to try our alternate platform, Doxy.me and text your therapist. If both platforms fail, the most reliable backup plan is to contact one another via telephone. Please make sure you have a phone with you, and your therapist has that phone number.
If you and your therapist get disconnected from a video conferencing or chat session, end and restart the session. If you are unable to reconnect within ten minutes, please call your therapist.
If you and your therapist are on a phone session and you get disconnected, please call your therapist back or contact your therapist to schedule another session. If the issue is due to your therapist's phone service, and the two of you are not able to reconnect, your therapist will not charge you for that session.
Limitations of Telehealth Therapy Services
Telehealth services may have some limitations. Primarily, there is a risk of misunderstanding one another when communication lacks visual or auditory cues. For example, if video quality is lacking for some reason, your therapist might not see a tear in your eye. Or, if audio quality is lacking, your therapist might not hear the crack in your voice that your therapist could easily pick up if you were in person.
There may also be a disruption to the service (e.g., phone gets cut off or video drops). This can be frustrating and interrupt the normal flow of personal interaction.
Please know that your therapist has the utmost respect and positive regard for you and your wellbeing. Your therapist would never do or say anything intentionally to hurt you in any way, and we strongly encourage you to let your therapist know if something they have done or said has upset you. We invite you to keep communication open with your therapist at all times to reduce any possible harm.
Telehealth Agreements
If you & your therapist decide to include telehealth as part of your treatment, there are additional procedures that we need to have in place specific to telehealth services. These are for your safety in case of an emergency and are as follows:
· You understand that if you are having suicidal or homicidal thoughts, experiencing psychotic symptoms, or in a crisis that we cannot solve remotely, we may determine that you need a higher level of care and telehealth services are not appropriate.
· We require an Emergency Contact Person (ECP) who we may contact on your behalf in a life-threatening emergency only. This will default to the emergency contact you list in demographics unless you request otherwise. Either you or we will verify that your ECP is willing and able to go to your location in the event of an emergency. Additionally, if either you, your ECP, or we determine necessary, the ECP agrees take you to a hospital. Your signature at the end of this document indicates that you understand we will only contact this individual in the extreme circumstances stated above.
· You agree to inform your therapist of the address where you are at the beginning of every telehealth session.
· You agree to inform your therapist of the nearest mental health hospital to your primary location that you prefer to go to in the event of a mental health emergency (usually located where you will typically be during a telehealth session)
Communication Response Time
Our practice is considered to be an outpatient small group practice, and we are set up to accommodate individuals who are reasonably safe and resourceful. We do not receive calls or messages out of business hours nor are we available at all times. If at any time this does not feel like sufficient support, please inform your therapist, and your therapist can discuss additional resources or transfer your case to a therapist or clinic with 24-hour availability. We will return phone calls, texts, and emails within 48 business hours. However, we do not respond to any form of communication on weekends or holidays. If you are having a mental health emergency and need immediate assistance, please follow the instructions below.
In Case of an Emergency
If you have a mental health emergency, we encourage you not to wait for a call back, but to do one or more of the following:
· Call 2-1-1 United Way InfoLine Emergency Mobile Psychiatric Services (EMPS)
· Call ACTION Line 1-800-HOPE-135 (1-800.467.3135)
· National Maternal Mental Health Hotline 1-833-TLC-MAMA (1-833-852-6262)
· Call or text “988” Suicide Prevention & Crisis Line
· Call “911.”
· Go to the emergency room of your choice.
Court Proceedings & Confidentiality
There is another dual relationship that therapists are ethically required to avoid. This is providing therapy while also providing a legal opinion. These are considered mutually exclusive unless you hire a therapist specifically for a legal opinion, which is considered "forensic" work and not therapy. Our passion is not in forensic work but in providing you with the best therapeutic care possible. Therefore, by signing this document, you acknowledge that your therapist will be providing therapy only and not forensic services. You also understand that this means your therapist will not participate in custody evaluations, depositions, court proceedings, or any other forensic activities. However, if for some reason we are compelled to testify to a court of law, we will require an upfront retainer of $3,000.00, and our billing rate will be $500.00 per hour, plus you agree to be responsible for the reasonable attorney fees we are charged by our counsel. There may be a charge for submission of clinical notes, completion of forms, or other non-counseling time required for your out of session needs.
Appointments & Attendance Policy, Cancellation
Individual appointments will ordinarily be 55 minutes in duration. We will agree upon a frequency of treatment at our first session and revise this as needed. The time scheduled for your appointment is assigned to you and you alone.
If you need to cancel or reschedule a session, you agree to provide with 24 hours’ notice- exceptions cannot be made outside of emergencies. If you miss a session without canceling, or cancel with less than 24:00 hours’ notice, you will be required to pay a no-show/late cancel fee of $75.00]. To be fair to everyone and keep this policy consistent, anything less than 24:00 hours notice will be considered “late.” If you or your child(ren) are ill, telehealth will be offered as an alternative, illness without hospitalization cannot be a reason to waive the fee less than 24-hours before your appointment. Growing Well LLC reserves the right to waive this fee at therapist discretion for emergencies.
It is important to note that insurance companies do not provide reimbursement for cancelled sessions; thus, you will be responsible the cancellation fee.
Refusal to pay the cancellation fee will result in a pause of services until the balance is paid, or administrative discharge from care with referral resources provided to client.
In addition, you are responsible for coming to your session on time; if you are late, your appointment will still end on time.
After 3 missed appointments, 2 late cancellations within 30 days, or no contact for 30 days, at therapist discretion we will consider your case closed and offer your time slot to another client. You are eligible to be provided referrals via email and/or USPS mail and your chart will be considered discharged.
In the event of a therapist cancellation, you will be offered the next available appointment by your therapist, prioritizing your reschedule over new clients or future scheduling. We will make our best efforts to avoid last-minute rescheduling and appreciate your patience if we are unexpectedly out of the office.
Social Media Policy
The Growing Well, LLC Facebook Page & Instagram accounts offer education and updates, serving as an informal resource for providers and clients where from time to time therapists may post articles of interest, news about mental health, inspirational quotes or photos, and other generic wellness focused information. We will never discuss, even in general terms, anything we or other clients discuss in session.
You are welcome to "follow" us on any of these professional pages where we post informational, humorous and educational content However, please do so only if you are comfortable with the general public being aware of the fact that your name is attached to Growing Well Counseling. Please refrain from making contact with us using social media messaging systems such as Facebook Messenger or Twitter. These methods have insufficient security, and we do not watch them closely. We would not want to miss an important message from you.
Out of respect for the counseling relationship, we do not socialize with clients out of session or after termination of therapy. Our interaction is unique in that we know much more about you than you know about us. We will not “friend” each other or seek each other out on any social media platform including but not limited to, Facebook, LinkedIn, Instagram, Twitter, etc, consistent with our Professional Codes of Ethics.
Statement Regarding Ethics, Client Welfare & Safety
Growing Well Counseling assures you that our services will be rendered in a professional manner consistent with the ethical standards of the American Counseling Association, the National Association of Social Workers and the American Association for Marriage and Family Therapy. If at any time you feel that your therapist is not performing in an ethical or professional manner, we ask that you please let your therapist know immediately. If the two of you are unable to resolve your concern, please contact Catharine McDonald, LPC, Clinical Director at (860) 837-0204 ext 1.
Due to the very nature of psychotherapy, as much as we would like to guarantee specific results regarding your therapeutic goals, we are unable to do so. However, your therapist, with your participation, will work to achieve the best possible results for you. Please also be aware that changes made in therapy may affect other people in your life. For example, an increase in your assertiveness may not always be welcomed by others. It is our intention to help you manage changes in your interpersonal relationships as they arise, but it is important for you to be aware of this possibility nonetheless.
Additionally, at times people find that they feel somewhat worse when they first start therapy before they begin to feel better. This may occur as you begin discussing certain sensitive areas of your life. However, a topic usually isn’t sensitive unless it needs attention. Therefore, discovering the discomfort is actually a success. Once you and your therapist are able to target your specific treatment needs and the particular modalities that work the best for you, help is generally on the way.
For the safety of all our clients, their accompanying family members and children, and our therapists and staff, Growing Well Counseling maintains a zero-tolerance weapons policy. No weapon of any kind is permitted on the premises, including guns, explosives, ammunition, knives, swords, razor blades, pepper spray, garrotes, or anything that could be harmful to yourself or others. Growing Well Counseling reserves the right to contact law enforcement officials and/or terminate treatment with any client who violates our weapons policy.
Contacting Your Therapist
Therapists are often not immediately available by telephone. You may leave a message on the business voice mail and your call will be returned as soon as possible- Therapists will try to return any calls within one business day and will give you advance notice if unavailable or out of town for a period of time.
You may text Growing Well, LLC non-urgent, appointment related messages such as a need to reschedule, alerting your therapist to a late arrival or cancellation. Know that therapists do not have constant access to the business phone. You may not use this number for crisis calls. If you are in crisis, feel unsafe, have thoughts of harming yourself or others, do not wait for my return call. In any emergency situation, go to your local hospital or call 911, Growing Well, LLC can be notified once you have received urgent assistance.
Record Keeping
As licensed mental health providers we must keep records of your counseling sessions and a treatment plan which includes goals for your counseling. These records are kept to ensure a direction to your sessions and continuity in service. We may periodically review your treatment plan and discuss progress to maximize benefit for you. Therapy notes are for our own record will not be shared except with respect to the limits to confidentiality noted above. Should you, the client wish to have records released, you are required to sign a release of information which specifies what information is to be released and to whom- your therapist will respond within 30 days and there may be a printing fee associated with printed records of up to sixty-five cents per page and the cost of first class postage where applicable per CT General Statutes. Records will be kept for at least 7 years but may be kept for longer. Therapy records will be kept electronically via a HIPAA-compliant secured private practice service.
Growing Well Counseling will not release any information to any parties, even at your request, without the necessary documentation [release of information signed and meet with client to determine purpose and content of disclosure, any content that should not be disclosed] in some cases it would not be necessary or beneficial or could be deemed to be harmful to release an entire records- Clinicians have an ethical obligation to release the minimum necessary to accomplish the stated goal for a disclosure. Our strong preference and clinical recommendation tends to be a clinical summary letter to serve your best interests.
Professional Fees
We accept both private pay (self-pay) and insurance payments. Some individuals prefer to maintain their privacy and opt to self-pay rather than bill their insurance, this is your choice. Some employers require a waiver of privacy and can request all mental health records, those affiliated with your healthcare insurance would be required. You may prefer self-pay if you have concerns about your care impacting current or future employment.
Please be aware that most insurance companies require you to authorize me to provide them with a clinical diagnosis. Sometimes we have to provide additional clinical information which will become part of the insurance company files. It is my personal policy that your therapy notes are not released to insurers unless you request that we do so for a specific reason. By signing this Agreement, you consent to our providing requested information to your carrier if you plan to pay with insurance.
You are responsible for payment at the time of your session unless prior arrangements have been made. Payment can be made by check, cash, credit/debit card, or with a prescription from your referring provider, your Healthcare Flexible Spending Account. *In signing this consent and policies you hereby authorize Growing Well, LLC to charge a saved credit card on file for any outstanding balances for copays, coinsurances, services not covered by insurance and/or cancellation/no show fees. You may revoke this consent in writing at any time however you may be required to pre-pay for sessions as determined by Growing Well, LLC. If you refuse to pay your debt, we reserve the right to use an attorney or collection agency to secure payment. Please make all checks payable to Growing Well, LLC. Any checks returned to our office are subject to an additional fee of up to $40.00 to cover the bank fee that we may incur.
Please keep in mind that professional fees include not only our time together, but also therapist time documenting our work, preparing for sessions, and communicating with your health insurance and other providers. Typically, Fees are non-negotiable. To receive sliding scale fees, you must present proof of income through recent pay stubs or tax forms. Fees are the same for all clients but subject to change at therapist’s discretion. We will not raise my fees more than once per year and will provide all clients at least 30 days’ notice.
If you are using your health insurance for payment, you may wish to contact your insurer prior to our first session to confirm your Behavioral Health Benefits so you are aware of what your specific plan may cover. Again, you are responsible for any co-pays at the time of service. You are also responsible for knowing your coverage and for letting us know if/when your coverage changes. In addition, some insurance companies also have a deductible, which is an out-of-pocket amount that must be paid by the patient before the insurance companies are willing to begin paying any amount for services, we will discuss this once we have reviewed your specific plan coverage.
If we are not a participating provider for your insurance plan, we can supply you with superbill, a receipt of payment for services, which you can submit to your insurance company for reimbursement, or submit an Out of Network claim on your behalf. Please note that not all insurance companies reimburse for out-of-network providers and payment is due at time of service.. If you prefer to use a participating provider, I can refer you to a colleague.
2024 Fee Schedule [with billing codes should you contact your insurer with coverage questions]
90791 Initial Intake [Diagnostic Evaluation] 54-60 min $220
90837 Individual Therapy w or w/o family present, 53-60 min $200
90834 Individual Therapy 38-52 Min $175
90853 Group Therapy 90 min $80
Complaints or Concerns
If you are unhappy with what is happening in therapy, we hope you will talk with your therapist or reach out to Growing Well, LLC so that we can address your concerns. Such comments will be taken seriously and handled with care and respect. You may also request that we refer you to another therapist and you are free to end therapy at any time. You have the right to considerate, safe and respectful care, without discrimination as to age, race, creed, color, national origin, sexual orientation, military status, sex, disability, pregnancy-related conditions, gender identity, predisposing genetic characteristics, familial status, marital status, relational orientation, or source of payment. You have the right to ask questions about any aspects of therapy and about your therapist’s specific training and experience. You have the right to expect that we will not have intimate relationships with clients or with former clients.
Counseling as a Voluntary Partnership
Both therapist and client must agree that the therapeutic relationship is beneficial and in the client’s best interest. You are free to terminate counseling at any time. In upholding the highest ethical standards, we will notify you if at any time I feel as though your needs are unable to be met at Growing Well, LLC, at which time we will offer alternative referrals. We will never continue to see a client whom we do not feel we can fully serve.
Our Agreement to Enter into a Therapeutic Relationship
Please electronically sign your name below indicating that you have read and understand the contents of this “Information, Authorization and Consent to Treatment” form as well as the Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices” provided to you separately. You are entitled to a print copy at your request, you may also review this consent form at any time on our website at www.growingwellcounseling.com/consentpolicies
If you sign this document in your electronic health record, that indicates that you agree to the policies of your relationship with your therapist and/or group leader, and you are authorizing your therapist to begin treatment with you.
Please note that this updated "Information, Authorization & Consent to Treatment" replaces any previously signed informed consents.
We are sincerely looking forward to facilitating you on your journey toward healing and growth. If you have any questions about any part of this document, please ask your therapist.