Informed Consent For Psychotherapy
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 that relationship works, and what each of us can expect. This consent will provide a clear framework for our work together. Please read it carefully and reach out with any questions you may have.
The Therapeutic Process
You have taken a very positive step by deciding to seek therapy. When applicable and appropriate, we use a combination of Cognitive Behavioral Therapy, Narrative Therapy, Solutions-Focused Therapy, Hypnotherapy, Somatic practices, Psychodynamic and Acceptance and Commitment Therapy (ACT). These theoretical orientations and their accompanying techniques are empirically-based and may sometimes cause some discomfort before relief.
The outcome of your treatment depends largely on your willingness to engage in this process and being proactive in attending weekly sessions and attempting or fulfilling any agreed upon tasks so that you may put into practice or apply the skills that you are learning through our sessions. Weekly sessions are essential in establishing a strong foundation and getting to know your therapist, and vice-versa. For this reason, we do not offer bi-weekly sessions at this point in the treatment process.
There are no miracle cures, “tips” or quick fixes. We cannot promise that your behavior or circumstance will change, but we can promise to support you and do our very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.
Therapeutic Session Confidentiality
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:
- If a client threatens or attempts to commit suicide or otherwise conducts him/her self in a manner in which there is a substantial risk of incurring serious bodily harm.
- If a client threatens grave bodily harm or death to another person.
- 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, or as stated above in the case of an elderly person who may be subjected to these abuses.
- Suspected neglect of the parties named in items #3 and # 4.
- If a court of law issues a legitimate subpoena for information stated on the subpoena.
- Occasionally we 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.
- Therapists-in-Training – Cohesive Therapy NYC provides training for post-graduate Licensed Masters Social Worker (LMSW) therapists and Mental Health Counselor-Limited Permit who are working towards full licensure as a mental health provider. The therapists-in-training are supervised by licensed staff of Cohesive Therapy NYC. LMSW and MHC-LP therapists discuss their cases with their supervisor. Both LMSW and MHC-LP therapists-in-training and the supervisors will maintain confidentiality in accordance with state and federal privacy regulations.
- If you and your therapist accidentally see or meet each other outside of the therapy space, we will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to us, and we do not wish to jeopardize your privacy. However, if you acknowledge us first, we 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.
If you need to contact us between sessions, please leave a message on my voicemail or text us. Our appointments are scheduled-based and therefore, our clinicians are often not available for immediately needs or crisis situations. We will attempt to return your call by 7:00pm that same evening, within 24 hours, or by next business day with the exception of weekends, holidays, and scheduled vacations. Please note that we do not facilitate phone sessions. The two session options available are face-to-face or telehealth sessions. We do not provide 24-hour on-call service.
In the event of a life or limb-threatening emergency, always call 911 or go to the nearest emergency room.
We do not provide 24-hour on-call emergency services. You are free to call us after hours and leave a message on our voicemail. Should you have a mental health emergency and are unable to reach us, please go to your nearest hospital emergency room or call 911.
Social Media and Telecommunication
Due to the importance of your confidentiality and the importance of minimizing dual relationships, we do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, 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 questions about this, please bring them up when we meet and we can talk more about it.
We cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, we will do so.
FOR SECURE, HIPAA COMPLIANT TEXTING:PLEASE DOWNLOAD THE APP CALLED “SPRUCE” FROM YOUR APP STORE AND YOU CAN REACH ME VIA TEXT THAT WAY.
YOU MAY ALSO EMAIL US SECURELY AT firstname.lastname@example.org
YOU MAY ALSO SECURELY AND DIRECTLY TEXT YOUR CLIENT VIA YOUR SECURE SIMPLE PRACTICE CLIENT PORTAL MESSAGING.
While we may try to return messages in a timely manner, we cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.
For added convenience, we provide HIPPA compliant secure online video sessions. In the event of inclement weather, we will conduct a video session.
If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that:
- You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.
- All existing confidentiality protections are equally applicable.
- Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee.
- Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent.
- There are potential 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.
- 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.
Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. We may terminate treatment after appropriate discussion with you and a termination process if we determine that the psychotherapy is not being effectively used.
We will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, we can provide you with a list of referrals for you to explore further. You may also choose someone on your own or from another referral source.
Should you fail to schedule an appointment or to respond to any attempts to outreach for three consecutive weeks or more, unless other arrangements have been made in advance, we will reach out to you to advise that your file will be closed for administrative purposes.
However, you are welcomed to contact us if you wish to reengage in therapy within our Practice.
HIPAA provides you with several new or expanded rights with regard to your clinical records and disclosure of Protected Health Information (PHI). These rights include:
- requesting to amend your clinical record
- requesting to place restrictions on what information from your clinical records is disclosed to others
- requesting an accounting of most disclosures of Protected Health Information that you have neither consented to nor authorized
- determining the location to which Protected Health Information disclosures are sent
- having any complaints you make about my policies and procedures recorded in your records
- requesting a paper copy of this Psychotherapy Services Contract including this Notice of Privacy Practices
- refusing or ending treatment at any time for any reason.
If you believe we have violated your privacy rights, or you disagree with a decision we made about access to your records, you have the right to file a complaint in writing with us and/or with the Secretary of Health and Human Services at 200 Independence Avenue, S.W. Washington, D.C. 20201 or by calling (202) 619-0257.
You may also contact the New York Professional Misconduct Enforcement System at 1-800-442-8106 or email@example.com.
We will not retaliate against you for filing a complaint.
Therapist Education and Credentials
Karen Conlon, LCSW, Practice Owner- Received a Masters of Social Work (MSW) in 2015 from New York University and has been providing psychotherapy since that time.
Licensed by the state of New York, LCSW License #087803, NPI #117498777, Karen Conlon, LCSW has received extensive training in Cognitive Behavioral Therapy through the Beck Institute for Cognitive Behavioral Therapy, as well as hypnosis training from the American Society of Clinical Hypnosis. Also a Certified Clinical Anxiety Treatment Professional, achieved through training with the Institute of Certified Anxiety Treatment Professionals.
Our treatment focuses on: working with clients who struggle with general anxiety, attachment resulting from childhood emotional trauma/issues and anxiety related to chronic illness with a focus on Gastrointestinal diseases and disorders.
Use of this Website
Cohesive Therapy NYC maintains this website for educational and promotional purposes. It may change the contents of this site, restrict access to the site, or terminate the site at any time.
The information included on this website is solely for educational purposes and is not intended to be a substitute for health care or medical treatment by a physician or other health care professional. Do not rely on any of the information contained on this website for diagnosis or treatment. Should you have any questions, you should contact your health care provider. If you think you may have a medical or psychiatric emergency, call 911 immediately,
Website Confidentiality and Privacy
Cohesive Therapy NYC cannot guarantee the security of any information provided. Please only provide non-confidential information in transmitting this form or in providing any information to this site by email. By using this form and communicating information to Cohesive Therapy NYC you understand that all communications will not be able to be considered confidential and that it is possible that some third party may have access to this information.
Accuracy and Completeness
Cohesive Therapy NYC does not guarantee the accuracy or completeness of any information on this site. Although care has been taken in preparing the information contained in this website, all information is provided “AS IS” without warranty of quality or accuracy of any kind. The views and opinions on this site do not necessary state or reflect those of Cohesive Therapy NYC or any of its owners, members, or therapists.
Services may be provided using remote audiovisual technology. You understand there are potential risks to the use of this technology, including interruptions in treatment, unauthorized access to information, and technical difficulties in the communications. Although we will make every attempt to maintain the security of this information, you understand there are other individuals or entities that will have access to the transmission of information and the services provided.
You understand the risks inherent in telehealth consultations and consent to accepting these risks. You can discontinue the telehealth sessions if you believe the sessions, including the videoconferencing connections, are inadequate for the purposes of our services.
Links to third-party websites on this site are merely provided as a convenience. Should there be a link to any other site, Cohesive Therapy NYC does not necessarily know what is on any other site, has not necessarily reviewed any of these third-party sites, and does not control and is not responsible for the content of any site. Cohesive Therapy NYC does not endorse any other site or make any representations about the sites or any information found within those sites. If you decide to access any of the third-party sites linked to this site, you do so entirely at your own risk.