Counseling Relationship: During the time that we work together, we will meet at a mutually agreed uponfrequency for approximately 45 minute sessions. Due to ethical guidelines, our relationship will be strictly professional and not social. The policy of the counseling center and professional counselor ethics prohibit the receipt of gifts valued more than $50 by counselors from clients.
Effects of Counseling: At any time, you may initiate a discussion of possible positive or negative effects of entering, not entering, continuing, or discontinuing counseling. While benefits are expected from counseling, specific results are not guaranteed. Counseling is a personal exploration and may lead to major changes in your life perspectives and decisions. These changes may affect significant relationships, your job, and/or your understanding of yourself. Some of these changes could be temporarily distressing. The exact nature of these changes cannot be predicted. Together we will work to achieve the best possible results for you.
Client Rights: You have the right to be provided with professional and respectfulcare. You have the right to know your therapist’s assessment of the problem, the recommended treatment, and resources available to help deal with your situation. You also have the right to refuse our suggestions. I am notable to resolve your concerns, you may refer your complaints to Huston McComb, LPC Supervisor at (281) 813-7360 or the Texas Board of Examiners of Professional Counselors at (512) 834-6658.
Client Responsibilities:1. To be honest, open, and willing to share your concerns 2. To ask questions when you don’t understand or need clarification 3. To discuss any reservations you have about your treatment plan 4. To follow agreed upon treatment plan 5. To report changes or unexpected events related to your problem 6. To keep appointments whenever possible or call to cancel within 24 hours prior to your appointment. 7. To not electronically record any aspect of yours or anyone else’s experience while on TSFW premises
No Show Policy: 261. Please cancel or reschedule yourappointment with at least 24 hours notice: There is a waiting list to receive ourcounseling services and whenever possible, we like to offercancelled spaces to our clients in order to shorten thewaiting period.2. If less than a 24 hour cancellation or reschedule is given this will be documented as a “Late Cancellation”appointment.3. If you do not present to the office for your appointment, this will be documented as a “No-Show”appointment. 4. After the 1st “No-Show/Late Cancellation” appointment, you will receive a phone call informing you that you have broken our "No-Show/Late Cancellation" policy. TSFW will assist you to reschedule this appointment, if needed. 5. If you have 2 “No-Show/LateCancellation”appointments within a one year time period, you will receive another verbal warning. 6. If you have 3 "No-Show/LateCancellation" appointments within a one year time period, suspension or termination from the practice will be suggested. You will be notified by email or letter if the dismissal was approved.
Referrals:Should you and/or I believe that a referral is needed, I will provide some alternatives including programs and/or people who may be available to assist you. A verbal exploration of alternatives to counseling will also be made available upon request. You will be responsible for contacting and evaluating those referrals and/or alternatives.
Records and Confidentiality: All of our communication becomes part of the clinical record. Records are the property of The Source for Women. Adult client records are disposed of seven years after the file is closed. Minor client records are disposed of seven years after the client’s 18th birthday. Most of our communication is confidential, but the following limitations and exceptions do exist: a) I determine that you are a danger to yourself or someone else; b) you disclose abuse, neglect, or exploitation of a child, elderly, or disabled person; c) you disclose sexual contact with another mental health professional or clergy; d) I am ordered by the court to disclose information; e) you direct me to release your records;or f) I am otherwise required by law to disclose information. If I see you in public, including in the church, I will protect your confidentiality by acknowledging you only if you approach me first. Office clerical personnel will only have enough information to schedule appointments, contact you, and facilitate the collection of fees. In the case of marriage or family counseling, I will keep confidential (within the limits cited above) anything you disclose to me without your family member’s knowledge. However, I encourage open communication between family membersand I reserve the right to terminate our counseling relationship if I judge the secret to be detrimental to therapeutic progress.
Emergency Contact: The limited resources of the Counseling Center prevent us from providing crisis interventionor intensive counseling. If you have a crisis after office hours, please either: contact your physician; call the crisis hotline at (713) 228-1505; or go to the nearest hospital emergency room. If a hospitalization occurs, please contactthis office as soon as possible to coordinate your care. You may leave a message at (713) 780-0030.
Acknowledgement and Consent: By your signature below, you are indicating that you have read and understood this statement, or that any questions you have about this statement were answered to your satisfaction, and that you were furnished a copy of this statement. By my signature, I verify the accuracy of this statement and acknowledge my commitment to conform to its specifications.