ONLINE DRAMATHERAPY SERVICES CONTRACT
Welcome to my practice. This document contains important information about my professional services and business policies. Please read it carefully and jot down any questions you might have so that we can discuss them at our next meeting. When you sign this document, it will represent an agreement between us.
Dramatherapy is not easily described in general statements. It varies depending on the personalities of the therapist and client, and the particular problems you hope to address. There are many different methods I may use to deal with those problems. Dramatherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things we talk about both during our sessions and at home.
Dramatherapy can have benefits and risks. Because therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, dramatherapy has also been shown to have benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But, there are no guarantees as to what you will experience.
Our first few sessions will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and a treatment plan to follow, if you decide to continue with therapy. You should evaluate this information along with your own opinions about whether you feel comfortable working with me. At the end of the evaluation, I will notify you if I believe that I am not the right therapist for you and, if so, I will give you referrals to other practitioners whom I believe are better suited to help you.
Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion.
MEETINGS AND CANCELLATIONS
I normally conduct an evaluation that will last from 2 to 4 sessions. During this time, we can both decide if I am the best person to provide the services you need in order to meet your treatment goals. If we agree to begin therapy, I will usually schedule one 45-minute session (one appointment hour of 45 minutes duration) per week, at a time we agree on, although some sessions may be longer or more frequent. Once an appointment hour is scheduled, you will be expected to pay for it unless you provide 24 hours advance notice of cancellation unless we both agree that you were unable to attend due to circumstances beyond your control. If it is possible, I will try to find another time to reschedule the appointment. Should you be unable to commit to weekly therapy, we can work together to find a time period that suits your psychological or financial needs. Email blocks are purchased in advance, and can be used as needed.
Video call sessions will be conducted using ZOOM. This is similar to Skype, but is end-to-end encrypted, which makes it a more secure platform. ZOOM is free to use, and you can either download the app, or access it via your internet browser. Before your session begins, I will send you the ID for our meeting, which you can type into your browser to join. It is recommended that you have a quiet, private area to sit in during the session.
I may also suggest we use a free app called SnapCamera in our sessions. This is a filter app that lets us use masks and costumes on our video feed to mimic the use of actual costumes. If I feel that this will be beneficial to our sessions, I will guide you in downloading and using the application.
Email therapy is purchased in blocks, where one block consists of one email from you, and one reply from me. To begin, I will send you an email with a set of questions to get us started, which will not count as a block. I use Hushmail, which is an encrypted email service. This means that emails from me will not be readable accidently by anyone else. The first email you receive from me will ask you to set up a code. This is like a password that ensures my emails remain private. Keep this code safe, as you will use it each time to open my emails. I will reply to your email within 72 hours, unless I have otherwise informed you in advance. Please note that I will not treat emails as emergencies, and will not get back to you immediately. If you have an emergency please rather get in touch via Signal, phone call, or with your local hospital.
Instant messaging therapy works similarly to video calls, with 45 minute blocks. I use a free app called Signal, which is encrypted. I will send you a link to download the app when you book an IM session, and I will add you as a contact. Signal can be used on a phone or on your laptop if you prefer. I recommend finding a quiet, private space to chat, and to make sure you will not be distracted by people or other technology. Please note that you can IM me on Signal outside of your therapy times, however I will not respond if I am with a client. If it is vital that you get hold of me quickly, please begin your message with EMERGENCY, so that I know to get to it as soon as possible.
It is understandable that technological difficulties may at times impact our meetings. Should an unforeseen event such as a power cut, internet service cut, or computer error arise during our sessions, I will attempt to re-establish contact with you for 10 minutes. After this time, I will contact you to reschedule the appointment. Should the disconnection occur in the first 15 minutes of the session, we will reschedule with no additional charges. Should the disconnection occur after 15 minutes, I will charge you a prorated fee for the time we used.
Should it be your first time using a particular program or platform, I will support you in setting up the required applications, and allow up to 15 minutes of set-up time during our first session using the application, which will not take away from your therapy time. I highly recommend setting up and testing the programs beforehand, and am happy to provide you with email support to make sure you are ready to go at our allotted time.
My standard 45 minute fee for video-call or instant message therapy is R450/$30. Couples or family video call therapy is R600/$40 for an hour session. If we meet more than the usual time, I will charge accordingly. My fee for a block of 10 emails (10 emails from you with 10 replies from me) is R650/$43, with a 5 email block being R400/$27. Booking 4 or more sessions in advance will be discounted.
I charge on a sliding scale, and should you wish to talk about getting a reduced fee, please contact me directly. A reduced fee is based on your income, and you will be required to show proof of income in some form. If your income changes significantly during our therapy, please get in touch to discuss reducing your fee until such time as you can pay full fees again.
BILLING AND PAYMENTS
You will be expected to pay for each session at the time of booking, or within 48 hours of completing the booking, unless we agree otherwise.
If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. If such legal action is necessary, its costs will be included in the claim. In most collection situations, the only information I will release regarding a patient’s treatment is his/her name, the dates, times, and nature of services provided, and the amount due.
I do not deal directly with insurance or medical aid companies. Should you wish to claim from medical aid, please get in touch with me directly to get the required documentation to support your claim.
I am often not immediately available by telephone. Though I am usually in my office between 9 AM and 5 PM (Thailand time), I probably will not answer the phone when I am with a client. As it is probable that we are not in the same country, please either use email, or a text service such as Whatsapp or Signal in order to reach me. I will make every effort to reply to your message on the day it is sent, with the exception of weekends and holidays. If you are difficult to reach, please inform me of some times when you will be available. If you are unable to reach me and feel that you cannot wait for me to return your call, contact your family physician or the nearest emergency room and ask for the psychologist on call. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact, if necessary.
CONFIDENTIALITY [for adult clients]
In general, the privacy of all communications between a patient and a therapist is protected by law, and I can only release information about our work to others with your written permission. But there are a few exceptions.
In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some legal proceedings, a judge may order my testimony if he/she determines that the issues demand it, and I must comply with that court order.
There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a client’s treatment. For example, if I believe that a child, elderly person or person with disabilities is being abused or has been abused, I may be required to make a report to the appropriate agency.
If I believe that a client is threatening serious bodily harm to another, I may be required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the client. If the client threatens to harm themselves, I may be obligated to seek hospitalization for them or to contact family members or others who can help provide protection. If a similar situation occurs in the course of our work together, I will attempt to fully discuss it with you before taking any action.
I may occasionally find it helpful to consult other professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my client. The consultant is also legally bound to keep the information confidential. Ordinarily, I will not tell you about these consultations unless I believe that it is important to our work together.
Although this written summary of exceptions to confidentiality is intended to inform you about potential issues that could arise, it is important that we discuss any questions or concerns that you may have at our next meeting. I will be happy to discuss these issues with you and provide clarification when possible.
Your signature below indicates that you have read the information in this document and agree to abide by its terms during our professional relationship.
CLIENT SIGNATURE ________________________________ DATE _________________
Parent Authorization for Minor’s Mental Health Treatment
In order to authorize mental health treatment for your child, you must have either sole or joint legal custody of your child. If you are separated or divorced from the other parent of your child, please notify me immediately. I will ask you to provide me with a copy of the most recent custody decree that establishes custody rights of you and the other parent or otherwise demonstrates that you have the right to authorize treatment for your child.
If you are separated or divorced from the child’s other parent, please be aware that it is my policy to notify the other parent that I am meeting with your child. I believe it is important that all parents have the right to know, unless there are truly exceptional circumstances, that their child is receiving mental health evaluation or treatment.
One risk of child therapy involves disagreement among parents and/or disagreement between parents and the therapist regarding the child’s treatment. If such disagreements occur, I will strive to listen carefully so that I can understand your perspectives and fully explain my perspective. We can resolve such disagreements or we can agree to disagree, so long as this enables your child’s therapeutic progress. Ultimately, parents decide whether therapy will continue. If either parent decides that therapy should end, I will honor that decision, unless there are extraordinary circumstances. However, in most cases, I will ask that you allow me the option of having a few closing sessions with your child to appropriately end the treatment relationship.
Individual Parent/Guardian Communications with Me
In the course of my treatment of your child, I may meet with the child’s parents/guardians either separately or together. Please be aware, however, that, at all times, my patient is your child – not the parents/guardians nor any siblings or other family members of the child.
If I meet with you or other family members in the course of your child’s treatment, I will make notes of that meeting in your child’s treatment records. Please be aware that those notes will be available to any person or entity that has legal access to your child’s treatment record.
Mandatory Disclosures of Treatment Information
In some situations, I am required by law or by the guidelines of my profession to disclose information, whether or not I have your or your child’s permission. I have listed some of these situations below.
Confidentiality cannot be maintained when:
- Child clients tell me they plan to cause serious harm or death to themselves, and I believe they have the intent and ability to carry out this threat in the very near future. I must take steps to inform a parent or guardian or others of what the child has told me and how serious I believe this threat to be and to try to prevent the occurrence of such harm.
- Child clients tell me they plan to cause serious harm or death to someone else, and I believe they have the intent and ability to carry out this threat in the very near future. In this situation, I must inform a parent or guardian or others, and I may be required to inform the person who is the target of the threatened harm and the police.
- Child clients are doing things that could cause serious harm to them or someone else, even if they do not intend to harm themselves or another person. In these situations, I will need to use my professional judgment to decide whether a parent or guardian should be informed.
- Child clients tell me, or I otherwise learn that, it appears that a child is being neglected or abused–physically, sexually or emotionally–or that it appears that they have been neglected or abused in the past. In this situation, I may be required by law to report the alleged abuse to the appropriate child-protective agency.
- I am ordered by a court to disclose information.
Disclosure of Minor’s Treatment Information to Parents
Therapy is most effective when a trusting relationship exists between the therapist and the client. Privacy is especially important in earning and keeping that trust. As a result, it is important for children to have a “zone of privacy” where children feel free to discuss personal matters without fear that their thoughts and feelings will be immediately communicated to their parents. This is particularly true for adolescents who are naturally developing a greater sense of independence and autonomy.
It is my policy to provide you with general information about your child’s treatment, but NOT to share specific information your child has disclosed to me without your child’s agreement. This includes activities and behavior that you would not approve of — or might be upset by — but that do not put your child at risk of serious and immediate harm. However, if your child’s risk-taking behavior becomes more serious, then I will need to use my professional judgment to decide whether your child is in serious and immediate danger of harm. If I feel that your child is in such danger, I will communicate this information to you.
Example: If your child tells me that they have tried alcohol at a few parties, I would keep this information confidential. If you child tells me that they are drinking and driving or are a passenger in a car with a driver who is drunk, I would not keep this information confidential from you. If your child tells me, or if I believe based on things I learn about your child, that your child is addicted to drugs or alcohol, I would not keep that information confidential.
Example: If your child tells me that they are having voluntary, protected sex with a peer, I would keep this information confidential. If your child tells me that, on several occasions, the child has engaged in unprotected sex with strangers or in unsafe situations, I will not keep this information confidential.
You can always ask me questions about the types of information I would disclose. You can ask in the form of “hypothetical situations,” such as: “If a child told you that he or she were doing ________, would you tell the parents?”
Even when we have agreed to keep your child’s treatment information confidential from you, I may believe that it is important for you to know about a particular situation that is going on in your child’s life. In these situations, I will encourage your child to tell you, and I will help your child find the best way to do so. Also, when meeting with you, I may sometimes describe your child’s problems in general terms, without using specifics, in order to help you know how to be more helpful to your child.
Disclosure of Minor’s Treatment Records to Parents
Although the laws of your country may give parents the right to see any written records I keep about your child’s treatment, by signing this agreement, you are agreeing that your child or teen should have a “zone of privacy” in their meetings with me, and you agree not to request access to your child’s written treatment records.
Parent/Guardian Agreement Not to Use Minor’s Therapy Information/Records in Custody Litigation
When a family is in conflict, particularly conflict due to parental separation or divorce, it is very difficult for everyone, particularly for children. Although my responsibility to your child may require my helping to address conflicts between the child’s parents, my role will be strictly limited to providing treatment to your child. You agree that in any child custody/visitation proceedings, neither of you will seek to subpoena my records or ask me to testify in court, whether in person or by affidavit, or to provide letters or documentation expressing my opinion about parental fitness or custody/visitation arrangements.
Please note that your agreement may not prevent a judge from requiring my testimony, even though I will not do so unless legally compelled. If I am required to testify, I am ethically bound not to give my opinion about either parent’s custody, visitation suitability, or fitness. If the court appoints a custody evaluator, guardian ad litem, or parenting coordinator, I will provide information as needed, if appropriate releases are signed or a court order is provided, but I will not make any recommendation about the final decision(s).
By signing below, you show that you have read and understood the policies described above. If you have any questions as we progress with therapy, you can ask me at any time.
Minor’s Signature* _______________________________________ Date___________________
Parent/Guardian of Minor Patient:
Please initial after each line and sign below, indicating your agreement to respect your child’s privacy:
I will refrain from requesting detailed information about individual therapy sessions with my child. I understand that I will be provided with periodic updates about general progress, and/or may be asked to participate in therapy sessions as needed. ________ ________
Although I may have the legal right to request written records/session notes since my child is a minor, I agree NOT to request these records in order to respect the confidentiality of my child’s/adolescent’s treatment. ________ ________
I understand that I will be informed about situations that could endanger my child. I know this decision to breach confidentiality in these circumstances is up to the therapist’s professional judgment, unless otherwise noted above. ________ ________
Parent/Guardian Signature ________________________________________ Date__________
Parent/Guardian Signature ________________________________________ Date__________
* For very young children, the child’s signature is not required.
Electronic Communication Policy
In order to maintain clarity regarding our use of electronic modes of communication during your treatment, I have prepared the following policy. This is because the use of various types of electronic communications is common in our society, and many individuals believe this is the preferred method of communication with others, whether their relationships are social or professional. Many of these common modes of communication, however, put your privacy at risk and can be inconsistent with the law and with the standards of my profession. Consequently, this policy has been prepared to assure the security and confidentiality of your treatment and to assure that it is consistent with ethics and the law.
If you have any questions about this policy, please feel free to discuss this with me.
The use of my company email address (email@example.com) is only for administrative purposes unless we have made another agreement. That means that email exchanges with my office should be limited to things like setting and changing appointments, billing matters and other related issues. Please do not email me on this email address about clinical matters because email is not a secure way to contact me. If you need to discuss a clinical matter with me, please contact me for my secure email address, or purchase a block of email sessions, so that I can ensure that emails are properly encrypted to maintain security and confidentiality.
Because text messaging is a very unsecure mode of communication, I do not text message to nor do I respond to text messages from anyone in treatment with me. So, please do not text message me unless we have made other arrangements. If you wish to communicate via instant messaging, I use the secure platform Signal, please ask me for my details should you wish to communicate this way.
I do not communicate with, or contact, any of my clients through social media platforms like Twitter, Instagram and Facebook. In addition, if I discover that I have accidentally established an online relationship with you, I will cancel that relationship. This is because these types of casual social contacts can create significant security risks for you.
I participate on various social networks, both personally and in my professional capacity. If you have an online presence, there is a possibility that you may encounter me by accident. If that occurs, please discuss it with me during our time together. I believe that any communications with clients online have a high potential to compromise the professional relationship. In addition, please do not try to contact me in this way. I will not respond and will terminate any online contact no matter how accidental.
I have a website that you are free to access. I use it for professional reasons to provide information to others about me and my practice. You are welcome to access and review the information that I have on my website and, if you have questions about it, we should discuss this during your therapy sessions.
I will not use web searches to gather information about you without your permission. I believe that this violates your privacy rights; however, I understand that you might choose to gather information about me in this way. In this day and age there is an incredible amount of information available about individuals on the internet, much of which may actually be known to that person and some of which may be inaccurate or unknown. If you encounter any information about me through web searches, or in any other fashion for that matter, please discuss this with me during our time together so that we can deal with it and its potential impact on your treatment.
Recently it has become fashionable for clients to review their health care provider on various websites. Unfortunately, mental health professionals cannot respond to such comments and related errors because of confidentiality restrictions. If you encounter such reviews of me or any professional with whom you are working, please share it with me so we can discuss it and its potential impact on your therapy. Please do not rate my work with you while we are in treatment together on any of these websites. This is because it has a significant potential to damage our ability to work together.