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Informed Consent : the Client/Clinician Services Agreement

Welcome to Penhaligon Applied Psychology. It is a condition of provision of services by Penhaligon Applied Psychology (or the ‘Practice’) that you, as ‘the Client’ review, fully understand, absorb and accept this agreement prior to treatment. 

 

This document contains important information about Penhaligon Applied Psychology’s professional services and business policies. It details privacy protections, patient rights and provisions, and explains how this Practice uses and handles your Personal Information for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. This document should be read in conjunction with the Clinic Terms & Conditions

 

When you confirm your acceptance of this document, it will also represent an Agreement between us. We can and should discuss any questions you have before you begin treatment. Psychotherapy (and the use of hypnotherapy) establishes a relationship that works in part because of clearly defined rights and responsibilities held by both the Client and the ‘Clinician’ (your therapist). As a Client of Penhaligon Applied Psychology, 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. Penhaligon Applied Psychology and its’ Clinicians have corresponding responsibilities to you. These rights and responsibilities are described in the following sections. 

 

GOALS OF THERAPY 

There can be many goals we can establish for your treatment and your relationship with your Clinician. Some of these will be long-term goals such as improving the quality of your life and helping you learn to live with mindfulness and self-actualisation. Others may be more immediate goals such as decreasing anxiety and depression symptoms, developing healthy relationships, changing a specific behaviour or decreasing/ending drug use. 

Whatever goals we establish, we will always aim to establish them prior to commencing treatment. The Clinician may make suggestions on how to reach a given Goal, but you as the Client will ultimately decide where you want to go. 

 

RISKS / BENEFITS OF THERAPY 

Clinical hypnosis may be used as a tool for strategic psychotherapy during your treatment. It can help you develop coping skills, improve aspects of your performance, make attitudinal and behavioural changes, reduce symptoms of mental health disorders, improve the quality of your life, learn to manage anger, learn to live in the present and many other advantages. It does however carry certain risks. Your Clinician will always seek your consent to treatment before each session.

 

Hypnotherapy is an intensely personal process. Depending on the focus area and our agreed form of Treatment, it can (in some cases) bring unpleasant memories or emotions to the surface. 

 

A Therapeutic Goal must always be regarded as an objective. Setting a mutually agreed Therapeutic Goal cannot be construed as a guarantee by the Clinician that it can or will be achieved. This form of treatment is a humanistic science. There are just too many variables, and success measures far too subjective, for that to be possible. We will guide you in goal setting to establish realistic Therapeutic Goals and apply our best efforts towards bringing you the best possible outcome. 

 

There are no guarantees that hypnotherapy will work for you. Clients can sometimes make improvements only to go backwards after a time. Progress may happen slowly. It might be experienced as an improvement, rather than the Goal being definitively achieved. To achieve best results, hypnotherapy requires active effort and full cooperation on your part as the Client. In order to be most successful, you will have to work as directed on things we discuss outside of sessions and to be fully cooperative. The success of Hypnotherapy can be seriously impacted where the Client is not fully cooperative, either consciously or unconsciously.

 

APPOINTMENTS 

Appointments will ordinarily be 50-60 minutes in duration, generally once per week at a time we agree on, although some sessions may be more or less frequent as needed. The time scheduled for your appointment is assigned to you and you alone. 

 

If you need to cancel or reschedule a session, 24 hours notice is required. If you miss a session without cancelling, or cancel with less than 24 hours notice, you may be required to pay for the session (unless we both agree that you were unable to attend due to circumstances beyond your control). In addition, you are responsible for attending your session on time; if you are late, your appointment will still need to end on time. 

 

CONFIDENTIALITY

Any information, written, recorded or verbally communicated about you with Penhaligon Applied Psychology will be appropriately secured. By virtue of the obligations imposed on this Practice by both the Privacy Act and the Australian Hypnotherapy Association, Penhaligon Applied Psychology will not disclose anything about you, or share your data or information with anyone without your express consent unless under very specific circumstance it’s legally obliged to do so. 

 

Those specific circumstances are as follows: 

  1. The Client or someone they mention is in real and immediate danger of being seriously harmed by the Client; 

  2. The Client has the genuine and immediate intent to commit a serious crime; 

  3. There is a chance the Client will be involved in the serious neglect or harm of a child; or where 

  4. For whatever reason Penhaligon Applied Psychology or one of its Clinician’s is formally directed by a Court of Law to do so. 

Your Clinician 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. 

 

There are some limitations to confidentiality to which you need to be aware. Your Clinician may consult with a supervisor or other professional clinician in order to give you the best service. In the event that your Clinician consults with another clinician, no identifying information such as your name would be released. If your Clinician receives a court order or subpoena, she may be required to release some information. In such a case, your Clinician will consult with other professionals and limit the release to only what is necessary by law. 

 

CONFIDENTIALITY AND GROUP THERAPY

The nature of group therapy makes it difficult to maintain confidentiality. If you choose to participate in group therapy, be aware that your Clinician cannot guarantee that other group members will maintain your confidentiality. However, your Clinician will make every effort to maintain your confidentiality by reminding group members frequently of the importance of keeping what is said in group confidential. Your Clinician also has the right to remove any group member from the group should she discover that a group member has violated the confidentiality rule. 

 

CONFIDENTIALITY AND TECHNOLOGY

Some Clients may choose to use technology in their hypnotherapy sessions. This includes but is not limited to online hypnotherapy via Zoom, Skype, telephone, email, text or chat. Due to the nature of online hypnotherapy, there is always the possibility that unauthorised persons may attempt to discover your personal information. Your Clinician will take every precaution to safeguard your information but cannot guarantee that unauthorised access to electronic communications could not occur. Please be advised to take precautions with regard to authorised and unauthorised access to any technology used in hypnotherapy 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 hypnotherapy sessions.

 

Should a Client have concerns about the safety of their email, your Clinician can arrange to encrypt email communication with you. Record Keeping Your Clinician may keep records of your Treatment sessions and a Treatment Plan which includes goals for your hypnotherapy. These records are kept to assist in maintaining the direction of your sessions and continuity in service. They will not be shared except with respect to the limits to confidentiality discussed in the Confidentiality section. Should the Client wish to have their records released, they are required to sign a release of information which specifies what information is to be released and to whom. Records will be kept for at least 7 years but may be kept for longer. Records will be kept either electronically on a digital storage device or in a paper file and stored in a locked cabinet. Penhaligon Applied Psychology operates predominantly on information in electronic form. As such, it reserves the right, where such release is required, to provide all such information in electronic form only.

 

PROFESSIONAL FEES

You are responsible for paying at the time of your session unless prior arrangements have been made. Payment must be made by credit/debit card or cash. If you refuse to pay your session fees, Penhaligon Applied Psychology reserves all rights to formally pursue and recover such payment, in addition to the costs to it of that debt recovery via a debt collection service. 

If you anticipate becoming involved in a court case, and your case might require my participation, you must discuss this fully with your me before you waive your right to confidentiality. If your case requires my participation, you will be expected to pay for the professional time required. Fees are non-negotiable. To receive sliding scale fees, you must present proof of income through recent pay slips or tax forms. Fees are subject to change at Clinician's discretion.

 

FEE SCHEDULE

Please refer to our “Plans and Pricing” page for our current schedule of prices.

 

INSURANCE

If you have a health insurance policy, it will usually provide some coverage for mental health treatment. Many policies provide rebates for Hypnotherapy. Where your insurer does so the amount of that rebate varies from insurer to insurer. As the Client, it is your responsibility to investigate with your insurer whether and to what extent the services we provide are covered before you commence treatment. This Practice will invoice you for, and at time of Treatment expects you to pay us the full amount of, your Treatment fees. It is your responsibility to then independently process your claim you’re your health insurer. You should also be aware that some health insurance companies require you to authorise us to provide them with a clinical diagnosis. Sometimes Penhaligon Applied Psychology is required to provide additional clinical information which will become part of the insurance company files about you. By accepting this Agreement, you authorise Penhaligon Applied Psychology to provide such information when requested by your insurer. Your invoice, when paid, will furnish what you need to lodge your insurance claim. 

 

CONTACTING ME 

Our offices and Clinicians are sometimes not immediately available by telephone. At these times, you may leave a message on our confidential voice mail and your call will be returned as soon as possible, but it may take a day or two for non-urgent matters. If you feel you cannot wait for a return call or it is an emergency situation, go to your local hospital or call 000. 

 

USE OF YOUR CONTACT DETAILS

Penhaligon Applied Psychology will request your email address, phone number and other contact details on our Client Intake Form. You have the right to refuse to divulge such information. By signing this document, you authorise Penhaligon Applied Psychology to use your email address and or mobile phone to periodically check in with you to monitor your progress.

 

You further authorise us to use your email address to send newsletters with valuable therapeutic information including wellness advice, and to notify you of events and offers. Your email address will also be used to maintain our general mailing list for our BLOG and VLOG.

Informed Consent

I have read this document in its entirety and agree to its terms.

Thanks for submitting!

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