Trauma Wellness; 402 Clyde Street, Suite 3, Knoxville, TN 37921; 865-328-6091; traumawellness.com

Informed Consent for Psychotherapy

General Information 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 our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with me. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.

All Therapists at Trauma Wellness have either a Master’s or Doctoral level degree. They are either a Professional Counselor, Marriage and Family Therapist, Psychologist, or Social Worker. Some may be still working under supervision with a Licensed therapist and working toward their own license.

The Therapeutic Process: You have taken a very positive step by deciding to seek therapy. The outcome of your or your child’s treatment depends largely on your and/or their willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. I cannot promise that your and/or their behavior or circumstance will change. I can promise to support you and/or them and do my very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself and/or your chid(ren).

It is important to note that for mental health care in TN, adolescents at age 16 and 17 have the same rights as adults, they are in charge of their treatment. We cannot share information about their treatment or their progress without written authorization from that individual. Therefore, they should read this and sign as it is the 16 or 17 year old consenting to treatment.

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:

1.     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.

2.     If a client threatens grave bodily harm or death to another person.

3.     If the therapist has a reasonable suspicion or knowledge that a client or other named individual is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.

4.     Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.

5.     Suspected neglect of the parties named in items #3 and # 4.

6.     If a court of law issues a legitimate subpoena for information stated on the subpoena.

7.     If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.

Occasionally the therapist 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.

If we see each other accidentally outside of the therapy office, the therapist 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 the therapist first, they 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.

After Hours

You may find a need to speak with someone after hours for varying reasons. Our phone number is answered during business hours only and typically all calls go to voicemail. You can contact the following after hours and/or if you have any of the crises mentioned below:

1.     If you are in immediate danger, call 911

2.     If you are feeling hopeless, not knowing where to turn, considering harming yourself, call the national suicide prevention lifeline: 1-800-273-8255 or you can call Mobile Crisis (for all ages) who can locally assess the situation and provide options for care: 865-539-2409

3.     If you are not safe in your home, call the Domestic Violence hotline: 865-637-8000

4.     If you have been sexually assaulted and do not wish to involve the police at this time, you may call the Sexual Assault Hotline: 865-522-7273

5.     If you or your child(ren) have runaway and need help, you can call the Youth Homeless/Runaway Hotline: 865-523-2689

6.     Otherwise, if not an emergency, you may send a message to me through the portal asking your therapist to call when they can.

Communication between you and your therapist:

Trauma Wellness utilizes an Electronic Medical Records (EMR) system called Simple Practice.  This program is HIPAA compliant and has a portal for communication and payment.  Emails and texts are not protected alone.  Utilizing the portal allows all messaging to be HIPAA compliant.  Additionally, your chart of treatment is kept on the portal.  Trauma Wellness does not keep paper charts.  You can send messages through the portal if you have requests/questions for your therapist or just wish to give them some information.  Additionally, you can call your therapist’s office line to leave messages for your therapist.  Please understand that the therapists are typically in sessions back to back and have little time to call you back so utilizing the portal makes it easier and faster to connect.

Payment options

We only offer self-pay and do not bill insurance. The rates vary depending on therapist and/or service. Payment options are:

1.     Paying at each session via credit card/check/cash, or,

2.     Making arrangements due to need of monthly invoices