Informed Consent

 

This document is designed to inform you about my professional background and services that I provide. Please read carefully, and feel free to ask me any questions after viewing this document.

 

I hold a Master’s Degree in Clinical Mental Health Counseling from Walden University. I am a Licensed Clinical Professional Counselor, a Licensed Addictions Counselor, and a Nationally Certified Counselor. I have completed training for Eye Movement Desensitization and Reprocessing (EMDR) therapy, as well as Mindfulness-Based Stress Reduction. I have also completed training in clinical hypnosis through the American Society for Clinical Hypnosis. I am also currently working toward a PhD in clinical sexology, as well as training in Imago therapy, yoga, and tantra.

 

I consider counseling to be an opportunity for a therapeutic alliance between counselor and client. This alliance allows for deeper understanding and change to occur. Coming from a holistic background, I view each individual as a whole person, recognizing that there is much that goes into our lives. Looking at various aspects of life, including the physical, emotional, mental, spiritual, environment, family, relationships, financial, learning, and play, we can work together to create positive and healthy changes to enhance life. Specializing in trauma and sexuality, I use EMDR as a therapeutic tool to fully process and begin to heal from past events that continue to affect us. Clinical hypnosis may also be an option depending on your needs and goals. I am grounded in person-centered therapy, and use tools from Transactional Analysis, Rational-Emotive Behavior Therapy, Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Imago Therapy and Mindfulness Based Stress Reduction. I also interweave yoga, meditation, energy work, and tantra philosophies in my practice. Throughout the counseling process, I will be your guide, co-worker, and most importantly, your ally. I am truly honored that you are willing to take the first step in seeking support and am eager to be a supporter of your life. Let’s take this leap together.

 

RISKS/BENEFITS

 

Counseling may involve discussing issues that may be uncomfortable. Sometimes, you may not like what you hear from me. At any time, you have the right to refuse any therapeutic interventions offered to you as a part of counseling, and the right to ask questions about the purpose of any therapeutic techniques or interventions. The process of counseling is intended to help you personally and to help you resolve concerns in various areas of your life. Although I anticipate otherwise, I cannot guarantee specific results from counseling treatment, you may not improve at all, as quickly as you might like, or you may start to improve only after treatment has ended. Also, see SPECIFIC SERVICES below.

 

CONFIDENTIALITY

 

Following American Counseling Association (ACA) standards, I will keep confidential anything you say to me with the following exceptions: you authorize the disclosure of your records through a signed release of confidential information; you indicate that you are a danger to yourself or others; I become aware of suspected child, disabled person, or elder abuse; I am ordered by a court of law to disclose information. Additionally, as a counselor I am advised to consult with other professionals in order to provide you with the best treatment. I also work with a supervisor for clinical mental health, as I am still working toward hours for licensure. Meetings with my supervisor are to ensure that you are receiving the best care possible. All of our communication becomes a part of the clinical record, which is accessible to you upon request.

 

APPOINTMENTS

 

Appointments are usually scheduled for the same time each week. Sessions are approximately fifty minutes in length. Your regular appointment time is reserved for you and you are financially responsible for the scheduled time. Meeting regularly is important to ensure quality of treatment. Conscious Counseling Services, PLLC Alex Saunders, LCPC, LAC (406)570-2241 Yourconsciousself.com 1201 US HWY 10 W Unit A4D Livingston, MT 59047 Counseling usually ends when there is agreement that the problems that motivated you to seek counseling have been satisfactorily resolved. However, you have the right to end counseling at any time, to request a different type of treatment, or to request a referral to another counselor. Treatment can also be terminated if there is a failure to keep appointments, failure to carry through with treatment expectations, and non-payment of agreed-upon fees.

 

CANCELLATION OF APPOINTMENTS

 

In the event you will not be able to keep an appointment, please notify me immediately, and at least 24 hours in advance. If an appointment is cancelled or missed without 24 hours advanced notice, you will be responsible for paying the full amount for the session missed. Exceptions will be made when there are extenuating circumstances. Additionally, you must reschedule for the following week if you miss or cancel an appointment, as a missed appointment will not automatically be rescheduled for you. If you fail to contact me the same week you miss your appointment, you may lose your regular appointment time, as other clients will be given priority.

 

PAYMENT FOR SERVICE

 

My fee for a 50-minute individual therapy session is $150 and for relationship therapy sessions, $180. It is payable in cash or check after each session. Longer sessions are prorated according to the time we meet, set at $10 per additional 10 minutes. Telephone conversations are prorated according to the time we talk when such conversations are an agreed-upon arrangement between client and counselor and are beyond the scheduling of appointments. Please notify me if a difficulty arises during the course of your therapy impacting your ability to make timely payments. Should an account remain unpaid with no prior arrangements, after 90 days, it may be sent to collection. Please note, there is no return or refund for services.

 

USE OF DIAGNOSIS

 

Some health companies will reimburse clients for counseling services and some will not. In addition, most will require a diagnosis of a mental health condition and indicate that you must have an “illness” before they will agree to reimburse you. Some conditions for which people seek counseling do not qualify for reimbursement. If a qualifying diagnosis is appropriate in your case, I will inform you of the diagnosis before we submit the diagnosis to the health insurance company. Any diagnosis made will become a part of your permanent insurance records.

 

CONFIDENTIALITY AND TECHNOLOGY

 

Currently, most sessions are held virtually. This includes but is not limited to online counseling via Zoom, telephone, email, text or chat. Due to the nature of virtual counseling, there is always the possibility that unauthorized persons may attempt to discover your personal information. I will take every precaution to safeguard your information but cannot guarantee that unauthorized access to electronic communications could not occur. Please be advised to take precautions with regard to authorized and unauthorized access to any technology used in counseling 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 counseling sessions. See notice of privacy practices for detailed information on confidentiality.

 

RECORD KEEPING

 

I may keep records of your counseling sessions and a treatment plan which includes goals for your counseling. These records are kept to ensure a direction to 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 that specifies what information is to be released and to whom. Records will be kept for at least 7 years but maybe kept for longer. Records will be kept using a secure software called TherapyNotes, on a USB or in a paper file and stored in a locked cabinet in the counselor’s office Conscious Counseling Services, PLLC Alex Saunders, LCPC, LAC (406)570-2241 Yourconsciousself.com 1201 US HWY 10 W Unit A4D Livingston, MT 59047

 

SPECIFIC SERVICES

 

Services include individual and couples counseling, EMDR therapy, sex therapy, and clinical hypnosis. Working with trauma can likely increase vulnerability to stress. It is important to take responsibility for your self care and do the work necessary to help the process be effective and potentially easier with priority on the self. Both EMDR and clinical hypnosis work with memories. Memories are malleable. EMDR can cause a person to remember memories long forgotten, possible due to self protection. It is important to understand you will NEVER be forced to address any issue that arises. You are in control. Many people fear the possible memory uncovering that can happen during hypnosis. Conscious Counseling Services does not typically dive into memories during hypnosis, rather the focus is on other issues. Memories are dealt with using EMDR therapy at this practice. Please note that all services are therapeutic and can address challenging issues and can increase vulnerability to stress, also possibly resulting in dreams or continued reprocessing in between sessions. This will always be addressed and prevention is at the heart of this practice. The focus will initially be on preparation to ensure best possible outcome and least harm. Also, please note that both EMDR and hypnosis can affect memories and emotional reactivity to memories. While this is usually emotionally beneficial, this could pose issues for legal issues. If you are involved in any legal issues, it is advised that you consult with your lawyer regarding the nature of these services before participating in EMDR or clinical hypnosis. Conscious Counseling Services follows ethical guidelines from the American Counseling Association, American Society of Clinical Hypnosis, The American Association of Sexuality Educators, Counselors and Therapists (AASECT), and Eye Movement Desensitization and Reprocessing International Association (EMDRIA). All ethical guidelines are available online.

 

TELEPHONE CALLS AND EMERGENCIES

 

My office phone number is 406.570.2241. I check messages regularly and try to respond promptly. If your call is in the evening, on a weekend, or over a holiday, I may be unable to call back until the next business day. In case of emergency, leave a message for me and then immediately contact The Help Center crisis line at 406.586.3333 or 211, your primary care provider, or 911 to receive assistance.

 

My signature below indicates that I have read the Informed Consent, and I understand and agree to the information and terms of office policies and professional practices

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