HealHer Virtual Spa Text-Talk Client Agreement
Text-Talk Services
I understand that the service provided is text-talk, which are delivered either by phone, audio or video communication via the internet/phone service. Text-Talk can bring deeper insight and awareness, better ways of understanding and coping with problems, as well as improved relationships. I understand that text-talk sometimes requires that I be willing to examine difficult topics or times in my life, to
experience stronger than usual emotions, and to try out new and different behaviors.
Documentation and Access
I understand that during the provision of text-talk services, Dr. Danielle Penson will need to securely collect and record personal information such as my name, address, and contact details. If the sessions are ongoing, I agree to regularly update my address, telephone number, and e-mail address, as well as any contact information for my emergency contacts. Failure to do so releases Dr. Penson from any and
all ethical and/or legal obligation to warn of life threatening situations.
Use of Technology and Limits of Communication
If I send any messages involving personal information to Dr. Penson without encryption, I agree to waive my privilege to confidentiality. In addition, I must assume full responsibility for the risks inherent in insecure internet transmissions, including any losses or damages. I also agree not to post transcripts or any other recording of my sessions online or to distribute them in any way. I have read and understood
the section below on confidentiality.
Text Talk Precautions
I understand that text talk and face-to-face counseling involve important differences that limit the responsibilities assumed by Dr. Penson. Unlike face-to-face sessions, Dr. Penson cannot guarantee the same degree of confidentiality since text talk partially takes place in a space outside of Dr. Penson’s control (i.e., the internet and my physical location). Because text talk takes place at a distance and possibly across jurisdictions Dr. Penson cannot reliably intervene in situations that may involve risk to my emotional or physical well-being (e.g., if I am in crisis, suicidal, or require hospitalization). Text based communication will be used for all sessions.
Financial Obligation
Monthly or Annual Subscription are done on the website: www.HealHerVirtualSpa.com
Emergency Contact Information
In case of emergency or clear imminent harm to myself or another person, Dr. Penson is legally and ethically bound to contact the appropriate authority. Dr. Penson has my permission to contact my family doctor, a friend/family member, or appropriate authority, in such cases. I understand that Dr. Penson will not agree to provide services unless this form is acknowledged. I also understand that falsification of this information releases Dr. Penson from all legal responsibility and repercussions related to notifying
appropriate authorities in the case of an emergency.
Confidentiality Agreement
In general, your identity as a client, as well as, the disclosures that you make to me in the course of our work are private and protected. This means that I do not reveal to others that you are a client of mine, nor do I share anything that you say during our work with anyone else. If you would ever like me to reveal your status as a client, or you would like me to share information with a third party, you will be asked to sign an agreement waiving your right to confidentiality.
Unintentional Breaches of Confidentiality
Text Talk has certain aspects to it which present challenges to confidentiality that do not exist in conventional, face-to-face sessions. There are breaches of confidentiality that a traditional session has control over that text talk does not. Please be aware of areas where your confidentiality might unknowingly be breached.
1. E-mail
Any e-mail that you send from conventional online e-mail services like Gmail, Hotmail, Yahoo or other similar agencies are not secure. These organizations reserve the right to search the content of your letters. Similarly, private non web-based e-mail messages (such as ones you may send from a program on your own computer, Outlook Express or the Macintosh Mail program) may be intercepted by others once sent. Finally, if you are using a work provided e-mail your employer almost always has the right to access the information in e-mails that you send. In many locations those messages are considered to be the property of the employer. In order to overcome this breach of security you might consider setting up an online, encrypted and secure e-mail address that you use for sending and receiving messages from me. Any message that you send to me from a non-encrypted source, or that you send to an e-mail
account of mine other than my DrDanielleAssistant@gmail.com account represents a possible breach of security that I cannot secure.
2. Conversational privacy
In conventional text talk it is the responsibility of Dr. Penson to ensure that no one can read the text conversation. However, I cannot assure the privacy of your location. If you are somewhere where a family member, co-worker or even a stranger might be able to hear or see you then our conversation cannot be kept secure. I strongly encourage you to find a private location to have our conversation. I also cannot ensure that your phone or computer is free of malicious software that might record your end of the conversation. If you have any concerns about this, you should have your computer or phone examined by a qualified IT professional. This is important not only for confidentiality, but for the process of text talking. It is very difficult to be attentive and focused on the process if there are constant interruptions, or if you feel others can see or hear you (and therefore possibly judge you). For this reason, and for your sake, I will refuse to begin or might possibly end a conversation.
Limits on Confidentiality
There are certain situations which can arise in which disclosures made to me cannot be kept strictly private due to professional ethics or law. The following information describes these situations.
1. If you indicate that you are in serious and immediate risk of harming yourself or someone else. The most typical situation would be when the threat of suicide is such that I cannot be assured of your safety once you leave the session. It is important to note that this does not apply to talking about thoughts of harming yourself that you may be experiencing. Many people who are feeling discouraged and hopeless think about harming themselves, and it is very important to talk openly about this in psychotherapy. Talking about suicide or other thoughts of self-harm would not automatically lead to a breach confidentiality. However, in the event that you intended to act on your thought to kill or harm yourself, I would be required to act to protect you even if that involved breaching confidentiality. Your life is more
important than your right to privacy! In the event that you reveal a serious intention to harm someone else, I would be required to take the same action to protect that person as I would to prevent you from harming yourself.
2. If you indicate that you are involved in the abuse of a minor child, an elderly adult, or a disabled person. In these cases I am ethically and legally required to file a report about these activities with the appropriate authorities in your location. Once filed, I would be unable to safeguard the privacy of the information that those authorities would then have.
3. If I am ordered to release information by subpoena. If you should become involved in a court proceeding, the court may use the power of subpoena to gain access to information that you have shared with me. Although it is my policy to limit my involvement in legal proceedings as much as possible, under court order I may be required by law to provide written or verbal testimony to the court.
4. If you indicate that you were sexually abused by another licensed mental health professional. If you indicate that you were sexually violated by another licensed mental health professional, I am ethically required to report this information to the authorities where the incident took place, as well as to the licensing board governing that person’s license. Please note: this does not apply to disclosures of sexual misconduct by anyone other than a licensed mental health professional from whom you were receiving treatment.
Assurance of Intent
Be assured that your right to confidentiality is very important to me. In the unlikely event that I must breach confidentiality, I will make every effort to use care and discretion while meeting my legal and ethical obligations. By booking any service, I confirm that I consent to the terms and conditions set out in this agreement. I agree that signing up for
an annual or monthly subscription shall be interpreted as constituting a signature of consent to the terms and conditions set out in this document for legal purposes.
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