Client Agreement

and

Informed Consent Form

 

Welcome! I’m so glad you’ve decided to reach out for support. I appreciate your trust in giving me the opportunity to work with you. This document will provide you with information about my qualifications, my treatment approach, and the services I offer, and introduce you to the nature of the counseling process. In the second half you will find an informed consent form.

 

Qualifications.

I am a Licensed Professional Counselor (LPC), licensed in the state of Texas (License Number 64378.) I received my Bachelor's Degree in Christian Studies from Howard Payne University, my Master’s Degree in Counseling from Texas A&M University, Corpus Christi, and have accumulated multiple hours toward a Ph.D. in Psychology at Northcentral University. In the event you are dissatisfied with my services for any reason, please let me know.

 

Treatment Types.

I offer a variety of professional services.

  • Individual Psychotherapy.  I help my clients reduce the internal struggles behind problematic feelings, thoughts, beliefs, and behaviors.

Typically, we meet once a week, for six to twelve weeks.

  • Couples/Marriage Psychotherapy. Beyond the communication, problem solving, and conflict resolution of typical couples therapy, I focus on helping couples improve their relationship by identifying and dealing with the underlying issues that (most people don't even realize) drive actions, thoughts, and even feelings. In couples therapy, the couple, itself – that third party you are creating together – is my client, not either of you as individuals.

Typically, we meet once a week for six to eight weeks.

  • Premarital Counseling. So many marital issues can be forestalled with good premarital counseling. And the best premarital focuses on building reflexes for handling marital challenges before they come...relfexes in each member to appreciate the differences that both drew them together and threaten to tear them apart. Communication, decision making, conflict resolution, finances, intimacy and sex, and children and futures are important. But they are secondary, and are learned very easily after these reflexes are in place.

Typically, we meet once a week for four to sixweeks.

  • Family Counseling. I help families improve their relationships and solve challenges by observing behavioral patterns and encouraging and instructing members in healthy patterns. Frequently, when young children are involved, I teach familial therapy, a type of play therapy for parents and children.

Typically, we meet once a week for six to eight weeks.

  • Other Issues. 
                Depression                   Anxiety                     Women's Issues
                Stress Management       Grief Counseling          Spiritual Counseling

 

Confidentiality.

Your story is important and, well…yours. I will treat everything you share with me with great care. In all but a few rare situations, confidentiality is protected by state law, the rules of ethics of my profession, and my personal integrity. Texas law requires me to inform you that your information may be disclosed to the appropriate authorities/agencies in the following situations.

  • If I come to believe you may harm yourself or others;

  • If I come to believe you are involved in or have knowledge of abuse or neglect of a child or abuse, neglect, or exploitation of a person who is elderly or has a disability; or

  • If I am ordered to disclose by state or federal courts.

Finally, I will disclose information if you sign a release form granting permission to designated third parties to receive information that you request me to share.

 

I will never disclose your information for any reason without informing you.

 

Minor Clients.

If you are a parent or guardian requesting counseling services for your children under the age of 18, I will need your permission to work with them. Please keep in mind that, while you have the right to question and understand the nature of your child’s sessions, treatment for minors (as well as adults) is most effective when clients have the freedom to talk openly. It is therapeutically important that your child develops a level of trust with me. I will provide you with a general overview of each session along with your child’s level of participation and progress, but will not disclose the content of our sessions. (Of course, the same limits to confidentiality listed in the section, above, labeled “Confidentiality” apply to minors.) Play Therapy – a modality that is limited but not impossible in the online environment – is my main choice for young children. If you would like me to work with your child, let’s brainstorm ways we can include Play Therapy.

 

Policies, Procedures and Fees.

  • Session Length

    • Sessions are 50 minutes long.

    • The first session is free.

    • Each additional counseling session is $60.

    • Each additional premarital counseling session is $50.

    • Each addition life coaching session is $50.

  • Payment
    • Payments are collected when you book your appointment at www.catrussell.com via PayPal with your credit card or PayPal account.

    • I do not accept any form of insurance.

  • Professional Records

I keep a record of the counseling services I provide to each client. You may ask to see and/or copy your record by making an appointment specifically for that purpose or I can prepare a summary for you instead. You may also ask me to correct your record.

Contact Information.

The primary way to get in touch with me is by via email at cat@catrussell.com.

 

Signatures.

I have read and fully understand this document. All questions have been answered to my satisfaction and I understand I have the opportunity now and in the future to discuss any questions I may have with my therapist. I agree to the policies, procedures and fees explained herein.

 

______________________________________________________________________________________________

Printed Client Name    

 

______________________________________________________________________________________________

Client Signature                                                                                                                        Date

 

 

For clients who are minors

 

______________________________________________________________________________________________

Printed Minor Client Name      

 

I declare that I am the legal guardian and/or managing conservator of the above named child and grant permission for his/her psychological treatment.

 

______________________________________________________________________________________________

Printed Client Name

 

______________________________________________________________________________________________

Signature of Parent or Guardian                                                                                                 Date