The therapists at Connect Couples Therapy, PLLC/In Session Psych, PLLC are thankful to have the opportunity to work with you and your family members to develop a healthier, more satisfying life.

Sessions will typically run between 50 and 80 minutes, depending on the needs of the client. Your reasons for seeking therapy will determine the number of sessions. During treatment, open dialogue addressing assessment and evaluation will take place between you and your therapist.
Your therapy sessions are confidential, meaning that no one, other than the Connect Couples Therapy, PLLC/In Session Psych, PLLC personnel, will have access to anything in your case file, unless you provide written consent or disclosure is allowed or required by law or a court order. Your therapist may at times consult with other licensed mental health professionals, who are also required to keep your information confidential.
We hope this information helps you understand our method of operation and the reasons behind it. Feel free to ask questions or discuss any part of our procedures with your therapist. Your therapist can be reached by calling 704.776.2464.

OUR VALUES
Your therapist will listen to your concerns in a confidential setting.
Your therapist will be knowledgeable and skilled in the application of therapeutic strategies.
Your therapist may provide appropriate referrals, if necessary, to other individuals,  groups, or agencies.
Our therapists will provide professional, supportive, and compassionate service.

GRIEVANCE PROCEDURE
 If you have any ethical complaints regarding your therapist, first discuss the concern with your therapist. If you do not feel that your concern was adequately addressed or resolved after speaking with the therapist, you may contact the following licensing board that corresponds with your therapist’s credentials.
NC Marriage & Family Licensure Board  https://www.ncbmft.org/complaint/
NC Board of Licensed Clinical Mental Health Counselors  https://www.ncblpc.org/Complaints
NC Social Work Certification & Licensure Board  https://www.ncswboard.org/page/complaintdisciplinary-process.html

If you or a family member are having an emergency, such as feeling like you may hurt yourself or another person, call law enforcement (911) as soon as possible. In addition, it may be of great benefit to transport the individual(s) in danger of harming self or harm to someone else to the emergency room for an evaluation.

INTOXICATION
For the safety of our clients and staff, it is the policy of Connect Couples Therapy, PLLC, to refuse service to anyone who is suspected of being under the influence of alcohol and/or drugs. A person in such condition will be asked to remain in the waiting room until someone can be notified to transport that person safely home. Refusal to comply will result in our staff contacting law enforcement.

CLIENT RESPONSIBILITIES
In order to assist us in providing our services, we ask you to take responsibility for the following aspects of counseling:

Accuracy – Please give your therapist complete and accurate information by completing the intake questionnaire honestly.

Appointments – Please be on time for your appointments. If you are unable to keep an appointment or will be late, please call as soon as possible. To avoid cancelation fees, we require you give 48 hours advance notice.

If you miss, reschedule, or cancel appointments to the point of not being seen for 60 days or longer, your file will be considered inactive and will be terminated. You can continue therapy at any time by calling Connect Couples Therapy, PLLC/In Session Psych, PLLC, at 704.776.2464.

Confidentiality - Please do not reveal any information about any client or other visitor you may see or meet at the Connect Couples Therapy, PLLC. This will help protect the privacy and confidentiality of all clients and their families.

Participation – We ask that you actively participate in developing your treatment plan. Your therapist will appreciate your continued input throughout the therapeutic process, and will gladly answer any questions you may have.

Courtesy – Please be considerate and respectful of the rights of other clients and staff

COMMON EXPERIENCES
 Our staff is committed to providing quality therapy and assistance for individuals, couples, families, and groups. Connect Couples Therapy, PLLC/In Session Psych, PLLC strives to create and maintain an environment that enhances and encourages the positive self-image of the client and family, and preserves human dignity. It is our belief that therapy can enable you to improve your personal and professional relationships, as well as assist in meeting your personal goals. Please be advised that attending therapy may increase personal awareness; this initially may be emotionally painful, and cause feelings of anxiety, frustration, or depression as your concerns are being explored and resolved. This is a normal, expected part of therapy, and is not an indication of lack of progress. Seeking to resolve issues between family members, significant partners, and other persons can similarly lead to discomfort, as well as relationship changes that may not be originally intended.   

CLIENT RIGHTS
 Therapy is most effective when it is viewed as a partnership in which each person has certain rights and responsibilities. This information will help inform you of your rights.

As a client of Connect Couples Therapy, PLLC/In Session Psych, PLLC, you have the right to:
- courteous, competent, and respectful care in a safe setting
- refuse to answer any questions or disclose any information you choose not to reveal
- inspect and obtain certain information from your file and/or records (as limited by applicable legal and ethical restraints)
- participate in the development and implementation of your treatment plan  
- receive from your therapist information necessary to give informed consent prior to  the start of therapy  
- request and receive full information about your therapist’s professional capabilities and training  
- refuse treatment to the extent permitted by law, and to be informed of the consequences of such a refusal  
- approve or refuse the release of confidential information within the legal and ethical constraints of the mental health profession  

No client will be denied services on the basis of race, religion, gender, ethnicity, age, lifestyle, or disability.

CONFIDENTIALITY
Your case records will be kept confidential and private unless disclosure is authorized by you and/or authorized by law. Under current North Carolina law, what you say to your therapist is not protected completely as a “privileged communication.” Furthermore, there are certain occasions when federal and/or North Carolina law or ethical considerations allow or require the disclosure of confidential information to others.

Such considerations for disclosure are:

1) North Carolina law and ethical practice requires us to notify appropriate state agencies if we suspect or know of a child abuse situation or have cause to believe that an elderly or disabled person is being abused.

2) If there is a threat to harm yourself or another person and the threat is determined to be serious, the therapist may take whatever actions are necessary to protect the person at risk, even if it involves disclosing confidential information. If the therapist assesses that the client has made a serious threat, the therapist may disclose information to law enforcement and/or the intended target of the threat.

3) In matter where disclosure is not authorized or required by law or a court order, confidential information will not be released without your written authorization. If you wish to share information in your case file with someone outside of the Connect Couples Therapy, PLLC/In Session Psych, PLLC office (e.g., your physician or another therapist), you will first be asked to sign a form authorizing the transfer of the information. Within Connect Couples Therapy, PLLC/In Session Psych, PLLC, therapists may consult with their colleagues about your case when appropriate without communicating any identifying information.

TECHNOLOGY
At Connect Couples Therapy, PLLC/In Session Psych, PLLC our goal is to always protect your confidential data. Please be aware that there are risks and potential consequences with any technology used, including but not limited to: emails, voice messages, texts, client notes, and recordings. The transmission of any medical information could be interrupted by unauthorized persons, or the electronic storage of any medical information could be accessed by unauthorized persons.

ONLINE THERAPY
Online sessions will be conducted with the same professional formalities as sessions held in the office. It is the client's responsibility to determine whether the current setting they are in will respect their privacy standards. If the current setting is not appropriate for service, the therapist has the right to reschedule the session. It is the client's responsibility to inform the therapist of their location for each session in order for the therapist to determine if treatment is possible under the jurisdiction the client is located in. It is the client's responsibility to inform the therapist if there is anyone else present during the online therapy session, but not visible by the camera. Clients agree to prohibit from recording online therapy sessions.

There are risks and potential consequences for online therapy. These may include, but are not limited to, the possibility, despite reasonable efforts on the part of the therapist that the transmission of my medical information could be disrupted or distorted by technical failures, the transmission of my medical information could be interrupted by unauthorized persons, or the electronic storage of my medical information could be accessed by unauthorized persons and/or misunderstandings can more easily occur.

In order to reduce and limit the risks associated with online therapy, it is recommended that clients reset their router password from the original password designated by their internet provider. The therapist will discuss with clients an alternative communication plan should the internet connection be disrupted during session and emergency contact information should a crisis arise.

I understand that e-therapy based services and care may not be as complete as face-to-face services. I also understand that if my psychotherapist believes I would be better served by another form of psychotherapeutic services (e.g. face-to-face services) I will be referred to a psychotherapist who can provide such services in my area. Finally, I understand that there are potential risks and benefits associated with any form of psychotherapy, and that despite my efforts and the efforts of my psychotherapist, my condition may not be improve, and in some cases may even get worse.

I understand that I may benefit from e-therapy, but that results cannot be guaranteed or assured.

I understand that I have a right to access my medical information and copies of medical records in accordance with North Carolina law. I have asked my therapist for any needed clarification of the procedures and conditions mentioned in this consent statement. I am satisfied with the explanations, and agree to abide by the conditions in of this consent form for e-therapy.

THERAPIST INFORMATION
 George W. Bitar, Ph.D., NC LMFT #1273, TX LMFT #202667, AZ LMFT #15181  
Faith Drew, Ph.D., NC LMFT #1274, TX LMFT #200863, TX LPC #60786, AZ LMFT #15182
 Hanna Rose, NC LCMHC #13550 , SC LPC #7803
Anna Malles, NC LCSW-A #P013820 
Helen Marie Humphrey, NC LCMHC #12771 , SC LPC #7815,
Kelsee White, NC LMFT #1682
Brittany Bolden, NC LMFT-A #12301A

SUPERVISION & CONSULTATION
 In order to ensure clients are receiving the highest quality treatment, clinicians may consult or seek supervision with other mental health professionals. Each client’s identity remains completely anonymous and confidentiality is maintained.

THERAPIST'S ROLE
The client understands that the role of Connect Couples Therapy, PLLC is to assist the couple in identifying and navigating certain relationship dynamics and tools. It is expressly not the role of Connect Couples Therapy, PLLC or any individual therapist to serve as an evaluator of the relationship, assign blame to any specific individual, or to provide opinions as to problems or issues within the relationship. To that end, the client understands and agrees that Connect Couples Therapy, PLLC has no place in any legal proceeding as to these matters and will avoid, to the greatest extent possible, involving Connect Couples Therapy, PLLC and/or any individual therapist in such proceedings.

LEGAL FEES
Notwithstanding the client's acknowledgment and agreement in the subsection entitled "Therapist's Role", above, the client understands and agrees that, should the client or any party acting on behalf of the client, such as client's attorney, solicit the assistance or cooperation of Connect Couples Therapy, PLLC or any individual therapist in conjunction with any legal proceeding, the therapist expressly reserves the right to bill the client on whose behalf the request is made for all time associated with the request in the following amounts:

$150 per hour, to be billed in quarter-hour increments, for all time spent communicating in conjunction with the request;
$200 per hour, to be billed in quarter-hour increments, for all time spent being deposed or in court in conjunction with the request (for a minimum of 2 hours);
$150 per hour, to be billed in quarter-hour increments, for all time spent reviewing or preparing records in conjunction with the request;
$135 per hour, to be billed in quarter-hour increments, for all time spent traveling in conjunction with the request;
$.575 per mile traveled in conjunction with the request; and
At a rate to be determined in advance of the provision of any act or service for acts and services not expressly listed herein.

PERMISSION TO RECORD
In order to ensure that clients are provided with the best possible care, the therapist may videotape part or all of a session and may receive feedback from a supervisor in Gottman Method Couples Therapy, Emotionally Focused Couples Therapy, or from colleagues at Connect Couples Therapy, PLLC/In Session Psych, PLLC.

These videos are stored securely and are erased once they have served their immediate purpose. They are not considered part of the client's record and cannot be used for any other purposes than those stated above.

If you have any concerns or questions about the recording or would prefer to opt-out of the videotaping, please let your therapist know during the first session.