Telepsycology Informed Consent

    1. There are potential benefits and risks of telepsychology sessions (e.g., limits to confidentiality) that differ from in-person sessions. One of the benefits of telepsychology is that we can engage in treatment without being in the same physical location. Also, it is more convenient and takes less time. There are also some risks. For example:

    Risks to confidentiality – There is the potential for other people to over-hear our sessions if you are not in a private place. On my end I will take reasonable steps to insure your privacy, but it is important for you to make sure you find a private place for our session where you will not be interrupted. You should participate in the session only while in a room or area where other people are not present and cannot over-hear the conversation.

    Issues related to technology - The technology may stop working during a session, other people might be able to get access to our private conversation, or stored data could be accessed by unauthorized people or companies.

    Crisis-management and intervention - Before starting, we will need to have an emergency response plan to address potential crisis situations that may arise during the course of our telepsychology work. If a crisis situation arises and I am not available, you are instructed to call Rescue Crisis at 419-255-9585 if you need to speak with someone immediately. If you are in any other emergency situation, call 911.

    Efficacy - Most research shows that telepsychology is about as effective as in person counseling.

    2. If a session is interrupted due to an audio failure, video failure, or both, exit the "room" and then start the process over. I will do the same and restart the call.

    3. It is important to use a secure Internet connection rather than public/free Wi-Fi.

    4. It is important to be on time. If you need to cancel or change your tele-appointments you must notify the office 24 hours in advance by calling 419-531–3500.

    5. We need to have a back-up plan (e.g., a phone number where you can be reached) to restart the session in the event of technical problems.

    6. As your therapist, I may determine that due to certain circumstances, telepsychology is no longer appropriate and that we should resume our sessions in person.

    8. Telepsychology sessions shall not be recorded in any way unless agreed to in writing by mutual consent. I will maintain a record of our session the same way I maintain records of in person sessions.

    This agreement is intended as a supplement to the general informed consent that we agreed to at the onset of our clinical work together and does not amend any of the terms of that agreement. Your signature below or verbal consent indicates agreement with its terms and conditions.