Informed Consent for Distance Counseling

Mount Comfort Counseling Services

P. O. Box 3381, Fayetteville AR 72702
3281 W. Mt Comfort Road
Fayetteville AR 72704
Glenda Davis, MSC, LMFT, LPC – Therapist

The purpose of this document is to inform you about aspects of internet counseling services, the process of that counseling, the potential benefits and risks of counseling other than in a face-to-face setting; and what can be done to guard against those risks. While it can seem to be desirable because of convenience, internet counseling presents unique challenges and must be a mutual decision between the therapist and the client. Please read this entire document and carefully consider what is presented so that we can make the best decision.

Procedures: Actual paid sessions will scheduled and paid for prior to the session on the counselor’s website:, and will be conducted via live video using Communication may also take place via e-mails or phone calls, however these are supplemental to the sessions. Phone calls should be reserved for crisis situations. E-mails may be received and read by the therapist, but only brief answers should be expected. Text messages may be used for brief communications about appointment times, etc. All written communication, including texts, will be recorded and become part of the case record. Other types of communication such as instant messages, tweets, etc. should not be attempted.

Potential Benefits: Live video counseling can be done anywhere in Arkansas, provided the client has access to high-speed internet and can operate the necessary software. It is also possible to bring family members into a session who are not available otherwise. Communication via e-mail allows the client to think about what they want to say and reflect on it before sending it. It can avoid playing “phone tag” and leaving messages that others might intercept. May people find they feel more comfortable in their own home and are able to be more open with the counselor.

Potential Risks: There are various risks related to electronic provision of counseling service related to the technology used, the distance between counselor, and client and issues related to timeliness. For example, the potential risks of email based counseling may include messages not being received and confidentiality being breached through unencrypted e-mail, lack of password protection, or leaving information on a screen whether others might see it. Messages could fail to go the intended recipient due to addressing errors or they might be overlooked by the counselor. Confidentiality could be breeched in transit by internet service providers or hackers. Work computers are particularly vulnerable because employers and/or IT departments may assume privacy does not apply on their equipment. Access from public places offering free Yi-Fi is not considered secure and anyone seated where they can see the computer screen may ease drop.

Safeguards: Your counselor uses an encrypted e-mail account with Hushmail and uses for real-time video counseling to allow for the most secure and user friendly communications. You, as the client, are responsible for safeguarding your own computer communications. Communication goes both ways and the information you receive from your counselor is for you alone. You must seek permission of the counselor before recording any part of the session or posting on Facebook or other social media any communication from the counselor. You must respect the privacy of the counselor as well as yourself and safeguard your personal accounts, passwords and computer access.

Choice of counseling type: Online counseling may not appropriate for many types of clients including those who have numerous concerns over the risks of internet counseling, those with active suicidal/homicidal thoughts and clients who are experiencing active manic/psychotic symptoms. Face-to-Face counseling may be the best choice. If on-line counseling is desired because of distance considerations, assistance to find a local counselor will be provided. Minors may benefit from on-line counseling, but the decision will be that of the minor’s parent or guardian who will have to sign all consents in the initial joint session.

Confidentiality and Protected Health Information: When you receive mental health care, including treatment for substance abuse, information related to that care may be more protected than other forms of health information. Communications with a therapist in treatment are privileged and may not be disclosed without your permission, except as required by law. For example, mental health professionals are mandated reporters if they suspect child abuse and may have to breach confidentiality if you appear to pose an imminent danger to yourself or others, in order to reduce the likelihood of harm to you or others.

Records: Video counseling sessions will not be recorded by the therapist without prior knowledge and consent and only for a specific purpose. Records of the session will be paper notes kept in a secure file as with face-to-face sessions. All e-mails, texts and other correspondence will be maintained in a secure setting, which may include encrypted and/or password protected e-files.

Communication problems: E-mails may be sent to the counselor a way of providing information, but the client should not necessarily expect an answer. Phone calls should be reserved for situations of crisis. If ever there is a disruption in services, call 479-738-7059. If the counselor is not immediately available, then the counselor recommends contacting a crisis line or a local agency or emergency room. Clients may utilize the following crisis hotlines:

1-800-SUICIDE (1-800-784-2433)

1-800-273-TALK (1-800-273-8255)

For the Deaf – 1-800-799-4TTY (1-800-799-4889)

Payment: Payment for sessions will be made in advance on the counselor’s website: via Stripe.

My signature below attests that I have read and agreed to the above provisions in order to receive internet (technology assisted) counseling.

Download Informed Consent for Distance Counseling PDF