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Untangle: Informed Consent Form for Individual Therapy

This informed consent form is designed to provide you with important information about the therapy process and ensure that you fully understand your rights and responsibilities as a client. Please read this form carefully and let us know if you have any questions or concerns before proceeding with therapy.

 

Psychotherapy is a collaborative process between you and your therapist aimed at addressing psychological concerns, promoting personal growth, and improving overall well-being. The therapy sessions will involve discussing and exploring various aspects of your life, emotions, thoughts, and behaviors to help you gain insight, develop coping strategies, and work towards your therapeutic goals.

 

Somethings to note about Untangle’s therapy practice:

 

1) Depending on the type of professional you have chosen, your experience of therapy will differ. Clinical Psychologists are more focused on diagnosis & symptom management. They adopt a directive, goal-oriented approach to therapy. A Counselling Psychologist is more wellness and strength focused, they are gentle and non-directive,  giving client adequate space for reflection and deep introspective work. Our recommendation is for you to consult a counselling psychologist for therapy UNLESS you are looking for a formal assessment for a mental health condition or have been advised by a doctor to meet a clinical psychologist.

 

2) We are not a medical establishment and your therapist is not a medical doctor. Therefore no medication/medical advice will be provided.

3) We offer assessment services for certain mental health concerns. These assessments will have to purchased as a separate service and will not be included as a part of the regular therapy session.

 

4) Your therapist is dedicated to providing you with the best possible care. In some instances, they may determine that your specific needs require support or expertise beyond their scope of practice. If it is determined that additional expertise is beneficial for your therapeutic journey, your therapist may refer you to another professional. This referral could involve either consulting with the other professional alongside your current therapist or consulting with them after terminating your current therapy.

 

5) Therapy is a collaborative partnership between you and your therapist. While your therapist serves as a facilitator and guide, the ultimate responsibility for change and growth lies with you. Your active participation is essential for achieving positive outcomes

 

6) Our therapists are dedicated to working with you in a sustainable manner. They will not offer simplistic or instant solutions to your problems. It is important to have realistic expectations about therapy. If you are seeking immediate, quick guidance or a ready-made solution without investing time and effort into the process, our platform may not align with your expectations. Therapy requires a genuine commitment to self-exploration and growth.

 

7) It is normal for disagreements or misunderstandings to arise during therapy. If there is something your therapist said that you disagree with or find challenging, we encourage you to express your thoughts and concerns. Your feedback allows for a deeper understanding and growth within the therapeutic relationship.

 

8) Therapy has proven benefits but we cannot give 100% guarantee as success depends on factors outside the therapist’s control.

 

Terms of Confidentiality

 

All your details and session information will be kept strictly confidential. However there are some exceptions to this clause keeping safety and legalities in mind:

 

Confidentiality will be breached and your emergency contact will be informed if:

 

1) If your therapist assesses that you maybe at a high risk for suicide, serious mental disorder, harm to yourself or any grave danger.  

 

2) If you report to your therapist that you have a malicious plan to harm anyone in your life.

 

3) If your case history is demanded by the court of law. 

 

4) If you report case of child sexual abuse, drug peddling or any illegal activity that the law requires us to file a report. 

 

5) If you request your therapist to break confidentiality and inform another person/professional about certain matters of your life.

 

Also note: 

1) Your therapist may discuss your case history with their supervisor/peer group, keeping your identifying information hidden.

 

2) For administrative and operational purposes some/all of our staff might have access to your information.

 

Cancellation Policy

 

Cancellation by client:

We have a 24-hour cancellation policy. In order to reschedule (reschedule is considered as a cancellation) or cancel your appointment, please notify us at least 24 hours prior to your scheduled appointment time.

Please note that failing to provide this notice or not attending the session will result in a 100% session fee, and no refunds will be offered. We understand that emergencies can arise, but please be aware that the cancellation fee applies regardless of the reason.

 

Cancellation by therapist:

We make every effort to uphold scheduled appointments; however, there may be instances when a therapist is unwell or encounters an emergency situation. In such circumstances, we will promptly inform you and provide options for rescheduling or obtaining a full refund based on your preference. Your understanding and flexibility are greatly appreciated in these unforeseen situations.

 

Payment Terms, Session Extension and Late Coming

 

Fee Structure:  The fee amount will be communicated to you at the time of enquiry and this is fixed and non-negotiable.

 

We have the right to periodically revise the fee, the updated fee will be notified to you on email.

 

The payment for the session has to be made in advance at the time of booking.

 

We reserve the rights to cancel any appointment for which payment has not been received.

 

An appointment will be automatically cancelled if the payment has not been made 48 hours in advance to the session time

 

Session extension: The duration for individual therapy session is 60 mins If your session exceeds 10 mins beyond session time, the fee will be prorated accordingly and you will be asked to pay the additional amount at the end of the session.

Late Coming: Sessions timings is fixed and cannot be extended if you are late as your therapist has to honour the next appointment.

 

If you are going to be late please inform the office at +91 9696810606 so that we can inform your therapist.

 

If you are later than 20 mins for the session and the have not informed us of late coming, it will be considered a no-show and the cancellation fee will be charged.

 

If you are later than 30 mins for the session, the appointment will be automatically cancelled as 30 mins is inadequate for a therapeutic conversation. 

 

Contact Between Sessions

 

To avoid dependency on therapy, we would discourage contact with your therapist between sessions.

 

However we understand that there can be emergencies where it is important to communicate with your therapist. In such cases please contact the office and we will set up a 10 mins call with your therapist depending on their availability. 

 

Our office timings are from 10 AM to 7 PM and we would be accessible for any calls or messages during this time.

 

If there is a psychological/psychiatric emergency post office hours, please contact the helplines or visit your nearest hospital. Untangle is not equipped for crisis support.

 

Letter of Recommendation & Record Keeping

 

Record Keeping: Your therapist will be taking notes during the session to help them keep a track of your discussions. These notes would be accessible only to your therapist/supervisor. These notes are private to the therapist and will not be released to the client under any circumstances. 

 

Letter of Recommendation: We do not provide any letter of recommendation (LOR) unless you are a regular client with us (10+ sessions) and the therapist deems it necessary for the wellbeing of the client. LOR will only be provided on therapist discretion and they have the right to refuse the same if it doesn’t align with their professional judgment.

 

We also do not provide testimonials in court or connect with your legal team regarding any discussion you may have had with your therapist. 

 

Termination of Sessions, Complaints & Transfer of Case

 

Termination of Session: It is recommended that you participate in all the planned sessions. However, you have the  flexibility to discontinue or pause therapy at any time. You are also welcome to restart therapy after termination  or a long gap for the same or different issue. You could also request for a change of therapist if the current therapist doesn’t feel like the right fit. 

 

Feedback/Complaints: We will also be collecting periodic feedback from you to assess the quality of our services. If there are any complaints you wish to raise against your therapist or any staff of Untangle, please email – chaitra.m@untangle.co.in

 

Transfer of Case: In case your therapist resigns from Untangle, you will be informed in advance and be given the option of choosing to terminate your sessions or take a transfer of therapist. Any advance payment made will be carried forward.

 

Other Important Things to Note

Substance Use: Client should not be intoxicated with any substance when attending the session. If the therapist feels that the client is high on any substance, the session will be terminated and you will be charged in full for the appointment.

 

Safety: Therapists have the right to terminate sessions if they feel unsafe with the client.

 

Social Media Policy: Please follow Untangle’s professional pages on Facebook, Pinterest & Instagram to receive good mental health content and  updates about our work. Objectivity is an important aspect of therapy, therefore clients and therapists are discouraged  from following each other’s personal social media profiles or maintaining personal relationships outside therapy. 

 

Risks of Therapy & Waiver

 

While therapy has benefits, its also important to understand the potential risks associated with the therapy process. Below are some of the risks that you have to be mindful of before signing up for your therapy journey.

 

Emotional Discomfort: Therapy may involve exploring and discussing difficult emotions, memories, or experiences, which can lead to temporary feelings of sadness, anger, anxiety, or other uncomfortable emotions.

 

Psychological Intensification: In some cases, therapy may temporarily intensify existing symptoms or bring up new psychological symptoms, such as increased anxiety, depression, or intrusive thoughts.

 

Relationship Challenges: Engaging in therapy might bring up relationship issues or conflicts, as personal growth and change can impact existing relationships with family, friends, or romantic partners.

Lack of Immediate Results: Therapy is a process that requires time and effort. It’s important to recognize that change may not occur immediately, and progress may be gradual and nonlinear.

 

Unforeseen Personal Discoveries: Engaging in therapy might lead to unexpected personal insights or realizations that can be unsettling or disruptive to one’s worldview or self-identity.

 

Emotional Dependence: In some cases, clients may develop a dependency on their therapist or experience strong emotional attachment. This can make the termination of therapy challenging and may require additional work.

 

Unresolved Issues: Therapy may not fully resolve all the issues or concerns that a client brings to therapy. Some problems may require ongoing or additional treatment, and therapy might provide tools for coping rather than complete resolution.

 

By choosing to work with Untangle, you agree that you have been briefed in detail about the risks and benefits of therapy and are signing up for this service with full information and understanding. 

 

In an unfortunate situation, if you choose to take your own life, you agree that you or your family/friends will not hold Untangle or its employees liable.

 

You also agree to take full responsibility for the therapy outcome & the outcome of any action  undertaken by you – with or without therapist recommendation – that could potentially be risky/harmful by any means. 

 

By registering for our service, you are confirming that you have read and understood this full document. You also agree to comply  with all the terms and conditions mentioned above, including the cancellation and confidentiality clause and are giving  us a full waiver to contact your emergency contacts in case of need. You also confirm that the contact details of the  emergency contact shared are accurate to the best of your knowledge.

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