Ethredge Counseling Group

COMMUNICATION

2.1 Email or text policy. By providing your email or text contact information, you consent to receiving

appointment reminders and healthcare communications from Landrie H Ethredge Professional Counseling,

LLC d/b/a Ethredge Counseling Group. You may receive messages at the provided email or text address.

Standard text messaging rates may apply according to your wireless plan.

2.2 Informed Consent for Telemedicine Services. You consent to telemedicine services provided by Landrie

H Ethredge Professional Counseling, LLC d/b/a Ethredge Counseling Group, using HIPAA-compliant platforms

for psychotherapy remotely. You understand that privacy laws apply to telemedicine and acknowledge that

insurance coverage may not extend to these services, making you responsible for associated fees. You can

revoke this consent in writing at any time, specifying an expiration date if desired, otherwise it expires one

year from initiation.

2.3 Contact Between Session and Telephone Accessibility. For non-emergency contact between sessions,

please message your therapist or counselor through the client portal or leave a voicemail. We aim to respond

within 1-2 business days. Phone sessions are unavailable; face-to-face sessions are recommended for

effective therapy engagement. In emergencies, please dial 911 or visit your nearest emergency room.

2.4 Social Media and Telecommunication. Due to the importance of your confidentiality and the importance

of minimizing dual relationships, we do not accept friend or contact requests from current or former clients

on any social networking site (Facebook, LinkedIn, Instagram, etc). We believe that adding clients as friends

or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur

the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when

you meet with your therapist or counselor and we can talk more about it.

2.5 Electronic Communication. We cannot guarantee confidentiality for electronic communications, including

text messages. Appointment reminders will be sent from a non-reply number and email address. For

scheduling or cancellations, email communication is available, but please refrain from discussing therapeutic

content or emergencies through these channels. Telemedicine encompasses services provided via telephone,

internet, fax, or email. By opting for telemedicine, you understand and agree that:

1. You can withdraw consent at any time without affecting future care or program benefits.

2. Existing confidentiality protections apply.

3. You have access to all transmitted medical information, with copies available for a reasonable fee.

4. Your identifiable information won't be shared without consent.

5. There are potential risks, consequences, and benefits of telemedicine.

a. Telemedicine offers benefits such as improved access to therapy and reduction of lost work time and travel

costs.

b. Effective therapy is often facilitated when the therapist or counselor gathers within a session or a series of

sessions, a multitude of observations, information, and experiences about the client. Therapists and

counselors may make clinical assessments, diagnosis, and interventions based not only on direct verbal or

auditory communications, written reports, and third person consultations, but also from direct visual and

olfactory observations, information, and experiences.

c. When using information technology in therapy services, potential risks include, but are not limited to the

therapist’s or counselor’s inability to make visual and olfactory observations of clinically or therapeutically

potentially relevant issues such as: your physical condition including deformities, apparent height and weight,

body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination,

posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including

bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any

changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body

language, and congruence of language and facial or bodily expression. Potential consequences thus include

the therapist or counselor not being aware of what he or she would consider important information, that you

may not recognize as significant to present verbally to the therapist or counselor. Effective therapy often

requires direct observations and interactions. Risks include the therapist or counselor potentially missing

clinically relevant information.

INFORMED CONSENT AND PRACTICE POLICIES

4.1 Appointments, Cancellations, and Boundaries: The standard meeting time for psychotherapy is 45

minutes. It is up to you, however, to determine the length of time of your sessions. Requests to change the

45-minute session needs to be discussed with the therapist or counselor in order for time to be scheduled in

advance. A $80.00 service charge will be charged for any checks returned for any reason for special handling.

Cancellations and re-scheduled sessions will be subject to a FULL CHARGE IF NOT RECEIVED AT LEAST 48

HOURS IN ADVANCE OF THE INITIALLY SCHEDULED SESSION. Please note, this includes sickness and

inclement weather. This is necessary because a time commitment is made to you and is held exclusively for

you. If you are late for a session, you may lose some of that session time.

4.2 The Couple is the Client: When you attend couples therapy or couples counseling sessions, the couple is

considered “the client,” and your mental health records therefore belong to both of you. This means that

except in the circumstances outlined below, both partners must provide their consent to release couples

counseling records. If one partner does not provide consent, records will not be released.

4.3 Therapeutic Process and Limitations of Individual Therapy or Individual Counseling: Individual therapy

or counseling can be beneficial in addressing personal challenges, reducing feelings of distress, and

improving overall well-being. It often leads to the resolution of specific issues, increased self-awareness, and

a greater sense of personal empowerment. However, it’s important to understand the potential risks

involved. During the therapeutic process, you may be asked to explore difficult areas of your life, which can

evoke uncomfortable feelings such as sadness, guilt, anxiety, anger, loneliness, or helplessness. You may

also recall unpleasant or painful experiences from your past. This can sometimes lead to a temporary

intensification of difficult emotions as you work through these issues.

Additionally, therapy may affect your relationships with significant others in your life. Family dynamics, long-

standing relationship patterns, or family secrets may come to light, which can sometimes create tension in

these relationships. It’s also possible that, despite our best efforts, therapy may not produce the outcome

you hoped for. Success in therapy is more likely when you are open to introspection, willing to take

responsibility for your actions, and motivated to actively engage in the therapeutic process. Deliberate

dishonesty, resistance to self-reflection, or a lack of interest in the therapeutic process may reduce its

effectiveness.

Individual therapy or counseling may not be appropriate or effective in certain situations, and therefore, it is

not advised if you are in active alcohol or drug addiction, or in active psychosis. If any of these conditions

apply to you, it is important to inform your therapist, as specialized treatment or additional support may be

needed. Therapy is a collaborative process, and your honest participation is essential to achieving the best

possible outcomes.

4.4 Length of Individual Therapy or Counseling: The length of individual therapy or counseling varies widely,

typically ranging from 8 to 30 sessions or more. The duration depends on the complexity and severity of the

issues being addressed, as well as factors like history of trauma, presence of co-occurring emotional or

psychological challenges (such as mood disorders, depressive symptoms, substance use issues, or

personality disorder traits). You may end therapy at any time; however, when possible, it is often beneficial to

complete a closure session to reflect on progress and discuss next steps.

4.5 Boundaries: Your therapist or counselor reserves the right to end a session if a minor or third party is

present, if you are operating a motor vehicle, or if you are more than 10 minutes late to an appointment.

4.6 Confidentiality: (Please read the Privacy Policy below for a fuller explanation of confidentiality and your

PHI rights) When you attend sessions with a therapist or counselor, the information you share is protected by

strict confidentiality laws. Without your written consent and permission, we cannot reveal whether or not you

are a client, nor can we discuss any information from our sessions with a third party. The following are the

most common exceptions to this rule:

• If one of you poses an imminent danger to yourself, your partner, or a third person, we are allowed to

disclose information to law enforcement personnel or hospital staff to keep you safe and coordinate your

care.

• If you talk about events that lead us to believe that a child under the age of 18 or an elderly or disabled

person is at risk of emotional, physical or sexual abuse; neglect; or exploitation; we are required by law

to make a report to South Carolina Department of Social Services.

• If a Judge orders us to release information or if we are required to respond to a lawfully issued

subpoena.

4.7 Insurance, Superbills, and Payment: Landrie H Ethredge Professional Counseling, LLC d/b/a Ethredge

Counseling Group is not on any insurance panels and is not considered an in-network provider. Please note

that payment is due upon receipt and future sessions will be cancelled if there is an outstanding balance.

4.8 Virtual Telehealth Sessions: Landrie H Ethredge Professional Counseling, LLC d/b/a Ethredge Counseling

Group encourages clients to meet in-person with their therapist or counselor whenever possible. If your

therapist or counselor agrees to meet with you via telehealth, the following requirements must be made, or

your session will be terminated and you will be charged the full cost of the session:

• No third party may be present in the room with the individual or couple, unless it was previously agreed

upon and part of the treatment plan

• No minors may be present so that they may overhear of visually see the couple

• The client must be in a private location with good internet connection

• No party may be operating a motorized vehicle or be otherwise distracted

• All persons present must be seated and fully clothed

4.9 Termination: Landrie H Ethredge Professional Counseling, LLC d/b/a Ethredge Counseling Group reserves

the right to terminate treatment under certain conditions which compromise our ability to provide effective

services, the client’s ability to benefit from services, or when it is legally and/or ethically appropriate to do so.

Such circumstances include, but are not limited to:

• Three weeks of no session attendance

• Non-adherence to the treatment plan

• Non-compliance with practice policies & procedures

• Refusal to accept recommendations for a higher level of or supplemental care

• Behaviors that are disrespectful, devaluing, threatening, or otherwise inappropriate toward the provider,

staff, other clients, or any persons present in the building

• Misrepresentation or omission of pertinent clinical information

• Non-payment of fees

4.10 Diagnosing: At Landrie H Ethredge Professional Counseling, LLC d/b/a Ethredge Counseling Group, a

formal diagnosis is typically only provided when it is deemed clinically or therapeutically beneficial, or if you

request a superbill for insurance purposes. We generally refrain from offering a diagnosis for several reasons:

• Diagnoses can, in some cases, have unintended negative effects on clients.

• They may lead to an emphasis on pathology and deficits over personal strengths and resilience.

• Diagnoses can result in treatment that prioritizes symptom management rather than holistic, person-

centered growth.

• The process carries a risk of misdiagnosis or unnecessary pathologizing.

• Diagnoses can contribute to social stigma and discrimination.

• They can sometimes impact a client’s sense of identity.

• Labels may create a “ceiling” effect, potentially limiting clients’ perceptions of their ability to improve.

PRIVACY PRACTICES

5.1 Notice of Privacy Practices. THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND

DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

5.2 Pledge. I understand that your health information is private and confidential. I am committed to

protecting this information and will create and maintain records of the care and services provided to you. This

notice covers all records generated by this mental health care practice. It explains how your health

information may be used and disclosed, your rights regarding this information, and my obligations under the

law. Specifically, I am obligated to:

• Ensure that your protected health information (PHI) remains confidential.

• Provide you with this notice regarding my legal duties and privacy practices.

• Adhere to the terms of the current notice.

• I may update this notice, and any changes will apply to all your information. The updated notice will be

available upon request, in my office, and on my website.

5.3 Disclosing Health Information. Categories of Use and Disclosure: I use and disclose health information

for treatment, payment, and health care operations as permitted by federal privacy rules. This includes

sharing your information with other healthcare providers involved in your treatment without requiring your

written authorization. For instance, if consulting with another licensed provider to aid in your diagnosis or

treatment.

(a) Disclosure for treatment purposes may involve sharing your complete health record, as necessary for

quality care, without adhering to the minimum necessary standard. Treatment encompasses coordinating

care with third parties, consultations between providers, and patient referrals.

(b) Legal Proceedings: In legal matters, I may disclose health information in response to a court order or

administrative request. If your child is involved, I may also disclose information in response to a subpoena or

discovery request, provided efforts have been made to notify you or obtain a protective order.

5.4 Certain Uses and Disclosures. Psychotherapy Notes. I do keep “psychotherapy notes” as that term is

defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the

use or disclosure is:

(a). For my use in treating you, For my use in training or supervising mental health practitioners to help them

improve their skills in group, joint, family, or individual counseling or therapy, For my use in defending myself

in legal proceedings instituted by you, For use by the Secretary of Health and Human Services to investigate

my compliance with HIPAA., Required by law and the use or disclosure is limited to the requirements of such

law, Required by law for certain health oversight activities pertaining to the originator of the psychotherapy

notes, Required by a coroner who is performing duties authorized by law, Required to help avert a serious

threat to the health and safety of others,

(b) Marketing Purposes. As a psychotherapist, I will not use or disclose your PHI for marketing purposes,

5.5 Certain Uses and Disclosures Do Not Require Your Authorization. Subject to certain limitations in the

law, I can use and disclose your PHI without your Authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited

7 of 9to the relevant requirements of such law.

2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or

preventing or reducing a serious threat to anyone’s health or safety.

3. For health oversight activities, including audits and investigations.

4. For judicial and administrative proceedings, including responding to a court or administrative order,

although my preference is to obtain an Authorization from you before doing so.

5. For law enforcement purposes, including reporting crimes occurring on my premises.

6. To coroners or medical examiners, when such individuals are performing duties authorized by law.

7. For research purposes, including studying and comparing the mental health of patients who received one

form of therapy versus those who received another form of therapy for the same condition.

8. Specialized government functions, including, ensuring the proper execution of military missions; protecting

the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to

ensure the safety of those working within or housed in correctional institutions.

9. For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I

may provide your PHI in order to comply with workers’ compensation laws.

10. Appointment reminders and health related benefits or services. I may use and disclose your PHI to

contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell

you about treatment alternatives, or other health care services or benefits that I offer

5.6 Certain Uses and Disclosures Require You to Have the Opportunity to Object. Disclosures to family,

friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is

involved in your care or the payment for your health care, unless you object in whole or in part. The

opportunity to consent may be obtained retroactively in emergency situations.

YOUR RIGHTS WITH PRIVATE HEALTH INFORMATION (PHI)

6.1 · Right to Limit Uses and Disclosures: You can ask me not to use or disclose certain PHI for treatment,

payment, or health care operations. I may deny your request if I believe it affects your care.

· Restrictions on Out-of-Pocket Expenses: You can request limits on disclosures of your PHI to health plans if

you've paid out-of-pocket in full for a healthcare item or service.

· Preferred Communication Method: You can specify how I should contact you (e.g., home phone) or where to

send mail, and I'll accommodate reasonable requests.

· Access to PHI: You have the right to request and receive a copy of your medical record or a summary,

excluding psychotherapy notes, within 30 days of your written request. A reasonable fee may apply.

· Disclosure List: You can request a list of instances where I've disclosed your PHI for reasons other than

treatment, payment, or health care operations. I'll provide this within 60 days, free of charge for the first

request annually.

· Correcting Your PHI: If you believe there's an error or missing information in your PHI, you can request

corrections. I'll respond within 60 days, explaining any denials in writing.

· Notice of Privacy Practices: You can obtain a paper or electronic copy of this Notice upon request, including

via email, even if you initially agreed to receive it electronically.

6.2 Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Under HIPAA you have

certain rights regarding the use and disclosure of your protected health information. By agreeing to this form,

you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practice