General Information:

The therapeutic relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with me, the clinician, Jooyoung Kim, LPCC. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.

Services Provided:

I provide mental health counseling to adult individuals and couples (18 and up), integrating a number of different therapeutic styles and modalities, depending on what fits the best with the client(s) and situation. Some of the therapy models I use are Motivational Interviewing Process, Rational Emotive Behavior Therapy, Dialectical Behavior Therapy, and Cognitive Processing Therapy, with humanistic views. My approach to therapy is holistic, client centered, and with focus on social justice.

Free Introductory Consultation:

I offer a free introductory 15-minute consultation call to all potential clients to see if we may be a good fit and work well together. We can discuss the reasons that bring you to therapy, talk about your goals and I can answer any questions you may have about counseling.

The Therapeutic Process:

You have taken a very positive step by deciding to seek therapy. The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. Therapy is also a collaborative process where you and I will work together on equal footing to achieve goals that you define. This means that you will follow a defined process supported by scientific evidence, where you and I  have specific rights and responsibilities. Therapy generally shows positive outcomes for individuals who follow the process. Better outcomes are often associated with a good relationship between a client and I, your counselor. To foster the best possible relationship, it is important you understand as much about the process before deciding to commit. However, I cannot promise that your behavior or circumstances will change. I can promise to support you and do my very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.

Therapy begins with the intake process. First, you will review my policies and procedures, talk about fees, identify emergency contacts, and decide if you want health insurance to pay your fees depending on your plan's benefits. Second, you will discuss what to expect during therapy, including the type of therapy, the length of treatment, and the risks and benefits. Third, you will form a treatment plan, including the type of therapy, how often you will attend therapy, your short- and long-term goals, and the steps you will take to achieve them. Over time, you and I may edit your treatment plan to be sure it describes your goals and steps you need to take. After intake, you will attend regular therapy sessions at my office or through video, called telehealth. Participation in therapy is voluntary - you can stop at any time. At some point, you will achieve your goals. At this time, you will review your progress, identify supports that will help you maintain your progress, and discuss how to return to therapy if you need it in the future.

Professional Boundaries:

Licensed professional counselors are obligated to establish and maintain appropriate professional boundaries (relationships) with present and past clients (and, in some cases, client’s family members). For example, therapists should not socialize or become friends with clients and should never become sexually involved with a client.

Professional Records:

I maintain a file for each client (or set of clients). This includes intake, diagnosis, treatment plan, billing, consent to treatment, treatment notes, discharge summary, and any other written or electronic information I received from or about the client. Treatment notes include the date and time of each session and a brief summary of key facts and issues discussed as well as treatment recommendations. The client is entitled to a copy of the record for a fee which covers the copying and administrative costs. If you wish to see a copy of your records, I recommend that you review them with me so that we can discuss the content.

Confidentiality:

The session content and all relevant materials to your treatment will be held confidential unless you request in writing to have all or portions of such content released to a specifically named person/persons. I will not disclose your personal information without your permission unless required by law. If I must disclose your personal information without your permission, I will only disclose the minimum necessary to satisfy the obligation. 

Exceptions to client confidentiality include, but are not limited to:

• If you report that another healthcare provider is engaging in inappropriate behavior, I may be required to report this information to the appropriate licensing board. I will discuss making this report with you first, and will only share the minimum information needed while making a report. If I must share your personal information without getting your permission first, I will only share the minimum information needed. There are a few times that I may not keep your personal information confidential.

• I may speak to other healthcare providers involved in your care.

• I may speak to emergency personnel.

• Danger to self or others - If I believe that you are at imminent risk of harming yourself, I may contact law enforcement or other crisis services. However, before contacting emergency or crisis services, I will work with you to discuss other options to keep you safe. & If I believe there is a specific, credible threat of harm to someone else, I may be required by law or may make my own decision about whether to warn the other person and notify law enforcement. The term specific, credible threat is defined by state law. I can explain more if you have questions.

• If you are a minor (under age 19), your parents or legal guardian(s) have access to your records and discretion over them

• I have a reason to believe a minor or elderly individual, or animal(s) is a victim of abuse or neglect, I am required by law to contact the appropriate authorities.

• If a third party issues a lawful subpoena for your records, I may be legally obligated to disclose your records. I will ensure you are notified of any subpoena and, as required by law, take steps to ensure the records are produced subject to a protective order.

If we see each other accidentally outside of the therapy office, I will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.

Professional Consultation:

Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name or any other identifiable factors. Consultation helps me ensure that I am treating you appropriately. However, in the event I become aware of a conflict of interest, I will appropriately limit or eliminate such consultation. All counselors involved in the consultation are ethically bound to preserve confidentiality to the same extent as I, as your counselor.

Client Rights:

Client Rights As a client, you have the right to:

• Be treated with dignity and respect;

• Know your counselor’s qualifications and professional experience;

• Expect your counselor to keep your treatment confidential, except as noted further herein;

• Ask questions about your treatment;

• Be informed about diagnoses, treatment philosophy, method, progress, and prognosis;

• Participate in decisions regarding your treatment;

• Obtain any assessment results and have them explained to you in a manner that you understand;

• Refuse treatment methods or recommendations;

• End therapy/counseling at any time (though we ask that you please discuss your reason for wanting to end therapy/counseling with your counselor);

• Request a second opinion, referral to another provider/counselor, or transfer to another College counselor. Please let me know if you would like to explore a different option for another counselor or have any concerns related to the effectiveness of the therapy/counseling process and the compatibility with the counselor.

Client Responsibility:

You have responsibility to:

• Maintain your own personal health and safety; 

• Take an active role in the therapy/counseling process, including honestly sharing your thoughts, feelings, and concerns;

• Help plan and follow through with your therapeutic goals;

• Provide accurate information regarding past and present physical and psychological problems (including hospitalizations, medications, and/or prior treatment);

• Provide notice of your desire to terminate the counseling relationship before entering into a counseling relationship with another provider;

• Keep scheduled appointments (contact your counselor in advance to cancel and/or reschedule appointments);

• Inform your counselor if, during the course of treatment, you become aware of any conflicts of interest with another client or; and

• Promptly notify your counselor of any problems or concerns that render you unable to participate in counseling.

Telehealth Services:

To use telehealth, you need an internet connection and a device with a camera for video. I can explain how to log in and use any features on the telehealth platform. If telehealth is not a good fit for you, I will recommend a different option. There are some risks and benefits to using telehealth:

Risks

• Privacy and Confidentiality. You may be asked to share personal information with the telehealth platform to create an account, such as your name, date of birth, location, and contact information. I carefully vet any telehealth platform to ensure your information is secured to the appropriate standards.

• Technology. At times, you could have problems with your internet, video, or sound. If you have issues during a session, I will follow the backup plan that you agree to prior to sessions.

• Crisis Management. It may be difficult for me to provide immediate support during an emergency or crisis. You and I will develop a plan for emergencies or crises, such as choosing a local emergency contact, creating a communication plan, and making a list of local support, emergency, and crisis services.

Benefits

• Flexibility. You can attend therapy wherever is convenient for you.

• Ease of Access. You can attend telehealth sessions without worrying about traveling, meaning you can schedule less time per session and can attend therapy during inclement wether or illness.

Recommendations

• Make sure that other people cannot hear your conversation or see your screen during sessions.

• Do not use video or audio to record your session unless you ask mer for their permission in advance.

• Make sure to let me know if you are not in your usual location before starting any telehealth session.

Service Fees:

My fees are $160 (individual) and $180 (couples) for Diagnostic Intake Session (60 minutes) and $130 (individual) & $150 (couples) for follow-up sessions (50minutes). I offer a sliding scale as well. I am currently not accepting any insurance and my No Insurance Policy is as follow:

After thoughtful consideration, I am no longer in-network with any insurances. There are pros and cons to using your insurance, and I have found that the risks of using insurance outweigh the benefits: when you choose to use your insurance, ultimately your insurance company is the decider of your treatment, and has the final say over me as provider and you as a client. However, when you choose to pay out of pocket/use your out-of-network benefits, you are able to maintain more confidentiality, as well as have more control over your treatment plan, and have more collaboration with your provider about the type of treatment you want to receive.

I have a lot of success using our client’s out-of-network benefits, and about 90-95% of the clients I serve do receive some kind of reimbursement from their insurance company. If you are open to it, I can explain more about how this works.

First, you will need to contact your insurance company to find out about your out-of-network benefits. Specifically, you will want to ask them the following:

• Do I have out-of-network benefits?

• What is my deductible?

• What is the reimbursement rate to work with an out-of-network provider?

Your insurance will respond by giving you a percentage. At a minimum, I have found that most insurances will reimburse at 50%. However, depending on your specific plan, your insurance may reimburse at a higher rate.

Therefore, if your insurance reimburses at 50% and you pay $150/session, then I know that your insurance company will send you a check for $75. Does that make sense?

How it works on our end, is you pay out of pocket for your service at the time of service. Then we submit to you a Superbill, which is a document that has all the information your insurance company needs for reimbursement. You will send the Superbill to your insurance company, and then your insurance company will send you a check. Any questions about this process?”

Payment:

I only accept credit card payment. Fees are due at the end of each session. Services will be suspended if you are more than 30 days overdue with payment. Phone calls more than 10 minutes in length will be charged at fifteen minute increments based on the hourly fee.

Discharge Based on Professional Judgment:

If I determine that your needs go beyond my level of expertise, I have an ethical obligation to refer you to another professional who can provide the care you need. This might include, for example, a specialized counselor, medical care provider, psychologist, or psychiatrist. If, based on professional judgment, I determine I cannot provide (or continue to provide) treatment to you, I may discontinue treatment and, as appropriate, refer you to another provider. Referrals may be to another counselor at another agency or sources of finding counselors (e.g. PsychologyToday.com).

Authorization to Release Client Information:

As the client, you may authorize release of your information whenever you choose. For example, if you wish to have your counselor communicate with your family members, partner/spouse, other helping professionals (these individuals include, but are not limited to: your Primary Care Physicians, Psychiatrists, etc.) on your behalf, you can request for and sign a release of information form and provide it to myself. Please note that I will only provide information as specifically authorized and directed by you. Any additional or ongoing disclosures must be prompted by you or expressly directed in writing on your release form.

Limits of Availability for Emergency Coverage:

If you need to speak with me between sessions to alert me of an emergency, please call (614) 323-3578. Your call will be returned as soon as possible. Messages are checked daily (but never during the night time) and less frequently on weekends and holidays. If an emergency requires immediate attention, you agree to call the National Suicide Hotline at 800-784-2433 or call 911, contact a local crisis hotline, or go to a hospital emergency room.

Complaints:

Complaints: If you have a complaint about my professional service, I hope you will speak to me directly so that the problem can be clarified and resolved. However, you have the right to file a complaint with the Ohio Counselor Social Worker and Marriage and Family Therapist Board if you believe you experienced professional misconduct. You may visit this website to do so: https://cswmft.ohio.gov/for-the-public/file-a-complaint-elicense-portal.