How to Seattle Therapy

Before You Sign On the Dotted Line

Before You Sign On The Dotted Line
by B. Imei Hsu, RN, LMHC

Unless you stay in your home for days at a time, unplugged from the Internet, and living a cash-only lifestyle, you regularly consume and purchase goods and services that require your signature. Many services require your signature along with some form of a Terms Of Use Agreement (TOUA), waiver, contract, consent form, and/or a disclaimer. The purpose of these forms are to gain your consent to use the service you are purchasing, whether free or for a fee. These terms become critical in cases of potential or real liability. Before you sign on the dotted line, you should always read and understand these consent forms, even when you step into the therapy office.

Read and understand what you are signing.

Did They Know What They Were Signing
Recently, Skype fired some of its employees before the completion of the acquisition by Microsoft. As if that wasn’t painful enough, it has come to light that Skype had another surprising, but perhaps no longer uncommon action awaiting their employees. In a blog post released by Michael Arrington (TechCrunch), Skype had a clause in its Management Partnership, indicating that both the vested and unvested stock options of Skype employees could be terminated. Long story made short, it’s plausible that employees may not have been aware of this clause, nor the legalese explained well enough for employees to know what they were signing. Assuming that employees were banking (no pun intended) on a return on their stock options while perhaps taking less pay upfront, they are now facing the termination of those stock options. I can only imagine that there will be an ensuing legal battle, especially if the fired executives were not fairly advised of these clauses in their signed contract.

While I’d like to think that the days of signing documents under duress are gone, it seems like another kind of sneaky contract has taken its place. If other companies follow suit, it’s up to the consumer/employee/patient to know exactly what s/he is signing, and in the above case, that may not have been all too clear. And unless you’re a lawyer yourself, that can be a bit frightening. I am uneasy with the thought, “What you don’t know can hurt you.” And I am uncomfortable being told that the public will likely be hearing about this kind of sneaky contract again. Personally, I’d like to follow the story about Skype’s stock options to see if employees were given the opportunity to understand what they were signing, even though I can’t imagine anyone agreeing to sign if they truly did understand what it meant.

The Clinician’s Office
When you walk into the therapy office for your first session, you should receive several forms to read and sign, advising you of your rights as a client for the services outlined by the helping professional. These usually include:

1. A client registration form (your contact information) and why you are seeking therapeutic services.
2. An explanation of therapy and the professional’s role.
3. A summary of the kind of therapy the professional employs, and a list of his/her degree(s) and license(s).
4. A place to sign that explains the cost of the service, and the time that this service ends at that fee (usually 6-12 months).
5. An explanation of HIPPA and confidentiality (usually not included in your forms, but available for you to read and discuss in the first session).
6. Any additional forms or paragraphs describing unique aspects of the professional’s therapy, i.e. late cancellation fees, use of electronic transmissions, credit card information forms, billing information).

On my website, you can obtain my forms by directly downloading them from my website by going to Forms. I have added a form for the use of electronic transmissions, because many of my clients use a combination of F2F and telephone or video camera platforms from the Internet for their sessions, or they email me their schedules, updates, and other requests. This form is made available only be request, as it is unique to my office, and I wish to remain in control of how it is used until I should choose to release it on a Creative Commons listing. I’ll be adding a Social Media form as well, outlining the use of Social Media in regards to my private practice.

I personally believe signing the forms are not enough. Every client is asked at the start of the first session to take a moment to go over any questions on the forms before I sign after each space the client has signed. I also take five minutes to discuss how confidentiality works, and I discuss under what conditions confidentiality can be breached. Included in the first session is a frank discussion of how payment and billing will be conducted, and under what circumstances a patient will be billed for a late cancellation. First session discussion also includes an open discussion of the use of their third-party payor.

If you’re still following me on this topic, you might be saying, “Wow! That’s a lot of stuff to discuss. And I have to pay for that?” The answer to that is: NO. I offer each of my potential clients a FREE thirty-minute consultation that includes a brief summary of the issues you want to discuss, so I can determine whether I would be the right therapist or coach for you, and I cover 90% of the contract. The other ten percent is reserved for the first session, which is my opportunity to make sure the client understands the contract s/he signed. where the forms are stored, and how the client can contact the WA State Department of Health with any questions or complaints about my services. In some cases, that thirty minute free consult becomes an hour-long consult, but I find that hour of non-therapy consult and demonstration of my methodology to be invaluable to the client in terms of a meaningful contract between therapist and client. Essentially, I’m showing my client how I am in his or her corner on making the most of the relationship.

Ultimately, solid paperwork is not enough. As a client, you want a counselor or a coach to care about you and to demonstrate effective skills in helping you with particular challenges. But a caring coach or counselor needs to help you understand the kind of therapeutic relationship you are entering before you sign on the dotted line. Don’t be afraid to ask questions, and do know that at any time, you can revisit your contract if you are unclear about any points. The paperwork should be clear, understandable, with no hidden clauses.

While I can’t guarantee that your therapy will be easy, your paperwork should be piece of cake. Read before you sign.

For more articles about what went down between Skype and Silver Lake (the large investor), please see Wired’s article, republished in several places:

Boing Boing
Wired Originally, the writer said he thought Skype’s decision was not evil; later, the writer recanted and issued that he has downgraded his assessment of Skype to “evil”.