Effective date: 2024-08-23
SelfWitte is providing counseling services to you, and I (Jonobie Ford) will be your counselor. This document is designed to inform you about my background and our work together. Please sign once you have received all of the information you need to determine whether to proceed with treatment at SelfWitte.
Counseling is a collaborative process with an ongoing relationship between a client (you) and a mental health counselor (me). The counseling experience supports you in establishing new behaviors and in working towards wellness. You have the right to ask questions about our therapy at any time, to refuse treatment, and to choose a practitioner and treatment modality that best suits your needs.
The most important aspect of therapy’s success is you. Client factors, such as willingness to experiment and work between sessions on techniques we’ve discussed, your life context, strengths and relationships account for up to 85% of change in therapy. Because of this, I prioritize building a forward-looking, strengths-based and collaborative relationship. Counseling goals are developed and implemented in partnership between us. My goal is to help you progress towards achieving your goals. Together, we will regularly assess your progress, and if improvement is not happening to your satisfaction, I will provide a referral to another professional.
Risks of therapy
Therapy is the Greek word for change, and there is always a chance for change to be painful. You may learn things about yourself that you do not like, and may need to face feelings of fear, sadness, sorrow, anxiety, or pain. You may also find that as you come to better understand yourself, your relationships with others shift. One risk of therapy relating to relationships is the possibility of the dissolution of some relationships (i.e., a divorce or a breakup). While not common, some people do deteriorate with therapy. Some variation is expected early in therapy, but if you find you are consistently feeling worse, please raise that in therapy. We can then discuss potential different options, including a referral or discontinuing therapy.
Length of therapy
Therapy sessions are a 50 minute clinical hour instead of a 60 minute clock hour so that I may review my notes and assessments on your behalf. I also use the last few minutes of each session to use a 3-question assessment on how the session went so I can make adjustments as we work together. This feedback helps me keep your voice and needs central to our work, and helps me be accountable to you. It also has been shown to make a difference in how effective clients find therapy.
A common question is how long therapy will take. This is difficult to answer as therapy depends on a variety of factors. Additionally, clients’ goals often change as therapy evolves, organically lengthening the process as we work towards those new goals. However, research shows that typically clients start to feel some improvement within 5-8 sessions. If you you’ve experienced no improvement by that time, please share that as part of the assessment portion of the therapy so that we can try something different or I can refer you to another professional.
Your location during therapy
I am only licensed to provide therapy to clients in the state of Washington. Therefore, even though we will be using video conferencing technology or the phone, you must be located in the state of Washington during our therapy sessions.
Termination
You may end our counseling relationship at any time, and I will be supportive of that decision. If you choose to end the counseling relationship, I may offer an termination session with you to close out our work together. While such a session can be beneficial for closure, it is also completely optional. For legal and ethical reasons, if you fail to schedule an appointment for four (4) consecutive weeks, unless other arrangements have been made in advance, I will consider our professional relationship to have ended.
If I need to terminate the relationship other than for the prior reason (no appointments for 4 weeks), I will provide referrals to other professionals before doing so.
Confidentiality and its limits
Confidentiality is key to creating a safe and beneficial therapeutic relationship. You have a right to this confidentiality, including the fact that you are or have been a therapy client. There are certain exceptions to my responsibility to keep our sessions confidential and possible risks to confidentiality that are discussed below.
1. Supervision and recording for supervision
I am currently working under supervision and regularly discuss the progress of therapy with my supervisor. Sessions may be recorded so that my supervisor can help me adjust and improve my counseling techniques. Files will be stored in a HIPAA compliant location and are only shared with my supervisor or supervising group through encrypted communication methods. They are deleted 1 month after recording and are not part of your medical record. By signing this document, you consent to recording sessions for supervision and to this use of the recording.
2. Consultation
As an ongoing part of my clinical development, and in pursuit of providing you with the best care, I consult regularly with other therapists who are required to keep client information confidential. Consultation is typically done by obscuring your details (using “they” as a pronoun for everyone and avoiding the use of names, places, or unusual or identifying information).
3. Release of records in case of therapist’s incapacity or death
If I become incapacitated or die, it will become necessary for another therapist to take possession of your file and records so that they continue to be available to you. By signing this document, you give consent to allow a designated successor therapist to take possession of your file and records and provide you with copies upon request.
4. Shared communities
The nerdy, queer, polyamorous, kink, arts, re-enactment, and Burning Man communities in Washington can be small and interconnected. This can sometimes create additional risks around confidentiality. We might attend the same events, share social or romantic circles, or I might provide therapy to people you know or have been in a relationship with. I am committed to maintaining confidentiality of all parties I work with and working ethically. If you have any concerns, please bring them up so we can discuss how to manage them, including the option of a referral to another therapist. Note that in the same way I cannot confirm to others that you are a client, I cannot confirm to you who my other clients are.
If we encounter each other outside of therapy, I’ll maintain professional boundaries, may briefly say hello, and won’t acknowledge how we know one another unless you do first. We may also have overlap in former partners, metamours, or close acquaintances. I will disclose if I am aware of any connections that may affect our work together, and I will take steps to manage these situations ethically. You have the right to inquire about any potential overlapping connections and to voice any discomfort or concerns you may have. If a significant overlap exists, we can discuss the best course of action, which might include a referral.
5. Legal requirements
In certain circumstances, I am required by law to release information to responsible authorities. This is meant to ensure your safety and the safety of others, and would only occur in unusual circumstances including:
- I suspect that you are in serious danger of harming yourself or another person.
- I suspect that a child, teenager, or dependent adult is being abused or neglected.
- I receive a court order to share specific information with a judge or lawyer.
If I am required to disclose confidential information in this way, I will discuss that with you beforehand if possible.
Under most other circumstances, I must have your authorization to speak to anyone about you. If you are seeing me for couple’s therapy, I must have both partners’ signatures to release any part of your file. If you are 13 or older, in the state of Washington you have the right to consent to your own treatment. This includes requiring your signature on a Release of Information before I can share most information with your parents, with the exception to the above limits to confidentiality.
Contact information
Be aware that email communication and text messaging are not secure and should not be used for therapeutic content. Unless you specify otherwise, I will use the phone number you provide me on your registration form to contact you if needed. You do have the right to request that I use email or text messaging to contact you instead.
Social media
Adding clients as friends or contacts on these social media can compromise the professional relationship as well as confidentiality and privacy of the therapist and the client. Because of that, I ask that you do not send friend requests, messages, or follow my non-marketing accounts on social media. To the extent I can recognize user names or faces, I do not accept friend or contact requests from current clients on any social networking sites. In some instances where we may be in shared communities online, I might block your account (and you should feel free to do the same with mine) so that I reduce the chance of seeing posts containing information you may not want to bring into the therapy room.
Emergency and crisis services
I provide non-emergency therapeutic services by scheduled appointment only. I do not provide emergency or crisis services. In the event of an emergency, please dial 911 or go to the nearest hospital. You may also contact the Crisis Clinic of King County (24 hours) at 866-427-4747, the National Crisis line at 988, or call the National Hope Network at 1-800-784-2433. If you are not in crisis, but in need of more immediate mental health support than an upcoming appointment would provide, also consider using the Washington Warm Line at 877-500-WARM (9AM-10PM) to talk with volunteers who have lived experience with mental health challenges.
Payment and fees
Payment and fees information is stored in the Payment and fees document.
Consent for telehealth
Currently I am only offering services through telehealth. This means that by signing this document, you consent to use telehealth for mental health services. This will typically be using a HIPAA-secure video service, such as Google Meet. In the case that our video conferencing connection is disrupted, we will wait 30 seconds to see if it will stabilize on its own. If connection is not re-established, will both end the session and re-login. If this doesn’t work, then I will call you at your designated telephone number.
I work in a private office space where others cannot overhear my audio with you. Note that you are responsible for maintaining the privacy of your side of the connection; this means you will typically want to be in a private and quiet space with a closing door.
Electronic records
SelfWitte may keep and store client information electronically on SelfWitte laptop or desktop computers, or some mobile devices. In order to maintain security and protect this information, SelfWitte may employ the use of passwords, firewalls, antivirus software, and encryption methods to protect computers or mobile devices from unauthorized access. SelfWitte may also remotely wipe out data on mobile devices if the mobile device is lost, stolen, or damaged.
Records are stored online in the cloud. In order to maintain security of the electronically-stored information, SelfWitte has entered into a HIPAA Business Associates Agreement with the cloud provider. Because of this Agreement, the cloud-based company and email service provider are obligated by federal law to protect the electronically stored information from unauthorized use or disclosure. It may be necessary for other individuals to have access to electronically stored information, such as the cloud-based company or email service provider’s workforce members, in order to maintain the system itself. Federal law protecting electronically stored information extends to these workforce members. If you have any questions about the security measures SelfWitte uses, please ask.
Therapist education, credentials, and modalities used
I have a Masters of Counseling from Saybrook University, and am a Licensed Mental Health Counselor Associate (LMHCA) in Washington state. My Washington state license number is MC 61555549. I trained in a humanistic style and primarily practice common factors therapy, focusing on empathetic listening, building an honest relationship, understanding emotional and cognitive processes, and regularly evaluating progress. As a technical eclectic, I use what works, regardless of the approach. In sessions, we may use ACT, CBT, psychodynamic, Solution-focused, DBT, mindfulness, mindful movement or art or play therapy techniques. I am working under the supervision of Alycia O’Conner (LCSW, LICSW, CACD III).
Complaints
If you come to believe that I have behaved unprofessionally in our work together, please bring this up with me first. If I seem to be unwilling to hear or address your concerns, you can also contact the department of health:
Department of Health
Health Professions Quality Assurance, Counselor Section
P.O. Box 47869
Olympia, Washington 98504
(360) 236-4700