Pamela Henry, M.A., L.C.M.H.C.
N.H. #005
845 South Street · Portsmouth, New Hampshire 03801 · (603) 431-3530

 

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Confidentiality:

One of your most important rights involves confidentiality. Within certain limits, information revealed by you during therapy will be kept strictly confidential and will not be revealed to any other person or agency without your written permission. Recognizing the benefit of second opinions, I may occasionally share information with a colleague for purposes of consultation, always preserving your privacy and shielding your identity. You should also know that there are certain situations in which, as a mental health counselor, I am legally required to reveal information obtained during therapy to other persons and/or agencies, without your permission. In the following situations, I am not required to inform you of my actions:

 

1)      If you threaten grave bodily harm or death to another person, I am required to inform the intended victim(s) and appropriate law enforcement agencies.

2)      If you indicate a clear and present danger to hurt yourself and refuse to accept further appropriate treatment, I am required to inform your family, agencies or other individuals who, in my opinion, would assist in protecting your safety.

3)      Any information indicating the possibility of abuse of children or the elderly must be reported to the proper authorities.

 

In order to process health insurance claims, your insurance carrier may require disclosure of confidential information. Only the minimum necessary information will be communicated to the carrier. I have no control or knowledge over what insurance companies do with the information submitted. Involving and informing your carrier is completely up to you. I will accommodate by providing paid receipts and required documentation to submit to your carrier.

 

Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters of a personal and confidential nature, it is agreed that should there be legal proceedings (such as, but not limited to divorce and custody disputes, injuries, lawsuits, etc.), neither you (client/s) nor your attorney/s, nor anyone acting on your behalf will call on me (Pamela Henry, MA, LCMHC) to testify in court or at any other proceedings, nor will a disclosure of the psychotherapy records be requested. Upon your request, I will release a brief summary of your sessions, in the form of a written treatment summary, to any agency/person you specify, unless releasing this information might be harmful to you, in any way. Written treatment summaries of couple’s therapy contain information about each person.  Therefore, in such cases treatment summaries can only be released by joint consent. Any time spent in preparation for legal proceedings will be billed at $350.00 per hour.

 

 

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