Informed Consent

This page contains important information about my professional services and business policies. Please read it carefully and jot down any questions you might have so that we can discuss them at our next meeting. When you sign the Disclaimer Sign Page, it will represent an agreement between us, that you agree to the policies and procedures of this practice, as well as indicating that you have read the Discloser Statement, Client Rights, and Confidentiality.



Psychotherapy is practiced by Psychologists, Psychiatrists, Psychiatric Nurse Practitioners, Licensed Clinical Social Workers, Marriage and Family Therapists and Licensed Professional Counselors. No other providers are permitted to claim to practice psychotherapy. In Pennsylvania, only the psychiatrist and nurse practitioner can prescribe medication. Psychotherapy is talk therapy for the purpose of improving mental/behavioral health. The methods vary greatly, so psychotherapy is not easily described. It varies depending on the personalities of the therapist and patient and the school of practice/personality theory to which the therapist subscribes.


I am an insured Professional Counselor (LPC) licensed by the Commonwealth of Pennsylvania, which means that I have met and continue to meet all of the requirements of the Commonwealth to advertise my practice as a Licensed Professional Counselor and to practice psychotherapy in this state. I cannot prescribe medication (I refer my clients to a psychiatrist or their primary care physician). I abide by the regulations placed upon LPC’s, LICSW’s, Psychologists, and MFT's by this state.


Different psychotherapists follow different schools of theory and practice (Adlerian, Jungian, Gestalt, etc.). I am best described as a Christian Counselor whose my theory of the person is based on the Bible, with additional insight from cognitive science, human development, psychodynamics, and social psychology.  Years of experience have led me to utilize a combination of cognitive-behavioral and Rogerian therapy in my clinical practice, but I subscribe to neither personality theory. My understanding of the psyche is based on a biblical theology of the person as well as scientific research. The techniques I use in clinical practice are supported by research and based upon an evaluation of your specific needs.


Unlike a medical doctor visit, psychotherapy calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things we talk about both during after each session, by yourself and often with others. My practice emphasizes homework, peer-support, discipleship, and sometimes in-situation sessions.


Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have benefits for people who go through it. Therapy typically leads to improved functioning in relationships, solutions to specific problems, and significant reductions in feelings of anxiety, an improved and more stable mood, improved resilience and greater competence. But there are no guarantees of what you will experience.


Our first session will be a short time to get to know each other. It is free of charge and is designed to help you and I to determine if we are a good fit. If one or both of us decide that we are not a good fit, there are plenty of other competent Christian therapists to whom I can refer you. I do not discriminate for any reason. If I decide not to accept you as a client, it is typically because either there is too close an association, which could compromise confidentiality, or I lack the training to address your psychological diagnosis.


Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion.


If we decide to move forward, I will give you an assessment to complete, and our next session will be an hour and a half evaluation session. During the next session, we will co-develop a treatment plan. 


Fifty minutes is the standard for one therapy session, though the length of a session varies depending on what we are trying to accomplish or restrictions from your insurance company. The intake is typically an hour and an half. Most subsequent sessions are between forty-five minutes and an hour.  If you need to cancel a session, do so by phone call only, so that I am made aware of the cancellation as soon as possible.  If you miss an appointment or cancel with less than 24 hours notice, you will be charged a $35 late cancellation/no show fee.  If it is possible, I will try to find another time to reschedule the appointment.


Aborting treatment prior to completion can be harmful. For this reason, I do not terminate services if I believe it may cause harm. I may terminate treatment for lack of payment, for lack of progress in treatment, or for abuse of or threats toward me or others on the church premises. However, if termination is warranted, you will be given a session to plan your discharge from treatment with (an) appropriate referral(s) and a recovery plan.


You will be expected to pay for each session at the time it is held, unless we agree otherwise or unless you have insurance coverage that requires another arrangement. Payment schedules for other professional services will be agreed to when they are requested.  Payment can be made by personal check made out to DeVine Interventions Group, LLC, cash or credit card.  Please do not use bonus point cards, because I do not offer rebates to clients (i.e., bonus points are paid by me when you use such cards).  You can also use your credit card through the client portal or on this website under Payments.

Although registered as for-profit, this practice is a ministry; except for the cost of intake, my fee is negotiable. Often, a church will supplement the fee. In circumstances of unusual financial hardship, I may do the work pro bono.


In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have an health insurance policy, it will usually provide some coverage for mental health treatment. I will fill out forms and provide you with whatever assistance I can in helping you receive the benefits to which you are entitled; however, you (not your insurance company) are responsible for full payment of my fees. It is very important that you find out exactly what mental health services your insurance policy covers.


You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator. Of course I will provide you with whatever information I can based on my experience and will be happy to help you in understanding the information you receive from your insurance company. If it is necessary to clear confusion, I will be willing to call the company on your behalf.


Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. “Managed Health Care” plans such as HMOs and PPOs often require authorization before they provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot can be accomplished in short-term therapy, some patients feel that they need more services after insurance benefits end. [Some managed-care plans will not allow me to provide services to you once your benefits end. If this is the case, I will do my best to find another provider who will help you continue your psychotherapy.]


You should also be aware that most insurance companies require you to authorize me to provide them with a clinical diagnosis. Sometimes I have to provide additional clinical information such as treatment plans or summaries, or copies of the entire record (in rare cases). This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. I will provide you with a copy of any report I submit, if you request it.


Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if they run out before you feel ready to end our sessions. It is important to remember that you always have the right to pay for my services yourself to avoid the problems described above [unless prohibited by contract].


I offer a few channels of communication, including mobile phone, texting, email, fax and client portal.  I will not be immediately available by telephone.  Because I am often in session, I seldom answer my phone, but I will get back to you within a few hours, except on Sundays and holidays.  When I am unavailable, leave your name and number and the purpose of your call on my confidential voice mail. If you are difficult to reach, please inform me of some times when you will be available.  Texts receive the same response time, while emails and the web  portal may take over 24 hours.


If you are in the midst of an emergency, leave a phone message and text me until you get a response, and I can usually respond in 10 minutes. If you are unable to reach me and feel that you can’t wait for me to return your call, contact your pastor or deacon, or go to the nearest emergency room. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact, if necessary.


The laws and standards of my profession require that I keep treatment records. You are entitled to receive a copy of your records, or I can prepare a summary for you instead. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. If you wish to see your records, I recommend that you review them in my presence so that we can discuss the contents. I am sometimes willing to conduct a review meeting without charge. Patients will be charged an appropriate fee for any professional time spent in responding to information requests.


If you are under eighteen years of age, please be aware that the law may provide your parents the right to examine your treatment records. It is my policy to request an agreement from parents that they agree to give up access to your records. If they agree, I will provide them only with general information about our work together, unless I feel there is a high risk that you will seriously harm yourself or someone else. In this case, I will notify them of my concern. I will also provide them with a summary of your treatment when it is complete. Before giving them any information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have with what I am prepared to discuss. [At the end of your treatment, I will prepare a summary of our work together for your parents, and we will discuss it before I send it to them.]


In general, the privacy of all communications between a patient and a psychologist is protected by law, and I can only release information about our work to others with your written permission. But there are a few exceptions.


In most legal proceedings, you have the right to prevent me from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if he/she determines that the issues demand it, in which case, I would comply with the order.


There are some situations in which I am legally obligated to take action to protect you or others from harm, even if I have to reveal some information about a patient’s treatment. For example, if I believe that a child [elderly person, or disabled person] is being abused, I must [may be required to] file a report with the appropriate state agency.


If I believe that a patient is threatening serious bodily harm to another, I am [may be] required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the patient. If the patient threatens to harm himself/herself, I may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection.


I may occasionally find it helpful to consult other professionals about a case. During a consultation, I make every effort to avoid revealing the identity of my patient. The consultant is also legally bound to keep the information confidential. If you don’t object, I will not tell you about these consultations unless I feel that it is important to our work together.


While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have at our next meeting. I will be happy to discuss these issues with you if you need specific advice, but formal legal advice may be needed because the laws governing confidentiality are quite complex, and I am not an attorney.
For more information, visit the Confidentiality page of this website.

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