Qualifications and experience:

Certified in EFT (Emotionally Focused Therapy) 2016

Licensed Professional Counselor #783 1993

MA in Counseling from C.U. Boulder 1985

Regulatory Requirements:

The Colorado Department of Regulatory Agencies  (DORA) has the general responsibility of regulating the practice of licensed therapists, as well as individuals who practice therapy without a license.

The agency within the Department that has responsibility specifically for licensed psychotherapist is the State Grievance Board, 1500 Broadway Suite 1340 Denver, CO. 80202  303-894-7766

Client Rights:

You are entitled to receive information from me about my methods of therapy, the techniques I use, the duration of your therapy (if I can determine it) and my fee structure (which will follow). Please ask if you would like to receive further information.

Clients often engage in therapeutic work in intervals. Your file will be considered closed if you indicate that you are done with therapy, if it is determined your clinical needs are better supported by other services and we transition you to other providers, or if we have not met or communicated for two or more months. If your file has been closed, you are welcome to contact me at a future date to resume services. Your file will be re-opened and updated with current paperwork as needed if we begin to work together again.

You can seek a second opinion form another therapist or terminate therapy at any time.

I agree not to record our sessions without your written consent and you agree not to record our sessions or a conversation with me without my written consent. If you agree for me to record your sessions, please sign a separate release.

In a professional relationship (such as ours), sexual intimacy between therapist and client is never appropriate, and should be immediately reported to the State Grievance Board. Situations of abuse are contraindicated for couples therapy.

Confidentiality:

Generally speaking, the information shared in therapy sessions is legally confidential to persons or agencies outside of therapy and can only be shared with your written consent.

There are exceptions to confidentiality including the following:

~I am required to report any suspected child, at-risk adult, or elder abuse or neglect to proper authorities.

~I am required to report to law enforcement any threat of imminent physical harm by a client and to the person(s) threatened.

~I am required to initiate a mental health evaluation of a client who is imminently dangerous to self or others (homicide or suicide), or who is gravely disabled as a result of a mental disorder or issue.

~I am required to report any suspected threat to national security and/or terrorism to federal officials. If I am concerned about a client's immediate safely, it is my policy to contact a family member, close friend and/or request a Welfare Check through local law enforcement. In doing so, I may discuss information regarding my concerns.

~ To provide the best possible care, I may consult with other professionals concerning your therapy. This may include consultation with clinical supervisors, consultants, other treatment team members or attorneys. The same confidentiality rules detailed herein apply to all professionals consulted.

~If you are 18 years or older and disclose to me that you were abused as a minor, I do have a duty to report if there is reasonable cause to know or suspect that the perpetrator has subjected another child currently under 18 to abuse or neglect or to circumstances that would likely result in abuse or neglect or if the perpetrator is currently in a position of trust as defined in C.R.S. 18-3-4-1 93.5) with regard to any child currently under 18.

~If you are seeing another mental health care provider for treatment and you are in treatment with me, I will require that you sign a release to exchange information in order to coordinate treatment.

~By signing this disclosure statement, you consent to these confidentiality policies and practices.

Confidentiality and Technology:

Any of the following forms of communication are not considered confidential: email, text, video conferencing (FaceTime, Skype), information stored in cloud formats, telephone voice mails, fax communication, automated payment (i.e. Square, PayPal, Venmo), and communication by U.S. mail. By signing this disclosure, you assume the risk of sending or receiving any unsecured information should you choose to do so. All treatment issues must be talked about in session.

Disclosure regarding divorce and custody litigation:

If you are involved in divorce or custody litigation, my role as a therapist is not to make recommendations to the court concerning custody or or parenting issues By signing the Disclosure Statement, you agree not to subpoena me to court for testimony or for disclosure of treatment information in such litigation; and you agree not to request that I write any reports to the court or to your attorney, making recommendations concerning custody. The court can appoint professionals who have no prior relationship with family members to conduct an investigation or evaluation and to make recommendations to the court concerning parental responsibilities or parenting time in the best interests of the family's children.

Office Hours and Emergencies:

I am generally in the office Monday-Thursday 9:00-5:00. I check messages regularly throughout the business day and make every effort to return calls as promptly as possible. I may not be able to on weekends or holidays and on personal vacations. I do not provide 24-hour services. If you need emergency services, please call 911 or proceed to your nearest emergency department. You can also call Mental Health Partnerscrisis line: 303-447-1665 or Colorado Crisis Hotline 844-493-8255.

Fees and Cancellations:

My fee is $200/50 minutes. Should we agree that a longer session is needed, my fee is prorated according to session length. Unless other arrangements have been made, you are responsible for full payment at the time of each session. Payment may be made by check or cash.

No Secrets Policy:

When treating a couple, the couple is considered the client. If one member of the couple discloses a secret to me in private and it is my clinical judgment that this undisclosed secret will block treatment progress, I will ask you to disclose this secret and if not, I may terminate treatment.

 If a request is made for the records of the couple, records will only be released with the consent of all parties and any information that is released will be released to both members of the couple. This "no secrets" policy is intended to allow me to continue to provide therapy to the couple by preventing, as much as possible, conflicts of interest that may arise. If you feel it necessary to talk about matters that you do not wish to have disclosed, you should consult with a separate therapist for individual treatment.

Good endings are part of a good therapeutic relationship. My expectation is that we will discuss this prospect during our sessions and that the actual ending will are done face to face in a therapy session, even if this comes sooner than we'd discussed. The goal is that the ending process be done is such a way as to solidify and augment the benefits and changes that therapy has achieved.

Dual Relationships:

I do not provide individual counseling to a client who is receiving couples counseling from me. However, while I am working on behalf of the couple relationship, I will be seeing each partner individually, when clinically advise and needed. I will do my best to provide an equal number of sessions for each person.

If I saw you for couples counseling, you terminated therapy, your relationship ended and you decide to come back to see me for individual counseling, it is my policy to, when possible, get permission from your ex partner to enter  into this new type of individual counseling relationship with you. In that case, you and your ex partner both understand that if you decide to get back together and continue couples work, I will to refer you out to a different couples therapist.

Interruption of Services-Professional Designee:

In the event that I am disabled, die or become incapacitated, the following provider will act as my Professional Designee and will have access to my client files. The Professional Designee will contact you to notify you of of the event and will assist in continuing your care and treatment with the least amount of disruption possible by providing you with referrals and transferring your client record, if requested, to your new provider. If you are not comfortable with the below listed Professional Designee for any reason, please let me know and will will discuss alternatives.

Robyn Fusco, MA LPC 303-507-0301   707 Ryder Ridge Drive Longmont, Co. 80504

I have received a copy of this disclosure, read and understand its contents, agree to the policies and procedures listed above, and authorize Sara Cohen to provide treatment.