Appointments

3 STEPS TO PREPARE FOR YOUR TELEPHONE OR VIDEO COUNSELING

We ask that prospective and newly scheduled private-pay and contracted program clients complete our Registration Form with your scheduling requirements. For EAP and school programs with which we contract, this will give us the information we will need to verify your participation and the number of sessions that have been authorized. Expedited and efficient access to our services is best obtained by completing all of the following 3 steps:

[NOTE: Whenever possible, please use a computer or laptop to complete and submit your forms. Use of a cell phone may not work perfectly. If you have trouble in the submission process, please contact the office (360) 626-1457, and we will email the forms to you.]

STEP 1: Complete and submit this form. (For couples counseling, only one participant has to complete this form.) All the information will be transferred to our secure office email, and you should receive an emailed confirmation that we have received it.

STEP 2: Once you have set up an appointment, EVERY participant in the counseling must click on–and read–all of the following documents:

STEP 3: Complete and submit the following form to attest that you have reviewed the above forms and affirm that you understand and agree to the policies and procedures specified. EVERY participant must complete and submit this form prior to your first session:

For COUPLES COUNSELING, both parties also please complete this form:

Couples Counseling Agreement

For Face-To-Face and Telehealth Counseling

Kenneth Eisenberger, LICSW, DCSW
WA License #LW00005218 / CA License #27020
Hidden Hill Counseling, LLC / videocounseling.net

Policy and Informed Consent

Relationship therapy works best when the focus of our work is on your relationship. When working with you, it is expressly understood that my client is both your relationship and each of you as individuals. In order to maintain ethical integrity to both of you and to your relationship, I ask for your consent on the following agreements:

Confidentiality

All information disclosed within sessions is confidential and may not be revealed to anyone without written permission except where disclosure is permitted or required by law. Those situations include but are not limited to: (a) when there is reasonable suspicion of abuse to a child or to a dependent or elder adult; (b) when the client communicates a threat of bodily injury to others; (c) when the client is suicidal and in imminent danger; (d) when the client has been physically injured due to violence; (e) when disclosure is required pursuant to a legal proceeding. I receive occasional professional consultation. In such cases, neither your name nor any identifying information about you is revealed.

No Secrets Policy

When a couple enters into counseling, it is considered to be one unit. This means that my allegiance is to the couple “unit,” and not to either partner as individuals. I find this is particularly important in creating a space where both partners can feel safe. Therefore, I adhere to a strict “No Secrets” policy. This means that I will not hold secrets for either partner. This policy is intended to allow me to continue to treat the couple by preventing, to the extent possible, a conflict of interest to arise where an individual’s interests may not be consistent with the interests of the unit being treated. On occasion during the counseling process, individual partners may be seen for an individual counseling session. In this case, the individual session is still considered as part of the couple’s counseling relationship. Information disclosed during individual sessions may be relevant or even essential to the proper treatment of the couple. If an individual chooses to share such information with me, I will offer the individual every opportunity to disclose the relevant information and will provide guidance in this process. If the individual refuses to disclose this information within the couple’s session, I may determine that it is necessary to discontinue the counseling relationship with the couple. If there is information that an individual desires to address within a context of individual confidentiality, I will be happy to provide referrals to therapists who can provide concurrent individual therapy. This policy is intended to maintain the integrity of the couples/marital counseling relationship.

Court Proceedings/Subpoena of Records

It is understood that the purpose of marital/couples therapy is for the amelioration of distress within a relationship. Therefore, if both partners request my services as a marriage or relationship counselor, they are expected not to use information given to me during the therapy process against the other party in a judicial setting of any kind, be it civil, criminal, or circuit. Likewise, neither party shall for any reason attempt to subpoena my testimony or my records to be presented in a deposition or court hearing of any kind for any reason, such as a divorce case.

Release of Records

Both partners must provide their consent to release marital/couples counseling records. If one partner does not provide consent, records will not be released.

Course of Treatment

The continued participation by each person is voluntary. Either participant may suspend or terminate the therapy at her or his individual request.

We hereby affirm by our signatures below that we have read, fully understand, and agree to abide by the stated policies.