This addendum supplements the general informed consent for psychological services and applies specifically to psychotherapy and altered-state modalities delivered via telehealth by a Licensed Psychologist in the State of Indiana.

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1. Teletherapy Services

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Teletherapy involves the provision of psychological services using secure, interactive audio and/or video communication technology rather than in-person sessions. Services under this addendum may include psychotherapy and structured altered-state interventions (e.g., hypnosis, regression, guided imagery) conducted within the psychologist's scope of practice and professional competence.

Services are provided in accordance with:

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• Indiana Code § 25-1-9.5 (Teletherapy Services)

• Indiana Professional Licensing Agency expectations

• Applicable APA Ethical Principles and Standards of Conduct

2. Confidentiality and Legal Limits

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Teletherapy sessions, recordings, and transcripts are confidential to the same extent as in-person psychological services. Exceptions to confidentiality include circumstances required or permitted by law, such as risk of serious harm, suspected abuse or neglect, or court order.

3. Indiana Teletherapy Requirements

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Indiana law requires informed consent and the establishment of a provider-patient relationship prior to telehealth services. This includes verification of identity and location, disclosure of licensure, collection of clinically relevant information, and maintenance of appropriate psychological records.

4. Risks to confidentiality

Because telepsychology sessions take place outside of the therapist's private office, there is potential for other people to overhear sessions if you are not in a private place during the session. On my end I will take reasonable steps to ensure your privacy. But it is important for you to make sure you find a private place for our session where you will not be interrupted. It is also important for you to protect the privacy of our session on your cell phone or other device. You should participate in therapy only while in a room or area where other people are not present and cannot overhear the conversation.

5. Issues related to technology

There are many ways that technology issues might impact telepsychology. For example, technology may stop working during a session, other people might be able to get access to our private conversation, or stored data could be accessed by unauthorized people or companies. For regression work it is doubly important that the internet connection is stable. Frequently when people are in an altered state their voice volume can become very soft. It is important that your equipment is sensitive enough and close enough to pick up and transmit your voice adequately.

6. Crisis management and intervention

Usually, I will not engage in telepsychology with clients who are currently in a crisis situation requiring high levels of support and intervention. Before engaging in telepsychology, we will develop an emergency response plan to address potential crisis situations that may arise during the course of our telepsychology work. Assessment of telepsychology appropriateness is an ongoing process. We will both continue to assess whether meeting this way offers a good option for your care.

7. Preference

Most research shows that telepsychology is about as effective as in-person psychotherapy. However, some therapists and patients believe that something is lost by not being in the same room. For example, there is debate about a therapist's ability to fully understand nonverbal information when working remotely. Or, some patients report feeling a superior connection to their therapist in-person.
 

Required Acknowledgments and Consents

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All items below must be acknowledged to receive telepsychology services.

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