The state of Colorado requires that I provide you with information about my credentials as a therapist and your rights as a client associated with the therapy process. Please take time to read this document carefully. Feel free to ask any questions that may develop about any of the material contained in the document. After your reading and full comprehension of the material, please initial at the bottom of each page and sign at the end of the document designating your informed consent of, and agreement to, the psychotherapy services through John Vargas Counseling, LLC. This document will be placed in your file.
As a practicing therapist, I am committed to providing quality, time-effective treatment to individuals and couples regardless of age, race, gender identity, sexual orientation or religious affiliation.
Therapist Name: John Vargas
Business Name: John Vargas Counseling LLC
Clinical Address: 1414 Marion Street Unit 19 Denver, Co. 80218
Business Phone: 720-507-8982
Web Address: http://johnvargascounseling.com/
Email Address: info@johnvargascounseling.com
Degrees and Credentials
NLC.0110382 Registered Psychotherapist permitted to practice in the state of Colorado
Clinical experience includes direct service to adults and couples.
M.A. in Counseling and Psychotherapy from Lincoln Seminary, 2008
B.A. in Counseling from Trinity International University, 2004
Colorado State Law requires that I provide you with the following information:
1. The practice of licensed or registered persons in the field of psychotherapy is regulated by the Colorado Department of Regulatory Agencies through the Mental Health Licensing Section of the Division of Professions and Occupations. The Board of Registered Psychotherapists can be reached at 1560 Broadway, Suite 1350, Denver, Colorado 80202, (303) 894-7800.
2. As to the regulatory requirements applicable to mental health professionals, unlicensed psychotherapist is a psychotherapist listed in the State's database and authorized by law to practice psychotherapy in Colorado but is not licensed by the state and is not required to satisfy any standardized educational or testing requirements to obtain a registration from the state. A Certified Addiction Counselor I (CAC I) must be a high school graduate, complete required training hours and 1,000 hours of supervised experience. A Certified Addiction Counselor II (CAC II) must complete additional required training hours and 2,000 hours of supervised experience. A Certified Addiction Counselor III (CAC III) must have a bachelor’s degree in behavioral health, complete additional required training hours and 2,000 hours of supervised experience. A Licensed Addiction Counselor must have a clinical master’s degree and meet the CAC III requirements. A Licensed Social Worker must hold a master’s degree in social work. A Psychologist Candidate, a Marriage and Family Therapist Candidate and a Licensed Professional Counselor Candidate must hold the necessary licensing degree and be in the process of completing the required supervision for licensure. A Licensed Professional Counselor, Licensed Clinical Social Worker, and a Licensed Marriage and Family Therapist must hold a master’s degree in their profession and have two years of post- master’s supervision. A Licensed Psychologist must hold a doctorate degree in psychology and have one year of post-doctoral supervision.
3. You are entitled to receive information from your therapist about the methods of therapy, the techniques used, the duration of your therapy (if known), and the fee structure. You also have the right to seek a second opinion from another therapist or terminate therapy at any time. Please see the respective sections below for more detail about this information.
4. In a professional relationship, such as psychotherapy, sexual intimacy is never appropriate and should be reported to the board that licenses, registers, or certifies the licensee, registrant or certificate holder.
5. Generally speaking, the information provided by and to the client during therapy sessions is legally confidential and cannot be released without the client’s consent. There are exceptions to this confidentiality (see below), some of which are listed in section 12-43-218 of the Colorado Revised Statutes and the HIPAA Notice of Privacy Rights, as well as other exceptions in Colorado and Federal law.
Exceptions to therapist-client confidentiality include:
a. I am required to initiate a mental health evaluation if a client is imminently dangerous to self or to others, or gravely disabled, as a result of a mental disorder;
b. I am required to report any suspected incident of child abuse or neglect to law enforcement;
c. I am required to report any threat of imminent physical harm by a client to law enforcement and to the person(s) threatened;
d. I am required to report if you disclose or I observe that a child, or disabled person, or an at-risk elder person is suffering or at imminent risk of abuse, neglect or exploitation;
e. I am required to report any suspected threat to national security to federal officials;
f. I may be required by Court Order to disclose treatment information.
If abuse or neglect is disclosed under the conditions given above, I am mandated by Colorado law to report such information to an appropriate state agency. If feasible, you will be informed accordingly.
Additionally, it is my policy to request a Welfare Check through local law enforcement whenever I am concerned about a client’s safety. In doing so, I may disclose to law enforcement officers information regarding my concerns. By signing this document, you consent to this practice should it become necessary.
6. Under Colorado law, C.R.S. § 14-10-123.8, parents have the right to access mental health treatment information concerning their minor children, unless the court has restricted access to such information. If you request treatment information from me, I may provide you with a treatment summary, in compliance with Colorado law and HIPPA Standards.
Methods of Therapy:
I use a combination of therapeutic modalities adapted to fit my particular style of inquiry and therapeutic intervention. The modalities that I draw from include but are not limited to: Internal Family Systems, Transpersonal therapy, Cognitive Behavioral and Dialectic Behavioral therapy, Emotionally Focused Therapy, Polyvagal theory, Attachment theory, Object Relations theory and Personality theory.
There are no guarantees to the outcome of therapy or the length of time required. Successful sessions often depend on the therapist - client relationship and the committed effort of both parties. At any time during our counseling relationship, I am happy to discuss average treatment duration for conditions similar to yours. You have the right to know what other treatment options are available and the possible effectiveness of those alternatives. You may at any time seek a second opinion from another clinician and/or terminate the counseling process. It is your responsibility to ensure that I am informed if you are working with more than one counselor.
I will not record our sessions (audio or video) without your written consent; and expect that you will not record a conversation in any manner without my written consent.
Supervision:
As part of my commitment to providing quality care, I regularly participate in direct individual supervision with licensed professional counselors and/or licensed psychologists and, as deemed necessary, seek peer consultation with a colleague on your case. Supervisors and colleagues are subject to the same confidentiality laws as described above.
Hey Communications:
I use standard business communications equipment in my private practice to communicate with clients, colleagues, third-party vendors and other professionals. This equipment includes cellular telephones, Gmail email service, and the Internet. It is understood that this equipment is not encrypted and confidentiality cannot be guaranteed with the use of this equipment, though passwords are assigned as appropriate. It is also understood that I am the only person with authorized access to all equipment.
Crisis/Emergency:
John Vargas Counseling LLC is not able to handle 24 hour contact and/or emergencies. Any emergency situation that you experience, should be directed to the appropriate emergency personnel such as the services provided by calling 911, the police, the fire department, a hospital, or your county mental health department.
Fee Structure:
Counseling fees are $150.00 per 50-minute session for individuals and couples. Sliding scale fee of $100.00 is available for a prearranged number of sessions. When those sessions have been completed we will revisit the sliding scale agreement and either extend the agreement or shift to the regular fee.
If formal psychological assessments are necessary, those costs are in addition to session fees and will be discussed at the time of consideration. Any requests for written reports or summaries of our sessions will be charged an hourly fee of $150.00 with a 1 hour minimum.
Missed appointments or no shows will be assessed at full session rates.
Phone consultations are your responsibility and are billed in 15 minute increments. Phone calls over 15 minutes will be prorated 100.00 per hour.
Payment:
Full payment for counseling or testing services is due at the time of service. Any other arrangements must be made in advance. Accepted forms of payment are cash, credit card, debit card, and Venmo. A $25.00 administration fee will be charged on all charges that are returned or declined due to insufficient funds.
If desired, credit and debit card payments can be pre-authorized and kept on file. Your card will automatically be charged after your counseling sessions.
In cases in which adolescents of divorced parents are receiving services, all fees due must be paid at the time of service by the accompanying adult. If there are expenses due to legal action necessitating a therapist - attorney consult, the client will be responsible for all fees, including time spent in consult, writing reports and travel.
Out-of-Network Insurance:
I intentionally do not work with insurance providers. I realize this may be an inconvenience to you, however, it is for your protection and to ensure full confidentiality of everything discussed in our sessions. Any insurance claim requires a medical diagnosis to authorize treatment, even if one does not exist in your situation. This can result in a documented, negative label following you through life possibly impacting parts of your life. As well, the insurance provider will determine how many counseling sessions are appropriate for your treatment, regardless of your lived experience. What’s more, when billing through an insurance provider, some of your confidential information must be shared with the provider, even under new HIPPA privacy policies. You may prefer that your mental health matters not be exposed to your insurance provider or your employer. I strive to keep your life challenges private to you. Billing through an insurance provider greatly hampers this approach. By not accepting insurance, I am able to ensure that the confidential information you share in session remains confidential and private to you.
I am more than willing to provide you with the necessary paperwork to submit to your insurance company for possible reimbursement. Some health insurance plans offer partial reimbursement for out-of-network providers. It is your responsibility to contact your insurance provider to learn to what extent your plan covers out-of- network mental health services.
Cancellations/Missed Appointments:
Your appointment scheduling is your commitment to attend our session and signifies your agreement to pay the counseling session fee in full. Appointments must be cancelled 24 hours in advance on normal work days to avoid being charged. Missed appointments or cancellations made less than 24 hours in advance will result in you being charged at the full session rate.
Divorce, Custody Litigation and other Court Proceedings:
I will not voluntarily represent any client in any litigation of any kind, including expert witness or witness of fact, divorce cases, child custody issues, criminal cases, or any other type of court proceeding. By signing this document, you agree not to subpoena me to court for testimony or for disclosure of treatment information; and you agree not to request that I write any reports to the court or to your attorney, making recommendations concerning custody issues or parenting time. 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 children. I cannot fulfill that role. Due to the preparation time required for court involvement and the potential for missed counseling income in my private practice, the charge for any court appearances, including preparation and transportation, is $250 per hour.
Maintenance of Records:
Any person who alleges that a mental health professional has violated the licensing laws related to the maintenance of records of a client 18 years of age or older, must file a complaint or other notice with the licensing board within seven years after the person discovered or reasonably should have discovered the violation. Pursuant to law, this practice will maintain records for a period of seven years commencing on the date of termination of services or on the date of last contact with the client, whichever is later. When the client is a child, the records must be retained for a period of seven years commencing either upon the last day of treatment or when the child reaches 18 years of age, whichever comes later, but in no event, shall records be kept for more than 12 years.
Cessation or Termination of the Clinical Relationship:
You have the right to terminate the clinical relationship at any time you see fit for any reason.
Psychologists and Therapists provide services, teach and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study or professional experience.
Psychologists and Therapists strive to benefit those with whom they work and take care to do no harm. Competence is a cornerstone of ethics. A psychologist who is not competent is likely to cause harm. Clinical termination is the best way to avoid that harm.
I will chose to terminate the clinical relationship if it becomes reasonably clear that you the client no longer need the service, you are not likely to benefit from the service, or you are being harmed by continued service. Termination against your wishes does not constitute abandonment.
I may chose cessation of services if I determine we are not a good therapeutic fit, if what you are going through requires more training than I currently possess, if you require specialized support or if we are not able to form a therapeutically effective relationship.
If you chose not to schedule with me for longer than 30 sequential days, you are agreeing that you are no longer using me as a primary care therapist. Any attempt to return to the therapeutic relationship is contingent on my practice having the space to accept you back. If I am full, I will not be able to reenter the therapeutic relationship at that time. If we do begin meeting again the client must sign a new disclosure statement and agree to the current fee schedule of the practice.