Collateral Agreement

WELL MINDS COUNSELING, PLLC

Tana Carpita, MSW, LICSW

2525 E. Arizona Biltmore Circle, Suite B220

Phoenix, Arizona 85016
(425) 588.9280

Collateral Agreement

I want to thank you for accepting the invitation to assist in the psychotherapeutic treatment of:

Your participation is important and is sometimes essential to the success of the treatment.

Not everyone who enters one or more sessions of psychotherapy or counseling becomes a client. Sometimes people, including grandparents, siblings, spouses, and even parents of minors, become participants in the therapeutic process without becoming clients. They are there as “collaterals” to contribute to the therapy of the client, without becoming a subject of the treatment.

My primary responsibility is to my client, and I must place their interests first. They have more privacy protection; you would have less privacy protection. Your role as a collateral is to contribute to the success of the client’s treatment by providing useful insight and information, collaborating on the treatment plan, following up with
‘homework’ assignments, and helping the client stay motivated. Please understand how helpful your participation becomes in this process, and that your willingness to contribute here is greatly appreciated.

UNDERSTANDING YOUR ROLE AS A COLLATERAL:

1. A collateral is not a client and is not the subject of treatment.  The collateral is there to provide assistance to the treatment of the client.
2. A collateral does not have the right to the records of the client (if you are the Legal Representative of the client, then you have the right to client records).
3. Statements by a collateral are not automatically shared with the client.
4. A collateral does not have the right to confidentiality.  Your statements in session become part of the client’s treatment record.  A Legal Representative has clear rights to all client records.
5. As a collateral you do have the right to privacy in regard to some of your information, including, but not limited to: your personal information, your medical history, and your financial information.  I will redact that information if I ever have to provide records of the sessions in which you have participated.
6. Although your consent is not required to release records in response to a subpoena or court order, I will notify you in such an event so you have the opportunity to intervene or hire an attorney to intervene if you are concerned about the contents of the records.