Before We begin: important information about Therapy

You will be asked to sign a consent that states the following if we agree to work with each other following a consultation.

"I understand  should  I  choose  to  engage  in  online therapy services provided by Natalie McBroom, LMFT,  these  services  are not intended for crisis situations and urgent needs. In a crisis situation, I agree to call 911 or local emergency services  in  my  community , or visit the nearest emergency room. 

I  understand  should  I  choose  to  engage in face  to  face  therapy  with  Natalie  McBroom,  LMFT,  at  her  office  located  at  251  W  Main  Street,  Suite M,  Brawley,  CA  92227, that  after  office hours  she  will  have  a voice  mail  at  (442)  275-8544  where  I  can  let  her  know  I  have  a  true  mental  health  emergency  and  that  I  also  agree  to  either  contact  the  Imperial  County  Behavioral  Health  Services 24-hour  Emergency  number listed  below,  or  911,  or  my  local  police  number, or find  a  safe  ride to  the nearest  emergency  room or  crisis  center for  the  safety  of  myself  and  others  as  I  may  need  a  higher  level  of  assistance.

Imperial County Mental Health Crisis Number: 1-800-817-5292

Imperial County Behavioral Health Services: (442) 265-1525
Crisis  center:  202 N. Eighth St., El Centro, CA 92243

I  understand  that  the  following  numbers  are  community  agencies  that  I  can  reach  out  to  for  additional  support  and  are  not  affiliated  with  Natalie  McBroom,  LMFT.

Center for Family Solutions: (760)-353-8530
Child Protective Services: (760)-337-7500
SURE 24-Hour Helpline: (760)-352-7873
Rape Crisis Center: (760)-352-7273

The following is a website that provides support when I may not be available if you are feeling in distress and thinking about hurting yourself or someone else: http://suicidehotlines.com/national.html

***Important emergency mental health HELP numbers to have on hand are: 1-800-SUICIDE/

1-800-784-2433 and 1-800-273-TALK/1-800-273-8255.***

Information shared with my therapist is confidential except in the following circumstances: If I present as a danger to myself or others, mandated reporting of abuse of children or elders, or if I sign a release of information. Please continue reading for more important information that you need to understand before we get started. 

Risks and Benefits of Therapy: Psychotherapy is a process in which the therapist and client discuss a myriad of issues, events, experiences and memories for the purpose of creating positive change so the client can experience life more fully. It provides an opportunity to better, and more deeply understand oneself, as well as, any problems or difficulties the client may be experiencing. Psychotherapy is a joint effort between the client(s) and the therapist. Progress and success may vary depending upon the particular problems or issues being addressed, as well as many other factors. Participating in therapy may result in a number of benefits, including, but not limited to, reduced stress and anxiety, increased ability to relate to others, a decrease in negative thoughts and self-sabotaging behaviors, improved interpersonal relationships, increased comfort in school, social, work, and family settings, increased capacity for intimacy, and increased self-confidence. Such benefits may also require substantial effort on the part of the client(s), including an active participation in the therapeutic process, honesty, and a willingness to change feelings, thoughts and behaviors. 

There is no guarantee that therapy will yield any or all of the benefits listed above. Participating in therapy may also involve some discomfort, including remembering and discussing unpleasant events, feelings and experiences. The process may evoke strong feelings of sadness, anger, fear, etc. There may be times in which a client’s perceptions and assumptions are challenged, and different perspectives offered. The issues presented by clients may result in unintended outcomes, including changes in personal relationships. Clients should be aware that any decision on the status of his/her personal relationships is your responsibility. During the therapeutic process, many clients find that they feel worse before they feel better. This is generally a normal course of events. Personal growth and change may be easy and swift at times but may also be slow and frustrating. You may address any concerns you have regarding progress during your session. 

Confidentiality: All communications between you and your therapist will be held in strict confidence unless you provide written permission to release information about your treatment. If you participate in marital or family therapy, your therapist will not disclose confidential information about your treatment unless all person(s) who participated in the treatment with you provide their written authorization to release.

Exceptions to confidentiality: There are exceptions to confidentiality. For example, therapists are required to report instances of suspected child or elder abuse. Therapists may be required or permitted to break confidentiality when they have determined that a patient presents a serious danger of physical violence to another person or when a patient is dangerous to him or herself. In addition, a federal law known as The Patriot Act of 2001 requires therapists (and others) in certain circumstances, to provide FBI agents with books, records, papers and documents and other items and prohibits the therapist from disclosing to the patient that the FBI sought or obtained the items under the Act. 

I understand that Natalie McBroom,  LMFT does not provide documents for the courts, return to work reports, disability claims, SSI services, or to other agencies when  services  are  rendered  via  an  online  modality such  as tele-behavioral  health  via  live  video.

If  I  choose  to  engage  in  tele-behavioral  health,  I understand the limitations inherent in online counseling,  such  as  problems  with  technology,  limited  mental health  emergency  assistance,  and  the  inability  for  Natalie  McBroom, LMFT  to  fully  assess  my  behavior  and  other  elements  of  my  character  and  personality.   I  understand if I require more in-depth assessment for court-related, character attestation, custody-related, or injury/disability claim-related issues, that I will need to seek assistance from a professional  who is  trained  to  meet those specific needs. 

I understand that as a Marriage and Family Therapist, Natalie McBroom, LMFT is pro-marriage, pro-family, and will work with couples who are interested in saving their relationship, be it engaged, married, or co-habitating.  Your therapist has a no secrets policy when treating couples in therapy and ongoing infidelity as defined by the couple will not be held  in  confidence  by  your  therapist.    Mrs.  McBroom  will  help  you  discuss  and  process  such  relationship  crises.

I understand that as a therapist in California, Natalie McBroom, LMFT cannot provide conversion therapy to a minor. You are encouraged to seek out non-therapist assistance for such concerns with a minor.

I understand that Natalie McBroom, LMFT does not discriminate on the basis of race, creed, color, ethnicity, national origin, religion, sex, sexual orientation, gender expression, age, height, weight, physical or mental ability, veteran status, military obligations, and marital status. 

I understand that Natalie McBroom, LMFT cannot give medical, legal, or other advice outside of the scope of her practice as a Marriage and Family Therapist. I understand that Natalie McBroom is not licensed to determine someone fit for employment, law enforcement, or military duty, nor can she perform the duties of a licensed psychologist or psychiatrist. 

I understand that Natalie McBroom, LMFT is bound ethically to discuss with me if therapy is not appropriate for me at this time based on my type of interaction with her and my level of involvement in therapy. 

I understand that Natalie McBroom LMFT is only licensed by the state of California to provide therapy (psychotherapy/counseling) to clients who are physically located within California state lines. I understand I must let Natalie McBroom LMFT know if I will be moving out of state or traveling out of state for an extended period so that arrangements can be made to assist me with my mental health treatment.

I  understand  my  therapist  may  be  unavailable at  certain  times  for  personal  reasons  and  I  will  leave  a  message  at  (442)  275-8544  if  I  have  questions  or  concerns.   I  understand  Natalie  McBroom,  LMFT  will  do  her  best  to  return  my  call  within  24  hours  or one  business day.    I understand  my  therapist’s  vacations, personal appointments, or therapist emergencies may cause delays in response time and your therapist will do her best to contact you within  1  business  day if a later response is to be expected.

I  understand  that my  therapist  may  need  to  consult  with  peer professionals  about  my  care  from  time  to  time  and  that  those  professionals  will  not  be  given  personal  health  information  that  might  identify  me  to  that  professional.    

I  understand  all  efforts, via  technology  and  physical  barriers,  will  be  taken  to  protect  my personal  health  information  per  HIPAA  regulations.    I   understand  that  if  my  personal  health  information  is  found  to  have  been  released  without  my  permission  my  therapist  will  take  the  appropriate  legal steps  to  follow  up  with  such  breeches in  privacy  and  will  let  me  know  what  kind  of  information  might  have  possibly  been seen  or  obtained  without  my  permission."

Updated  11/14/2019  by  Natalie  McBroom,  LMFT