Telecounseling Information and Consent Form



The purpose of the counseling relationship is to promote the growth of the client by offering a safe atmosphere of understanding and trust.  The counselor’s responsibility is to assist the client in developing an understanding of personal issues, to define goals, and to plan actions related to meeting these goals.  The counselor’s job is to reflect, provide feedback, and to support any positive decisions that you decide to make. It is important to recognize the relationship between counselor and client is one of a professional nature.




The ULM counselors have experience in addressing mental health issues that relate to those individuals within the college population, including but not limited to depression, anxiety, and relationship issues.  If your issues are in an area we do not feel qualified to treat, we will discuss this with you and will refer you to a professional who will best serve your needs. 




Information obtained in the counseling session may be used for professional staffing or consultation, but will not be discussed outside this department without your permission.  As counselors, we agree on the essential value of confidentiality.  However, information can be divulged when it is clear to the counselor that the client could do serious harm to himself/herself or someone else or when the counselor has reasonable suspicion there may be abuse or neglect of a child, or an elderly or disabled person. 


A counselor may be required to take protective actions if a client communicates an immediate threat of harm to an identifiable victim or if a client has a history of violence and exhibits the apparent intent and ability to carry out the threat. These actions may include notifying the potential victim and/or their parents if the victim is a minor, contacting the police and/or appropriate authorities, and/or seeking hospitalization for the client.


In rare cases where there is a risk to the student or the community, the Self-Development, Counseling, and Special Accommodations Center reserves the right to notify the Vice President for Student Affairs, University Police, and other “appropriate persons, including university officials and parents of an eligible student” in connection with an emergency if knowledge is necessary to protect the health and safety of the student or other individuals.




Counseling services are free of charge to currently enrolled students. If you are unable to keep a scheduled appointment, please notify the Self-Development,Counseling and Special Accommodations Center in advance.  The counseling sessions will be approximately 50 minutes in length.   Clients are seen by scheduled appointment Monday through Thursday, from 7:30 a.m. until 5:00 p.m., and on Friday, from 7:30 a.m. until 11:30 a.m., central standard time.  It is important for the counselor and the client to note time zone differences when scheduling appointments. 


In the event the client is a minor, written consent of the legal guardian shall be obtained prior to rendering services. 




Counselors approach counseling from an eclectic perspective in that various theories and strategies are used based on the client’s individual issues and needs. 


Students eligible to participate in telecounseling services must be currently enrolled at ULM.





The counselors are required by state law to adhere to the Louisiana State Code of Conduct for practice that has been adopted by the licensing Board.  A copy of this Code of Conduct is available upon request. 




Information learned during the counseling process will remain strictly confidential except for:


  1. The client signs a release of information indicating informed consent of such release
  2. The client expresses intent to harm him/herself or someone else
  3. There is reasonable suspicion of abuse/neglect against a minor child, elderly person (60 or older), or a dependent adult
  4. A court order is received directing the disclosure of information


It is the Self-Development,Counseling and Special Accommodations Center’s policy to assert privileged communication on behalf of the client and the right to consult with the client, if at all possible, except during an emergency, before mandated disclosure.




A mental health emergency is an emotional or behavioral crisis that warrants immediate attention by a mental health professional. This may include, but is not limited to, significant changes in behavior that are not characteristic of a person, the presence of disruptive symptoms that interfere with the responsibilities of daily living, direct or indirect expressions of the intent to harm self or others, or the experience of a trauma.


When a mental health emergency occurs and a student is off-campus, the student should call 911 or go to the nearest hospital emergency room for assistance. 


During the orientation phase of the counseling process, the counselor will assist the client in identifying an appropriately trained professional who can provide local assistance if the counselor is unavailable or if crisis intervention is needed.  The counselor and the client will also collaborate to determine a local emergency telephone number. 



The Self-Development,Counseling and Special Accommodations Center utilizes an electronic scheduling system, which allows the counselor to record your reported contact information, demographic information, and brief records of your counseling sessions. The staff members maintain strict security measures to protect this information - electronic encryption, firewalls, and password protection.

Session notes are printed and maintained in locked filing cabinets, separate and independent from your academic and health records, and can only be accessed by members of the staff.  These records are maintained for ten years, which is consistent with the professional ethical guidelines. You have a right to know the contents of your file unless your counselor (or parents, if you're under 18) deem that viewing it would be harmful to your mental health.



The client is a full partner in counseling. Honesty and effort is essential to success.  As counseling progresses, share suggestions or concerns about your counseling so that necessary adjustments can be made.  If it is determined another mental health provider would better serve the client’s needs, the client will be assisted with the referral process. 


The client shall inform the counselor if they are receiving services from another mental health professional.  The client shall grant permission for the counselor to share information with this professional so that services can be coordinated. 




Physical health can be an important factor in the emotional well-being of an individual.  If you have not had a physical examination in the last year, it is recommended that you do so.  Also, clients shall provide their counselor with a list of their current medications.




Clients should be aware that counseling poses potential risks.  In the course of counseling, additional problems may surface of which client was not initially aware.  If this occurs, clients should feel free to share their concerns with their counselor. 


Wherever telecounseling is mentioned, this is referring to electronic counseling services provided by the Self-Development,Counseling and Special Accommodations Center, which includes live electronic appointments with counselors and the use of an unsecured email.  If technology-assisted distance counseling is deemed inappropriate by the counselor or client, then the counselor can assist in making a referral to a mental health provider who can provide face-to-face counseling. 

When utilizing telecounseling services, clients must protect their personal information from others.  Therefore:

  • Clients will provide an accurate email address with the understanding that the Zoom meeting center will email confirmation messages and notifications to the address provided by the student. 
  • If a client chooses to share an email account with another person, that person will have access to their meeting ID# and password, which may allow that person eventual access to the student’s personal information. 
  • If a student chooses to share an email account, they release the Self-Development,Counseling and Special Accommodations Center telecounseling service from any liability resulting from such action. 

If during the session, a technology failure occurs, the client shall call 318-342-5220 and request to speak with their counselor so that they can reschedule the appointment or determine an alternate method of service delivery. 

Please fill the information below to indicate that you understand and agree to participate in telecounseling in accordance with these policies.
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