Consent for Therapy

This document contains important information about the professional services and business policies of both your Lyra Clinical Associates (LCA) therapist, and Lyra Clinical Associates P.C. Please read it carefully and discuss any questions you have with your therapist.

Confidentiality: Your therapist and LCA take your privacy and confidentiality very seriously. LCA complies with Federal and California laws regarding confidentiality of client information. LCA’s Notice of Privacy Practices details how we use any information we collect, including for treatment, coordination of care, payment and other business operations. We will minimize the amount of information we share without your express consent, however we want to bring your attention to certain circumstances in which we may disclose details of your care:

  • Your therapist may share information about your assessment and treatment with the clinical team at LCA in a way that minimizes the sharing of your personal information to only that necessary to ensure that we are providing you with the most effective care possible and/or to improve your experience with our services. You may let us know that you do not want your information shared in this way by speaking with your provider.
  • In certain circumstances, your therapist is required by law to inform legal authorities, or potentially impacted individuals, regarding the following possibilities:
    • If there is suspected elder, dependent adult, or child abuse or neglect.
    • If, in your therapist’s judgment, you are in danger of harming yourself or another person, or are unable to care for yourself.
    • If you communicate to your therapist a serious threat of physical violence against another person.
  • If your therapist is ordered by a court to release information as part of a legal proceeding, your therapist may be required to share details of your care.
  • As otherwise required by law and/or detailed in our Notice of Privacy Practices.

The Process of Psychotherapy: The process and outcome of psychotherapy may vary depending on the particular problems addressed, the personalities of the therapist and client, and various other factors. While we cannot predict exactly what your experience will be like, we are committed to providing you with the most professional and ethical treatment possible.

Participation in therapy can result in a number of benefits to you, including improved interpersonal relationships, resolution of specific problems, and positive personal change. In order for therapy to be successful, you will need to make an active effort both during and outside of your sessions. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable and intense feelings like sadness, guilt, anxiety, frustration and anger. In addition, it may result in changes that were not originally intended (such as divorce or remaining in a relationship you believed you would leave). Change can often happen quickly, but may also occur more slowly. There are no guarantees about what you will experience. Your therapist’s role is to help guide you through the therapy process by offering emotional support, actively listening to your concerns, asking relevant questions, providing treatment plans and recommendations, and monitoring your treatment progress.

During your first session, you will discuss with your LCA therapist the reasons you are seeking therapy, goals you would like to achieve, and any background information related to your presenting concerns. In subsequent sessions, you and your therapist will work collaboratively towards achieving your goals of therapy. Subsequent sessions may focus on understanding thought patterns, feelings, and behaviors that are relevant to presenting concerns and work towards more effective ways of coping.

Throughout therapy, you will work with your therapist to tailor treatment to meet your goals and assess whether your goals are being met. If at any point you are unhappy about the progress, process, or outcome of the treatment, please discuss this with your therapist. There are many different methods your therapist may use to address the concerns that bring you to therapy. Your therapist strives for genuineness and a nonjudgmental stance in all of his/her patient relationships. However, if at any time you feel that you are not connecting or that he/she has misunderstood you in an important way, you should discuss them in session with your therapist. In addition, the Lyra Care Team is always available to work with you, and may also reach out to you to discuss your overall satisfaction with the therapy.

The Lyra Website: As part of therapy you will use the Lyra Website. You will need to access the Lyra Website to participate in the video sessions, submit assessments and practices in between sessions, as well as to connect with your therapist via secure messaging.

Your therapist will orient you to using the Lyra Website for the above purposes during your first therapy session. If you decide to have your sessions with your therapist by phone (without using the video option in the Lyra Website), your therapist will call you at the number you provided at registration. You will still need to use the Lyra Website to complete assessments and submit records of therapy practices.

Therapy Assessments: Before your first session, your therapist will ask you to answer a set of questions that will help them get to know you and better tailor treatment to respond to your situation. Throughout therapy, your therapist will also assign other assessments to be completed before your sessions to inform treatment.

Therapeutic Focus: LCA therapists do not make recommendations, write letters of recommendation or complete application forms related to items outside the scope of treatment (e.g.,medical leave, medical disability, fitness to work, child custody, or emotional support animals).

Video Therapy: Please note that:

  • As part of this program you will engage in telehealth sessions with your LCA therapist.
  • All telehealth sessions are held by video using the Lyra Website.
  • Your therapist will initiate the video session with you at the scheduled time using the Lyra Website.
  • The video conferencing technology will not be the same as an in-person session with a therapist due to the fact that you will not be in the same room as your therapist.
  • In order to have the best results for your video session, you should be in a quiet place with limited interruptions when you start the session.
  • There are potential risks to this technology, including interruptions, unauthorized access and technical difficulties.
  • Your Lyra therapist or yourself can discontinue the telehealth session if it is felt that the videoconferencing connections are not adequate for the situation.
  • Your LCA therapist will inform you and obtain your consent if another person is present during the consultation, for any reason.
  • There are alternatives to a telehealth session available, including the option of finding an LCA therapist to see in-person.
  • You can direct questions about your telehealth sessions at any time to your LCA therapist or Lyra Care Advisor.
  • This consent will last for the duration of the relationship with your LCA therapist, and it covers all telehealth sessions you may have.
  • You can withdraw your consent for telehealth sessions at any time, and Lyra will work with you to find a suitable alternative.
  • The same confidentiality protections, limits to confidentiality, and rules around your records apply to a telehealth session as they would to an in-person session.
  • Your LCA therapist may decide to terminate telehealth services, if they deem it inappropriate for you to continue therapy through video sessions. Your LCA therapist will work with other team members to identify another LCA therapist for in-person care.
  • By signing this consent form you agree to work with your LCA therapist to come up with a safety plan, including identifying one or two emergency contacts, in the event of a crisis situation during your sessions.

Video Recording: Your therapist will ask you at the start of each session if you consent to the session being recorded. If you consent, your therapist will record the session for ongoing quality improvement and quality assurance of our services. Recordings are kept for 2 weeks and then deleted.No one other than the therapist (including you) has permission to record sessions.

Your Location During Video Sessions: Like all health care providers, LCA’s therapists are licensed to offer services on a state by state basis. In order to ensure your LCA therapist is appropriately licensed, we ask that you please search for a provider based upon your planned location at the time your session takes place. If your location changes at any point from one state to another, please let your LCA therapist know as soon as possible. Please be aware that your LCA therapist may not be able to provide services when you travel to a different state and is not able to provide services when you travel outside of the U.S.

Missed Appointments and Cancellations: LCA requires at least 24 hours advance notice for cancellation of an appointment. If you are unable to attend your scheduled appointment due to circumstances beyond your control, please message your therapist in the Lyra Website as soon as possible so we can reschedule your appointment to a more suitable time. Once an appointment is scheduled, you will be expected to attend unless you contact your therapist to reschedule. You can also use email to reschedule; however, please note that receiving emails in your personal account may be unsecure. Failure to provide sufficient notice for cancellations and/or repeated no-shows for your appointment may impact your ability to schedule additional appointments with your therapist. If you cancel or reschedule within 24 hours of a scheduled session, or you do not attend a scheduled session you may be charged a $105.00 Cancellation Fee.

In-Between Session Communication: If you need to contact your LCA therapist between sessions, for non-urgent issues, please message them within the Lyra Website. Your therapist checks his/her messages in the Lyra Website regularly during business hours and will make every effort to return your message within 2 business days. These messages will remain available for thirteen (13) months and then will be deleted.

Emergency Procedures: In a crisis, please call 911 or go to the local emergency room. Please do not use the Lyra Care messaging or email if you are experiencing an emergency. If you would like to speak to someone for support prior to your therapy appointment, or if you experience distress prior to your appointment, please use the Lyra Health Care Team number (877-505-7174) for non-emergency situations. Your Lyra therapist may not be available to respond to you immediately due to variations in working hours. Your Lyra therapist will respond to messages within 48 business hours of receipt.

If you experience an emergency during your sessions with your LCA therapist, or if your LCA therapist becomes concerned about your personal safety, the possibility of you injuring someone else, or about you receiving proper psychiatric care, your LCA therapist and LCA will do whatever possible within the limits of the law to prevent you from injuring yourself or others and to ensure that you receive the proper medical care. For this purpose, LCA or your LCA therapist may contact the person whose name you have provided on the biographical sheet as your emergency contact.

Social Media Policy: LCA and our therapists believe that adding clients as friends or contacts on social media sites (e.g., Facebook, LinkedIn, etc.) can compromise clients’ confidentiality and privacy. Consequently, given the importance of client confidentiality, your LCA therapist will not accept friend or contact requests from current or former clients on any social networking site. If you have questions about this, please bring them up during your session.

Billing and Payments: The fees for your sessions may be partially or fully paid for by your, or your eligible sponsor’s, employer or Health Plan, with or without any cost share to you, as long as you are an eligible employee in good standing with the company, and as long as further sessions are considered clinically appropriate. Please note that certain professional services outside of the presenting problems may be outside the services paid for by your employer or Health Plan and may incur additional fees. Any additional fees will be discussed and agreed upon when they are requested. Fees for services may be subject to change in the future.  If you have questions about the full cost of a session prior to any health plan cost coverage, you may contact the Lyra Care Team at [email protected]

Research, Writing, Teaching: Your therapist and others at LCA conduct internal research, training, and supervision, or publish information for professional and/or lay audiences. De-identified information about you and your treatment may be used to support these initiatives. Any use of information about your treatment would be only in an anonymized and/or de-identified way for these publications.

Length of Therapy: Evidence-based treatments, or treatments that have been rigorously tested and proven to be helpful, typically are shorter-term treatments than general counseling or the general provision of support. Most clients notice some initial changes or relief within the first few sessions of treatment. Your course of treatment will be individualized depending on the intensity and duration of your presenting concerns, your level of engagement and active participation in the treatment plan, and the specific nature of your concerns.

Ending Treatment: You may withdraw from treatment at any time. Your therapist recommends that you discuss your plan to end treatment with them before taking action, so that they have an opportunity to offer further recommendations or referral options.

If at any point during psychotherapy your therapist assesses that the sessions are not effective in helping you reach the therapeutic goals, he/she will discuss this with you and, if appropriate, end treatment. In such a case, they will work with you and the Lyra Care Team to identify alternative options.

If you do not keep your scheduled appointments and do not respond to communications from your therapist, we will assume you have elected to end your treatment and we will close your case. If this occurs, and you wish to resume your treatment, please contact the Lyra Care Team to reinitiate therapy.


If at any time you have questions about the details above, please ask your therapist or the Lyra Care Team. By continuing your sessions with your therapist you accept and agree to abide by the contents and terms of this agreement and consent to participate in evaluation and/or treatment.