Principles and Values for Private Practice 

My principals as a psychotherapist in private practice is based on the National Association of Social Workers (NASW) Code of Ethics. Social workers are sensitive to culture and ethnic diversity and strive to end discrimination, oppression, poverty and other forms of social justice. Social workers also seek to enhance the capacity of people to address their own needs. As a social worker in private practice, I work to incorporate the ethical principals in my therapy and service to clients. 

Ethical Principals 

The following broad ethical principles are based on social work’s core values of service, social justice, dignity and worth of the person, importance of human relationships, integrity and competence. The principals set forth ideals principals all social workers should aspire: 

  • Service: Social work’s primary goal is to help people in need and to address social problems
  • Social Justice: Social workers challenge social injustice
  • Dignity and Worth of the Person: Social workers respect the inherent dignity and worth of the person
  • Importance of Human Relationships: Social workers recognize the central importance of human relationships
  • Integrity: Social workers behave in a trustworthy manner
  • Competence: Social workers practice within their areas of competence and develop and enhance their professional expertise

Telemental Health Informed Consent 

I understand the following with respect to telemental health: 

I hereby consent to participate in telemental health with, Thomas Garth Mintun, LCSW, as part of my psychotherapy. I understand that telemental health is the practice of delivering clinical health care services via technology assisted media or other electronic means between a practitioner and a client who are located in two different locations in the same state of Indiana. 

  1. I understand that I have the right to withdraw consent at any time without affecting my right to future care, services or program benefits to which I would otherwise be entitled.
  2. I understand that there are risks, benefits and consequences associated with telemental health, including but not limited to, disruption of transmission by technology failures, interruptions and/or breached of confidentiality by unauthorized persons and /or limited ability to respond to emergencies.
  3. I understand that there will be no recording of any of the online sessions by either party. All information disclosed within sessions and written records pertaining to those session is confidential and may not be disclosed to anyone without authorization, except when the disclosure is permitted and /or required by law.
  4. I understand that the privacy laws that protect the confidentiality of my protected health information (PHI) also apply to telemental health unless an exception to confidentiality applies (i.e., Mandatory reporting of child, elder, or vulnerable adult abuse, danger to self or others: therapist raises mental/emotional health as an issue in a legal proceeding).
  5. I understand that if I am having suicidal or homicidal thoughts, actively experiencing psychotic symptoms or experiencing a mental health crisis that cannot be resolved remotely, it may be determined that telemental health services are not appropriate and a higher level of care is required.
  6. I understand that during a telemental health session, we could encounter technical difficulties resulting in service interruptions. If this occurs, end and restart the session. If we are unable to reconnect within ten minutes, please call me at 317-578-2122.
  7. My clinical license at this time only covers clients in the state of Indiana. I will ask you where you are for each session and need to know you are in Indiana for psychotherapy to continue. Please be advised that the therapist needs to be in Indiana as well unless there are new laws that states join with Indiana in a compact.
  8. I understand that my therapist may need to contact my emergency contact and/or appropriate authorities in case of an emergency 

Emergency Protocols

I need to know your location in case of an emergency. You agree to inform me of the location if you are not at your home in Indiana. I also need a contact person who I may contact on your behalf in a life threatening emergency only. This person will only be contacted to go to your location or take you to the hospital in the event of an emergency. 

Communication Policy

Social Media 

My license requires that that I follow the Code of Ethics by the National Association of Social Work (NASW). This code considers “virtual relationships” to be equivalent to face-to-face relationships and the Code discourages multiple relationships with clients. The code also states that Social Workers are prohibited from engaging in a personal virtual relationship when they are in counseling. Therefore, my practice policy shall be to not knowingly accept a “friend”,” follower” or any other term on any social networking platform (linkin, twitter, etc.) from clients past and present in which I believe that blurring of counselor-client relationship may be adversely affected. This policy applies to all social networking platforms. 

Instant Messaging (IM) 

I will not knowingly participate in any instant messaging for “chatting”. 


Please note that sending me any un-encrypted emails may mean that your personal health information may be compromised. I will be sending you messages through an encrypted HIPPA approved email system only, especially when it comes to documents or forms. You can easily participate with me on my encrypted email system. 


Texting is not encrypted and I prefer that you do not send me a text with any pertinent information about yourself. I would rather use the encrypted HIPPA approved email platform that I use or telephone calls to 317-578-2122. 

Phone Calls 

You may call me at 317-578-2122 and leave a message on my confidential voice mail. Also remember that I may not be available at the time of your call. For emergencies, please call 911 or the behavioral unit at a local hospital. I do check my confidential voicemails frequently during the business day and that the limits of confidentiality apply in the Telemental Informed Consent.