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Couples and Families

Praxi supports complex relationship structures for couples and family therapy, including shared notes, separate records, and consent management.

Relationship Types​

Praxi supports various relationship configurations:

TypeDescriptionShared Notes
CoupleTwo partners in therapy togetherOptional per session
FamilyMultiple family membersConfigurable
Parent-ChildGuardian and minorAge-dependent
Separated CoupleFormer partners co-parentingUsually separate

Setting Up Couples​

Creating a Couple Relationship​

  1. Create both partner's individual profiles
  2. Open one partner's profile
  3. Go to the Profile tab and expand Family & Relationships
  4. Click Add Relationship
  5. Select Partner/Spouse
  6. Search for and select the other partner
  7. Confirm the relationship

Both partners now appear linked in each other's profiles.

Relationship Details​

Configure relationship settings:

  • Relationship type -- Spouse, partner, de facto, married, engaged, separated (in therapy), or other
  • Billing configuration -- Separate (identified patient), joint invoice, or 50/50 split (custom splits and alternating billing can be set after creation)
  • Shared notes -- Allow shared session notes (both partners must consent)
  • Separate notes -- Maintain separate individual notes (enabled by default)
  • No-secrets policy -- Whether the practitioner will hold information shared by one partner confidential from the other. Enabled by default; can be discussed and adjusted at the start of treatment.
  • Billing responsible client -- Designate which partner is the primary payer
Both Must Consent

Both partners must consent to shared notes. Without consent from both, sessions must be documented separately. This is a professional ethics requirement for couples therapy.

  1. Open either partner's profile
  2. Go to the Profile tab and expand Consent
  3. Select Couples Consent and record consent for:
    • Joint treatment
    • Shared session notes
    • Information visible to partner
  4. Both partners must acknowledge
  5. Save
ActionConsent Required
Booking joint appointmentsEither partner
Shared session notesBoth partners
Partner viewing notesBoth partners
Billing to one partnerThat partner
Sharing with third partyBoth partners

Joint Appointments​

Booking a Couple Session​

  1. Go to Calendar
  2. Create new appointment
  3. Select one partner as primary client
  4. Click Add Client
  5. Select the partner
  6. Both are now attached to the appointment

The appointment appears on both client records.

Appointment Display​

Joint appointments show:

  • Both client names
  • "Couples Session" tag
  • Primary client (for billing)
  • Individual vs shared note indicator
Filtering Couple Sessions

In either partner's client record, open the Notes tab and select the Couple filter to view only joint sessions.

Clinical Notes for Couples​

Shared Notes​

When both consent to shared notes:

  1. Create note from the appointment
  2. Note is automatically linked to both clients
  3. Both can view the note (if they have portal access)
  4. Note appears in both client records

Separate Notes​

If you need separate documentation:

  1. Create note from appointment
  2. Select Create Separate Notes
  3. Write individual notes for each partner
  4. Notes are private to each client

Mixed Approach​

Sometimes you need both:

  1. Create a shared session summary
  2. Add individual notes for private content
  3. Clearly label what's shared vs private

What to Document Separately​

Keep separate when:

  • Individual disclosures made in confidence
  • Safety concerns about one partner
  • Information about individual therapy
  • Risk assessments

Family Therapy​

Creating a Family Group​

  1. Create all family member profiles
  2. For each member, go to the Profile tab, expand Family & Relationships, and add relationships:
    • Parent → Child
    • Sibling → Sibling
    • etc.
  3. Designate the primary client (usually parents for billing)

Family Appointments​

  1. Create appointment
  2. Add all attending family members
  3. Mark primary client for billing
  4. Note which members attended

Notes for Family Sessions​

Consider:

  • What's appropriate to share with all members
  • Age-appropriate documentation
  • Individual concerns vs family dynamics
  • Minor consent rules (see below)

Minors in Family Therapy​

For family therapy involving minors:

Minor's AgeConsent Requirements
0-13Guardian consent only (Family Law Act 1975)
14-17Client + guardian consent (both must consent)
18+Client consent only (standard adult consent)

Separate Minor Records​

Even in family therapy, minors should have:

  • Their own clinical record
  • Age-appropriate privacy
  • Individual risk assessments
  • Separate progress tracking

Billing for Couples/Families​

Billing Options​

OptionDescription
Joint InvoiceOne invoice to the designated billing-responsible partner
50/50 SplitInvoice split equally between both partners
Custom SplitInvoice split by a percentage you choose (for example 70/30)
AlternatePartners take turns being invoiced, rotating each session
SeparateThe designated identified patient is billed (required for insurance/Medicare claims)

Medicare for Couples​

Medicare considerations:

  • Only one person -- the identified patient on the relationship -- can claim per session
  • Choose whose Medicare to use when setting up the relationship's billing
  • Track sessions for each individual

Setting Primary Payer​

  1. Open joint appointment
  2. Go to Billing
  3. Select Primary Payer
  4. Invoice generates to that client

Separation During Treatment​

When couples separate:

Update Relationship Status​

  1. Open either profile
  2. Go to the Profile tab and expand Family & Relationships
  3. Update status to "Separated" or "Former Partner"
  4. Adjust sharing permissions
  • Review and update consent
  • Typically cease shared notes
  • Consider individual therapy continuation
  • Document consent changes

Record Access Post-Separation​

  • Each retains access to their own records
  • Shared notes remain visible to both
  • New notes should be separate
  • Consider archiving couple record

Portal Access for Couples​

If you use the client portal:

Shared vs Individual Access​

  • Each partner has own login
  • Shared notes visible to both (if consented)
  • Individual notes only visible to that person
  • Billing visible to payer

Managing Portal Permissions​

  1. Go to Settings → Client Portal Accounts
  2. Configure couple access:
    • Shared calendar view
    • Shared vs private notes
    • Billing visibility

Tips​

  1. Clarify consent early - Discuss shared vs private before first session
  2. Document preferences - Record each partner's sharing preferences
  3. Review consent regularly - Especially if relationship status changes
  4. Be clear about confidentiality - What will and won't be shared
  5. Use separate notes when in doubt - Err on side of privacy

Ethical Considerations​

Dual Relationships​

When seeing individuals who become a couple:

  • Discuss implications
  • Consider referral for couples work
  • Document arrangement clearly

Secrets and Confidentiality​

If one partner discloses something:

  • Clarify your confidentiality policy upfront
  • Don't hold secrets that compromise treatment
  • Consider individual sessions if needed

Separation and Allegiance​

If couple separates:

  • Maintain neutrality in records
  • Consider referral to avoid taking sides
  • Document any concerns

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