• Informed Consent

  • Part 1:  Your Rights as Client(s)

    1.  You have the right to ask questions about any procedures used during therapy; I will explain my approach and methods to you.  If I see a child under the age of consent, all custodial parents have a right to information shared in the session.  Custodial parents should be aware that exercising this right may be detrimental to the therapeutic process, and so may wish to allow confidentiality between the child and therapist.

    2.  You have the right to decide not to receive therapeutic assistance from me; I will provide you with the names of other qualified professionals whose services you might prefer at a cost equal to or less than my own usual customary fee.

    3.   You have the right to end therapy at any time without any moral, legal, or financial obligations other than those already accrued.  I ask that you contact me by phone if you make such a decision without consulting with me.

    4.   You have a right to review your records in the files at any time; however this is done at the office with your therapist. 

    5.   One of the most important rights involves confidentiality: Within limits of the law, information revealed by you during therapy will be kept strictly confidential and will not be revealed to any other person or agency without your written permission.  Additionally when more than one family member is being seen in therapy, the therapist views the family as a whole as the client.  Therefore, releases of information for family sessions require the written approval of all consenting members of the family who were present at any time during the treatment.

    6.   If you request it, any part of your record in the files can be released to any person or agency you designate.  I will advise you if I think releasing the information to that person or agency might be harmful to you in any way.

    7.   You should also know that there are certain situations in which I am required by law to reveal information obtained during therapy to other persons or agencies without your permission.  Also, I am not required to inform you of my actions in this regard.  These situations are as follows:

    ·        If you threaten grave or bodily harm or death to another person, I am required by law to notify police and endangered person.

    ·        If a court of law issues a legitimate court order (signed by a judge) for therapy, I am required by law to provide your attendance record AND the results of the treatment ordered specifically described in that order.

    ·        If you reveal information relative to child abuse, child neglect, or elder abuse, I am required by law to report this to the appropriate authority.

      

    Part 2: The Therapeutic Process

    Therapy will seek to meet goals established by all persons involved, usually revolving around a specific presenting problem.  A major benefit that may be gained from participating in therapy includes a better ability to handle or cope with marital, family and other interpersonal relationships.  Another possible benefit may be a greater understanding of family and personal goals and values; that may lead to a greater maturity and happiness as individual and increased relational harmony.  Other benefits relate to the probable outcomes resulting from resolving specific concerns brought to therapy.

    In working to achieve these potential benefits; however, therapy will require that firm efforts be made to change and may involve the experiencing of some discomfort.  Therapeutically resolving unpleasant events and relationship patters can arouse intense feelings.  Seeking to resolve problems can similarly lead to discomfort as well as relationship changes that may not be originally intended.

  • If client is under 18, parent / legal guardian must sign in the provided space below

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