CONSENT FOR TREATMENT
and LIMITS OF LIABILITY
Limits of Services and Assumption of Risks
Therapy sessions carry both benefits and risks. Therapy sessions can significantly reduce the amount of distress you are feeling, improve relationships, and/or resolve other specific issues. However, these improvements cannot be guaranteed for any condition due to the many variables that affect psychological events and personal functioning.
Limits of Confidentiality
What you discuss during your therapy session is kept confidential. No contents of the therapy sessions, whether verbal or written may be shared with another party without your written consent. The following is a list of exceptions:
1) Duty to Warn and Protect- If you discolse a plan or threat to harm yourself, the therapist must attempt to notify your family and notify legal authorities. In addition, if you disclose a plan or threat to harm another person, the therapist is required to warn the possible victim and notify legal authorities.
2) Abuse of Children and Vulnerable Adults- If you disclose, or it is suspected that there is abuse or harmful neglect of children or vulnerable adults, the therapist must report this information to the appropriate state agency and/or legal authorities.
3) Prenatal Exposure to Controlled Substances- Therapists must report any admitted prenatal exposure of controlled substances that could be harmful to the mother or the child.
4) Insurance Providers- Insurance companies and other third-party payers are given informtiaon that they request regarding services to the client.
The type of information that may be requested includes: types of services, dates of service, diagnosis, treatment plan, description of impairment, progress in therapy, case notes, and summaries.
By signing below, I agree to the above assumption of risk and limits of confidentiality and understand their meanings and ramifications.