Psychotherapy/Counseling is a professional service I will provide to you. Because of the nature of services, your relationship with me has to be different from most relationships. It may differ in how long it lasts, the objectives, or the topics discussed. It must also be limited to only the relationship of therapist and client. If you and I were to interact in any other ways, you would then have a "dual relationship," which could prove to be harmful to you in the long run and is, therefore, unethical in the mental health profession.
Dual relationships can set up conflicts between the therapist's interests and the client’s interests, and then the client’s (your) interests might not be put first. To offer all my clients the best care, my judgment needs to be purely focused on your needs. As your provider, I am collaborating with you to offer you choices and to help you choose what is best for you. A therapist helps you learn how to solve problems better and make better decisions. A therapist's responses to your situation are based on tested theories and methods of change.
You should also know that therapists are required to keep the identity of their client’s secret. As much as I would like to, for your confidentiality I will not address you in public unless you speak to me first. If so, I will only address you with a common courtesy greeting. In sum, it is my duty to always maintain a professional role. Please note that these guidelines are not meant to be discourteous in any way, they are strictly for your long-term protection.
Statement Regarding Ethics, Client Welfare & Safety
I assure you that my services will be rendered in a professional manner consistent with the ethical standards of the American Counseling Association. If at any time you feel that I am not performing in an ethical or professional manner, I ask that you please let me know immediately. Due to the very nature of counseling and applicable interventions, as much as I would like to guarantee specific results regarding your therapeutic goals, I am unable to do so. However, with your participation, we will work to achieve the best possible results for you.
Please also be aware that changes made in this format may affect other people in your life. For example, an increase in your assertiveness may not always be welcomed by others. It is my intention to help you manage changes in your interpersonal relationships as they arise, but it is important for you to be aware of this possibility nonetheless.
I am sincerely looking forward to facilitating interventions while on your journey toward healing and growth. If you have any questions about any part of this document, please ask.
FMLA and Forms
Please be advised that therapist does not complete any insurance, or employer associated FMLA documentation. These sessions are non-reimbursable for insurance formats of any nature. At therapist discretion a letter of support may be supplied pending 6 months or more of recurring treatment with Relate-2-Clinic and current Therapist.
Please print, date, and sign your name below indicating that you have read and understand the contents of this form, you agree to the policies of your relationship with me as your provider, and you are authorizing me to begin treatment with you.