Informed Consent

Office Policies My Background Committing to Therapy Boundaries of Therapy Appointments Informed Consent Limits of Confidentiality What You Should Know Payment for Therapy Contact Me

Informed Consent/ Consent for Services

bulletThere are no guarantees that therapy will be beneficial to you. It likely will be very helpful to you, but no one is able to guarantee this.  
bulletThere can be some risks to therapy. You are likely to go through painful sessions as a part of the healing process. As you grow and learn more about yourself, it is possible that this can have a negative impact on your relationships. While the goal of therapy is to improve the overall quality of your relationships, therapy can act as a springboard for changing relationships that are not working. Some relationships are unable to withstand the upheaval that therapy can create. This is dependent upon the reasons you are coming to therapy and what you discover about yourself in the process.
bulletI cannot promise you that your life will get better. I cannot "fix" you or your child. This is an unreasonable expectation of any therapist. Your success or failure in therapy depends upon many factors.
bulletI cannot guarantee that the referrals I provide to you will help you. I will provide referrals that I believe to be helpful, but I cannot guarantee the quality of other professionals work or services.
bulletIf you are a parent bringing in your child for therapy, you agree to respect your child's confidentiality, even though this is not legally required of you. It is important to your child's treatment. I will inform you of any safety concerns.
bulletTherapy is strictly confidential. What happens in therapy stays in therapy. I will not discuss your therapy or treatment with anyone else without your written permission, unless I am seeking outside clinical consultation of your case from a supervisor or peer supervision group. Every therapist seeks support and outside consultation of client cases. This is important in being able to provide you with the best services. Even in this case, your identity will remain protected. I will not discuss your involvement in therapy with anyone, including my own family members, for any reason. Please see the Limits of Confidentiality page for times your confidentiality will have to be broken under the law.
bulletYour fee for therapy is $_______ per 50 minute hour/80 minute hour. You agree to pay this fee at the beginning of each therapy session, and you understand and are agreeing to the terms of missed appointment charges, phone session fees, and rescheduling appointments.
bulletYou will notify me of any changes in your income make it difficult to pay for services.
bulletYou will keep yourself safe by not intentionally harming yourself or attempting to kill yourself, but will notify the therapist if you are contemplating suicide - right away.
bulletYou will notify me if you want to harm another person and are agreeing NOT to harm others while in my care.
bulletYou won't engage in unsafe behaviors and are making the commitment to therapy as outlined in my office policies.
bulletYou will inform me if you are unhappy with your therapy.
bulletIf you are unhappy with therapy, you will agree to use the services of an arbitrator instead of a lawyer, which is better both for you and I. It is less costly for both of us and provides both of us with fair outcomes.
bulletYou have the right to terminate therapy at any time if you do not wish to continue your treatment for any reason.
bulletYou understand what services I am offering and are consenting to services provided by me as a therapist.

            

                 

Back Next