INFORMED CONSENT FOR TREATMENT
Psychologists are guided by the ethics of their profession and several California and federal laws. These guidelines and laws are to protect the individuals who use the services of these professionals.
1. The issue of confidentiality needs to be clearly spelled out. By law you have the right to confidentiality and I as your therapist am prohibited from revealing to any other person what you have said to me without your permission. However, there are limits to your rights under this law. In the following three instances your right to confidentiality must be set aside and I am required by law to reveal information disclosed to me even without your permission.
a. If you should initiate a lawsuit against anyone, and make your “state of mind” an issue, the records of mental health treatment if subpoenaed cannot be withheld by the treating therapist.
b. When there is a suspected case of sexual, physical, or severe emotional child or elder abuse.
c. Although a patient’s right to confidentiality shall be broadly interpreted, confidentiality must be set aside if a therapist has reasonable cause to believe a patient is a danger to him/herself or others, including property.
Failure to report under any of the above circumstances renders the therapist liable to punitive action such as loss of license, imprisonment, fine, or civil lawsuit for malpractice.
Lastly, Minors do not hold the privilege of confidential communications with a therapist. The holder of the privilege for a minor rests with the parent(s). If parents are legally divorced but retain joint legal custody, both parents remain holders of the privilege. However, it is important that children and adolescents feel that their discussions with their therapist are private.
2. Therapy can have benefits and risks. You are expected to benefit from therapy, but you should know that you may feel temporarily worse while in treatment due to discussing, unveiling, or exploring emotional memories, situations, or events. Maximum benefits occur with regular attendance. Therapy is not like a medical visit. Instead, it calls for a very active effort on your part. In order for therapy to be most successful, you will have to work on things we talk about both during our sessions and at home. Should you feel you are not benefiting from therapy you are strongly encouraged to discuss this with me as soon as possible.
3. Length of treatment varies from patient to patient. Working in collaboration, you and I will be developing treatment goals and evaluating them periodically to be sure your personal goals and needs are being met. Unless otherwise indicated, therapy sessions last 45 to 50 minutes.
4. There may be instances in which I will consult with another colleague to best help you. Your situation may be discussed, however YOU WILL NOT BE NAMED AND NO DESCRIPTION WILL BE USED WHICH MIGHT REVEAL YOUR IDENTITY.
5. I tend to use a cognitive behavioral and family systems approach to therapy. I have specialized experience in the area of trauma. Should you request a treatment modality outside of my area of competence I will make every effort to provide you with the appropriate referrals.
If you have any questions regarding these guidelines and laws ask me about them or you may call the Board of Psychology in Sacramento at 916-263-2699.
I have read and understand the above statement.
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Name(Patient/parent/guardian)Date
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Name of Minor Child