Michele M. Vincent, LCSW - INFORMED CONSENT FOR PSYCHOTHERAPY
The therapeutic relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with me. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.
The Therapeutic Process:
You have taken a very positive step by deciding to seek therapy.
The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort.
Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. I cannot promise that your behavior or circumstance will change. I can promise to support you and do my very best to understand you and your therapeutic needs, as well as to help you clarify what it is that you want for yourself.
General Information
- If a you threaten or attempt to commit suicide or otherwise conduct yourself in a manner in which there is a substantial risk of incurring serious bodily harm.
- If you threaten grave bodily harm or death to another person.
- If I have a reasonable suspicion that you or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.
- Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.
- Suspected neglect of the parties named in items #3 and # 4.
- If a court of law issues a legitimate subpoena for information stated on the subpoena.
- If you are in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.
Confidentiality
Professional Consult
If we see each other accidentally outside of the therapy office, I will not acknowledge you first.
Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy.
However, if you acknowledge me first, I will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.
