In General:

The counseling process brings with it certain risks of which you need to be aware. As issues come to light you may have an increase of uncomfortable feelings. Some of these feelings may include anger, guilt, sadness, or anxiety. There is also a risk that as you change, your relationships will change also. Sometimes those we are in a relationship with are unwilling to change, thus possibly ending relationships.

Psychotherapy is confidential, with the below stated exceptions:

Duty to Warn: Therapists are mandated by law to disclose pertinent information discussed in therapy if the client has an intent or plan to harm another person. We are required to inform the intended victim and notify legal authorities.

Suicide/Self harm: Depression is common emotion expressed in therapy, but if a client is feeling hopeless enough to imply or disclose a plan for suicide; steps need to be taken to ensure safety.

This would include notifying the legal authorities as well as make reasonable attempts to notify your family and/or emergency contact.

Animal abuse: I will report animal abuse, including cases of neglect and hoarding.

Vulnerable Adults and Children: Mental health professionals are required by law to report stated or suspected abuse of a child or vulnerable adult to the appropriate social service agencies and/or legal authorities.

Prenatal Exposure to Controlled Substances: in keeping with protecting vulnerable populations, Mental Health Providers are required to report admitted use of controlled substances during pregnancy that are potentially harmful to the fetus.

Minors/Guardianship: Parents or legal guardians have the right to access a minor client’s health information. Age of adult for psychotherapy is .

Insurance Providers: Information requested includes description of impairments, dates and times of service, diagnosis, treatment plans, treatment progress, prognosis for improvement, case notes and summaries.

When working with me, you will be asked to sign to your understanding of the above limitations:

I  ______________________ have read and understand the above-stated limitations to confidentiality. I accept the subsequent ramifications should there be a need to act on one of the above- stated exceptions. Other than the noted exceptions, if there are reasons to disclose my protected confidential information I understand that I will be provided a Release of Information form.

Thank you in advance for understanding and accepting the boundaries I need to put in place so that I can work as a clinical professional from a place of integrity and extend the most generous interpretation of  intentions, words and actions of you, my client.