Informed Consent Document

 

Informed Consent Document
Introduction

Thank you for choosing our counseling services. This Informed Consent Document is designed to provide you with essential information about the counseling process, your rights as a client, the responsibilities of the counselor, and the limits of confidentiality. It aims to ensure that you have a clear understanding of what to expect from our therapeutic relationship. Please read this document carefully and feel free to ask any questions you may have before proceeding with counseling.

Counseling Process

Confidentiality:

All information shared during counseling sessions will be kept strictly confidential, except in the following circumstances:
If there is imminent risk of harm to yourself or others.
If there is suspected child or elder abuse.
If there is a court order or legal obligation to disclose information.
Goals and Objectives:

Together, we will establish goals and objectives for your counseling journey. These will be reviewed periodically to ensure that they remain relevant and meaningful.
Duration and Frequency:

Counseling sessions typically last 50 minutes, unless otherwise agreed upon.
The frequency of sessions will be determined collaboratively based on your needs and availability.
Termination:

Either party may terminate the counseling relationship at any time.
It is recommended that termination is discussed in advance to allow for closure and appropriate referrals if needed.
Rights and Responsibilities

Client’s Rights:

You have the right to be treated with respect, dignity, and cultural sensitivity.
You have the right to participate actively in the therapeutic process and make decisions regarding your treatment.
You have the right to ask questions, seek clarification, and voice any concerns you may have.
Client’s Responsibilities:

It is important to attend scheduled counseling sessions promptly and inform your counselor in advance if you need to cancel or reschedule.
Openly communicate your needs, expectations, and any changes in your circumstances that may impact your therapy.
Counselor’s Role:

Your counselor will provide a safe and non-judgmental environment for exploration and growth.
Your counselor will employ their professional expertise to facilitate change, support your well-being, and maintain ethical standards.
Limits of Confidentiality

Confidentiality is a fundamental aspect of counseling; however, there are legal and ethical limits to this principle.
Your counselor may be required to break confidentiality if:
There is imminent risk of harm to yourself or others.
There is suspected child or elder abuse.
There is a court order or legal obligation to disclose information.
Benefits, Risks, and Alternatives

Benefits of Counseling:

Gain insight into personal challenges and develop coping strategies.
Improve self-esteem, communication skills, and relationships.
Enhance personal growth and overall well-being.
Risks of Counseling:

Some clients may experience temporary discomfort or emotional distress as they explore difficult emotions or memories.
There is a small possibility that counseling may not meet your specific needs or expectations.
Alternatives to Counseling:

You have the right to explore other forms of support or treatment outside of counseling.
Your counselor can provide referrals or collaborate with other professionals if necessary.
Complaints and Grievances

If you have any concerns, complaints, or grievances about the counseling process or your counselor’s conduct, please discuss them openly with your counselor. If resolution cannot be achieved through this discussion, you may contact the appropriate licensing board in your jurisdiction.

By signing below, you acknowledge that you have read and understood this Informed Consent Document. You agree to participate voluntarily in counseling services provided by our practice and consent to the terms outlined in this document.

Client’s Name (Printed)

Client’s Signature

Date

Counselor’s Name (Printed)

Counselor’s Signature

Date