INDIVIDUAL PSYCHOTHERAPY CONSENT FORM

PSYCHOTHERAPY is a form treatment that involves talking with a mental health care provider (a psychologist in this instance). This is a private process aimed at dealing with concerns and establishing managing and coping strategies. This form of treatment works by building a therapeutic alliance with your psychologist who works to support and guide you towards developing a healthier mental state and improved psychological well-being. The nature of this relationship is unique and contractual thus, understanding is essential.

The nature of the therapy:

Individual therapy is an approach to psychotherapy that involves a one on one talk session with a psychologist, aimed at using psychological skills and tools to improve the patient’s wellbeing and reduce any form of distress (emotional or psychological). Your sessions will include initial assessments, creating a bio psychosocial data for the psychologist’s use, creating a treatment plan and implementing this plan.

Anticipated course of therapy:

Therapy may run for a minimum course of 3 months, and an additional time frame can be added to accommodate and address individual needs. Therapy sessions are held once a week in the sanctuary for a period of 45 minutes to 1 hour.

Fees:

Payment is made in advance to secure your appointment. Alternatively, a monthly lump sum can be made to the centre to secure your appointment. To avoid forfeiting session fee paid, appointments can be cancelled 24 hours before scheduled time.

Confidentiality:

This is paramount to the ethics of our practice. The client is the primary informant, while relatives and authorities are secondary informants, depending on the situation. To this effect, information about your session with psychologist will remain between both parties. However, if information shared during session is perceived to be of harm to the client or to people around the client, the psychologist is by law not obligated to maintain such confidentiality.

CONFIDENTIALITY:

  • All interactions with psychologist, including scheduling of attendance or appointments, content of your sessions, progress in therapy, and your records are confidential.
  • No record of therapy session is contained in any academic, educational, or job placement file.
  • You may request in writing that the psychologist release specific information about your therapy session to persons you designate.
  • If a guardian gives consent on behalf of a client under 18 years of age, the guardian will not be given any access to client’s information, except the client provides written consent to release information to his/her guardian.

Exceptions to Confidentiality:

  • The clinical staff works as a team. Your psychologist may consult with other clinical staff to provide the best possible care. These consultations are for professional and training purposes.
  • If there is evidence of clear and imminent danger or harm to self and/or others, your psychologist is legally required to report this information to the authorities responsible for ensuring safety.
  • A court order, issued by a judge, may require the psychologist to release information contained in your records and/or require a therapist to testify in a court hearing.

We appreciate prompt arrival for appointments. Please notify us if you will be late. Twenty-four-hour notice of cancellation allows us to use the time for others. If you are 15 minutes late without prior information, your non-refundable session will be cancelled.

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