RAWR LLC
Honolulu, HI 96815
808-500-4240
Informed Consent for Psychotherapy
General Information
The therapeutic relationship is unique in that it is both highly personal and 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 provides a clear framework for our work together. Please feel free to discuss any of this with me. After reviewing this information, indicate agreement by filling in the checkbox at the end of this document.
The Therapeutic Process
You have taken a 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 the feelings attached to those events can bring up strong emotions, such as anger, depression, and anxiety. There are no miracle cures. I cannot promise that your behavior or circumstances will change. However,I can promise to support you, do my best to understand you and your repeating patterns, and help you clarify what you want for yourself.
Confidentiality
All client information and session content is confidential unless the client requests in writing to have all or portions of such content released to a specifically named person or persons, except for the following circumstances:
If a client threatens or attempts to commit suicide or otherwise conducts themselves in a manner in which there is a substantial risk of incurring serious bodily harm.
If a client threatens grave bodily harm or death to another person.
If the therapist has a reasonable suspicion that a client or other named individual is the perpetrator of, observer of, or victim of pathogenic care, defined as anyone under the age of 18 years old experiencing neglect, physical abuse, emotional abuse, or sexual abuse.
Suspicions as stated in #3 above in the case of an elderly person or otherwise vulnerable adult as defined by Hawaii Revised Statutes, Chapter 346, Part X (Act 154, SLH 2008).
If a court of law issues a legitimate subpoena for information stated on the subpoena. If a client is court ordered to treatment, on probation, or on parole, information will not be released without a signed release of information.
Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name or other identifiable information.
If we see each other accidentally outside of therapy, I will not acknowledge you first. This is not to be rude; rather, 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 say hello, I will be more than happy to speak briefly with you. That said, I do not feel it is appropriate to engage in lengthy discussions, especially about treatment, in public or outside the therapy office.