CLIENT - THERAPIST CONTRACT
 
                               PSYCHOTHERAPY INFORMATION DISCLOSURE STATEMENT

Therapy is a collaborative relationship between a therapist and a client wherein both are working together towards defined specific goals. There are certain rights and responsibilities held by each person to create the safety to take risks and the support to become empowered to change.

About Therapy

The major goal of therapy is to help the client identify and cope more effectively with problems in daily living and to deal with internal conflicts in order to achieve more satisfying personal and interpersonal relationships. This purpose is accomplished by:

1.       Increasing personal awareness of obstacles and strengths.

2.       Taking personal responsibility to make the changes necessary to attain your goals.

3.       Identifying specific psychotherapy goals.


Risks and Benefits of Psychotherapy
 
Therapy also has potential emotional risks. Approaching feelings or thoughts that you have tried not to think about for a long time may be painful. Making changes in your beliefs or behaviors can be difficult, and sometimes disruptive to the relationships you already have. You may find your relationship with me to be a source of strong feelings, some of them painful at times. However, therapy also comes with potential benefits as well. Therapy is a safe space for you to express your feelings, emotions, and thoughts about the struggles, troubles, or problems you may be currently facing or have faced in the past. Therapy may also help you in coming up with a set of plans on how to face and/or process your current or past issues. It is important that you carefully consider whether the possible risks are worth the possible benefits to you.
 

Confidentiality
 
Both client and therapist are protected through ethical standards to ensure safety within the therapeutic relationship. This enables counseling to be more effective. Issues discussed during therapy are given importance and are legally protected as both confidential information and “privileged communication.” However, there are limits to the privilege of confidentiality. The therapist may legally break confidentiality and inform the proper persons (including, but not limited to, family, guardian, or the appropriate legal authorities) in the following situations:

1. If the therapist has good reason to believe that the client is abusing or neglecting a child or a vulnerable adult, or if the client gives the therapist information about someone else who is doing the same.

2. If the therapist believes that the client is in imminent danger of self-harm or self-inflicted injuries.

3. If the therapist has good reason to believe that the client will harm another person, the therapist must attempt to inform such person and warn them of the client’s intentions. The therapist must also contact the proper authorities and ask them to protect the intended victim.

4. If the therapist is ordered by court to release information as part of a legal involvement.

5. If the client is engaged in any illegal activity punishable under the penal laws of the Philippines.

6. Only in an emergency situation, the therapist may legally contact another health care provider or a member of the client’s family about the client without prior consent. The client may direct the therapist to share information with whomever the client chooses. The client can change their mind and revoke such permission at any time.

7. Any other situation analogous to the foregoing.


Treatment Agreement
 
It is important that we develop a treatment plan so we would both know the direction of our therapy sessions. Usually our first two sessions are understood as assessment sessions during which time we mutually decide what kind of interventions will be best for you. A referral to an outside support group or treatment program may be suggested or required.

You are expected to take an active role in therapy, which includes regular feedback to your therapist as to your progress. At times you will be asked to complete assignments outside of the therapy hour. These might include journaling, thought and behavior tracking logs, practicing stress reduction techniques, practicing assertive communication skills or attending various support groups. The outside assignments are essential aspects of your treatment and are designed to help you practice skills that you have picked up during the sessions, as well as possibly attain new learning/awareness.

You have the right to ask questions about anything that happens in therapy. I am always willing to discuss how and why I have decided to proceed with the sessions in a certain manner. I am open to alternatives that might work better for you. You are free to ask me to try something that you think will be helpful, which I will consider, provided that they have been scientifically proven to be effective or highly recommended by other professionals in the field.


Referral

You can request that I refer you to someone else if at any point you decide that I am not the right therapist for you. You are free to leave our therapy session at any time. In the same way, if you threaten (verbally and/or physically), harass, and/or commit acts of violence towards me, I reserve the right to terminate the client-therapist relationship. I can offer you referrals to other sources of care, however, I cannot guarantee that they will accept you for therapy.


Sessions

A psychotherapy session lasts for 45 minutes to 1 hour, through either face-to-face or online settings. Face to face sessions will be conducted in a clinic, institution, or an otherwise agreed upon location conducive to the therapy session. Online sessions will be conducted via Google Meet. Links to the online session will be provided by the therapist to the client. All communication made via text messages, phone call, email, and video call are considered private, personal and sensitive information and is protected by data privacy law. Patient’s information is secured and stored in encrypted email, personal drive and are password-protected. Recording of psychotherapy sessions and revealing of personal information in any way (e.g. audio, video recording, etc.) is strictly prohibited and is against the data privacy law.

 
Schedule of Appointments

● Appointment schedule can be set through text, messaging apps, email, or at the end of each session. I will reply to scheduling queries between 8:00 am to 5:00 pm.

● Proof of full payment must be sent on the same day that a schedule is agreed upon for a session in order to reserve the time slot.

● Time slots must be reserved at least one day in advance.

● Sessions may be scheduled from Tuesdays to Saturdays (excluding holidays), from 10:00 am to 4:00 pm.

The available time slots are as follows:
○ 10:00 am - 11:00 am
○ 11:00 am - 12:00 noon
○ 2:00 pm - 3:00 pm
○ 3:00 pm - 4:00 pm


Tardiness

● Coming in late for the appointment will mean a shortened session, as to not intrude upon the sessions of other clients and/or other scheduled activities of the therapist.
● Client will be deemed to have missed the session if client comes in 20 minutes late.


Non-attendance

● Client will be deemed to have missed a session if, without prior notice, client fails to attend the session on the scheduled date and time. In this case, payment will be deemed forfeited.
● No confirmation and/or non-attendance for 3 consecutive sessions will mean the client's voluntary termination of psychotherapy engagement.
● Repeated non-consecutive cancellations / rescheduling / non-attendance / missed appointments will be considered for possible termination of the client-therapist relationship.


Cancellations

● A cancellation fee of 500php will be charged if client cancels within two (2) days prior to the scheduled session.
● There will be no cancellation fee if client cancels more than two (2) days prior to the scheduled session.


Rescheduling

● No fee will be charged for rescheduling, however, a session may only be rescheduled once. If client fails to attend on the rescheduled date, payment will be forfeited and shall not be refunded.