Informed Consent for Therapy - Individual
This form will explain the obligations of the therapist, some expectations of you as the client, that are to be upheld throughout the therapy process. Terms of service and policies are included as well. Please read through it and append your initials at the end if you consent to beginning the therapy process.
If you have any questions, please contact your therapist or request an open discussion during the next session.
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Confidentiality & the Therapy Process

Therapy is an individually tailored process which is designed to assist in dealing with your concerns, coming to a greater understanding of yourself, better functioning in your personal relationships and using effective means of coping which utilize personal and interpersonal resources.

The therapy service is voluntary and confidential. All information that you disclose to your therapist is confidential. This means it will not be disclosed to any other individual.

Confidentiality may be broken in exceptional circumstances: where your life or the safety of others is threatened, there are child protection concerns, or criminal activity is involved, this confidentiality may be waived. In these circumstances, I will explain the procedure to you.

Please note, it is not guaranteed that the therapy process with always be fun or easy. It requires consistent effort and time for achieving your goals, which is also dependent on your ability to show up for sessions and engage with the process.
The Therapist's Role

Your therapist will be prepared to be present and show up for all sessions (except in emergency cases), to assist you in attending to your concerns, exploring and understanding your personality, patterns & goals. Your therapist does not give direct advice, instead they will help you explore and gain different perspectives that empower you to make your own choices, as you know yourself best.

The Client's Role
All clients are expected to attend sessions on time and in a sober state. In case of emergencies (accidents, sudden illness), please contact your therapist as soon as possible by phone or WhatsApp. Your therapist will cancel a session if you attend a session intoxicated in any way.
All clients are expected to be honest and open about their goals for therapy, so that your therapist can assist you as best they can.
All clients are expected to engage fully in the therapy process i.e during the session and doing homework assignments. This is important as it increases the effectiveness of the therapeutic process and allows you to apply skills learnt during the sessions.
Terms of Service
During sessions: A 20 minute grace period is given at the beginning of every session, during which your therapist will text and/or call you if you have not communicated with them. When the grace period elapses, that will count as a cancelled session and you will have to book and pay for another session at a different date and time.

Rescheduling sessions: Clients are allowed to reschedule sessions before the session or during the 20 minute grace period. Your therapist reserves the right to end the therapeutic relationship after 4 consecutive cancellations.

Communication outside sessions: Clients are allowed to text the therapist briefly on WhatsApp for updates and calls for emergency situations. Your therapist will not engage in lengthy conversations or sessions on text.
I have read the above information and understand what is expected of both me and the therapist. I have been given the opportunity to ask questions and discuss any concerns about these matters. I understand the risks and benefits of therapy, the nature and limits of confidentiality and what is expected of me as a client.

Write your initials in the space below to affirm your consent.

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