INFORMED CONSENT FOR TNT YOUTH MINISTRY COUNSELING
Introduction: Welcome to therapy at TNT Youth Ministry. There are some things that you should be aware of before beginning therapy. Your therapy reflects a commitment of time and money on your part and I want to honor that with professional caring and knowledge. I will do everything I can to make your experience beneficial to you and those who are in your life.
Approach to therapy: My approach to therapy is from a systemic perspective. I will rarely look to individualize your struggles but rather try to put them in the context of your relationship with others. Systems can include your role in your family of origin, your role within your marriage, or even your role in the workplace or church. I will look to you to provide an honest interpretation of your struggles and together we can first search for meaning and understanding. Therapy is about change and requires your active participation in order to change thoughts, feelings, and/or behaviors. There is rarely an “easy fix” and my role is to guide you in the process. I will consider you holistically with consideration for your spirit, your emotions, your thoughts, and your physical well-being. My role is limited to one as your therapist and do not profess any other expertise such as financial advisor, lawyer, or doctor.
Benefits and risks to therapy: The benefits of therapy have been researched, can be empirically supported, and can include but not limited to: less anxiety, more stable relationships, managing depression, stabilizing addictions, interruption of family patterns, and healing and understanding in marriages. Your coping skills may be greatly enhanced which could have lasting effects in your life and yourself. The risks of therapy may include uncovering suppressed feelings or memories that may actually cause discord in your relationships. There may be uncomfortable levels of guilt, anxiety, depression, frustration, loneliness, or helplessness. Family secrets can be revealed which could lead to extreme discord or even divorce. These risks are to be expected when you are seeking to make major changes in your life through the therapeutic process but are sometimes a necessary threshold to be crossed in order to facilitate healing.
Limitations to therapy: Selecting a therapist is a decision that needs to be based in trust and feeling that you have found a person with whom you can work cooperatively and productively. If you are not comfortable with me as your therapist, I will do what I can to refer you to someone who may be better suited for the type of issues you face. I may also ask that you seek a medical exam in order to ensure that you are in good physical health. You will always be consulted before requesting records from other professionals and be required to sign a form releasing that information. I cannot see minor children under the age of 14 without the express written consent of either parents or guardians. In the event the parents are divorced, both biological parents must sign releases regardless of who has physical custody. A copy of the divorce decree may have to be provided.
Confidentiality: You can be assured that whatever you, the client, tell me in the therapy room will remain confidential except for the conditions listed below. Your privacy will be protected and I will not divulge that I am seeing you as a client. This means that even if I see you in public, I might act differently than I do when we meet professionally. The only times when your confidentiality is not protected by law is 1. If you were sent to me by an employer or court for evaluation or treatment because they will expect a report. If there is anything you do not want them to know, please explain at the onset of your therapy. 2. If you are involved in a legal dispute and you tell the court you are in therapy they may request records. Please consult an attorney before disclosure. 3. If you make a serious threat to harm yourself or another person, I am legally required to protect you or that other person. This usually requires telling others about the threat. I cannot promise not to tell others about threats you make. 4. If I believe a child or an elder has been or will be abused or neglected and the event has not been reported, I am legally bound to report this to the authorities.
Recording: I understand that in some scenarios we will be recording sessions for accountability, protection, and future review to provide a more effective counseling experience. These recordings will not be used for any purpose other than legal protection, learning, and review.
Commitment: You can be assured that I will keep our relationship professional and not a business, social, romantic, or even personal relationship. I will offer care to the best of my ability and will seek professional advice from a licensed supervisor when necessary. I will not provide evaluations or testimony in a court case involving divorce or custody because it might damage your case and because it would affect our therapeutic relationship.
Your signature below acknowledges that you have read and understood this document.
Client signature: ____________________________________Date:_______________________
Therapist signature: ___________________________________Date:______________________