Therapy Agreement



Confidentiality means that your therapist has a responsibility to safeguard information obtained during therapy. All identifying information about your assessment and treatment is kept confidential, except as mandated by law. In certain situations, mental health professionals are required by law to reveal information obtained during therapy to other persons or agencies. Please note confidentiality does not apply to:


• Cases of suspected abuse/neglect of children or the elderly.

• Cases deemed an imminent potential harm to self or others.

• Cases involving criminal proceedings.

• Confidentiality may not apply in cases involving legal proceedings affecting the parent-child relationship.

• Confidentiality may not apply to cases involving a minor child. In such cases, the mental health professional may advise a parent, managing conservator or guardian of a minor, with or without minor’s consent, of the treatment needed by or given to the minor.


Cancellation policy


Please give as much notice as possible if you need to cancel or re-schedule your appointment. A missed appointment is a loss to three people; the client who missed the valuable time, another client who could have used the valuable time and the clinician who was prepared for the treatment. There is a 50% cancellation fee if you cancel or reschedule your appointment with less than 48 hours’ notice as this often means that another client will miss out on this appointment time. If you fail to attend your appointment without notice, you will be billed for the full appointment fee/lose that prepaid session.


Commitment to Therapy


Through the duration of therapy, your therapist will commit to assessing your individual circumstances and providing the appropriate therapy for your needs. They will commit to do the best to assess progress and provide referral to other sources if deemed necessary. One major benefit that may be gained from participating in therapy is the resolution of the concerns brought to therapy. Other possible benefits may be a better ability to cope with marital, family and other interpersonal relationships, and /or a greater understanding of personal goals and values. In signing this agreement, you, the client, accept that a large part of the gains of therapy is in the commitment to the process. It is understood that if treatment is cut short or sessions frequently cancelled, resulting in an interrupted stop-start therapy process; this may negatively impact expected outcomes. Psychotherapy is a collaborative process and the progress you make will depend in large measure upon your investment in the process.


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