Informed Consent for Grief and Loss Counseling and Support (individual or group)
The therapeutic relationship is unique in that it is a highly personal and, at the same time, a contractual agreement. Given this, it is important for us to understand how our relationship will work and what each of us can expect. Feel free to discuss any of this with me. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.
The Therapeutic Process
Participation in grief and loss counseling can result in several benefits to you, including improving relationships and integrating your specific loss into your life today. I will ask for your feedback and views on your grief and loss counseling throughout our time together. Sometimes, more than one approach can help deal with a particular situation. During grief and loss counseling, remembering or talking about your loss and the associated feelings or thoughts can result in you experiencing considerable discomfort or strong feelings of anger, sadness, worry, fear, etc., or experiencing anxiety, depression, insomnia, etc. I cannot guarantee a specific outcome. During grief and loss counseling, I am likely to draw on various approaches according, in part, to your particular type of loss and my assessment of what will best benefit you. Please feel free to discuss these matters with me in more detail.
Confidentiality
The session content and all relevant materials to the client’s grief and loss counseling will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client-held privilege of confidentiality exist and are itemized below:
- If a client threatens or attempts to commit suicide or otherwise conducts themselves self 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 victim is the perpetrator, observer of, or actual victim of physical, emotional, or sexual abuse of children under the age of 18 years.
- Suspicions, as stated above, in the case of an elderly person who may be subjected to these abuses.
- Suspected neglect of the parties named in items #3 and # 4.
- If a court of law issues a legitimate subpoena for information stated on the subpoena.
Occasionally, I may need to consult with other professionals in their areas of expertise to provide the best treatment for you. Information about you may be shared in this context without using your name.
By signing below, I am agreeing that I have read, understood, and agree to the items contained in this document: