Psychotherapy is confidential, with the below stated exceptions.
Duty to Warn: Therapists are mandated by law to disclose pertinent information
discussed in therapy if the client has an intent or plan to harm another person. We
are required to inform the intended victim and notify legal authorities.
Suicide/Self harm: Depression is common emotion expressed in therapy, but if a
client is feeling hopeless enough to imply or disclose a plan for suicide; steps need to
be taken to ensure safety.
This would include notifying the legal authorities as well as make reasonable
attempts to notify the family.
Animal abuse: I will report animal abuse, including cases of neglect and hoarding.
Vulnerable Adults and Children: Mental health professionals are required by law to
report stated or suspected abuse of a child or vulnerable adult to the appropriate
social service agencies and/or legal authorities.
Prenatal Exposure to Controlled Substances: in keeping with protecting vulnerable
populations, Mental Health Providers are required to report admitted use of
controlled substances during pregnancy that are potentially harmful to the fetus.
Minors/Guardianship: Parents or legal guardians have the right to access a minor
client’s health information. Age of adult for psychotherapy is .
Insurance Providers: Information requested includes description of impairments,
dates and times of service, diagnosis, treatment plans, treatment progress,
prognosis for improvement, case notes and summaries.
I have read and understand the above-stated limitations to confidentiality. I accept
the subsequent ramifications should there be a need to act on one of the abovestated exceptions. Other than the noted exceptions, if there are reasons to disclose
my protected confidential information I understand that I will be provided a Release
of Information form.