Policies, Forms, and Consent

Confidentiality is essential to the therapy process in that it provides you with a safe context within which you can discuss things that are personal and private. However, there are some exceptions to the rule and it is important that you understand what they are. Under the following circumstances your case will be discussed with others:

  • Sometimes it is important for me to discuss your situation with other professionals, your family, or others involved with you with whom consultation may be helpful. If I feel this is the case, I will talk it over with you, and if you agree, I will ask you to sign a “Release of Confidential Information” that will specify with whom, for what purpose, and what type of information will be discussed.
  • If I determine that there is a threat of violence to yourself or others, or if I learn of any abuse of children, spouse, elders, or others with whom you are involved, I am required both legally and ethically to make a report to the proper authorities.
  • In order to assure my clients of continued quality of care, I routinely review my caseload with other therapists with whom I have contracted for consultation. Whenever I am doing case review, however, I am careful to disguise identifying information.

Missed Appointments

If you need to miss a scheduled appointment please let me know as soon as you can so that I can make that hour available for someone else. I will ask you to pay for your missed session if you give me less than a 24 hour notice. If you miss more than a few, I will ask you if missed appointments reflect some ambivalence about therapy that would be worth exploring.

Your safety is of the utmost importance. If at any time you feel you are in danger of harming yourself or someone else, please do not hesitate to call me. However, since I am frequently unavailable, and am unable to return calls promptly, please understand that your safety is primarily your responsibility. If you can’t reach me and you feel the situation is urgent, then go to the nearest emergency room. Ask a friend to take you if you feel it is not safe for you to drive. If no one is available, then call 911 and tell the operator your location. Emergency personnel will come to help you. Remember, no therapist can guarantee your safety, so it is important that you know what steps to take if you feel you are at risk of hurting yourself or someone else.


If we decide to work together, I will ask you to fill out and sign several forms. These will include a “HIPAA Disclosure Form,” a “Personal Information Form,” and in some circumstances I may ask you to sign a “Release of Confidential Information.” Here’s a brief description of what information is included in these forms:

  • The “HIPAA Disclosure” form. HIPAA stands for “Health Insurance Portability and Accountability Act.” Among other things, HIPAA covers your health information privacy. The disclosure form includes a statement about the risks of email communication. It also includes information about the security, confidentiality and disposition of clinical records.
  • The “Personal Information Form” gives me a way of learning a lot about you quickly. It helps me to understand your concerns and goals, something about your interests, relationships, and your faith journey. I also ask about previous therapy, medications, and any potential risks to your safety.
  • The “Release of Confidential Information” form gives me your permission to discuss your case with particular individuals or agencies that we identify as important to your therapy. For example, if you are seeing a psychiatrist for medication management, we will need to be able to consult with each other.

Once all that’s clear and you’ve asked any questions you may have, if we decide to go forward, I’ll ask you to sign a “Consent for Treatment” that states that you understand and agree to my policies, that we’ve agreed upon a fee, and that we’ve agreed to work together.