Professional Disclosure: I understand that my counselor is a Master’s level mental health clinician, practicing with a license issued from the State of Arkansas and not a medical doctor, or a doctor of Psychology. My counselor’s primary role is to provide professional counseling services. If I have questions, I am welcome to ask for clarification of my counselor’s credentials, specializations, and training.
Risks and Benefits: I am aware that there are both risks and benefits to counseling. While most people experience some level of distress that leads them to seek counseling, it should be understood that when a counselor and client are working towards the goals of counseling, distress, problems in relationships, and other unforeseen circumstances may arise. It is also understood that a goal of counseling will be to alleviate or manage these potential stressors, but an exacerbation of problems may occur. The benefits of therapy may include, but are not limited to, the diminishing of symptoms, distress, relationship growth and a general sense of well-being. However, individual results are not predictable and may vary.
Limits of Confidentiality: I understand that confidentiality is not absolute, that in some circumstances my counselor may be required by law or by the ethical standards of the American Counseling Association to share information about my case. Information may be released without my consent in situations where there is reason to believe I might harm myself or others, in the case of actual or suspected abuse of a child, elder or handicapped person. For the purpose of case consultation, my information may also be discussed with others associated with Still Waters Family Counseling and/or with supervisors/other supervisee.
Emergency Notification: My counselor can be called in the case of psychological emergencies. However, he will not always be available by phone or in the evenings. If I cannot reach my counselor I can call 911 or go to the nearest emergency room.
I have read and understand the above information and agree to receive counseling for myself or for my child. I also give consent for my mental health clinician to leave a voicemail, text my phone, or contact me via email, as needed.