I/we agree to the following:
Confidentiality is an ethical guideline essential to the safety, trust, and ability to work openly and effectively in our work together. Due to the nature of highly personal disclosure that often takes place in psychotherapy it is never appropriate for me, as your therapist, to disclose any information which you have shared with me in the course of our work together. If I consult with other professionals, I will always take every precaution to guard your anonymity and the anonymity of those people and circumstances in relationship to you.
Exceptions to Confidentiality:
In our work together we decide that it would be helpful for me to speak to or otherwise include another person in professional or personal collaboration in your treatment, and you have signed a Release of Information Form.
If, after careful assessment I determine that you are A.) At risk of, or a danger to taking your own life or B.) At risk of or a danger to taking the life of another human being. Under these circumstances, I have a duty to inform law enforcement of that danger.
If, after careful assessment and information gathering, I deem that the life a child/minor or elder is at risk or I suspect elder or child abuse, I have a duty to inform law enforcement of that threat.
By typing my name below, I agree to and acknowledge the confidentiality agreement above.
