Wilde Counseling, LLC Informed Consent for Psychotherapy 

General Information 

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 reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. 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  the checkbox at the end of this document. 

The Therapeutic Process 

You have taken a very positive step by deciding to seek therapy. The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. I cannot promise that your behavior or circumstance will change. I can promise to support you and do my very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself. 

Fee Schedule

Fees are reviewed and modified annually to accommodate inflation, advancement training, and increased business expenses. Clients are notified of any change in fee 30 da prior to it taking effect. 

Confidentially 

The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such conte released to a specifically named person/persons. Limitations of such client held privilege  confidentiality exist and are itemized belo 

● If a client threatens or attempts to commit suicide or otherwise conducts themselves 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. 

● If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney. 

Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name.

If we see each other accidentally outside of the therapy office, I will not acknowledge  first. Your right to privacy and confidentiality is of the utmost importance to me, and I do wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak briefly with you, but feel it appropriate not to engage in any length discussions in public or outside of the therapy office.