Informed Consent for Therapy
The Therapeutic Process
Welcome! You have taken a very courageous step by deciding to seek therapy! Therapy is a collaborative process designed to support emotional, relational, and psychological well-being. As a Licensed Marriage and Family Therapist Associate, I take a relational and systemic approach, meaning we will explore not only your individual experiences but also the patterns, relationships, and contexts that shape your life.
Therapy outcomes largely depend on your willingness to engage in the process and may involve discussing difficult emotions, past experiences, and current challenges that could bring temporary discomfort. Sessions may include individuals, couples, families, or children, depending on your needs and desires. While many clients experience growth and relief, therapy is not a quick fix, and outcomes cannot be guaranteed. I will provide professional support and guidance throughout the therapeutic process.
The therapeutic relationship is unique in that it is both highly personal and contractual. This consent will provide a clear framework for our work together. Fees and cancellation policies are outlined in the Practice Policies document. Feel free to discuss any of these with me. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.
Client Rights
You have the right to:
Participate actively in your treatment
Ask questions about the therapy process
Refuse or discontinue services at any time
Request referrals to other providers
Receive respectful, non-discriminatory care
Review or request a copy of your records (subject to legal limitations)
Be informed of fees and policies
Confidentiality
The session content and all relevant materials (records) to the client’s treatment will be stored securely and held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Written authorization is required for release of information except where disclosure is required or permitted by law, including:
Risk of serious harm to yourself or others
Suspected abuse or neglect of a child, elderly, or vulnerable person
Court orders, subpoenas, or other legal requirements
Professional consultation for purposes of treatment (without identifying information when possible)
Therapist Credentials and Supervision
I am a Licensed Marriage and Family Therapist Associate in Texas, regulated by the Texas Behavioral Health Executive Council. I practice under the supervision of Emily Burrow, LMFT-S (#203755)
Your case may be discussed in supervision to support quality of care. All such discussions remain confidential in accordance with legal and ethical standards.
Termination of Services
You have the right to discontinue therapy at any time. When possible, we will discuss termination in advance and provide appropriate referrals to ensure continuity of care. Additional termination policies are outlined in the Practice Policies.
Emergency Procedures
This practice does not provide 24/7 crisis services. In an emergency, call 911, go to the nearest emergency room, or contact the 988 Suicide & Crisis Lifeline.
Complaints
If you have concerns about your care, you are encouraged to discuss them directly. You may also file a complaint with:
Texas Behavioral Health Executive Council
George H.W. Bush State Office Building
1801 Congress Ave., Ste. 7.300
Austin, Texas 78701
Main Line (512) 305-7700
Investigations/Complaints 24-hour, toll-free system (800) 821-3205