Confdentially Statement
My responsibilities to you:
With the exception to California law of specific legal circumstances described below, your therapy will be held with absolute confidentiality. I cannot and will not disclose what we discuss in session, or that you are even in therapy, without your direct written permission.
The following are legal exceptions to your right to confidentiality. I will inform you when I need to act on this. I am legally and ethically bound to inform the proper law enforcement agency:
1. If I have good reason to believe that you will harm another person, I must attempt to inform that person and warn them of your intentions. I must also contact the police and ask them to protect your intended victim.
2. If I have good reason to believe that you are abusing or neglecting a child or vulnerable adult, or reveal information about someone else who is doing this, I am legally bound to inform Child Protective Services and Adult Protective Services.
3. If I believe that you are in imminent danger of harming yourself, I may legally break confidentiality and call the police or the appropriate agency. I am not obligated to do this, and would explore all other options with you before I took this step. If at that point you were unwilling to take steps to guarantee your safety, I would call the appropriate agency.
These are exceptions that will be identified to you should any such situation arise during therapy.
Your rights as a client:
1. You are entitled to information about my methods of therapy, techniques I use, the duration of therapy (if it can be determined), as well as my fee structure, per the CA Health and Safety Code ยง 123105. Please feel free to ask if you would like this information or if you have any additional questions.
2. You are entitled to seek a second opinion from another therapist or terminate therapy at anytime.
3. In a professional relationship (such as ours), sexual intimacy between a therapist and client is never appropriate and should be reported to the Department of Mental Health.
4. Confidentiality with the limits allowed by the California law.
5. I am mandated to comply with the U.S. Government regulations concerning the protection of medical information as specified in the Health Insurance Providers Accountability Act (HIPAA). Accordingly, you will be asked to sign HIPAA Confidentiality statement and given a copy of it.