Informed Consent for Treatment

Please read the following information carefully and provide your consent to receive therapy services.

About Therapy Services

Psychotherapy is not easily described in general statements. It varies depending on the personalities of the therapist and client, and the particular problems you are experiencing. There are many different methods I may use to deal with the problems that you hope to address. Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part.

In order for the therapy to be most successful, you will have to work on things we talk about both during our sessions and at home. Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness.

On the other hand, psychotherapy has also been shown to have many benefits. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience.

About EMDR Therapy

Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based therapy approach that helps process traumatic memories and reduce their emotional intensity. During EMDR sessions, you will be asked to focus on a traumatic memory while following bilateral stimulation (such as eye movements, taps, or sounds).

EMDR may cause temporary disturbances such as heightened emotions, physical sensations, or vivid dreams between sessions. These are normal parts of the healing process and typically diminish as treatment progresses.

Confidentiality

In general, the privacy of all communications between a client and a therapist is protected by law. I can only release information about your treatment to others if you sign a written Authorization form that meets certain legal requirements.

However, there are some exceptions required by law:

If I believe there is a risk of harm to yourself or others
If there is suspected abuse or neglect of a child, elderly, or disabled person
If a court order requires disclosure
If you are involved in a legal proceeding and a judge orders disclosure

Cancellation Policy

24-Hour Notice Required: If you need to cancel or reschedule an appointment, please provide at least 24 hours notice.

Late cancellations (less than 24 hours) or missed appointments ("no-shows") will be charged a fee of $50, which cannot be billed to insurance.

Communication & Emergencies

I am often not immediately available by telephone. When I am unavailable, my telephone is answered by voicemail. I will make every effort to return your call within 24 hours.

In case of emergency: If you are experiencing a mental health emergency, please call 911 or go to your nearest emergency room. You may also call the National Suicide Prevention Lifeline at 988 (available 24/7).

Acknowledgments

I have read and understand the information about therapy services, including the benefits and risks of treatment. I understand that confidentiality has limits as described above, and I have had the opportunity to ask questions about confidentiality. I understand the 24-hour cancellation policy and agree to pay the $50 fee for late cancellations or missed appointments. I understand that I have the right to ask questions about my treatment and to terminate therapy at any time. I consent to receive psychotherapy services from Janet Mitchell, LCSW at Journey Ahead Resources, LLC.

Electronic Signature

Full Legal Name *

Today's Date *

By typing your name above, you are providing an electronic signature with the same legal effect as a handwritten signature.

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