I am a Counseling Psychologist, I have prepared this letter to inform you about my policies, as well as your own rights as a client. Please read it carefully and clarify any questions you may have.
As my client, first and foremost, you have the right to complete confidentiality. This is the foundation of a safe and effective psychotherapy relationship. I will not share with anyone (except my supervisors, without revealing your identifiers) anything that you say to me, and I will not reveal to anyone whether or not you are a client of mine.
You should be aware, however, that there are a few situations in which I cannot guarantee confidentiality, which is as follows. I would always let you know before taking any of the actions described below.

• If I believe that you are at serious risk of suicide, I may break confidentiality in order to protect you. I would explore all other options with you before doing this, and if at that point you were unwilling to take steps to ensure your safety, I would have to take action to make sure that you were protected from harming yourself.
• If you tell me that you are seriously planning to hurt an identifiable person, and I have reason to believe that you will follow through with it, I will try to inform that person and protect them from harm.
• If you tell me about a child or dependent adult who is being abused or neglected, then I am legally required to take steps to protect that child or adult by reporting this information to the legal authorities.
• If you request that I coordinate care with another care provider In our first session(s), I will ask questions to try to get a sense of what brings you into therapy. I will do an assessment that will require you to share your family history, life story, etc. We will talk together about a plan for your time in therapy and discuss what you want out of therapy. I may ask you about things that you do not normally feel very comfortable thinking about or feeling. You have the right to decide what you are comfortable sharing and may choose not to discuss certain topics. However, sometimes it is helpful to push yourself a little and see whether some benefit may come from enduring the discomfort.