Informed Consent for Treatment


Person-Centered Psychiatry

192 Wilson Road, Wilton, NH 03086

Informed Consent for Treatment 


General Information

Medical treatment, including psychiatric care and psychotherapy services, is unique in that it is highly personal and at the same time provided through a contractual agreement. Given this, it is important to reach a clear understanding about how treatment will work, and what each of us (Person-Centered Psychiatry and you the Patient) can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with us. 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.


The Therapeutic Process

You have taken a very positive step by deciding to seek mental-health treatment. 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. We cannot promise that your behavior or circumstance will change. We can promise to support you and do our very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.


Confidentiality

The session content and all relevant materials to your (the patient's) treatment will be held confidential unless you request in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such patient held privilege of confidentiality exist and are itemized below:

  1. If a patient 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.
  2. If a patient threatens grave bodily harm or death to another person.
  3. If the provider has a reasonable suspicion that a patient 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.
  4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.
  5. Suspected neglect of the parties named in items #3 and # 4.
  6. If a court of law issues a legitimate subpoena for information stated on the subpoena.
  7. If a patient 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 we 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 treatment, we will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to us, and we do not wish to jeopardize your privacy. However, if you acknowledge us first, we will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of treatment sessions.