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CREATIVE THERAPY FOR CHILDREN AND ADOLESCENTS

INFORMED CONSENT FOR CHILDREN/ADOLESCENTS

The purpose of this form is to share some important principles, which guide my counselling practice so that your decision to place your child into counselling with me can be based on accurate, informed expectations. Please read this carefully and feel free to ask any questions about what you have read or to have further clarification.

I will meet with parent/s of the child whenever possible before I start to work with your child. I would like to recommend a starting point of eight sessions and explain this to your child at the first session. After six sessions it would be useful to schedule in a telephone conversation with the parent/s of the child that I am working with to gather any feedback from the parent/s and discuss if another eight sessions would be valuable for your child. The reason this is discussed at session six is because if the sessions were to come to an end at session eight, then a thorough ending needs to be addressed with your child.

Counselling can have benefits and risks. Since therapy often involves discussing unpleasant aspects of one’s life. Your child may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness. Conversely, counselling has been proven to have benefits for individuals who go through the therapeutic process. Therapy can lead to better relationships, solutions to specific problems, significant reductions in feelings of distress and improved self-esteem. But there are no guarantees of what they will experience. Counselling is a personal exploration and may lead to major changes in their life perspectives and decisions. Together you, your child and I will work to achieve the best possible results for him/her.

 

CONFIDENTIALITY

In general one of the most important rights the person seeking counselling has involves confidentiality, even if its a young child.   Information revealed by a client during the counselling will be kept strictly confidential and will not be revealed to any other person or agency without written permission, with the following exceptions:

In order to maintain professionalism counsellors are required to be supervised by other counsellors. During these interactions, client anonymity is paramount.

Confidentiality has some legal limits as well. There are situations where the counsellor can be required to reveal information obtained during therapy to another person without the parent or child’s permission. These situations involve danger to self, danger to others and child abuse. In addition, counsellor notes on sessions can be subpoenaed in a court of law.

In the event of a medical, psychiatric or psychological emergency. I ask that I can contact the child’s doctor in order to offer more thorough support.

 

CHILDREN AND CONFIDENTIALITY

Counsellors who work with children have the difficult task of protecting the child’s right to privacy while at the same time respecting the parent’s or guardian’s right to information.

Therapy is most effective when a trusting relationship exists between the counsellor and the child. Privacy is especially important in securing and maintaining that trust. One goal of treatment is to promote a stronger and better relationship between children and their parents. However, it is often necessary for children to develop a “zone of privacy” whereby they feel free to discuss personal matters with greater freedom. This is particularly true for adolescents who are naturally developing a greater sense of independence and autonomy.

It is my policy to provide you with general information about treatment status. I may raise issues that may impact your child or adolescent either inside or outside the home. If it is necessary to refer your child to another mental health professional with more specialised skills, I will share that information with you and seek your permission accordingly.

I will not share with you what your child has disclosed to me without your child’s consent. I will ask your child if there is anything that he or she may want to share with you at the end of the session At the end of your child’s treatment, we will review the sessions in general including what issues were discussed, what progress was made, and what areas are likely to require intervention in the future.

 

COUNSELLING RELATIONSHIP

It is helpful to remember that our relationship is professional and not social. Our professional relationship is of utmost importance as we work together towards achieving your goals and bringing resolution and healing to your child’s life.

 

CLIENT RIGHTS AND RESPONSIBILITIES

Both you and your child or adolescent are in compete control and may end the counselling relationship at any time, although I do ask that your child or adolescent participates in a termination session. I have been trained to a high standard to cause no psychological harm, however you both also have to right to refuse or discuss modifications of any of my counselling techniques or suggestions that you believe might be harmful.

 

FEES AND APPOINTMENTS

The standard individual counselling fee is £60.00 for a 50 minute session, payable by cash or cheque at the beginning or end of each session.

 

CANCELLATION

Please contact me if you discover that your child will not be able to keep an appointment. I require 24 hours notice of cancellation. if the appointment is not cancelled within the 24 hour period I would expect the full fee of the missed appointment.

 

ACKNOWLEDGEMENT AND CONSENT

By your signature below, you are indicating that you read and understood this consent form or that any questions you had about this consent form were answered to your satisfaction, and that you were given a copy of this document.


OBTAINING PARENTAL/GUARDIAN CONSENT

(Consent from both parents for the child to have therapy is preferred if possible).

 

FIRST PARENT/CARER CONTACT INFORMATION

I/we consent that my son/daughter under the age of 18 may be treated as a client by Emma Cohn


Name of child: ………………………………………………………

 

Name:…………………………………………………………………

 

Relationship to child:

 

Address:………………………………………………………………………

 

…………………………………………………………………………………

 

Contact Number:……………………………………………………………..

 

Email address:…………………………………………………………………

 

SECOND PARENT/CARER INFORMATION (IF APPLICABLE)

 

Name:……………………………………………………………………………

 

Relationship to child::…………………………………………………………..

 

Address:………………………………………………………………………….

 

…………………………………………………………………………………….

 

Contact Number:…………………………………………………………………

 

Email address: ……………………………………………………………………

 

MEDICAL INFORMATION

Any diagnosed conditions of child: ……………………………………………………………………………………………..

 

CHILD’S DOCTOR’S CONTACT DETAILS

 

…………………………………………………………………………………………

 

………………………………………………………………………………………….

 

CONSENT FOR TREATMENT OF CHILD

Parent/Guardian’s name(s) (please print)

 

…………………………………………………………………………………………

 

…………………………………………………………………………………………

 

Parent/Guardian’s Signature(s)

 

…………………………………………………………………………………………

 

………………………………………………………………………………………….

 

Date: ………………………………………………………….

 

I agree to adhere to the conditions set out above as a practicing, professional therapist.

 

Emma Cohn PG DIP – HCPC

 

…………………………………………………………………………………………

 

Date: ……………………………………………………………

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