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    Informed Consent Form

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    ALAKA RAJEEV 1930317
    This informed consent form summarizes the counselling process and issues of confidentiality for a client receiving counselling from a trainee counsellor. Counselling aims to help the client address concerns and learn coping strategies, and involves sharing private information. There are exceptions to confidentiality if the client poses a danger to themselves or others. Sessions may be recorded for training purposes, but identities will remain confidential. The client consents to these terms by signing the form.

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    Informed Consent Form

    Uploaded by

    ALAKA RAJEEV 1930317
    1K views2 pages
    This informed consent form summarizes the counselling process and issues of confidentiality for a client receiving counselling from a trainee counsellor. Counselling aims to help the client address concerns and learn coping strategies, and involves sharing private information. There are exceptions to confidentiality if the client poses a danger to themselves or others. Sessions may be recorded for training purposes, but identities will remain confidential. The client consents to these terms by signing the form.

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    This informed consent form summarizes the counselling process and issues of confidentiality for a client receiving counselling from a trainee counsellor. Counselling aims to help the client address concerns and learn coping strategies, and involves sharing private information. There are exceptions to confidentiality if the client poses a danger to themselves or others. Sessions may be recorded for training purposes, but identities will remain confidential. The client consents to these terms by signing the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views2 pages

    Informed Consent Form

    Uploaded by

    ALAKA RAJEEV 1930317
    This informed consent form summarizes the counselling process and issues of confidentiality for a client receiving counselling from a trainee counsellor. Counselling aims to help the client address concerns and learn coping strategies, and involves sharing private information. There are exceptions to confidentiality if the client poses a danger to themselves or others. Sessions may be recorded for training purposes, but identities will remain confidential. The client consents to these terms by signing the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    INFORMED CONSENT FORM

    COUNSELLING is a confidential process designed to help you address your


    concerns, come to a greater understanding of yourself, and learn effective personal and
    interpersonal coping strategies. You are working with a trainee counsellor who is under
    supervision from a faculty at the Sampurna Institute of Advanced Studies.

    Counseling involves a relationship between you and the trainee counsellor who has
    the desire and willingness to help you accomplish your individual goals. Counselling
    involves sharing sensitive, personal, and private information that may at times be distressing.
    During the course of this counselling experience, if you experience any periods of increased
    anxiety or confusion, please discuss it with your counselor.

    The trainee counselor is available only during specific times and at other times in case
    of any help you can contact Montfort Counselling Centre (MCC) - 080- 2528 4050/ 3320/
    6666

    CONFIDENTIALITY:

    All counselling Services, including scheduling of or attendance at appointments,


    content of your sessions, progress in counselling, and your records are confidential. No
    information would be used without your prior permission.

    EXCEPTIONS TO CONFIDENTIALITY:

    ● The counsellors work as a team. Your therapist may consult with other counsellor /
    supervisors to provide the best possible care. These consultations are for professional
    and training purposes however your identity would not be revealed.
    ● If there is evidence of clear and imminent danger or harm to self and/or others, a
    therapist is legally required to report this information to the authorities responsible for
    ensuring safety.
    ● Disclosure of information, if required by law.
    I have read and discussed the above information with my counsellor. I
    understand the risks and benefits of counseling, the nature and limits of confidentiality,
    and what is expected of me as a client of the Counseling Services.

    _____________________

    Signature of Client with date Signature of Trainee counselor

    Purpose and Use of Recordings: As part of their professional training, graduate


    students perform counseling under the supervision of University/faculty members and/or
    field placement supervisors. To facilitate this training, counseling sessions are sometimes
    recorded on an audio or video device. Students use such recordings to review their own
    performance as counselors-in-training. Their counseling performance may also be reviewed
    by their supervisor(s) and other trainees in a small group setting. All recordings are erased
    after they are reviewed.

    I have read and understand the above statements regarding confidentiality,


    recording, and supervision of my sessions (or the sessions of my child). I give my
    permission for the sessions to be recorded for training purposes as described above. I
    further understand that I can withdraw this permission at any time.

    _____________________ _______________________

    Signature of Client /parent/guardian/teacher with date Signature of Trainee counselor

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