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Limits of Confidentiality: Please Read and Sign

Everything shared with a therapist is confidential except if you share:

1) Suicidality: A desire to harm yourself with the intention of potentially ending your life. If you have devised a plan, and have the means to carry out that plan, a therapist has the legal and ethical obligation to protect you from yourself. This includes breaking confidentiality to get you additional help.

2) Homicidal Intent: If you share with your therapist a desire to hurt or harm someone else, your therapist has a legal duty to warm that person and contact the authorities. This does not include figures or speech or expressions of frustration. There must be an expressed intent to harm with the means to carry out that threat.

3) Child Abuse/Neglect: A child is anyone under the age of 18. If your share that a child is being abused or neglected, your therapist must contact the Department of Child and Family Services to report the abuse.

5) Physical abuse is defined as any striking of a child (grabbing, pushing, shaking, etc..) above and beyond open hand spanking on the buttocks. A swat on the buttocks CANNOT leave a lasting mark or else it is considered abuse.

6) Neglect involves an absence of adequate care for a child. This includes but is not limited to a lack of nutrition, inadequate clothing, dirty home, lack of supervision, leaving a child in dangerous situations, or with dangerous people.

7) Sexual abuse: Sexual contact by someone over the age of 17 with someone under the age of 18. This includes large age discrepancies between minors (someone 13 years old cannot legally give consent to having sexual contact with a 17-year-old). The age difference for consent is 2 years between minors.

8) Domestic violence between adults is considered abuse. Physical altercations between adults in the presence of minors is considered abuse and will be reported to the Department of Family and Children?s Services.

9) Elder Abuse: Anyone physically, emotionally, or financially abusing an elderly person (over the age of 65) will be reported to Adult Protective Services. THIS INCLUDES neglecting the needs of an elderly person in your care (family members, home health workers, etc.) This includes but is not limited to a lack of nutrition, inadequate clothing, dirty home, lack of supervision, leaving an elderly adult in dangerous situations or with dangerous people.

PLEASE SIGN THAT YOU HAVE READ AND UNDERSTAND THE LIMITS OF CONFIDENTIALITY:

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