Arianne S.
Alvarez August 9, 2021
Advanced Counseling and Psychotherapy Assignment 2
Informed Consent for Counseling and Psychotherapy
Welcome
Hello there, Brave one!
Thank you for stepping-out in faith to seek help. I believe in the quotation that there are “No
hopeless cases, only hopeless clients.” The healing that you seek now begins. Acknowledging
that you need help is 1-big step to your healing. I will do my best with God’s help to be with you
in your way to recovery and wholeness. For I believe, that there is no impossible to the One who
believes. I hope and pray that you will find it delightful to partner with me as we help you
rediscover yourself and bring the best out of what situation you are in right now.
Congratulations!
Therapist
I am Arianne Santos Alvarez, a therapist trainee under the supervision of Dr. Armando Fabella,
is currently taking MA Psychology major in Counseling at Adventist University of the
Philippines. I graduated in the said University with a degree of AB Psychology. I am now a
Registered Psychometrician, a Certified Life Coach, and a School Guidance Teacher. Counseling
is a gift of God that I gladly share with others. Knowing our Saviour Jesus Christ and learning
from Him helped me to see the beauty of what Counseling could do to a person. I am a Mental
Health advocate since the breakthrough that happened to my family. I love empowering people
to realize how unique and wonderful they are and helping them see that they have hope.
Number and Length of Sessions
There will be 6 sessions to be done. Initial consultations are 60 minutes, and sessions thereafter
are 45-50 minutes.
Fees/Payments
The cost of initial session is P1,500.00 and the cost of follow-up sessions is P1,000.00. Rates for
professional appearances, i.e., court, depositions, school conferences, psychoeducation etc., are
also P1,000.00 per hour.
Appointments and Cancellations
Appointments are made by calling this mobile number 0912-203-8663 or 0965-800-6378,
Monday to Friday, 9:00 am to 5:00 pm. Please call to cancel or reschedule at least 24 hours in
advance, or you will be charged P500.00 for the missed appointment and the absence will be
marked on the record
Termination of Treatment
Clients have the right to refuse or discontinue services at any time. In addition, your therapist
may terminate treatment if payments are not made, if there is non-compliance with medication,
treatment recommendations, and if the client is not coming to session sober. Your therapist may
also refer you if, during the course of treatment, another problem emerges which is not within the
scope of practice of the therapist.
Availability
Your therapist is available for regular scheduled appointment time. Dates of vacations, and other
exceptions, will be given out in advance when possible. If you have an immediate need to speak
with your therapist, please give them a call.
Relationship
Your relationship with the therapist is a professional and therapeutic relationship. In order to
preserve this relationship, it is imperative that the therapist not have any other type of
relationship with you. Personal and/or business relationships undermine the effectiveness of the
therapeutic relationship. The therapist cares about helping you but is not in a position to be your
friend or to have a social and personal relationship with you. Gifts, bartering and trading services
are not appropriate between you and the therapist.
Goals, Purposes, and Techniques of Therapy
There may be multiple interventions to effectively treat the problems that you are experiencing.
It is important for you to discuss any questions you may have regarding the treatment
recommended by the therapist and to have input in setting goals of your therapy. As therapy
progresses, these goals may change.
Confidentiality
Discussions between a therapist and a client are confidential. No information will be released
without the client’s written consent unless mandated by law. Possible exceptions to
confidentiality include but are not limited to the following situations: child abuse; abuse of the
elderly or disabled; abuse of patients in mental health facilities; sexual exploitation; AIDS/HIV
infection and possible transmission; criminal prosecutions; child custody cases, suits in which
the mental health of a party is is in issue; situations where the therapist has a duty to disclose, or
where, in the therapist’s judgment, it is necessary to warn, notify, or disclose; fee disputes
between the therapist and the client; a negligence suit brought by the client against the therapist;
or the filing of a complaint with a licensing board or other state or federal regulatory authority.
Note that the therapist is a trainee that needs supervision; thus, it is possible for her to discuss
with her supervisor your case for a thorough and reliable assessment. Your identity here is
securely protected.
Risks of Therapy
Therapy is the Greek word for change. Clients often learn things about themselves that they
don’t like. Often growth cannot occur until past issues are experienced and confronted, often
causing distressing feelings such as sadness and anxiety. The success of therapy depends upon
the quality of the efforts of both the therapist and client, along with the reality that clients are
responsible for the lifestyle choices/changes that may result from therapy. Countertransference is
ensured by the Counselor not to
Audio/Video Recording
Audio/Video recording will be made in every session. These recordings will be used to aid the
counseling process and to gain further understanding of important aspects of the treatment. Also,
these will serve as a protection reference between the client and therapist dignity. The
audio/video file(s) will be treated with confidentiality by being stored on a password protected
computer. Also, I will be recording some notes to document important points from the
Counseling dialogue.
Consent to Treatment
By signing Informed Consent, you voluntarily agree to receive mental health assessment, care,
treatment or services and authorize the therapist to provide such care, treatment, or services as
are considered necessary and advisable. Signing indicates that you understand and agree that you
will participate in the planning of your care, treatment, or services, and that you may stop such
care, treatment or services at any time. By signing the informed Consent, you acknowledge that
you have both read and understood all the terms and information contained herein. Ample
opportunity has been offered for you to ask questions and seek clarification of anything that
remains unclear.
_______________________________ _______________________________
Client’s Signature Over Printed Name Date
_______________________________
Arianne S. Alvarez, RPsy, RPm, RGC
