Please fill out this form prior to your first visit with your therapist. This form is an initial way for the therapist to gather information about what your child/family is experiencing, what they may need, and how the therapist can best collaborate with you all. This information is confidential, and may be accessible by a minors parent or guardian. Access to this information can be limited/denied if the parents/guardians are willing to consent to waive access to the child’s records. This will be discussed further if needed. All information will be used for general assessment. In most cases therapist will not provide diagnosis. Therapist honors that sharing personal information in this way can be difficult and they will read this narrative with non-judgement and respect. If the child is 14-18 years of age they may fill out this form on their own.
Beyond all of this, I will look at your child as a whole person. I believe you know your child better than any “expert” and I respect and honor the challenges of being a parent. Though I will maintain confidentiality between myself and your child, I will work to collaborate with parents/guardians if necessary. The limits to confidentiality include if a child has expressed that someone has harmed them, they are thinking of harming themselves, or they are thinking of harming someone else, then it is my duty to breach confidentiality with those who are of concern. If your child is having difficulty and I see it would be best to express this to their parent/guardian I will work with the child to support them in communicating to their parents/guardians what is currently effecting them. I will not pathologize or diagnose them. I will not judge them. I will not engage in any limiting beliefs about who they are. I will do my best to always be present with them, offer playful opportunities to express themselves and respond to them with compassion.