[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-168412-105":53,"doc-detail-168412-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","sample-informed-consent-for-psychotherapy","Sample Informed Consent for Psychotherapy","","Sample informed consent template for psychotherapy provided by the APA Practice Directorate. It explains how clients acknowledge review and understanding of psychological services, including authorization to share information with insurers when insurance reimbursement is used. The template covers therapist credentials, offered services, evaluation process, psychotherapy expectations, and the potential benefits and risks, while emphasizing no guarantees and encouraging questions. It also details confidentiality limits, mandatory reporting, court orders, safety-related disclosures, fee structure, payment timing, and cancellation and unpaid-account policies.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/sample-informed-consent-for-psychotherapy/168412/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/sample-informed-consent-for-psychotherapy/168412.png","ImageObject",442,249,{"name":88,"@type":89},"Chloe Bennett","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-09-23","2026-09-01",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What does signing the informed consent form authorize?","Question",{"text":108,"@type":109},"By signing, the client acknowledges reading and understanding the information and that questions were answered. If insurance benefits are used, the client also authorizes sharing information with the insurance company as described in the insurance section.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How are therapy needs evaluated, and what happens after evaluation?",{"text":113,"@type":109},"The first sessions focus on evaluating the client’s needs, typically lasting a specified number of sessions. Afterward, the therapist discusses whether they are the right fit and offers a treatment plan, with referrals if another therapist is better suited.",{"name":115,"@type":106,"acceptedAnswer":116},"What are the main confidentiality exceptions?",{"text":117,"@type":109},"Information is kept confidential unless written permission is provided, with exceptions such as legal requirements to report suspected abuse or neglect, disclosure compelled by court order, actions needed to ensure safety if there is risk of harm, and consultations with other professionals to provide appropriate care while avoiding identifying details.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},168412,1788230965,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":125,"read_time":73},962084925782,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Sample Informed Consent for Psychotherapy\nBy the APA Practice Directorate\nPlease Note: This is a sample informed consent document only and does not constitute legal advice. You must ensure that your informed consent form incorporates your own state’s laws and regulations, and we recommend that you consult with an attorney to ensure your informed consent form complies with all applicable laws and regulations. The information in this sample consent should not be used as a substitute for obtaining personal legal advice and consultation.\nIntroduction\nWelcome! This document outlines the important details regarding the psychological services I offer in my private practice. Please read this information carefully and ask any questions you may have before signing below. By signing this form, you acknowledge that you have read and understood this information and that you have had all your questions answered. If you elect to use your insurance benefits, as described in the section below called Insurance Reimbursement, then by signing this form you are also giving me permission to share your information with your insurance company.\nAbout Me\nMy name is [Your Name], and I am a licensed psychologist in the state of [Your State].\nMy license number is [Your License Number].\nYou can find more information about my qualifications and experience on my website at [Your Website] (optional).\nServices Offered\nI provide individual therapy for [adults (ages 18+) or children (under 18)] experiencing a variety of challenges, including [list a few common areas you specialize in, e.g., anxiety, depression, relationship issues].\nI utilize [list your primary therapeutic approaches, e.g., cognitive-behavioral therapy, mindfulness-based therapies].\nI do not offer [list services you do not provide, e.g., medication management, court-ordered evaluations].\nEvaluation\nThe first few sessions will involve my evaluation of your needs. This evaluation typically lasts [insert range] sessions.\nBy the end, we will discuss if I am the right therapist for you and I will offer a treatment plan.\nI will refer you to another therapist if I believe someone else is better suited.\nPsychotherapy\nPsychotherapy is a collaborative effort that requires active participation from you.\nThe approach used will vary depending on your needs and it may involve discussing uncomfortable topics.\nThere are no guarantees about the outcome of therapy, but studies have shown psychotherapy to be helpful to those who undergo it.\nBenefits and Risks of Therapy\nTherapy requires a significant investment of time, money, and energy. Therapy can be a helpful and effective way to address emotional and behavioral difficulties.\nPotential benefits of therapy include improved mood, reduced stress, better coping skills, and enhanced relationships.\nHowever, therapy can also involve some emotional discomfort as you explore challenging issues.\nThroughout any therapy sessions, I encourage you to ask questions. Also, feel free to seek a second opinion at any time.\nConfidentiality\nAll information discussed in therapy sessions will be kept confidential, unless you give me written permission to share such information, with some exceptions as outlined below.\nI may be required by law to report suspected abuse or neglect, for example regarding children, elders, or disabled adults. [Please note: Mandatory reporting laws vary by state. In some states, not all suspected abuse would be mandated for reporting by law. It is always recommended that you review the relevant laws and regulations in the state(s) you are practicing concerning your state’s specific mandatory reporting requirements.]\nI may also be required to disclose information if compelled by a court order.\nIf I believe you may harm yourself or others, I may need to take steps to ensure your safety or the safety of others.\nI may consult with other professionals about your case to help provide you with appropriate care. If I do such consultations, I will make every effor","cbCaii12gxwbffHD","https://ap.wps.com/l/cbCaii12gxwbffHD","docx",33390,"English","# Introduction\n## Services Offered\n## Evaluation\n## Psychotherapy\n## Benefits and Risks of Therapy\n## Confidentiality\n## Fees\n## Payment","[{\"question\":\"What does signing the informed consent form authorize?\",\"answer\":\"By signing, the client acknowledges reading and understanding the information and that questions were answered. If insurance benefits are used, the client also authorizes sharing information with the insurance company as described in the insurance section.\"},{\"question\":\"How are therapy needs evaluated, and what happens after evaluation?\",\"answer\":\"The first sessions focus on evaluating the client’s needs, typically lasting a specified number of sessions. Afterward, the therapist discusses whether they are the right fit and offers a treatment plan, with referrals if another therapist is better suited.\"},{\"question\":\"What are the main confidentiality exceptions?\",\"answer\":\"Information is kept confidential unless written permission is provided, with exceptions such as legal requirements to report suspected abuse or neglect, disclosure compelled by court order, actions needed to ensure safety if there is risk of harm, and consultations with other professionals to provide appropriate care while avoiding identifying details.\"}]","Sample Informed Consent for Psychotherapy | DOCX"]