In eight pages this disclosure agreement, which despite its variations from state to state but still contains the same basic informatioin, is examined in detail in terms of disclosure, authorization, confidentiality, and rights. Two sources are cited in the bibliography.
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the counselors must disclose upon introduction to the client and in turn what rights the clients have in terms of session, communication and report information which may or may not
be disclosed by the counselor. For the large part, clients information is only disclosed upon written authorization from the client. Confidentiality may not be guaranteed however in some situations which
include times when the client may be a serious threat to him or herself or others; when there is reasonable suspicion of child abuse or abuse of the elderly or
infirm; when a court order is issued; or when the information is used in defense to a formal complaint to the counselor among other instances. Professional disclosure statements begin with
information about the counselor(s) and then proceed to the confidentiality and disclosure rights of the clients. EXAMPLE SECTION A: COUNSELOR INFORMATION 1. Jane Smith, Ph. D. Licenced Professional Counselor
in Washington State 123 Maple Ridge Drive Capitol City, Washington 03456 Phone (100) 555-3456 2. Degrees: Ph. D. Psychology, American University, Washington, 1988 M.A. Psychology, American University, Washington, 1980 B.A.
Psychology, American University, Washington, 1975 Licenses: Psychologist, Washington Professional Corporation of Psychologists (#01234-98) Professional Counselor, Licenced Professional Counselors Examiners Board (#2345) Associations: American Psychological Association American Mental Health Counselors Association
International Society for Mental Health Online 3. Ranges of clinical services offered: individual psychotherapy, group psychotherapy, couples counseling, family counseling, business and employee assistance within corporations, rehabilitation counseling, career/life planning
and community education (MCCA, 2003). 4. Approaches to therapies include: traditional, holistic and alternative therapies, individual and group sessions, house calls for clients with special needs and outdoor sessions which
incorporate horticultural and art therapy (MCCA, 2003; Leclerc-Shafer, 2003). 5. Clients have the right to expect complete session confidentiality except as required by law: - threat of serious harm to