University of Hawaiʻi at Hilo Counseling Services Consent Form
The Counseling Process is designed to help you address your concerns and come to a greater understanding of yourself. It involves a relationship between you and a counselor who will work with you to accomplish your goals. You will be meeting with a professional counselor or an intern under the supervision of the professional staff. In the counseling process, you may be sharing sensitive information. Sometimes there are periods of increased anxiety or confusion during the course of counseling. As part of therapy, you will have the opportunity to learn effective coping strategies, stress reduction exercises and interpersonal communication skills. Outcome of counseling is often positive; however, the level of satisfaction for any individual is not predictable. Counseling Services practices a brief model intervention and continuity of care may be reviewed after eight sessions. Your therapist is available to support you throughout the counseling process.
- Other than the exceptions to confidentiality listed below, all interactions with Counseling Services, including scheduling of or attendance at appointments, content of your sessions, progress in counseling, consultation during supervision and your records are confidential. No record of counseling is contained in any academic, educational, or job placement file. You may request in writing that the counseling staff release specific information about your counseling to persons you designate. You may also request in writing that counseling staff be allowed to obtain or discuss information about your medical or psychological status or history from relevant third parties such as doctors, psychotherapists, school personnel, parents, family members and/or other associates.
Exceptions to Confidentiality:
- The counseling staff works as a team. Your therapist may consult with other counseling staff to provide the best possible care. Interns may also consult with professors and peers in a graduate counseling program.
- If there is evidence of clear and imminent danger of harm to self and/or others, a counselor is legally required to report this information to third parties responsible for ensuring safety.
- Hawaiʻi State law requires that staff of Counseling Services who learn of or strongly suspect physical or sexual abuse of a child or elder must report this information to Child Protection Services (for child abuse) or Adult Protection Services (for elder abuse).
- A court order, issued by a judge, may require the Counseling Services staff to release information contained in records and/or require a therapist to testify in a court hearing.
- Student's Responsibilities
- We appreciate prompt arrival for appointments. You are asked to contact the office if a situation occurs that will delay you or require you to reschedule an appointment. If you do miss an appointment, it is your responsibility to contact the office to confirm your next appointment – otherwise the time may be used for another student. Your participation in counseling is voluntary. You can choose to start and end a counseling relationship at anytime as well as switch to another counselor. Notifying our office would be greatly appreciated prior to ending the relationship. You may also be asked to participate in a short survey to provide our center with valuable feedback on how to improve our services.
There is no fee for counseling services in our office.
I have read the above information. I understand the risks and benefits of counseling, the nature and limits of confidentiality, and what is expected of me as a client of Counseling Services.
Print Signature Date
Witnessed Print Signature Date