Psychotherapy Informed Consent  Form
Professor Maurice Eisenbruch

Referral

Before we can arrange an initial appointment, you will need a referral from your GP addressed
specifically to me. The evaluation typically runs over two or three sessions, which will allow me to better understand your history, your symptoms, and your reasons for seeking psychotherapy. By the end of your evaluation, I will offer you my initial formulation and propose an initial treatment plan for psychotherapy. You should evaluate this information along with your own assessment about whether you feel comfortable working with me.


Session Length
The initial session, which is part of the evaluation, will run for one hour. Thereafter, individual sessions, whether for evaluation or as part of the therapy, will be held at mutually agreed times, typically at least once a week, and will run for just over 45 minutes.


If clinically indicated, I may suggest to you that you consider augmenting your individual sessions by joining a psychotherapy group. Group sessions run for just over one hour, and most groups meet at a specific recurrent time twice-weekly. There are special considerations about confidentiality and privacy for group members.


There is no specific determination on how many sessions are needed by a patient as this may depend on the healing progress of the patient.


Relationship

The relationship that a patient that a patient has with their psychotherapist is strictly
professional. Any other relationship, such as a business or personal relationship, is forbidden.


Risks of psychotherapy

Through psychotherapy, you will learn more about yourself that you do not realise. Often, these are things that you do not like. Growth cannot happen until these issues are accepted and confronted. During or after a session, you may feel sadness, guilt, anxiety, anger, frustration, loneliness or helplessness. Psychotherapy could impact your relationships with others. You might feel physically unwell. These responses are normal and should be part of one's healing process. A therapy's success shall depend both on the efforts of the psychotherapist and the patient.


Advantages of psychotherapy

These are described under the Resources tab of this website
 

Alternatives to psychotherapy

You are welcome to seek reasonable alternatives to psychodynamic psychotherapy.


Depending on your clinical situation, these could include

  • Pharmacological treatment (this could include antidepressants, mood stabilisers, anti-anxiety medication, and stimulants). Medications are often used as adjuncts to psychotherapy. I would not be prescribing the medication, which could be done by your GP or by another psychiatrist

  • Cognitive Behaviour Therapy (CBT)

  • Dialectical Behaviour Therapy (DBT)

  • Eye Movement Desensitization and Reprocessing (EMDR)

  • Meditation

  • Biofeedback

  • Hypnosis

 

At any stage, we can discuss reasonable alternatives, including the advantages, disadvantages and risks of each option. I shall ensure that you understand the implications of not having the proposed therapeutic interventions.


New information

I shall provide you with new information, if it becomes available, that might influence
your original consent.


Medico-legal and court proceedings

I do not provide any medico-legal services
 

Confidentiality

Sessions are strictly confidential.

 

There is a reciprocal expectation that you will preserve and respect the privacy of other patients. If you are a member of a psychotherapy group, you are required not to disclose anything about other patients to any other person.

Professional records and confidential information

I keep appropriate records of the process and progress of the psychotherapy. Any notes taken by me shall be kept confidential and secure at all times and I shall not disclose the notes to anyone without prior written authority or consent by you, as follows.

There are circumstances when I may be required to disclose confidential information, or in my judgement I must do so. Examples are where  disclosure is required to avert a threat to life or injury to a person or to public safety or health, or when I am required by law to disclose information or provide my notes. 

Under the Health Records Act 2001 (Vic), you are entitled to see your records, have them explained to you, or be provided with a copy of them. Because these are professional records, they can be misinterpreted or upsetting, so I recommend that we review them together so that we can discuss what they contain. You may be charged an appropriate fee as provided for under the Health Records Regulations.

 

If you have any questions regarding confidentiality, please discuss this with me.


Withdrawal

Given the nature of psychotherapy -- often involving treatment over a period of many years --
consent should be viewed as an ongoing process. You may withdraw consent at any point without
jeopardising your care. That said, patients need to commit to work through major life decisions within rather than outside the therapy. Hence, decisions by patients to stop therapy should be made within the frame of the therapy itself.


Contact
Communication with patients is confined to the formal session times. The exceptions are logistics such as arrangement of appointments. If you face an emergency involving your mental health, please contact your GP or your local hospital.


If you have questions or concerns relating to informed consent, please feel comfortable to bring these to your next scheduled session.


Consent


Consent

  • I have read and fully understand the contents of this consent

  • I have had my questions answered by Professor Eisenbruch to my satisfaction

  • I understand the confidentiality that is required by my psychotherapist to provide therapy

  • I understand my psychotherapist's responsibilities as well as my rights, limitations, and responsibilities as a patient

  • I am aware that I can end my psychotherapy at anytime by informing my psychotherapist



I am above legal age and I hereby voluntarily provide my informed consent to psychotherapy by Professor Eisenbruch with full knowledge of my rights and obligations


Signed

Name

Date
 


Psychotherapist's confirmation
I, Professor Maurice Eisenbruch, have explained to the patient the information contained in this informed consent. I have given him/her the opportunity to ask questions which I believe I have answered to his/her satisfaction.