Children’s Consent Form

Please read the following information and complete the form at the bottom to confirm consent.

The purpose of this form is to share some important principles, which guide my counselling practice so that your decision to place your child into counselling with me can be based on accurate, informed expectations. Please read this carefully and feel free to ask any questions. I will meet with parent/s of the child whenever possible before I start to work with your child. I would like to recommend a starting point of six sessions and explain this to your child at the first session. After four sessions it would be useful to schedule in a telephone conversation to gather any feedback and discuss if further sessions
would be valuable for your child. The reason this is discussed at session four is because if the sessions were to come to an end at session six, then a thorough ending needs to be addressed with your child. Counselling can have benefits and risks. Since therapy often involves discussing unpleasant aspects of one’s life your child may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness. Conversely, counselling has been proven to have benefits for individuals who go through the therapeutic process. But there are no guarantees of what they will experience.


In general one of the most important rights the person seeking counselling has involves confidentiality, even if it’s a young child. Information revealed by a client during counselling will be kept strictly confidential and will not be revealed to any other person or agency without written permission, with the following exceptions: In order to maintain professionalism counsellors are required to be supervised by other counsellors. I attend monthly supervision for 1.5 hours and during these interactions, client anonymity is paramount. Confidentiality has some legal limits as well. There are situations where the counsellor can be required to reveal information obtained during therapy to another person without the parent or child’s permission. These situations involve danger to self, danger to others and child abuse. In addition, counsellor notes on sessions can be subpoenaed in a court of law.

Children and Confidentiality

Counsellors who work with children have the difficult task of protecting the child’s right to privacy while at the same time respecting the parent’s or guardian’s right to information. Therapy is most effective when a trusting relationship exists between the counsellor and the child. Privacy is especially important in securing and maintaining that trust. One goal of treatment is to promote a stronger and better relationship between children and their parents. However, it is often necessary for children to develop a “zone of privacy” whereby they feel free to discuss personal matters with greater freedom. This is particularly true for adolescents who are naturally developing a greater sense of independence and autonomy. It is my policy to provide you with general information about treatment status. I may raise issues that may impact your child either inside or outside the home. If it is necessary to refer your child to another mental health professional with more specialised skills, I will share that information with you and seek your permission accordingly. I will not share with you what your child has disclosed to me without your child’s consent. I will ask your child if there is anything that he or she may want to share with you at the end of the session. At the end of your child’s treatment, we will review the sessions in general including what issues were discussed, what progress was made, and what areas are likely to require intervention in the future.

Client Rights and Responsibilities

Both you and your child are in complete control and may end the counselling relationship at any time, although I do ask that your child participates in a termination session. I have been trained to a high standard to cause no psychological harm, however you both also have the right to refuse or discuss modifications of any of my counselling techniques or suggestions that you believe might be harmful.

By submitting the form below, you are indicating that you have read and understood this consent form or that any questions you had about this consent form were answered to your satisfaction.