What Should Be Included in Informed Consent for Therapy?

A therapist’s informed consent should include, at minimum, their credentials and therapeutic approach, the realistic risks and benefits of treatment, the rules of confidentiality and the specific situations that override it, your privacy rights under HIPAA, the full financial terms including a good faith estimate if you are paying out of pocket, session logistics, your rights as a client, how to reach the therapist between sessions, and what to do in a mental health emergency. If any of the work happens by video or phone, or if the client is a minor, additional disclosures apply. What should be included in informed consent for therapy is not a single form to sign once, but an ongoing conversation that gets revisited whenever the treatment plan changes.

Who the Therapist Is and How They Work

Consent starts with knowing who is treating you. The document should state the therapist’s license type, relevant training, and specialization. If the therapist is a trainee working under supervision, the APA Ethics Code requires that fact to be disclosed along with the supervisor’s name.¹ A supervisor has access to your case material, and that affects confidentiality in a way most clients would not otherwise expect.

The consent should also describe the therapist’s theoretical approach, since that shapes what actually happens in your sessions. A cognitive behavioral therapist focuses on changing unhelpful thought patterns. A psychodynamic therapist explores how past experiences drive current behavior. An EMDR practitioner uses bilateral stimulation to process trauma. Knowing the framework lets you evaluate whether it fits your situation and gives you a baseline for asking why a particular technique is being used.

Risks and Benefits

Most people come to therapy expecting to feel better, and most eventually do. But informed consent should be honest that therapy can be uncomfortable along the way. APA practice guidance requires therapists to describe potential risks and benefits and to make clients aware that therapy can involve emotional discomfort.²

Three realistic possibilities the consent should cover:

Symptoms can temporarily worsen when you start exploring painful memories or long-avoided feelings.
Relationships with family, friends, or a partner can feel strained as you change patterns, especially if those relationships benefited from the old ones.
No therapist can guarantee a specific outcome.

If the therapist plans to use techniques that are experimental or not yet widely established, the APA Ethics Code requires an even more detailed disclosure: the developing nature of the treatment, the potential risks, and what alternatives are available.¹ You cannot meaningfully agree to something you do not understand.

Confidentiality and Its Limits

Confidentiality is why people say things in therapy they would not say anywhere else. Your consent document should explain both the scope of that protection and the specific situations in which the therapist can or must break it.

Duty to Protect Others

If a therapist determines that you pose a serious risk of physical harm to someone else, they are obligated to take steps to protect the potential victim. The principle traces back to Tarasoff v. Regents of the University of California, which held that the duty to protect an identifiable potential victim may include warning that person or notifying law enforcement.³ Roughly 30 states and territories make this duty mandatory, while others make it permissive, meaning the therapist is allowed but not required to break confidentiality. A small number of states have no specific duty-to-warn statute.⁴ Your therapist should explain the rules that apply where you are.

The picture is less uniform when a client expresses intent to harm themselves. Courts have reached different conclusions about the scope of a therapist’s obligations when the danger is self-directed rather than aimed at a third party.⁵ In practice, most therapists will take protective action if they believe you are in imminent danger, which could include contacting emergency services or a family member.

Mandated Reporting of Abuse

Therapists are required to report any reasonable suspicion of child abuse or neglect to state authorities, and this obligation overrides confidentiality. Most reports are made by calling a state child abuse reporting hotline.⁶ Similar mandated reporting laws exist in most states for suspected abuse or neglect of elderly or dependent adults. The consent should make clear that the therapist has no discretion here. If they have a reasonable suspicion, they are legally obligated to report, regardless of your wishes.

Court Orders Versus Subpoenas

A court order from a judge can legally compel your therapist to hand over records or provide testimony. Under HIPAA, a covered provider may share protected health information when ordered by a court, but only the information the order specifically describes. A subpoena issued by an attorney is not the same thing. Before responding to one, your therapist should assert privilege on your behalf and will typically not release records without either your written consent or a direct order from a judge.⁷

Your Privacy Rights Under HIPAA

Federal law requires your therapist to give you a Notice of Privacy Practices no later than your first session. The notice must be in plain language and explain how your health information can be used, what your rights are regarding that information, and how to file a complaint if you believe your privacy has been violated.⁸ The therapist must make a good-faith effort to get your written acknowledgment that you received it.⁹

One distinction worth understanding, because the two receive very different protection: psychotherapy notes versus progress notes. Psychotherapy notes are a therapist’s private reflections recorded during or after a session. HIPAA requires them to be stored separately from the rest of your medical record and excludes them from the standard information insurers and other providers can access.¹⁰ Progress notes contain clinical details like your diagnosis, treatment plan, and symptom updates, and these can be shared with other treating providers and insurance companies. Your consent should explain which is which so you know what actually stays private.

Fees, Insurance, and Good Faith Estimates

The consent should leave no ambiguity about money. The APA Ethics Code requires therapists to discuss fees and financial arrangements as early as feasible in the therapeutic relationship.¹ At a minimum, the document should state the cost per session, accepted payment methods, and when payment is due.

Insurance and Superbills

The form should say whether your therapist bills insurance directly or whether you pay out of pocket and seek reimbursement yourself. Out-of-network therapists often use the second model, providing a superbill after each session. A superbill is a detailed receipt with diagnosis codes, procedure codes, and provider information that your insurer needs to evaluate a reimbursement claim. Your consent should walk through that process so you know your financial responsibility before treatment begins.²

Good Faith Estimates Under the No Surprises Act

If you do not have insurance or plan to pay out of pocket, federal law requires your therapist to give you a good faith estimate of expected charges. The estimate must list each anticipated service along with specific billing codes.¹¹ Timing depends on when you schedule:

If your appointment is scheduled at least 3 business days out, the estimate must arrive no later than 1 business day after scheduling.
If it is scheduled at least 10 business days out, the estimate must arrive no later than 3 business days after scheduling.

If the amount you are eventually billed exceeds the good faith estimate by $400 or more, you have the right to dispute the charge through a federal patient-provider dispute resolution process.¹² A well-drafted consent form should mention this protection.

Cancellation and No-Show Fees

The agreement should spell out how much notice you need to give to cancel without being charged, usually 24 or 48 hours. Most therapists charge the full session fee for a late cancellation or no-show, because the slot cannot be filled on short notice and insurance does not cover missed appointments.

Session Structure

Consent should set clear expectations about how treatment is organized: how long each session lasts (most commonly 50 minutes for individual therapy), how often you will meet (typically weekly at the start), and a rough sense of how long treatment is expected to run. A short-term, structured approach like CBT for a specific phobia might come with a 12- to 16-session plan. Longer-term work for complex trauma may not have a firm endpoint, but the therapist should explain why and revisit the timeline periodically.

Your Rights as a Client

Consent should clearly state your rights in the therapeutic relationship. These are practical protections, not abstractions.

You have the right to ask questions about your treatment and receive answers that make sense to you.¹³
You can refuse any specific technique. A patient with decision-making capacity can accept or refuse any recommended intervention.¹³
You can request a referral or a second opinion if therapy is not working or you want another perspective.¹³
You can end therapy at any time, for any reason, without being pressured to stay.

Contact Between Sessions and Emergencies

The consent should explain how to reach your therapist between sessions and what to expect when you do. Most therapists set boundaries around between-session communication: email and text are fine for scheduling, but not for clinical conversations or urgent matters. Your therapist should tell you their typical response time so you know not to expect an immediate reply to a non-urgent message.

The consent must also make clear that your therapist is not a crisis service. It should direct you to call 911 or go to the nearest emergency room in a mental health emergency, and it should provide the number for the 988 Suicide and Crisis Lifeline, a free, 24/7 national resource you can reach by calling or texting 988.¹⁴ Clients in crisis need to already know where to turn, and the intake session is the time to make that clear.

Telehealth Sessions

If any part of your therapy will happen by video or phone, the consent should address the extra considerations that come with remote treatment. HHS recommends that therapists explain what to expect from a telehealth visit, discuss responsibilities like wearing headphones and finding a private location, and disclose whether anyone else will be observing the session.¹⁵

The consent should also identify which video platform will be used and confirm that it complies with HIPAA. Covered providers must use technology vendors that have signed a HIPAA business associate agreement.¹⁶ Consumer platforms like FaceTime or standard Zoom do not meet this standard unless specifically configured for HIPAA compliance. The consent should note that while the therapist uses a secure platform, no technology is entirely risk-free, and you share responsibility for privacy on your end by choosing an appropriate location.

Consent for Minors and Families

When the client is a minor, consent works differently. A child cannot legally consent to their own treatment; that authority belongs to a parent or legal guardian. But ethical guidelines require the therapist to go beyond the parent’s signature and also seek the minor’s assent, a developmentally appropriate agreement to participate. The American Academy of Child and Adolescent Psychiatry’s ethics code states that children and adolescents should play a role in determining the services they receive to the extent they can understand their options.¹⁷ The APA Ethics Code similarly requires that when someone is legally incapable of consenting, the psychologist must provide an appropriate explanation, seek the individual’s assent, and consider their preferences.¹⁸

Consent with families also has to address who gets to know what. Parents generally have a right to information about a child’s treatment, but therapists often negotiate boundaries around what will and will not be shared, especially with adolescents. A teenager who believes every word will be reported home is unlikely to be honest in session. The consent should explain how the therapist handles this balance, including any information the therapist is legally obligated to share with parents regardless of the agreement.

Many states also allow minors to consent to their own mental health treatment without a parent’s involvement under certain circumstances, such as being above a specified age or living independently. These laws vary significantly by state, so the therapist should explain the rules that apply in their jurisdiction.

1
American Psychological Association. APA Ethical Principles of Psychologists and Code of Conduct
2
APA Services. Informed Consent Guidance and Templates for Psychologists
3
Justia. Tarasoff v Regents of University of California
4
National Conference of State Legislatures. Mental Health Professionals Duty to Warn
5
American Psychological Association. Are Clinicians Responsible for Clients Self-Inflicted Injuries
6
APA Services. Mandatory Reporting
7
U.S. Department of Health and Human Services. Court Orders and Subpoenas
8
U.S. Department of Health and Human Services. Notice of Privacy Practices for Protected Health Information
9
eCFR. 45 CFR 164.520
10
GovInfo. 45 CFR 164.501
11
Centers for Medicare and Medicaid Services. No Surprises – Whats a Good Faith Estimate
12
Centers for Medicare and Medicaid Services. No Surprises Act Good Faith Estimate and Patient-Provider Dispute Resolution Requirements
13
AMA Code of Medical Ethics. Patient Rights
14
SAMHSA. 988 Suicide and Crisis Lifeline
15
Telehealth.HHS.gov. Obtaining Informed Consent
16
Telehealth.HHS.gov. HIPAA Rules for Telehealth Technology
17
National Institutes of Health. Consent to Treatment of Minors Revisited
18
American Psychological Association. Ethical Principles of Psychologists and Code of Conduct