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28 November Informed consent Psychological healing of a sexually abused adolescent Purpose We are asking you to participate in a counseling program. This counseling program will psychologically heal a traumatized individual, especially when one has been sexually abused. People who participate in the counseling program will expose their feelings, experiences, and identify the abusers. More than 1000 people have benefitted from similar counseling program in the United States. In this counseling program, only one client is attended at a time during counseling.
The counselor will use the information and identify the reasons to why the trauma keeps disturbing you now and then. You will need to visit our office three times per week during the second, third, and fourth week. If your problems still persist after the forth week, you will continue visiting the offices until three months are over. Discomforts If there need for the government to know about the traumatic event, we won’t hesitate to inform them. This will break the secret between you and the counselor as the only people for the benefit of others who will be vulnerable to a similar event.
If the issue is very serious, the relevant authority may need your presence in order to record the issue appropriately. There may be other discomforts that are not known at this time. Therefore, you will be given additional information if more discomforts are found. Benefits You must benefit directly from participating in the counseling relationship. Information from the counseling program may enable the relevant authority to prevent and control similar events in the society. Therefore, the counseling program may benefit both the client and society at large.
Alternatives There are many other counseling programs that are used to help clients recover from psychological disturbances due to traumatic events. The counselor will discuss the other counseling programs with you. Confidentiality If you enter the counseling relationship, your personal information will be a secret between you and the counselor. During this time, you will be required to reveal all the relevant information including the assailant. Information gathered about you for this counseling program will be kept confidential according to law.
However, the counseling information about you may be revealed to the relevant authority and others who may be responsible for maintaining compliance with regulations and laws related to the counseling relationship. The results of the counseling may be published for the purpose of subsequent counseling relationships. The results could include the length of time that the intervention lasted. However, we don’t reveal the client’s identity to the public.Refusal without penalty Whether or not you participate in this counseling program is your choice.
You will not be penalized if you decide not to be in the counseling relationship. You are free to withdraw from the counseling relationship at any time. If you decide to leave the counseling relationship, your relationship with this institution will not be affected. Cost of the counseling relationship You will be charged for being attended to by the counseling professional. The charges will be done on the basis of the number of hours you spend with the counseling professional. Significant new findings You will be told by the counselor in case of new information and this might determine your choice to stay in the counseling relationship.
Questions In case of any questions, complaints, or concerns about the counseling relationship, please feel free to contact the counselor. He will be glad to respond to your questions. The counselor’s phone number is 205-XXX-9764. Signature of participant: Date: Relationship:
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