Youth Counseling (minor client)
Consent Addendum 

For the youth to read (and/or have explained by the guardian).


The purpose of meeting with a counselor or therapist is to get help with problems in your life that are bothering you or that are keeping you from being successful in important areas of your life. You may be here because you wanted to talk to a counselor or therapist about these problems. Or, you may be here because your parent, guardian, doctor or teacher had concerns about you.

When we meet, we will discuss these problems. I will ask questions, listen to you and suggest a plan for improving these problems. It is important that you feel comfortable talking to me about the issues that are bothering you. Sometimes these issues will include things you don’t want your parents or guardians to know about. For most people, knowing that what they say will be kept private helps them feel more comfortable and have more trust in their counselor or therapist. Privacy, also called confidentiality, is an important and necessary part of good counseling.



As a general rule, I will keep the information you share with me in our sessions private (confidential), unless we have your written permission to share certain information with specific people (like your parent, doctor, etc.). There are some times when we are required (by law) to break this rule to keep you or someone else safe.

  1. If you tell me you plan to cause serious harm or death to yourself, and I believe you have the intent and ability to carry out this threat in the very near future, I must take steps to tell a parent or guardian of what you have told me and how serious I believe this threat to be. I must make sure that you are protected from harming yourself.

  2. If you tell me you plan to cause serious harm or death to someone else who can be identified, and I believe you have the intent and ability to carry out this threat in the very near future, I must tell a parent, guardian or law enforcement.

  3. If you tell me you are being abused (physically, sexually or emotionally) or that you have been abused in the past. In this situation, I am required by law to report the abuse to the Texas Department of Social Services.

  4. If you are involved in a court case and a request is made for information about your counseling or therapy. If this happens, I will not disclose information without your written agreement unless the court requires me to. I will do all I can within the law to protect your privacy


Communicating with your Parent(s) or Guardian(s) 

Except for situations such as those listed above, I will not tell your parent or guardian specific things you share with me in our private sessions. This includes activities and behavior that your parent/guardian would not approve of — or would be upset by — but that do not put you at risk of serious and immediate harm. However, if your risk-taking behavior becomes more serious, then I will need to use my professional judgment to decide whether you are in serious and immediate danger of being harmed. If I feel that you are in immediate danger, I will communicate this information to your parent or guardian.  You should also know that, by law in Texas, your parent/guardian has the right to see any written records I keep about our sessions until you are considered an adult by state law.

Communicating with other people involved in your life

School: I will not share any information with your school unless I have your permission and permission from your parent or guardian. Sometimes I may request to speak to someone at your school to find out how things are going for you. Also, it may be helpful in some situations for me to give suggestions to your teacher or counselor at school. If I want to contact your school, or if someone at your school wants to contact me, I will discuss it with you and ask for your written permission. A very unlikely situation might come up in which I do not have your permission but both I and your parent or guardian believe that it is very important for me to be able to share certain information with someone at your school. In this situation, I will use my professional judgment to decide whether to share any information.

Doctors: Sometimes your doctor and I may need to work together; for example, if you need to take medication in addition to seeing a counselor or therapist. I will get your written permission and permission from your parent/guardian in advance to share information with your doctor. The only time I will share information with your doctor even if I don’t have your permission is if you are doing something that puts you at risk for serious and immediate physical/medical harm.

Anyone else:  You can choose to include anyone else you’d like in your counseling process (friends, partners, etc.) and we will discuss the best way to add them to our work together.  You will need to provide written permission for me to communicate with them. 

 If you have any questions about this information, please speak with your counselor or you may email the Practice Director at