Client Consent Form – Agreement for a Live Therapy Session

TEMPORARY

Use the following to copy-paste HMTL (Windows: Press Ctrl + U) into HTML blocks of gravity form

This agreement is between You (the client/couple)

YOUR NAME FIELD

and the International Centre for Excellence in Emotionally Focused Therapy (ICEEFT) for participation in a live therapy session conducted online. During this session, an ICEEFT Certified Trainer will conduct a therapy session with you while a group of therapists training in Emotionally Focused Therapy observe for educational purposes.

The purpose of this live session is twofold:

1. To contribute to the professional development and training of therapists learning Emotionally Focused Therapy, and
2. To provide you with a valuable and genuine therapy opportunity from an experienced EFT Trainer.

Your live therapy session with the EFT Trainer is free.

All participating therapists are bound by professional ethics to maintain strict confidentiality; therapists are required to follow HIPAA guidelines to protect your confidentiality

Included protections: [scrap dot points and turn into paragraph?]

• Any therapist who knows you personally must excuse themselves from the training room.
• Your identity will be protected throughout the process.
• All observers must adhere to professional confidentiality standards.

Your personal information can only be shared with your written permission, except in cases of risk of imminent danger to yourself or others, court-ordered subpoenas or legal proceedings.

By initialing below, I understand that:

• My therapist remains solely responsible for my ongoing therapy and its outcomes.
• The EFT Trainer is responsible only for conducting this live session and providing training to the observing therapists.
• The EFT Trainer and ICEEFT are not responsible for outcomes of future therapy sessions.
• My participation is voluntary and will not affect my ongoing treatment.
• I may withdraw consent at any time.

I ACKNOWLEDGE THESE LIMITS — please initial

In the minutes before you join, your therapist will provide a brief summary of your presenting concerns and history to the EFT Trainer and the group of therapists. No identifying information will be shared.

NAME OF MY THERAPIST —

• An ICEEFT Certified Trainer will conduct a therapy session with you.
• The session will last approximately 1 hour and 15 minutes.
• A group of therapists will observe the session with their cameras off and microphones muted.
• The session will focus on demonstrating EFT interventions while providing genuine therapeutic value.

I CONSENT TO TAKE PART IN THE LIVE SESSION — please initial

• If you agree to it, you will take a short break while the training group prepares feedback.
• You will return to receive constructive feedback from the EFT Trainer and have the opportunity to respond.
• The feedback is designed to support your ongoing therapy process.
• You may decline staying for feedback if you would prefer to leave after the live session is over.

I UNDERSTAND I HAVE THE CHOICE TO EITHER STAY FOR FEEDBACK OR TO LEAVE AFTER THE LIVE SESSION – please initial

If you consent to the live session being recorded, the recording can be reviewed by the EFT Trainer and your therapist for their own educational purposes. If the trainer is interested to use the recording for any further purpose, they will contact you seeking consent.

The recording is never shared with the group of therapists who attended the live session.

You have the right to:

• Request that recording be stopped at any time
• Have any recording immediately erased upon request

CONSENT TO HAVING THE SESSION RECORDED — **I consent/I decline**

By digitally signing below,

• I consent to participate as a client in a live therapy session with observing therapists present.
• I understand the live therapy session will take place virtually.
• I have given -or- withheld my consent to optional components, as noted above.

SIGNATURE FIELD

Date?

ADMIN – name of trainer

SUBMIT