CLIENT PORTAL

Couples Counseling Agreement

Couples Counseling Agreement

Client 1 Name(Required)
Client 2 Name(Required)
Therapist Name(Required)
MM slash DD slash YYYY

1. Purpose of Counseling

The purpose of couples counseling is to assist both individuals in understanding and improving their relationship. This includes, but is not limited to, enhancing communication, addressing conflict, rebuilding trust, and clarifying goals and expectations. In this counseling, the relationship is considered the primary client.

2. Nature of the Therapeutic Relationship

  • Couples counseling is a collaborative process focused on relationship issues, not individual therapy.
  • The therapist will remain neutral and avoid taking sides.
  • The success of counseling depends on both parties' active participation, honesty, and willingness to explore difficult topics.

3. Confidentiality

All communications within counseling sessions are confidential and protected by law. However, the following exceptions apply:

  • Suspected abuse or neglect of children, elders, or vulnerable adults.
  • A serious threat of harm to self or others.
  • Court orders requiring release of information.
  • Written consent from either client.

Joint Confidentiality: Because this is couples therapy, information shared by one partner may not be kept secret from the other if it is clinically relevant to the relationship. The therapist will use professional judgment to determine what may or may not be shared.

4. No-Secrets Policy

This therapist operates under a “no-secrets” policy, meaning that information shared privately may be disclosed to the other partner if relevant to the couple's work. The goal is transparency and maintaining trust in the therapeutic process. Clients are encouraged to bring all relevant concerns into joint sessions.

5. Individual Sessions

The therapist may occasionally meet with one member individually. These sessions are part of the overall couples work, and information shared may be brought into joint sessions if deemed relevant to relationship goals.

6. Records and Documentation

A single clinical record will be maintained for the couple as a unit. Both clients must agree in writing to any request to access, release, or transfer records. The therapist may deny access if it is considered harmful to the therapeutic process or either party.

7. Court Involvement and Legal Proceedings

Therapist’s Role: The therapist provides clinical support only and will not participate in any legal or court proceedings (e.g., divorce, custody disputes, immigration cases).

Agreement Not to Subpoena: Both clients agree not to subpoena the therapist or clinical records for any legal matter.

Legal Disclaimer: “We understand and agree that our therapist is not acting as a legal expert, custody evaluator, or forensic examiner, and therefore will not serve in any legal capacity related to our relationship.”

8. Limitations of Services

  • Couples counseling is not appropriate in cases of ongoing domestic violence, coercion, active addiction, or safety concerns. The therapist may terminate services and provide referrals as needed.
  • Counseling is not a substitute for legal, financial, or medical advice.

9. Fees and Payment Policy

  • Session Fee: $200.00 per session
  • Payment is due at the time of service by credit card, cash, or other approved methods.
  • Late Cancellation / No-Show: Cancellations must be made at least 24 hours in advance. Late or missed sessions will be charged in full.

10. Communication Between Sessions

Communication outside of sessions should be limited to administrative matters such as scheduling. The therapist does not provide emergency services. In case of an emergency, call 911 or visit the nearest emergency room.

11. Termination of Counseling

Either party may end counseling at any time. The therapist may also terminate services if therapy is no longer productive or clinically appropriate. When possible, the therapist will discuss this decision and provide referrals.

12. Consent to Treatment

By signing below, both clients acknowledge that they:

  • Have read and understood this agreement
  • Consent to participate voluntarily in couples counseling
  • Agree to abide by the terms outlined above
Client 1 Name (Print)(Required)
MM slash DD slash YYYY
Client 2 Name (Print)(Required)
MM slash DD slash YYYY
Therapist Name (Print)
MM slash DD slash YYYY

1. Purpose of Counseling

The purpose of couples counseling is to assist both individuals in understanding and improving their relationship. This includes, but is not limited to, enhancing communication, addressing conflict, rebuilding trust, and clarifying goals and expectations. In this counseling, the relationship is considered the primary client.

2. Nature of the Therapeutic Relationship

  • Couples counseling is a collaborative process focused on relationship issues, not individual therapy.
  • The therapist will remain neutral and avoid taking sides.
  • The success of counseling depends on both parties' active participation, honesty, and willingness to explore difficult topics.

3. Confidentiality

All communications within counseling sessions are confidential and protected by law. However, the following exceptions apply:

  • If there is suspected abuse or neglect of children, elders, or vulnerable adults.
  • If there is a serious threat of harm to self or others.
  • If ordered by a court.
  • If either client provides written consent to release information.

Joint Confidentiality: Because this is couples therapy, information shared by one partner may not be kept secret from the other if it is clinically relevant to the relationship. The therapist will use professional judgment to determine what may or may not be shared.

4. No-Secrets Policy

This therapist operates under a “no-secrets” policy, which means that information shared privately with the therapist may be shared with the other partner if it is relevant to the couple's work. The goal is to maintain transparency and avoid undermining trust within the therapeutic process. Clients are encouraged to bring all relevant concerns into the joint sessions.

5. Individual Sessions

Occasionally, the therapist may meet with one member of the couple individually. These sessions are considered part of the overall couples counseling process. Information shared during these individual meetings may be discussed in joint sessions if deemed important to the relationship goals.

6. Records and Documentation

A single clinical record will be maintained for the couple as a unit. Both clients must agree in writing to any request to access, release, or transfer records. The therapist reserves the right to deny access if it is deemed to be harmful to the therapeutic process or either party.

7. Court Involvement and Legal Proceedings

Therapist’s Role: The therapist's role is solely to provide clinical support to the couple’s relationship. The therapist will not participate in any legal or court proceedings, including but not limited to divorce, custody battles, immigration cases, or evaluations of any kind.

Agreement Not to Subpoena: Both clients agree not to subpoena the therapist, clinical records, or notes in any legal matter now or in the future. This includes court testimony, depositions, and any legal documentation requests.

Legal Disclaimer: “We understand and agree that our therapist is not acting as a legal expert, custody evaluator, or forensic examiner, and therefore will not serve in any legal capacity related to our relationship.”

8. Limitations of Services

  • Couples counseling is not appropriate in cases of ongoing domestic violence, coercion, active addiction, or safety concerns. If such issues arise, the therapist may terminate services and provide referrals to appropriate care.
  • Counseling is not a substitute for legal, financial, or medical advice. Clients are encouraged to consult professionals in those areas when needed.

9. Fees and Payment Policy

  • Session Fee: $200.00 per session
  • Payment is due at the time of service by credit card, cash, or other approved methods.
  • Late Cancellation / No-Show Policy: Cancellations must be made with at least 24 hours' notice. Sessions cancelled late or missed without notice will be charged in full.

10. Communication Between Sessions

Communication with the therapist outside of sessions should be limited to administrative matters such as scheduling. The therapist does not provide emergency services. In case of a crisis or emergency, call 911 or visit the nearest emergency room.

11. Termination of Counseling

Either party may end counseling at any time. The therapist may also terminate services if therapy is no longer productive or clinically appropriate. When possible, the therapist will discuss this decision in advance and provide referrals if needed.

12. Consent to Treatment

By signing below, both clients acknowledge that they:

  • Have read and understood this agreement
  • Consent to participate voluntarily in couples counseling
  • Agree to abide by the terms outlined above