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YOU:
There is not a person in the world who has not needed to reach out
for help at some point in life. To
a life partner. To a mother or father. To a trusted friend. A family
doctor or minister or teacher. And sometimes, to a total stranger.
You've heard it said that the troubles in the world are not new
- it is how you manage your way through them that makes all the
difference. Because you're here, connecting with my web site, I
will assume you need help, for yourself or for someone you care
about. I'm here to help.
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Genogram
Confidentiality
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My
questions about you:
This is the short form of the kind of questions I will be asking
you:
Past history, family history
Psychiatric history
Eating and exercise history
Drug and alcohol history
Sexual functioning
Trauma history
Mood and anxiety symptoms
Birth, places lived, time line of important events
Development history, childhood milestones, adolescence
Education, work, employment history
History of violence
Financial status
Relationships,
children, social history
Self description, skill, coping skills
and strengths
Values
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This
is a Genogram.
It
is Doctor Jody's way of taking a graphic look at you and your most
significant relations and life incidents.

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Confidentiality:
You have the absolute right to the confidentiality of your therapy.
There are a few exceptions, which I describe below. I cannot and will
not tell anyone else what you have told me, or even that you are in
therapy with me without your prior written permission. I will always
act so as to protect your privacy even if you do release me in writing
to share information about you. You may direct me to share information
with whomever you choose, and you can change your mind and revoke
that permission at any time.
The following are legal exceptions to your right to confidentiality.
I would inform you should I, at any time, think I will have to put
these into effect:
1. If I have good reason to believe that you will harm another person,
I must attempt to inform that person and warn them of your intentions.
I must also contact the police and ask them to protect your intended
victim.
2. If I have good reason to believe that you are abusing or neglecting
a child or vulnerable adult, or if you give me information about someone
else who is doing this, I am by law required to report this to Childrens
Aid Society (CAS).
3. If I believe that you are in imminent danger of harming yourself,
I may legally break confidentiality and call your family doctor and
the police, and make arrangements for you to be assessed by a psychiatrist
in a local mental health facility that could provide inpatient psychiatric
services. I would explore all other options with you before I took
this step.
4. In addition, it is my responsibility as a therapist to consult
professionally with other therapists about my work. This is done in
a way that protects the anonymity of my patients and they remain unidentifiable.
If you inform me that there is a particular person with whom you would
not wish even this anonymous consultation to occur, I will respect
your wishes.
5. If you are filing a complaint or are a plaintiff in a lawsuit,
it is possible that I or my notes may be subpoenaed. Please let me
know if you are in this kind of situation so that I can take the utmost
care possible to protect your privacy in my records.
6. Others may request information such as insurance companies who
provide long term disability (LTD) reports, Ontario Disability Support
Program and Workmans Compensation Board (WCB). All of these
agencies can be provided information in a timely fashion with full
consultation with you as my patient. |
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