Agreement for Parents

Psychotherapy can be a very important resource for children of separation and divorce. Establishing a therapeutic alliance outside of the home can:

  • Facilitate open and appropriate expression of the strong feelings which routinelyaccompany family transitions, including guilt, grief, anxiety, sadness, and anger.
  • Provide an emotionally neutral setting in which children can explore these feelings.
  • Help children understand and accept the new family composition and the plans for contactwith each member of the family.
  • Offer feedback to a child's caregivers based on knowledge of the child's specific emotionalneeds and developmental capacities.

However, the usefulness of such therapy is extremely limited when the therapy itself becomes simply another matter of dispute between parents. With this in mind, and in order to best help your child, I strongly recommend that each of the child's caregivers (e.g., parents, stepparents, daycare workers, guardian ad litem [GAL]) mutually accept the following as requisites to participation in therapy.

  • As your child's psychotherapist, it is my primary responsibility to respond to your child'semotional needs. This includes, but is not limited to, contact with your child and each of hisor her caregivers, and gathering information relevant to understanding your child's welfareand circumstances as perceived by important others (e.g., pediatrician, teachers). In somecases, this may include a recommendation that you consult with a physician, should mattersof your child's physical health be relevant to this therapy
  • I ask that all caregivers remain in communication regarding this child's emotional well-being. Open communication about his or her emotional state and behavior is critical. In thisregard, I invite each of you to initiate frequent and open exchange with me as your child'stherapist.
  • I ask that all parties recognize and, as necessary, reaffirm to the child, that I am the child'shelper and not allied with any disputing party.
  • I strongly recommend that all caregivers involved choose to participate in psycho-educational groups in which separating and divorced parents learn basic strategies forconducting a divorce in the best interests of the child.
  • Please be advised regarding the limits of confidentiality as it applies to psychotherapy with achild in these circumstances:

I keep records of all contacts relevant to your child's well-being. These records will not be released to either parent without a court order unless I agree with both parents that it is in the child's best interest that these records be revealed. These records are subject to court subpoena and may, under some circumstances, be subpoenaed by parties to your divorce, including your attorneys.

Any matter brought to my attention by either parent regarding the child may be revealed to the other parent. Matters that are brought to my attention that are irrelevant to the child's welfare may be kept in confidence. However, these matters may best be brought to the attention of others, such as attorneys, personal therapists or counselors.

I am legally obligated to bring any concern regarding the child's health and safety to the attention of relevant authorities. When possible, should this necessity arise, I will advise all parties regarding my concerns
  • This psychotherapy will not yield recommendations about custody. In general, Irecommend that parties who are disputing custody strongly consider participation in alternativeforms of negotiation and conflict resolution, including mediation and custody evaluation, ratherthan try to settle a custody dispute in court.
  • Payment for my services is due, in full, at the time of service unless other specificarrangements have been agreed upon. Any outstanding balance accrued (for example, inconference with attorneys, the GAL, or teachers), must be paid promptly and in full.

Your understanding of these points and agreement in advance of starting this therapy may resolve difficulties that would otherwise arise and will help make this therapy successful. Your signature, below, signifies that you have read and accept these points.

Child's Name
Date of Birth
Caregiver-1 Signature
Caregiver-1 Name
Caregiver-1 Address
Caregiver-1 Phone(s) Please do not list any numbers where you would prefer not to receive calls or messages
Caregiver-2 Signature
Caregiver-2 Name
Caregiver-2 Address
Caregiver-2 Phone(s) Please do not list any numbers where you would prefer not to receive calls or messages