Informed Consent for Psychotherapy
Your rights, responsibilities, and the parameters of care at Pasadena Clinical Group. Effective May 1, 2026. Last updated May 1, 2026.
Treatment Consent Sections
1. Voluntary Nature of Treatment
Your participation in psychotherapy at Pasadena Clinical Group is entirely voluntary. You have the right to terminate treatment at any time, for any reason, without penalty or coercion. If you choose to discontinue services, we recommend that you discuss this decision with your therapist so that appropriate closure can be facilitated, referrals can be provided if desired, and continuity of care concerns can be addressed. The Practice also reserves the right to terminate the therapeutic relationship under certain circumstances, as described in our Office Policies, and to facilitate a transfer of care to another provider when clinically indicated.
2. Risks and Benefits of Psychotherapy
Psychotherapy, including group therapy, has been demonstrated to produce significant benefits for individuals with ADHD and co-occurring conditions. These benefits may include improved executive functioning, enhanced emotional regulation, stronger interpersonal relationships, reduced symptom severity, and greater overall life satisfaction. At Pasadena Clinical Group, we employ evidence-based modalities including Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) skills, Motivational Interviewing, and skills-based group interventions specifically designed for adults with ADHD.
However, psychotherapy also carries risks. The therapeutic process may involve the discussion of difficult or distressing aspects of your life, which can temporarily increase emotional discomfort. You may experience feelings such as sadness, anxiety, anger, or frustration as you work through challenging material. Group therapy, in particular, requires navigating interpersonal dynamics with other group members, which may cause discomfort at times. Your therapist will work with you to manage these risks and will discuss any concerns you may have about the therapeutic process. You are encouraged to communicate openly with your therapist about any aspect of treatment that causes you distress.
3. Confidentiality and Its Limits
All communications between you and your therapist are confidential and protected under California law and the federal HIPAA Privacy Rule. Information about your treatment will not be disclosed to any third party without your prior written consent, except in the specific circumstances described below. These exceptions are mandated by California law and cannot be waived by this consent:
Child Abuse Reporting (CANRA): Under the California Child Abuse and Neglect Reporting Act (Penal Code § 11164 et seq.), licensed therapists are mandated reporters. If your therapist has reasonable suspicion that a child (under the age of 18) has been subjected to abuse or neglect, your therapist is legally required to make a report to the appropriate child protective services agency or law enforcement. This obligation exists regardless of whether the suspected abuse occurred in the past or present and regardless of who the suspected perpetrator may be.
Elder and Dependent Adult Abuse Reporting: Under California Welfare and Institutions Code § 15630, therapists are mandated to report known or suspected abuse of elder adults (persons 65 years or older) or dependent adults (persons 18-64 with physical or mental limitations that restrict their ability to carry out normal activities or protect their rights). This includes physical abuse, neglect, financial abuse, abandonment, and isolation.
Duty to Warn and Protect (Tarasoff): Under California Civil Code § 43.92, if you communicate to your therapist a serious threat of physical violence against a reasonably identifiable victim or victims, your therapist has a duty to take reasonable steps to protect the intended victim, which may include notifying the potential victim, notifying law enforcement, or taking other clinically appropriate actions. This duty also applies when the therapist believes you present a serious danger of violence to others based on your mental state and treatment history.
Imminent Danger to Self: If your therapist has reasonable cause to believe that you are in imminent danger of seriously harming yourself, your therapist may take actions necessary to protect your safety, including contacting emergency services, family members, or other support persons, and facilitating psychiatric hospitalization when warranted.
Court Orders and Subpoenas: If your therapist receives a valid court order or subpoena requiring disclosure of your treatment records, the Practice will make reasonable efforts to notify you before complying, so that you may have the opportunity to seek legal counsel to challenge the order, unless the order expressly prohibits such notification.
Insurance Authorization and PHI Disclosure: If you use health insurance to pay for services, your insurance company may require access to certain protected health information (PHI) to authorize and reimburse treatment. This may include diagnosis codes, treatment plans, session dates, and clinical summaries. By authorizing us to bill your insurance, you consent to the minimum necessary disclosure of PHI for these purposes. We encourage you to understand your insurer’s privacy practices, as information disclosed to insurers may no longer be protected by psychotherapist-patient privilege once in their possession.
4. Electronic Communication Consent
Pasadena Clinical Group may use email, text messaging (SMS), and telephone to communicate with you regarding appointment reminders, administrative matters, and treatment coordination. You acknowledge that electronic communications, including email and text messages, carry inherent privacy risks. Despite our use of HIPAA-compliant platforms wherever feasible, standard email and SMS are not encrypted end-to-end and may be vulnerable to interception or unauthorized access. By providing your email address and phone number, you consent to receive communications through these channels, understanding the associated limitations. You may withdraw this consent at any time by providing written notice to the Practice, in which case communications will be limited to telephone or in-person contact only.
Electronic communications (email, text, phone) should not be used for emergencies. If you are experiencing a mental health crisis, please call 988, 911, or go to your nearest emergency room.
5. Minors and Consent to Treatment
Under California Family Code § 6924, a minor who is twelve (12) years of age or older may consent to mental health treatment or counseling on an outpatient basis if, in the opinion of the attending therapist, the minor is mature enough to participate intelligently in the services and the minor either (a) would present a danger of serious physical or mental harm to self or others without the mental health treatment or counseling, or (b) is the alleged victim of incest or child abuse. This provision applies to outpatient services only. For minors under twelve (12) years of age, or for minors who do not meet the criteria of Family Code § 6924, consent must be obtained from a parent or legal guardian. However, Pasadena Clinical Group primarily serves adults; questions regarding minor treatment should be discussed directly with our intake coordinator.
6. Records Retention
Under California law, clinical records for adult patients must be retained for a minimum of seven (7) years from the date of the last service provided. For minor patients, records must be retained for at least one (1) year after the minor reaches the age of majority (i.e., until age nineteen), or for seven (7) years from the last date of service, whichever is longer. After the applicable retention period, records are securely destroyed in a manner that preserves confidentiality. If you anticipate needing your records beyond the retention period, you are encouraged to request copies in advance.
7. Group Therapy–Specific Considerations
Because our practice emphasizes group therapy, additional considerations apply. In group therapy, your confidentiality is protected by the Practice and your therapist in the same manner as individual therapy. However, confidentiality within the group itself depends on the commitment of all members. We require all group members to agree to maintain the confidentiality of information shared by other group members. While we reinforce this expectation, the Practice cannot guarantee that every group member will honor this commitment. You should exercise your own judgment about what personal information you choose to disclose in a group setting. If you have specific concerns about confidentiality in the group context, please discuss them with your therapist.
8. No Guarantee of Outcome; Realistic Expectations
Psychotherapy is a collaborative process whose effectiveness depends on many factors, including your active participation, your willingness to apply skills outside of session, your medical and psychiatric history, your social environment, and the nature and severity of your concerns. No clinician can guarantee any specific outcome, symptom reduction, diagnosis, recovery, return-to-work, custody outcome, academic outcome, employment outcome, immigration outcome, disability determination, court result, or improvement of any condition or relationship. Statements made by your clinician about likely benefits, expected duration of treatment, or anticipated progress are clinical impressions based on currently available information; they are not promises, warranties, or guarantees, and you agree not to interpret them as such. The Practice expressly disclaims any warranty, express or implied, as to the results of treatment.
9. Website and Educational Materials — Information Only
Any blog posts, articles, downloadable handouts, videos, slides, podcasts, recorded talks, social-media posts, screening checklists, infographics, or other educational resources distributed by the Practice (whether on our website, by email, or in printed form) are provided strictly for general informational and educational purposes. They are not a substitute for clinical evaluation, do not constitute medical or mental-health advice for any particular reader, and must not be used to self-diagnose or self-treat any condition. Diagnosis and treatment of ADHD, anxiety, depression, trauma, and any other condition require an individualized clinical assessment by a licensed clinician treating you under an established treatment relationship. If you have questions about whether something you read or heard applies to your situation, raise it with your treating clinician rather than acting on it independently.
10. Hold Harmless; Released and Indemnified Parties
To the fullest extent permitted by law (and without releasing any non-waivable Claim, including Claims for gross negligence, willful misconduct, or violation of California law that cannot lawfully be waived under Civil Code § 1668), you agree to release, hold harmless, and where applicable indemnify Pasadena Clinical Group and each of its parent companies, subsidiaries, affiliates, owners, members, managers, partners, officers, directors, shareholders, supervising clinicians, supervisors, employees, independent contractors, 1099 clinicians, supervisees, interns, post-doctoral fellows, externs, trainees, students, volunteers, peer-support workers, administrative staff, billing staff, intake coordinators, vendors, agents, attorneys, accountants, insurers, indemnitors, successors, and assigns (each a “Released Party”) from any Claim arising out of or relating to: (a) any decision you make, action you take, or action you decline to take based on educational materials or website content; (b) third-party violations of group-therapy confidentiality obligations; (c) any reasonable clinical judgment exercised in good faith by a licensed clinician; (d) lawful disclosures made under mandatory-reporting, Tarasoff, or court-ordered processes; (e) any failure of an electronic-communication channel that you elected to use after being informed of its risks; or (f) Force Majeure events beyond the Practice’s reasonable control. Each Released Party is an intended third-party beneficiary of this hold-harmless and is entitled to enforce it directly. Nothing in this Section limits any patient’s right to file a complaint with any licensing board, the California Department of Public Health, the U.S. Department of Health and Human Services, or any other governmental authority.
11. Mandatory Pre-Suit Notice, Mediation, and Binding Individual Arbitration
To the maximum extent permitted by California and federal law (and consistent with California Code of Civil Procedure § 1295 governing medical-malpractice arbitration agreements where applicable, the Federal Arbitration Act, 9 U.S.C. § 1 et seq., and the California Arbitration Act), you agree that any dispute arising out of or relating to this consent or your care that is not otherwise governed by a separately signed arbitration agreement shall be resolved as follows: first, by written notice to the Privacy Officer / Risk Management at the address in Section 12 followed by sixty (60) days of good-faith negotiation; second, by non-binding mediation administered by JAMS (or, by mutual written agreement, by the AAA Healthcare Mediation Rules) in Los Angeles County, California, with the mediator’s fees shared equally; and third, if not resolved, by final and binding individual arbitration administered by JAMS pursuant to the JAMS Comprehensive (or Streamlined) Arbitration Rules & Procedures and the JAMS Consumer Minimum Standards (or, by mutual written agreement, by the AAA Healthcare Payor Provider Rules), in Los Angeles County, California, before a single neutral arbitrator. The parties expressly waive any right to a jury trial; expressly waive any right to participate in a class, collective, mass, consolidated, representative, or private-attorney-general action (other than as expressly preserved by non-waivable statute); and agree that any judgment on the arbitration award may be entered in any court of competent jurisdiction. NOTICE: California Code of Civil Procedure § 1295(a) requires the following statement when arbitration of medical-malpractice claims is contemplated: “By signing this contract you are agreeing to have any issue of medical malpractice decided by neutral arbitration and you are giving up your right to a jury or court trial.” Patients who do not wish to be bound by this Section may rescind this provision (and only this provision) by delivering a written rescission notice to the address in Section 12 within thirty (30) days after first signing this consent; rescission does not affect any other part of this consent. Detailed dispute-resolution terms (including fee allocation, equitable-relief carve-outs, and severance of unenforceable class waivers) are set forth in our Terms & Conditions, which are incorporated by reference.
12. Acknowledgment of Consent
By signing the Treatment Consent Form provided by Pasadena Clinical Group, you acknowledge that you have read, understood, and agree to the terms of this informed consent. You confirm that you have had the opportunity to ask questions about any aspect of treatment, confidentiality, or these policies, and that your questions have been answered to your satisfaction. You understand that you may withdraw your consent at any time and that doing so will not affect your right to receive future care at the Practice, nor will it subject you to any penalty or discrimination. You further acknowledge that your signature on the Treatment Consent Form indicates your acceptance of Sections 8–11 above and constitutes a knowing and voluntary waiver of the rights described therein, with the exception of any rights that, as a matter of California or federal law, cannot be waived.
13. Contact Information
For questions about this treatment consent, confidentiality policies, or any aspect of your care: