Informed Consent for Counseling
Clark University Center for Counseling & Personal Growth
Welcome to Clark University Center for Counseling and Personal Growth! In order to serve you better,
we would like to provide you with important information regarding your treatment. Please take the
time to read and understand this document and if you have questions or concerns, please discuss them
with your counselor.
General Information
Services provided by Center for Counseling and Personal Growth (CPG) for individual and group
counseling are offered free of charge to all currently registered Clark students. The hours of operation
are Monday through Friday, 9:00 am to 5:00 pm. We are open during the school year and during Fall,
Winter, and Spring breaks, however we are closed during the summer (mid-May to mid-August). Our
website contains more detailed information about our services and philosophy, as well as a variety of
self-help materials and online screening for specific concerns.
Psychotherapy is not easily described in general statements. It varies depending on the personalities of
the counselor and client, and the particular problems you are experiencing. Psychotherapy calls for an
active effort on your part and, in order for therapy to be most successful, you will have to work on
things that are talked about in your therapy session and during the time in between sessions.
Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects
of your life, you may experience uncomfortable feelings. Benefits may often include better
relationships, solutions to specific problems, and significant reductions in feelings of distress. However,
there are no guarantees of what you will experience.
If you have questions about our procedures or if you feel uncomfortable or not understood, you should
discuss these concerns with your counselor whenever they arise. You have the right to ask for the
rationale for any aspect of your treatment or to decline any part of your treatment. You also have the
right to request a referral to another counselor. If you have any concerns about CPG, your treatment, or
you feel that you and your counselor are not a good fit, please contact Director of the Center for
Counseling and Personal Growth, Dr. Megan Kersting, at (508)793-7678 ext. 2 or mkersting@clarku.edu.
Emergency Information
Should an emergency arise that is psychiatric in nature during normal business hours, please call CPG at
(508)793-7678 ext. 1 and someone will get back to you within an hour. If an emergency arises during
non-business hours, you may call campus police at (508)793-7575 or UMASS Memorial Medical Center
(University Campus on Lake Avenue) Emergency Mental Health (EMH) team at (508)334-3562.
Your First Appointment
During your first visit, you will spend time with a counselor discussing your immediate concerns. This
will help both you and your counselor decide how CCPG can best help you. These services may consist
of individual counseling, group counseling, psycho-educational classes, and/or an appointment with an
off-campus consulting psychiatrist. In some instances, you may be referred to an off-campus service for
longer-term, intensive therapy or some other mental health expertise not offered through CPG.
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Additional Appointments
At CPG, we make every attempt possible to accommodate all students who are in need of our services.
With that said, we tend to offer more episodic care (“strike while the iron is hot”) depending on the
needs of the student. Typically, students utilize counseling more on a short-term basis (around 5-8
sessions). However, if a student is seeking longer-term counseling services (e.g. over a semester in
duration), they have the following options available to them: 1) They can continue with CPG, however
with less frequency (1-2 sessions per month), or 2) CPG can assist in helping the student find a local
counselor in the area.
Cancellations and Not Showing Up for an Appointment
A personal commitment is crucial to the success of counseling. If you cannot make a scheduled
appointment, please contact your counselor as soon as possible to reschedule. If you need to cancel, do
so as far in advance as possible (preferably at least 24 hours in advance of your scheduled appointment)
so we can accommodate other students who are in need of services. If you “no-show” (do not show and
do not call to cancel) three times within a semester, your treatment at CPG will be reassessed which
may necessitate a referral to an off-campus counselor. Lastly, please be aware that if you arrive late to
your appointment, your session will still end at the original time.
Counseling Center Staff
The staff at CPG is composed of licensed psychologists, professional counselors, and graduate level
practicum trainees in psychology. In addition, Clark University maintains a contract with an off-campus
psychiatrist in the Worcester area. All professional staff (psychologist and professional counselors) are
supervised by the Director of CPG. All graduate psychology practicum trainees are closely supervised by
licensed professional staff and the Director of CPG.
Confidentiality and Records
Because therapy is most effective when a student can be direct and honest with a counselor without
fear that personal information will be divulged, CPG does not release information about a student
without that student’s written permission. To provide effective service, and as consultation/supervision
is a standard component of professional practice, your counselor may discuss your case with other CPG
staff (e.g. supervisors or colleagues). Except in circumstances described below, no one outside of CPG
will be given any information (even the fact that you have had contact with CPG) without your consent.
Parents, professors, other students, or college administrators may not have access to information about
your visits without your written permission.
Each time you see a counselor at CPG, a record of your visit is made. This record may describe your
condition, diagnoses, treatment, and a plan for future care. Information in your chart at Clark University
CPG is subject to strict state and federal confidentiality laws governing health care providers. A
counselor’s notes and any other written information regarding your contact with CPG will never become
part of your college record and are accessible only by CPG staff.
You may examine and/or receive a copy of your Clinical Record if you request it in writing except in
unusual circumstances that involve: 1) danger to yourself and/or others, or 2) when another individual
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(other than your counselor) is referenced and we believe disclosing that information puts the other
person at risk of substantial harm. Because these are professional records, they can be misinterpreted
and/or upsetting to untrained readers. We therefore recommend that you initially review them in the
presence of your counselor, or have them forwarded to another mental health professional so you can
discuss the contents. Complete Clinical Records are maintained for seven years after graduation and
then destroyed in a confidential manner.
Exceptions to Confidentiality
There are certain circumstances in which legal statutes require or allow mental health professionals to
break confidentiality, without consent if necessary. These include circumstances where there is a
serious danger to self or others, or if a counselor at CPG learns that an elderly person, dependent adult,
or minor child is being abused or neglected. Also, in rare instances, confidentiality may be broken if a
valid subpoena is issued for a student’s counseling records, or the records are otherwise subject to a
court order or other legal process requiring disclosure. If you have any questions or concerns about
these exceptions, please ask your counselor for further information.
Electronic Mail Communications
Students should be aware that confidentiality of electronic mail (e-mail) transmission cannot be
guaranteed. For this reason, CPG discourages the sharing of compromising personal or clinical
information through this medium. Email use should be specifically used for the scheduling or cancelling
of appointments. If you have a clinical concern, it is suggested that you leave a message on your
counselor’s confidential voicemail.
Conclusion
Your signature on the accompanying Intake Form indicates you have read the information in this
document and agree to abide by its terms during our professional relationship. Again, if you have any
questions or concerns regarding your treatment at Clark University Center for Counseling and Personal
Growth, please feel free to contact the Director of CPG, Dr. Megan Kersting, at mkersting@clarku.edu.
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